Contraceptive knowledge and behavior of conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders

The aim of the survey was to determine the contraceptive behavior and knowledge on contraceptive methods of adolescents. We defined six clusters according to personality, leisure activities, and sociodemographic characteristics: conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders. 1010 Austrian adolescents aged 14–24 years participated in the survey. 96%–100% indicated that they were familiar with the condom and the contraceptive pill. The two most popular contraceptive methods cited were the condom (39%) and OC (34%). Whereas 40% of conventionalists reported that OC were their preferred method of contraception, 53% of idealists indicated that they preferred the condom. 66% of the desperadoes indicated that they considered the pill expensive. 85% of conventionalists and careerists believe that OC offer the best protection against pregnancy. Clusters with higher self-esteem and those with a higher educational level were more likely to believe that this method is unreliable. The results obtained indicate that outsiders, desperatoes, and bouncers show deficits in sex education; only careerists and idealists appeared to be better informed. Research on adolescent contraceptive behavior should drop the traditional stratifying criteria and appreciate the diversity of adolescent populations in order to be better able to classify adolescents according to their contraceptive attitudes. Received: 22 March 1999 / Accepted: 24 March 1999     

Prevention of pertussis, tetanus, and diphtheria among pregnant, postpartum women, and infants

Pertussis disease in the United States has been increasing since 1976 and many states are reporting epidemics. Pertussis is more severe in infants less than 3 months of age and is characterized by high hospital admission rates, apnea of the infant. The CDC recommends that Tdap be administered to all pregnant women after the 20th week of gestation to provide pertussis antibodies to the fetus which will offer protection against pertussis disease. Tdap is highly immunogenetic in the pregnant women and has an excellent safety profile. Tdap given to the postpartum patient and her cocoon family is an alternative strategy.     

Rate,type, and cost of pelvic organ prolapse surgery in Germany,France, and England

Objective

To estimate the rate, type and costs of surgical interventions for pelvic organ prolapse (POP) in Germany, France, and England.

Study design

We identified the number, rate, and type of hospital admissions for pelvic floor surgery in 2005 from national hospital activity databases in each country: the German Hospital Episode, the French Medical Care Program Information System, and the National Health Service England Hospital Episode Statistics. Costs to the payer were estimated using the Diagnosis-Related Group reimbursement rates for each country.

Results

In 2005, the number (rate) of admissions for POP surgery was 36,854 (0.87 per 1000 women) in Germany, 36,679 (1.14 per 1000 women) in France, and 28,959 (1.13 per 1000 women) in England. Admissions for POP surgery constituted 10.4%, 16.7% and 16.9% of all admissions for female genital tract therapeutic interventions in Germany, France and England, respectively. At least 20% of hysterectomies were performed for the primary indication of POP. 57.4%, 45.0%, and 40.1% of all admissions for POP surgery included a hysterectomy. The costs to payers were €144,236,557, €83,067,825, and €81,030,907 in Germany, France, and England, respectively.

Conclusion

Burden and costs associated with POP surgery are substantial in the three countries studied. Thus, programs aimed at reducing the burden of this disease are desirable.     

Etiopathogenesis,prediction, and prevention of preeclampsia

Hypertensive disorders are a major cause of maternal death. Preeclampsia (PE) affects about 5% of pregnancies and is associated to high cardiovascular death risk. Understanding of its origin and cause is difficult and many etiologies have been proposed. So far, little can be done for real prevention and the only treatment is pregnancy interruption, increasing the child’s risk for prematurity complications. Early markers of disease are a promising path for understanding the pathogenesis and developing new strategies for prediction and eventually disease prevention.     

