Female sterilization, AIDS, and medical culture in São Paulo and Porto Alegre, Brazil

This paper explores the factors associated with reproductive choices by HIV-positive pregnant women in two settings in Brazil, and particularly how health care providers and the local medical culture can affect these choices. Requesting and submitting to postpartum sterilization provide the focus of the analysis. The data come from a study conducted in prenatal care services in two cities, S?o Paulo and Porto Alegre. We employed two data collection strategies: collection of information from 427 patient records for HIV-positive women who had received prenatal care, and in-depth interviews with 60 women. While most women in both cities requested tubal ligation after delivery, a much higher proportion of women in Sao Paulo were actually sterilized, as compared to a tiny proportion of women in Porto Alegre. The local medical culture regarding sterilization and organization of prenatal care emerged as important factors for understanding the differences between the two cities.     

Husband or wife? A multivariate analysis of decision making for voluntary sterilization

The increasing popularity of sterilization as a contraceptive choice among married couples underscores the need for knowledge about differences between couples choosing male and female procedures. Data from national surveys suggest some sociodemographic differences, but these variables account for only a small amount of the variance. This research looks at other sets of variables--information sources, influence sources, and reasons husbands and wives give for wanting sterilization--in a multivariate analysis of the choice of a male versus a female operation. Particularly for husbands obtaining a vasectomy, the importance of social support is demonstrated.     

Do women's attitudes towards abortion and contraceptive methods influence their option for sterilization?

This paper analyzes the attitudes of low-income women towards abortion and contraception. A survey was conducted in 1992 with a total of 3,149 childbearing-age women living on the outskirts of the Greater Metropolitan S?o Paulo Area. The study focuses on a sub-sample of 583 women. Attitudes of sterilized and non-sterilized women are compared. Women, especially those sterilized, found the most important attribute of a contraceptive method to be its effectiveness. Women currently taking the pill were less likely than those sterilized to agree that sterilization was the best method because of its effectiveness. Sterilized women were less likely than non-sterilized women to trust the pill. Sterilized women were more likely than non-sterilized to have reported adverse effects from the pill. Most women found abortion unacceptable except in the case of risk to the woman's life. Women using more effective methods showed stronger negative attitudes towards abortion. The tendency to be sterilized while still young was associated with more negative attitudes towards abortion. Family planning activities in basic health care services should include individual counseling for contraceptive use.     

Voluntary surgical sterilization in Greater Metropolitan Campinas, São Paulo State, Brazil, before and after legal regulation of the procedure

This cross-sectional study compared the provision of surgical sterilization in public health services in Greater Metropolitan Campinas, S?o Paulo State, Brazil, and the characteristics of women and men who underwent sterilization before and after its legal regulation. Structured and pre-tested questionnaires were applied to 398 women, 15 directors of municipal family planning programs, and 15 coordinators of basic health units. Eight municipalities in Greater Metropolitan Campinas provided tubal ligation and nine performed vasectomy. Approximately half reported following the guidelines of the prevailing family planning legislation. There were no significant differences before or after legal regulation in terms of the characteristics of women and men sterilized or the waiting time for surgery. Most tubal ligations were still performed in combination with cesarean sections (the additional payment for sterilization had decreased, but the difference was not significant). There is strong evidence that in Greater Metropolitan Campinas the changes expected from legal regulation of surgical sterilization did not materialize. Although progress has been made, several distortions still need to be corrected.     

Will ethylene oxide sterilization influence the application of novel Cu/LDPE nanocomposite intrauterine devices?

Background

Copper/low-density polyethylene (Cu/LDPE) nanocomposite intrauterine device (IUD) is an implanted medicinal device that must be sterilized before use. Sterilization processes act either chemically or physically, leading to a lethal change in the structure or function of organic macromolecules in microorganisms. Given the nature of their action, sterilization might also attack the macromolecules of polymers by the same mechanisms, resulting in changes in surface functional groups and in the internal structure of the polymer. If sterilization leads to changes in surface functional groups and in the internal structure of the LDPE matrix, which will influence the mechanical property and cupric ions release rate of novel Cu/LDPE nanocomposite IUDs, potential clinical application will be limited. Therefore, it is necessary to study the influence of ethylene oxide sterilization on the potential clinical application of novel Cu/LDPE nanocomposite IUDs.

Study Design

The influence of ethylene oxide sterilization on the internal structure, surface functional groups, mechanical property and cupric ions release rate of novel Cu/LDPE nanocomposite IUDs was studied using differential scanning calorimetry, attenuated total reflection Fourier transform infrared spectroscopy, tensile testing and absorbance measurement.

Results

Ethylene oxide sterilization did not have any influence on the internal structure, surface functional groups, mechanical property and cupric ions release rate of novel Cu/LDPE nanocomposite intrauterine devices.

