Disturbingly low levels of contraception among women living with hepatitis C

OBJECTIVE: To describe the prevalence of contraception among a sample of women with hepatitis C (HCV), compare it with contraceptive use among Australian women generally, and look for associations between contraception and sample characteristics. METHOD: Women who self-identified as living with HCV were recruited through a wide range of non-clinical and clinical sites in the Australian Capital Territory (ACT) and Victoria to complete a self-administered questionnaire. RESULTS: Seventy-five per cent of distributed questionnaires were completed and returned. Of the 462 women surveyed, 34% of those aged 18-49 reported using contraceptives; a much lower prevalence than the 67% in the Australian population. Surprisingly, women who reported concerns about transmission to children were no more likely to use contraceptives. Not surprisingly, women who were lesbian or who did not have a current partner were even less likely to use contraceptives. Both employed women and those not on benefits reported significantly higher levels of contraception. Otherwise, contraception did not vary with a range of variables including age, education, injecting drug use status, self-rated health status, experience of HCV symptoms, time since diagnosis, ever having received HCV treatment, or venue at which the participants were recruited. CONCLUSIONS: The low prevalence of contraception among women with HCV is both disturbing and puzzling. IMPLICATIONS: These findings raise several important and hitherto unconsidered issues for the sexual and reproductive health and well-being of women with HCV. These require both further research and urgent attention by service providers.     

Assessing independence in community living

Community health professionals are frequently faced with the dilemma of assessing "independence in community living" in individuals with physical limitations. However, the validity of standardized assessment of "independence in community living" continues to be limited. Standardized assessment tools are unable to capture the true meaning of "community living" and "independence" being articulated through the Independent Living Movement by people who have physical limitations. We use examples from our experience with the Community Living Skills Project in Nova Scotia to highlight three limitations of standardized assessment of individuals in light of the Independent Living Movement's interpretation of "independence in community living". Standardized assessments were unable to attend to and integrate the complexities of interactional elements, individual differences and the concept of "independence" as personal control and mutual dependence. We conclude that individual assessment requires tools with greater sophistication than those currently available. This discussion is important since individual assessment guides decisions which have far reaching effects on people's lives and on the demands placed on limited health and social services.     

Plasma vitamin C levels in men and women from different ethnic backgrounds living in England.

BACKGROUND: People of South Asian origin living in the UK have higher death rates due to coronary heart disease than whites. The reasons for these differences are not fully understood. Previous attempts to relate diet to cardiovascular risk in South Asians have been inconclusive. METHODS: We compared the levels of plasma vitamin C in a cross-sectional population-based study of 1018 men and women aged 40-59 (455 men, 563 women, 328 South Asians, 355 of African descent, 335 whites) co-resident in a geographically defined area of South London, when allowing for potential confounders. RESULTS: Fasting plasma vitamin C levels were significantly higher in women, vegetarians, supplement takers and non-smokers. After adjustment for age, body mass index, current smoking, supplement use and vegetarianism the mean plasma vitamin C levels were 38.8 (SE 1.6) mumol/l in white men, 36.5 (1.6) mumol/l in men of African descent and 32.9 (1.5) mumol/l in South Asian men (P = 0.033 by analysis of co-variance). In women the adjusted mean plasma vitamin C levels were 52.4 (1.6) mumol/l in whites, 46.0 (1.4) mumol/l in women of African descent and 37.3 (1.8) mumol/l in South Asians (P < 0.0001 by analysis of covariance). South Asians had lower levels than whites in both men (difference 6.4 [95% CI: 1.5, 11.3] mumol/l) and women (16.8 [95% CI: 11.5, 22.1] mumol/l). South Asian women, but not men, also had lower levels than those of African descent (8.8 [95% CI: 4.5, 13.1] mumol/l). African women, but not men, had lower levels than white women (6.6 [95% CI: 2.3, 10.9] mumol/l). No significant differences were seen between Caribbeans and West Africans or between South Asian Hindus and Muslims. CONCLUSIONS: These data suggest that important dietary differences in vitamin C exist between different ethnic groups living in England. The larger differences in South Asians may contribute to their increased coronary risk.     