Etiology, diagnosis, and management of vaginitis

Vaginal complaints, including discharge, irritation, dyspareunia, urinary complaints, and malodor are frequent concerns for women. These symptoms are often self-diagnosed and self-treated without confirmatory diagnosis.² Misdiagnosis by the woman or by the provider may lead to inadequate treatment, and consequences such as coinfections with microbes may lead to infertility or to the increased risk of acquiring HIV. The practitioner must be aware of the most likely causes of the reported symptoms, the risk factors and consequences associated with the incorrect diagnosis, the most appropriate way to diagnose the condition, and the correct methods of treatment. Women should be discouraged from indiscriminate use of over-the-counter medications for vaginal complaints.²     

Maternal age and the size of White, Black, Hispanic, and mixed infants

OBJECTIVE: To clarify the interaction between maternal age and race in the prediction of infant size at birth. METHODS: Birth certificate data was used to study the relationship between maternal age, race/ethnicity, and the size of term, singleton infants born to 91,061 healthy, non-smoking, non-substance using, primigravidas. RESULTS: Maternal race/ethnicity (Black race: OR: 1.95, 95% CI: 1.49-2.56; Hispanic ethnicity: OR: 1.38, 95% CI: 1.19-1.61) and the interaction term, maternal age x race/ethnicity (OR: 1.06, 95% CI: 1.01-1.11) predicted small-for-gestational age (SGA) birth. The strength of the association between Black race and SGA delivery increased and the strength of the association between Hispanic ethnicity and SGA delivery decreased with age (P < 0.001 for trend). Thus, Black and Hispanic teenagers were more likely to have SGA babies than White teenagers (1.7% and 1.6%, respectively compared to 1.2%; P = 0.003). However, Black women who postponed childbearing until their mid-twenties were more likely to have SGA babies than their Hispanic and White counterparts (2.6% compared to 1.2%, and 1.0%, respectively; P < 0.0001). CONCLUSION: The findings suggest that acquired maternal characteristic(s) cause the reproductive health of Black primigravidas to deteriorate and Hispanic primigravidas to improve with age.     

A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis

A randomized, clinical trial was conducted to evaluate the spermicidal agent nonoxynol 9 as prophylaxis for sexually transmitted diseases. Eight hundred eighteen women using birth control who attended a sexually transmitted disease clinic were evaluated monthly for trichomoniasis, candidiasis, and bacterial vaginosis for 6 months. Women using the active spermicide experienced a somewhat lower incidence rate of trichomoniasis (relative rate 0.83; 95% confidence interval 0.61 to 1.12) and bacterial vaginosis (relative rate 0.86; 95% confidence interval 0.69 to 1.12) as compared with placebo users. The rate of candidiasis was nearly identical for spermicide and placebo users (relative rate 1.02; 95% confidence interval 0.77 to 1.35). The number of sexual partners during the preceding month was related directly to the occurrence of trichomoniasis (p = 0.047) and bacterial vaginosis (p = 0.009) but not candidiasis (p = 0.99). Subjects using oral contraceptives experienced a statistically significant lower rate of trichomoniasis than did women using an intrauterine contraceptive device or who had had a tubal ligation (relative rate 0.56; 95% confidence interval 0.39 to 0.81).     

Comparison of faculty,peer, self,and nurse assessment of obstetrics and gynecology residents

This project was undertaken to determine if the addition of peer, self, and nurse evaluators would enhance faculty assessment of resident performance. An evaluation form was developed that contained 16 items under three major headings: clinical competency, interpersonal skills, and overall assessment. These forms were distributed to the 16 residents in our program, and the residents were asked to complete an evaluation form on themselves and their 15 peers. Evaluation forms were also distributed to all 14 clinical faculty members and to six members of the Obstetrics and Gynecology nursing staff. Intraclass correlation coefficients were determined for each rating group, and using the attending ratings as the gold standard, Pearson correlation coefficients were calculated to determine correlations between groups of raters. The reliability of faculty ratings was good to excellent, whereas resident ratings showed excellent reliability for all three measured variables. Ratings provided by the nurses were the least reliable of the groups rating the residents. Compared with attending ratings, the peer ratings showed significant positive linear relationships in all categories evaluated. There was a low degree of correlation between attending and self-evaluations and attending and nurse evaluations. This small study supports the use of peer evaluations in addition to attending evaluations for Obstetrics and Gynecology residents in training. It also demonstrates that our residents may benefit from doing self-evaluations to improve their ability to honestly appraise their clinical and interpersonal skills.     