Conclusion

Ethylene oxide sterilization will not affect the potential application of novel Cu/LDPE nanocomposite IUDs.     

Long-term outcomes after elective sterilization procedures — a comparative retrospective cohort study of Medicaid patients

Objectives

The objectives were to compare the long-term outcomes, including hysterectomy, chronic pelvic pain (CPP) and abnormal uterine bleeding (AUB), in women post hysteroscopic sterilization (HS) and laparoscopic tubal ligation (TL) in the Medicaid population.

Is tubal sterilization associated with an increased risk of subsequent hysterectomy but a decreased risk of ovarian cancer? A review of recent literature

Recent epidemiologic studies have suggested that tubal sterilization (TS) may lead to an increased incidence of subsequent hysterectomy but a decreased risk of ovarian cancer. This review evaluates the nature and magnitude of these two relationships, which should be of great concern and interest to women, clinicians and the administrators of family planning programs.The positive relationship between TS and subsequent hysterectomy is more likely to be of a motivational rather than biological nature, and a considerable number of unnecessary hysterectomies after TS could be avoided by changing the attitudes of physicians and women.The inverse relationship between TS and ovarian cancer appears causal, although the exact biological mechanisms remain to be clarified. Theoretically, this non-contraceptive beneficial effect of TS could be used as a primary preventive measure to curb the incidence of the highly fatal ovarian cancer. However, a number of medical, ethical, and economic questions attending use of a generally irreversible contraceptive procedure as a preventive measure must first be answered.The issue of whether TS is associated with any long-term sequelae, and, if so, whether the association is of a cause-and-effect nature or a by-product of time passage and aging of the woman, should be addressed by well-designed studies.

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Resumen Recientes estudios epidemiológicos han sugerido que la esterilización tubárica (ET) podrá ocasionar una mayor incidencia de histerectomías posteriores pero un menor riesgo de cáncer ovárico. Este examen evalúa la naturaleza y magnitud de estas dos relaciones, que interesan y preocupan mucho a las mujeres, los médicos clínicos y los administradores de programas de planificación familiar.Es probable que la relación positiva entre la ET y la histerectomía posterior sea de naturaleza más bien motivacional que biológica, y se pordría evitar un número considerable de histerectomías innecesarias después de la ET cambiando las actitudes de los médicos y de las mujeres.La relación inversa entre la ET y el cáncer ovárico parece causal, si bien los mecanismos biológicos exactos no han sido aún aclarados. Teóricamente, este efecto benéfico no anticonceptivo de la ET podría utilizarse como medida preventiva primaria para reducir la incidencia del cáncer ovárico, de tan alta mortalidad. Sin embargo, primero debe responderse a una serie de preguntas de tipo médico, ético y económico relativas al uso de un procedimiento anticonceptivo generalmente irreversible como medida preventiva.La cuestión de si la ET está asociada con alguna secuela a largo plazo y, de ser así, si tal asociación es de naturaleza causa y efecto o un subproducto del transcurso del tiempo y del envejecimiento de la mujer debe ser examinada mediante estudios bien diseñados

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Resumé De récentes études épidémiologiques laissent à penser que la stérilisation tubaire (ST) peut entraîner une augmentation des cas d'hystérectomie ultérieure mais une diminution des cas de cancer ovarien. La présente étude passe en revue la nature et l'ordre de grandeur de ces deux relations, qui devraient représenter, pour les femmes, les cliniciens et les administrateurs des programmes de planning familial, un sujet de préoccupation et d'intérêt.La relation positive entre la ST et une hystérectomie ultérieure relève sans doute plus d'une question de motivation que du domaine biologique, et un nombre considérable d'hystérectomies inutiles après la ST pourrait être évité si l'on changeait les atttudes des médecins et des femmes.A l'inverse, la relation entre la ST et le cancer ovarien semble être causale, bien que ses mécanismes biologiques précis soient à élucider. En théorie, cet avantage non contraceptif de la ST pourrait être mis à profit comme mesure préventive primaire contre l'incidence du cancer de l'ovaire, le plus souvent mortel. Toutefois, il faudra d'abord trouver la réponse à un certain nombre de questions d'ordre médical, éthique et économique que pose une intervention contraceptive généralement irréversible en tant que mesure de prévention.Des études bien conçues devraient examiner la question de savoir si la TS est associée à des séquelles à long terme et, dans l'affirmative, si cette association est une relation de cause à effect ou produite par le passage du temps et le vieillissement de la femme.

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This paper was prepared while the author was associated with Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA     

Trends in food availability in Portugal in 1966–2003

BACKGROUND: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. AIM OF THE STUDY: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. METHODS: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. RESULTS: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. CONCLUSIONS: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.     

Reproduction in the year 2012: in vivo or in vitro?