Relationship of normal levels of activity of daily living and daily habits among elderly women at home

PURPOSE: The relationship of activities of daily living (ADL) with daily habits and age was investigated with a focus on the results of measurements of the normal speed (ordinary level: OL) and maximum speed (maximum capacity: MC) in performing items on a functional fitness test. The significance of the measurement of the ordinary level was also discussed. METHODS: The subjects were 69 women, aged 60-90 years old, who participated in a health workshop for the elderly sponsored by a local municipality and who performed at least 4 items on a functional fitness test. Public health nurses asked subjects about habitual life style, subjective health status and degree of satisfaction in daily life. The ADL level was measured using the tests of functional fitness developed by Oida et al and partially revised by ourselves and physical fitness tests (grip strength, sit and reach, and balancing on one leg with opened eyes). OL was measured as the time needed to perform functional fitness items at normal speed, and MC as the time needed when performing these tasks as quickly as possible. RESULTS: All functional fitness items were accomplished significantly faster with MC than OL. Correlation coefficient values between OL and MC were high significant. Age was found to be significantly related to the hand working test (Hand-T) to evaluate dexterity and the rope working test (Rope-T) to evaluate self-care, except with the MC. An analysis of covariance with age as the covariant revealed that, with OL, there were relationships between Hand-T and Rope-T and the item "active at home," and between the zigzag walking (Zigzag-T) and Rope-T and "walking or riding a bicycle to go shopping." With MC, there were relationships between Hand-T and "active at home," and between Zigzag-T and "walking of riding a bicycle to go shopping." Regarding physical capacity, relationships were seen between both hands and "high level of physical fitness" and "walking fast" and grip strength (Left hand), respectively. CONCLUSION: The ADL items measured in the preset study were related to the daily activities of elderly people. As the OL and MC results demonstrated a high correlation and the ADL items related with OL were found to have almost the same link with MC, we conclude that OL is suitable for testing with the advantage of safety. However, we could not explain differences in relationships between measurements and daily activities, pointing to a need for further research. Elderly people must maintain their capacity for ADL to support a good quality of life, and we have demonstrated the utility of measurements that include normal levels of activity as indicators.     

Lipid profile in spinal cord-injured women with different injury levels

Background. In dependence on their injury level, male subjects with spinal cord injury (SCI) exhibit a less favorable lipoprotein profile than control persons. The impairment of the sympathetic nervous system and the fact that persons with spinal cord injury are subject to extreme physical inactivity may have an influence on their lipid profile and lipoprotein(a) concentration. It has been shown that sex-specific differences in hormonal regulation are responsible for differences in lipoprotein levels between nondisabled men and women. However, the role of hormones on lipoprotein levels has not been investigated in female subjects with spinal cord injury. Methods. Therefore, we performed a detailed investigation regarding the lipid profile in 32 premenopausal women with spinal cord injury ranging from tetraplegia to low paraplegia and in 36 control subjects. VO(2max) was determined by a wheelchair ergometry with stepwise increase in work load. Result. VO(2max) was significantly higher in paraplegics than in tetraplegics but significantly lower than in control subjects. Paraplegics had significantly higher low-density lipoprotein levels than both tetraplegics and control persons. The lipid profile of female tetraplegics was characterized by elevated triglycerides. An association between high-density lipoprotein levels and spinal cord injury or the level of the injury was not observed. No significant difference in lipoprotein(a) was found within SCI individuals as well as between SCI individuals and control persons indicating the predominant genetic determination of lipoprotein(a) and the thus related cardiovascular risk. Conclusion. Despite the extreme reduction of VO(2max), the assumed physical inactivity and low serum catecholamine levels due to the impairment of the sympathetic nervous system, female tetraplegic persons did not show an adverse lipoprotein profile with respect to high-density lipoprotein cholesterol levels. If the higher low-density lipoprotein cholesterol concentrations in female with spinal cord injury with low lesion levels or the elevated TG levels in female tetraplegics bare relevance with respect to an increased cardiovascular risk in this population needs to be clarified in further longitudinal investigations.     

Serum insulin-like growth factor-I levels among women in Hawaii and Japan with different levels of tofu intake

