A pre-coital pill? A preliminary in vitro study

The use of the progestogen-only pill as a 'pre-coital contraceptive' was tested by in vitro studies of sperm-mucus interaction. The results suggest that a single tablet of levonorgestrel 30 microg, or norethisterone 350 microg, was effective in preventing sperm migration in the cervical mucus about 12 hours later. This suggests that the progestogen-only pill may be effective as a 'morning before pill'.     

A diagnostic sign in migraine?

At the bedside it was noted that, after ocular fundoscopy, patients with migraine complained more often of an after-image than did non-migraineurs. This phenomenon was then investigated in consecutive patients attending a general neurology outpatient clinic. The relative risk for the diagnosis of migraine in patients reporting an after-image was 2.91 (95% confidence interval 1.96 to 4.34), and the sensitivity, specificity and positive predictive value of this observation for the diagnosis of migraine were 0.63, 0.75 and 0.55 respectively. After-images were equally likely to be reported by migraineurs with and without aura, and by patients with migraine equivalents. The after-image phenomenon probably reflects the heightened sensitivity to visual stimuli of patients with migraine. Although a diagnosis of migraine is primarily established by the patient's history, the presence of an after-image following ocular fundoscopy may support this diagnosis.     

A country divided? Regional variation in mortality in Ukraine

Objectives

We set out to identify the contribution of various causes of death to regional differences in life expectancy in Ukraine.

Methods

Mortality data by oblast (province) were obtained from the State Statistical Committee of Ukraine. The contribution of various causes of death to differences in life expectancy between East, West and South Ukraine was estimated using decomposition.

Results

In 2008, life expectancy for men in South (61.8 years) and East Ukraine (61.2 years) was lower than for men in West Ukraine (64.0 years). A similar pattern was observed among women. This was mostly due to deaths from infectious disease and external causes among young adults, and cardio- and cerebro-vascular deaths among older adults. Deaths from TB among young adults contribute most to differences in life expectancy.

Conclusions

Deaths due to infectious disease, especially TB, play an important role in the gap in life expectancy between regions in Ukraine. These deaths are entirely preventable—further research is needed to identify what has ‘protected’ individuals in Western Ukraine from the burden of deaths experienced by their Southern and Eastern counterparts.     

Sexuality in Stroke Care: A Neglected Quality of Life Issue in Stroke Rehabilitation? A Pilot Study

Although there is a substantial body of literature on the physical and psychosexual consequences of stroke, there is a paucity of empirical studies on the experiences of rehabilitation professionals in addressing sexuality issues with patients during the rehabilitation process. This is the first small-scale pilot study in Northern Ireland, informed by a comprehensive literature review, which explores the experiences of health and social care professionals in addressing sexuality issues with patients and their perceptions of the training they require in this area of stroke rehabilitation. Questionnaire survey data were collected from community and hospital based stroke professionals in a Health and Social Services Trust in Northern Ireland. The study groups comprised nurses, doctors, physiotherapists, occupational therapists, speech and language therapists and social workers. The findings revealed that although the majority of staff had been asked for advice on sexuality issues during rehabilitation, most of them had received no training in this aspect of stroke rehabilitation since joining stroke services. The findings suggest that all rehabilitation professionals need to become more knowledgeable about sexuality issues in stroke care and could benefit from further education and training in comprehensive sexual health care.     

A role for conjoint analysis in technology assessment in health care?

The aim of this paper is to demonstrate the use of conjoint analysis (CA) in health services research. Conjoint analysis is first explained, with emphasis on the history of the technique, followed by an explanation of how to carry out such a study and how the results from such a study can be used. The technique is demonstrated with reference to a study that looks at the benefits of in vitro fertilization. It is shown how CA can be used to estimate the relative importance of attributes, the trade-offs individuals make between these attributes, willingness to pay if cost is included as an attribute, and utility or benefit scores for different ways of providing a service. The paper then considers the potential advantages of CA over other, more commonly used benefit assessment instruments. Finally, there is discussion of the issues raised in the design and analysis of CA studies. It is concluded that these issues must be addressed before the technique becomes an established instrument for technology assessment.     

Economic Hardship in Childhood: A Neglected Issue in ACE Studies?

Objectives Adverse childhood experiences (ACEs) have been linked with ill-health in adulthood, but ACE literature has focused on family disruption or dysfunction (e.g., child abuse, parental separation), with less attention to economic adversity. We examined whether a mother’s economic hardship in childhood (EHC) was associated with women’s hardships and health-risk behaviors during/just before pregnancy. Methods We analyzed population-based survey data on 27,102 postpartum California women. EHC included respondents’ reports that during childhood they/their families experienced hunger because of inability to afford food or moved because of problems paying rent/mortgage and the frequency of difficulty paying for basic needs. We examined six maternal hardships/behaviors during/just before pregnancy, including four hardships (poverty, food insecurity, homelessness/no regular place to sleep, intimate partner violence) and two behaviors (smoking, binge drinking). Prevalence ratios (PRs) were calculated from sequential logistic regression models estimating associations between EHC (categorized by level of hardship) and each maternal hardship/behavior, first without adjustment, then adjusting for other childhood and current maternal factors, and finally adding family disruption/dysfunction. Results Before adjustment for family disruption/dysfunction, the highest and intermediate EHC levels were associated with each maternal hardship/behavior; after full adjustment, those associations persisted except with smoking. Higher EHC levels generally appeared associated with larger PRs, although confidence intervals overlapped. Conclusions for Policy/Practice These findings link childhood economic hardship with women’s hardships, binge drinking, and possibly smoking around the time of pregnancy. Without establishing causality, they support previous research indicating that childhood economic adversity should be considered an ACE.     

Proteins Involved in Meiotic Recombination: A Role in Male Infertility?

Meiotic recombination results in the formation of crossovers, by which genetic information is exchanged between homologous chromosomes during prophase I of meiosis. Recombination is a complex process involving many proteins. Alterations in the genes involved in recombination may result in infertility. Molecular studies have improved our understanding of the roles and mechanisms of the proteins and protein complexes involved in recombination, some of which have function in mitotic cells as well as meiotic cells. Human gene sequencing studies have been performed for some of these genes and have provided further information on the phenotypes observed in some infertile individuals. However, further studies are needed to help elucidate the particular role(s) of a given protein and to increase our understanding of these protein systems. This review will focus on our current understanding of proteins involved in meiotic recombination from a genomic perspective, summarizing our current understanding of known mutations and single nucleotide polymorphisms that may affect male fertility by altering meiotic recombination.