The Dutch Minister of Health has proposed reducing the number of reimbursed in vitro fertilisation (IVF) cycles per couple from 3 to 1, in order to save 30 million euros per year. In the Netherlands, the number of IVF cycles has increased by 50% in the past 13 years, resulting in, on average, one child conceived through IVF in every classroom today. The increase in the number of IVF treatments is also caused by expansion of the indications for IVF, despite the lack of evidence proving the effectiveness of IVF for some of these indications. In a time of financial constraint, the restriction of reimbursed indications would be fairer than reducing the number of reimbursed treatments with IVF or intracytoplasmic sperm injection (ICSI) for all couples.     

Ethnic differences in self reported health in Malmö in southern Sweden

STUDY OBJECTIVE—The aim of this study was to investigate ethnic differences in self reported health in the city of Malmö, Sweden, and whether these differences could be explained by psychosocial and economic conditions.
DESIGN/SETTING/PARTICIPANTS—The public health survey in Malmö 1994 was a cross sectional study. A total of 5600 people aged 20-80 years completed a postal questionnaire. The participation rate was 71%. The population was categorised according to country of origin: born in Sweden, other Western countries, Yugoslavia, Poland, Arabic speaking countries and all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the importance of possible confounders on the differences by country of origin in self reported health. Finally, variables measuring psychosocial and economic conditions were introduced into the model.
MAIN RESULTS—The odds ratios of having poor self reported health were significantly higher among men born in other Western countries, Yugoslavia, Arabic speaking countries and in the category all other countries, as well as among women born in Yugoslavia, Poland and all other countries, compared with men and women born in Sweden. The multivariate analysis including age and education did not change these results. A huge reduction of the odds ratios was observed for men and women born in Yugoslavia, Arabic speaking countries and all other countries, and for women born in Poland after the introduction of the social network, social support and economic factors into the multivariate model.
CONCLUSIONS—There were significant ethnic group differences in self reported health. These differences were greatly reduced by psychosocial and economic factors, which suggest that these factors may be important determinants of self rated health in certain minority groups.


     

Does the Heartbeat Award scheme in England result in change in dietary behaviour in the workplace?

The Heartbeat Award (HBA) scheme is a national nutrition labelling scheme that operates throughout England. The aim of this study was to assess whether the implementation of the HBA scheme in the workplace results in an improvement in eating habits at work. A longitudinal survey of employees using a structured questionnaire pre- and post-HBA intervention in six workplaces in Leicestershire, England, was conducted. A qualitative food frequency questionnaire was used to assess dietary behaviour 6 months before the scheme was implemented and 6 months afterwards. Four HBA workplaces (n = 453 employees) were compared with two comparison workplaces (n = 124 employees). The outcome measures for dietary change were consumption of 20 food items, i.e. 16 food-frequency and four food-type items. Changes in pre-intervention data compared with post-intervention data evaluated the impact of the HBA on eating habits. Differences were considered statistically different at the p < 0.05 level. Crude and adjusted odds ratios were used to assess differences in change in dietary behaviour between the intervention and comparison workplaces. The results showed that there was significantly more positive change in intervention workplaces only (i.e. the changes were not detected in the comparison workplaces) for four of the 20 food items tested: increase in consumption of fruit (p = 0.029); reduction in consumption of fried foods (p = 0.044) and sweet puddings (p = 0.042); and change to lower fat milks (p = 0.034). In conclusion, the HBA had a modest impact on dietary intake, resulting in a significant positive change in four out of 20 foods consumed by employees in HBA-holding premises.     

Regional variations in pedal cyclist injuries in New Zealand: safety in numbers or risk in scarcity?

Objective: To assess regional variations in rates of traffic injuries to pedal cyclists resulting in death or hospital inpatient treatment, in relation to time spent cycling and time spent travelling in a car. Methods: Cycling injuries were identified from the Mortality Collection and the National Minimum Dataset. Time spent cycling and time spent travelling as a driver or passenger in a car/van/ute/SUV were computed from National Household Travel Surveys. There are 16 census regions in New Zealand, some of which were combined for this analysis to ensure an adequate sample size, resulting in eight regional groups. Analyses were undertaken for 1996–99 and 2003–07. Results: Injury rates, per million hours spent cycling, varied widely across regions (11 to 33 injuries during 1996–99 and 12 to 78 injuries during 2003–07). The injury rate increased with decreasing per capita time spent cycling. The rate also increased with increasing per capita time spent travelling in a car. There was an inverse association between the injury rate and the ratio of time spent cycling to time spent travelling in a car. The expected number of cycling injuries increased with increasing total time spent cycling but at a decreasing rate particularly after adjusting for total time spent travelling in a car. Conclusions: The findings indicate a ‘risk in scarcity’ effect for New Zealand cyclists such that risk profiles of cyclists are likely to deteriorate if fewer people use a bicycle and more use a car. Implications: Cooperative efforts to promote cycling and its safety and to restrict car use may reverse the risk in scarcity effect.