Insulin-like growth factor-I (IGF-I) has been proposed as the link between diet and breast cancer risk. Due to their estrogen-like structure, soy isoflavones may affect IGF-I levels in a similar way as exogenous estrogens. In a cross-sectional design, we compared IGF-I levels between women with high and low soy intake. The analysis included 611 pre- and postmenopausal women: Japanese in Japan and Japanese and Caucasians in Hawaii. The subjects had participated in a previous study, were never diagnosed with breast cancer, provided a screening mammogram and a blood sample, and completed validated food-frequency questionnaires. The same laboratory analyzed all serum samples for IGF-I and IGF binding protein (IGFBP)-3 by enzyme-linked immunosorbent assay. We estimated covariate-adjusted mean IGF-I and IGFBP-3 levels by tofu intake. The respective mean IGF-I levels were 213, 257, and 255 ng/ml for Japanese in Japan, Japanese in Hawaii, and Caucasians in Hawaii. Tofu intake was higher in Japan than among Japanese and Caucasians in Hawaii (11.0 vs. 9.4 and 4.9 g/1,000 kcal). Mean IGF-I levels were 11% lower among women in the highest tofu intake category compared with the lowest, but the difference in IGF-I levels between the highest and lowest tofu category was only significant among women in Japan. Inclusion of total energy, total protein, meat, and dairy intake did not materially alter the association between tofu consumption and IGF-I levels. These findings suggest that a diet rich in soy foods and low in meats may be related to lower IGF-I levels, but it is unclear whether soy or other characteristics of diet and lifestyle are responsible for this association.     

In your skin you are different: women living with ovarian cancer during childbearing years

The purpose of this study was to understand what it is like to live with ovarian cancer during childbearing years. The primary researcher (PR) conducted three to four in-depth interviews, lasting 60 to 90 minutes each, with five women living with ovarian cancer for 1 to 10 years. Van Manen's method of reflection and writing guided the inquiry. The process of existential investigation expanded the inquiry. Trustworthiness was assured through member checking, reflective journaling, coinvestigators checking the logic of the PR's analysis, and the achievement of consensus through dialogue. Analysis of the data revealed the themes of serendipitous diagnosis, managing treatment, horrible hair experience, hysterectomy violating one's sense of being, unfairness of menopause, body changes, intimate dreaming, being with others, being normal/different, being vigilant, being heard, and trying to make sense of it. The stories revealed provide us with a window into the experience of women with ovarian cancer.     

Dietary intake of homeless women residing at a transitional living center

Women who are homeless experience health problems due to many factors, including poor nutrition. This paper describes a nutritional assessment of women who are homeless living at a transitional living center in an urban setting. A rapid food screener was used to assess fat, fruit and vegetable, and fiber intake, and focus group analysis was used to assess nutritional attitudes and dietary behaviors. We found that the dietary intake of shelter residents does not meet the USDA recommendations in several key areas. We also found that shelter residents considered shelter cafeteria food to be inadequate in terms of taste, nutritional quality, and choices, and they believed the shelter diet contributed to chronic diseases and their symptoms. We conclude that addressing these barriers to good nutrition may help people who are homeless prevent and manage chronic illness.     

Blood and hair lead levels in boys and girls living in two Sardinian towns at different risks of lead pollution

This study reports blood and hair lead levels measured in 1998 in 222 children from two Sardinian towns: Portoscuso and Sestu. Portoscuso is in a polluted area of Sardinia due to its vicinity to the industrial zone of Portovesme. As a consequence of its economy and location, Sestu is not exposed to lead pollution. Blood lead (PbB) concentration was determined in heparinized venous blood samples by graphite furnace atomic absorption spectrophotometry (AAS). Hair lead (PbH) concentration was determined by inductively coupled plasma atomic emission spectrometry (ICP-AES). With respect to blood lead levels, the boys of Portoscuso have the highest arithmetic mean value (11.30 microg/dL), followed by the Portoscuso girls (7.39 microg/dL); they are followed, but with much lower values, by the boys (4.09 microg/dL) and girls (3.34 microg/dL) of Setsu. For hair lead levels, the Portoscuso boys have the highest arithmetic mean value (15.51 microg/g), followed by the Portoscuso girls (8.82 microg/g) and the Sestu boys (4.03 microg/g) and girls (2.83 microg/g). Therefore the mean values of PbB and PbH follow similar patterns in the boys and girls of the two Sardinian towns. Two-way ANOVA reveals a significant effect of sex and town on log PbB and log PbH. Moreover, values of the Bravais-Pearson coefficients of correlation between log PbB and log PbH are statistically significant for the total sample (r=0.5086; P<0.001), for males (r=0.4275; P<0.01), and for females (r=0.4859, P<0.001). The sensitivity of the hair lead analysis in identifying lead concentrations above 10 microg/g is 49%. The results support the hypothesis that hair lead levels can be considered an indicator of different relative exposure of populations to lead pollution.     