Advantages,inconveniences, and risks of minipills

Minipills contain only 30-40 mgs of ethinyl estradiol, plus Norgestrel or Norethindrone acetate. Administration is the same as for other estroprogestational agents. Minipills are extremely effective and present a few advantages over traditional OC (oral contraception): the risk of thrombotic accidents is decreased, as is the risk of vascular accidents; there is no increase in weight and incidence of headache is much lower. On the other hand breakthrough bleeding is common, as is mastopathy. Patients using the minipill must be closely surveilled; contraindications for minipill use are thrombotic accidents, hyperlipidemia, familial antecedents of hypertension or of vascular affections. The minipill is especially advisable to women over 35.     

Diagnosis,treatment, and prevention of tetanus

The disease tetanus results primarily from the contamination of wounds with the bacterium Clostridium tetani. C tetani is a grampositive, anaerobic bacillus that produces two exotoxins, one of which is responsible for the clinical manifestations of the disease. Generalized tetanus, the most frequent form of the disease, presents with symptoms of muscle rigidity and spasms, and the characteristic feature, trismus (lockjaw). Diagnosis is made primarily by clinical observation combined with a supporting history of a wound and lack of proper immunization. Prevention of the disease is paramount as treatment is mainly supportive, and fatality rates are as high as 75%. Primary prevention consists of a series of immunizations administered in infancy and early childhood of tetanus toxoid combined with diphtheria and pertussis vaccines. Boosters are recommended at 10-year intervals. Secondary prevention involves debridement of wounds and administration of tetanus immune globulin and tetanus toxoid as needed, depending on the type of wound and the immunization history. Despite the excellent rates of immunization in the United States, approximately 50% of adults older than 50 years of age are susceptible to tetanus, either due to declining levels of antibodies or to lack of complete vaccination.     

Digestion, absorption, and fermentation of carbohydrates

Newborn infants born after a term gestation appear to have an adequate capacity for small intestinal digestion and absorption of carbohydrate. Premature infants do not have a mature level of intestinal lactase activity. Apparently, in the premature infant, colonic fermentation serves an important, if not the only major route, for lactose carbon absorption, and it also appears that signs of fermentation activity such as increased BH2 are not indicative of disease. Important questions remaining in the premature infant relate to developmental aspects of colonic fermentative activity, effects of systemic antibiotic treatment on colonic salvage, the effects of various fermentation pathways on energy balance, the capacity for absorption of sugars, SCFA, and electrolytes by colonic epithelia, and the effects of fermentation products on metabolism and on the mucosal cells of the intestine or colon. Research addressing these questions may have relevance in the following areas: further development of formula diets for healthy premature infants and for patients of all ages with intestinal or colon dysfunction; the effects of colonic disease or surgical resection; the nutritional or clinical effects of dietary fiber; and the effects of antibiotic therapy on intestinal and colon function.     

Past,Present, and Future of Hysterectomy

Until the late 1930s, the standard type of abdominal hysterectomy was subtotal, leaving the cervix behind to decrease the risk of peritonitis with its attendant high mortality. With the discovery of antibiotics, careful attention to antisepsis, and other medical and surgical advances, this method was gradually replaced by total abdominal hysterectomy in the United States and the United Kingdom, although the subtotal approach still remained popular, in particular in Scandinavian countries. With the advent of laparoscopic hysterectomy, many surgeons, wanting a simpler approach and for a variety of other reasons, have returned to performance of subtotal hysterectomy. The objectives of the present article is to review the development of the operation from a historical perspective, and to attempt to answer some of the dilemmas posed when choosing between a total and subtotal procedure, using results from evidence-based research when possible.