The Eating Disorder Examination Questionnaire (EDE-Q) among university men and women at different levels of athleticism

The aim of the current study was to establish norms for the Eating Disorder (ED) Examination Questionnaire (EDE-Q) among competitive athletes and to explore the contribution of level of athletic involvement and gender to ED psychopathology, as measured by the EDE-Q. University students (n = 1637) from ten United States universities were recruited online via a social networking website and asked to complete an anonymous survey. The sample was then divided according to gender and level of sports participation. Females scored higher than males regardless of level of athleticism. Lower mean scores were frequently observed among those involved in competitive sports exclusively and highest scores among those involved in recreational sports (alone or in addition to competitive athletics). Recreational activity seems to be important in stratifying risk among competitive athletes; gender is an important interaction term in athletic populations.     

Health status of childbearing population of women in regions with different levels of infant mortality

Under conditions of present demographic situation in the USSR with a view of scientific substantiation of priority directions in the development of regional programmes of medico-social activities in the field of maternal and child health the major importance is being given to the valid information on the health status of mothers and factors of social environment determining the conditions for intrauterine development of foetus and the formation of child health at early stages of life under conditions existing in specific regions. For this purpose simultaneously in Panevezhis, Lipetsk and Fergana which are representatively reflecting the specificity of regions with low, average and high infant mortality, on the basis of unified methodology a complex socio-hygienic survey of three cohorts of children of 1986 year of birth and their mothers during the present period of pregnancy and delivery was conducted. The data suggested the rise in the level of pathology identified during pregnancy and delivery among Fergana women as compared with Lipetsk and especially Panevezhis women.     

Iron status in non-pregnant women of child-bearing age living at Greater Buenos Aires

This survey was conducted in Greater Buenos Aires to assess the iron nutritional status of non-pregnant women of child-bearing age. One hundred and eighty-four subjects aged 16-44 years were studied. The prevalence of anaemia (haemoglobin concentration less than 120 g/l) was 25.8 per cent. According to the multiple criteria approach, 21.6 per cent of women presented two or three abnormal values of iron status indicators (free erythrocyte protoporphyrin, serum ferritin and/or mean corpuscular volume). Prevalences of anaemia were 19.2 per cent, 51.8 per cent and 100 per cent in women with 0-1, 2 or 3 indicators in the abnormal range, respectively. The haemoglobin shift analysis showed a prevalence of anaemia of 19.5 per cent. Frequency distribution of iron stores was calculated as described by Cook & Finch, with slight modifications; median value of iron stores was estimated at 180 mg iron. Depletion of iron stores was significantly associated with the socio-economic status, prevalences being 5.3 per cent, 34.2 per cent and 43.2 per cent for the high, middle and low socioeconomic groups, respectively.     

孕期钙摄入量对孕产妇骨密度的影响

目的　研究孕期不同钙摄入量对产妇骨密度的影响。方法　对３５ 名２４ ～３１ 岁、孕１８周第１ 胎的健康妇女从孕２０ 周至产后４５ 天进行追踪研究, 以营养软件指导膳食,在热能和其他营养素摄入基本一致下,按钙摄入量分为Ⅰ、Ⅱ、Ⅲ组,钙摄入量分别为（５５０ ±１５０） ｍｇ／ｄ 、（９００ ±１５０） ｍｇ／ｄ 、（１ ５００ ±１５０） ｍｇ／ｄ ,产后４５ 天采用双能Ｘ线骨密度仪测定全身及各部位骨密度。结果　Ⅰ组多项部位骨密度值明显低于Ⅱ和Ⅲ组;与同年龄组健康妇女腰椎骨密度峰值相比,Ⅰ组仅能维持在（８５ ．１４±６ ．６１） ％ ,并出现个例腰椎骨骨质疏松;Ⅱ组可达（９０ ．７４ ±６ ．５３） ％ ,Ⅲ组则达（１００ ．４４ ±５ ．１９） ％ 。全身多部位骨密度与其均数相关极为显著,其中第３ 腰椎相关性最好;钙摄入量与各部位骨密度均呈正相关。结论　孕期钙摄入量为（３０ ．６８ ±３ ．５６） ｍｍｏｌ／ｄ ,即（１ ２７４ ．６ ±１４７） ｍｇ／ｄ 时,母体经妊娠分娩及短期哺乳仍能维持良好的骨密度,对预防骨质疏松有一定意义。采用骨密度来反映孕产妇钙营养状况时,以腰椎代表性最好。     

Adverse health effects among women living with heavy snorers

Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with non-snorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a "dose-response relationship" between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.