Menstrual Perceptions and Preparation Among Female Adolescents

Seventy-four 8th- and 10th-grade students attending a private girls' school in Hawaii were queried about their perceptions of and preparation for menstruation using a questionnaire administered in a health education class. Eighty percent had already started menstruating. The most frequently cited perceptions by the respondents referred to both the inconveniences and the normalcy of menstruation. Many were first informed about menstruation by their mothers and stated that they also first informed their mothers when they started menstruating. Surprise, fear, and embarrassment were common initial reactions, while strong negative or positive emotions were more rare. Only 35% wanted boys and girls together during class discussion, but 89% stated that boys needed to be informed about menstruation. The most frequent reasons cited for noncoed settings were the girls' concern about their comfort in openly discussing menstruation. Thirty-eight percent thought parents should inform other siblings when they started menstruation, although almost half gave specific conditions the parents should consider. The majority thought the fifth to sixth grades were the best times to introduce menstruation content.     

Plasma beta-thromboglobulin as a measure of platelet activity: Effect of risk factors and findings in ischemic heart disease and after acute myocardial infarction

The plasma concentration of beta-thromboglobulin (BTG), a platelet-specific protein released during platelet aggregation, is considered a sensitive marker of in vivo platelet activity. The mean plasma level in 133 asymptomatic individuals was 32.3 ± 1.1 ng/ml, and there was no difference between those with no risk factors (32.2 ± 1.2 ng/ml, n = 56), those who smoked (31.8 ± 1.8 ng/ml, n = 45), those with hyperlipidemia (32.8 ± 1.7 ng/ml, n = 15), and those exposed to both of these risk factors (34.1 ± 2.7 ng/ml, n = 17). The mean plasma BTG level in 104 patients with symptomatic ischemic heart disease was significantly elevated (40.9 ± 1.4 ng/ml, p < 0.01), but there was considerable overlap with normal levels. Although no difference was found between patients with no risk factors (38.1 ± 4.0 ng/ml, n = 13) and those with only 1 risk factor (37.0 ± 1.8 ng/ml, n = 44), patients with 2 or more risk factors had a significantly elevated plasma BTG level (45.2 ± 2.2 ng/ml, n = 47, p < 0.01). It is concluded that risk factors themselves do not increase platelet activity, but that patients with vascular disease have activated platelets that may contribute to the progression of the disease. Plasma BTG was also measured serially for 10 days in 29 patients after hospitalization with acute ischemic cardiac pain. Although the median plasma level was elevated above normal there were no acute changes in plasma BTG after either acute infarction (n = 22) or acute ischemia (n = 7), except in 2 patients in whom pericardial friction rubs developed. Thus, measurement of systemic plasma BTG did not detect platelet involvement in acute coronary occlusion or acute ischemia.     

“I don't want to look like an AIDS victim”: A New Zealand case study of facial lipoatrophy

The development of antiretroviral (ARV) drugs to treat HIV has turned what was once a death sentence into a chronic disorder. However, a focus on absence of disease in the form of an undetectable viral load and the dismissal of the so‐called “cosmetic” complications of the disease ignores perceptions of health and well‐being of those living with HIV. Facial lipoatrophy is a stigmatising side effect of treatment for HIV as it betrays the presence of the virus within the body. The study took a longitudinal qualitative approach, interviewing 11 people twice over a period of 1 year on their experience of living with HIV. Two participants were given cameras and asked to take photos which represented what it was like for them to live with this condition and were interviewed four times at four monthly intervals. This paper looks at one man's struggle to conceal or veil his facial lipoatrophy. His story is presented in the form of “selfies” and extracts from in‐depth interviews. It tells of an emotional (ongoing) journey of frustration, anger, excitement, depression and resignation which had a profound effect on his sense of social and psychological well‐being. This suggests a more holistic approach to treating people living with HIV is needed. While an undetectable viral load is indeed vital, it should not be seen as the only essential outcome of treatment.     

Cervical Cancer in South Australia: Trends in Incidence, Mortality and Case Survival

Summary: Approximately 90% of cervical cancers are considered preventable through regular screening and the treatment of precursor lesions, but fewer than 20% of South Australian women were found to have been screened in 1984.
Data from the State Cancer Registry have shown an increase in cervical cancer incidence of approximately 80% in women under 50 years of age in the 9-year period to 1986, but a decrease of about 25% in older women. Mortality data have shown similar patterns by age, although the increase in younger women tended to extend to an older age.
Case survival was unchanged between the diagnostic periods 1977–1981 and 1982–1987 and there was little change in the proportion of cases that were adeno-carcinomas.     

Productivity loss as a major component of disease-related costs in patients with hypercholesterolemia in Germany

Objective Hypercholesterolemia is a common risk factor for cardiovascular diseases; however, there are only few data available on associated costs. The objective of this study is, therefore, to analyse direct and indirect costs in patients with hypercholesterolemia and to determine predictors of costs. Methods The ORBITAL Study is a randomised controlled trial evaluating the effectiveness of a compliance-enhancing program in patients with statin therapy. Consecutive patients eligible for statin therapy according to the Joint European Guidelines were enrolled nationwide in 1961 primary care practices in Germany. For the present cost-of-illness analysis, patients were asked retrospectively about medical resource use and employment status in the 6 months preceding enrolment. The perspective chosen was societal. Factors associated with costs were determined using linear regression. Results A total of 7,640 patients (56% men, mean age 60 ± 10 years, and 44% women, 64 ± 10 years) were included. Of these patients, 32% were employed, 17% had a history of myocardial infarction, 7% a history of stroke, 58% had hypertension, and 29% diabetes. Total disease-related costs amounted to a mean of 2,498 ± 4,898 Euros per patient over 6 months, comprising direct (44%) and indirect (56%) costs. Disease-related early retirement was responsible for 42% of costs, followed by hospital visits (19%), medication (15%), workdays lost (14%), physician visits (5%), outpatient therapy (2%), and rehabilitation (2%). In multivariable analyses, factors associated with direct costs included coronary interventions, risk stratum, and medical history. Factors associated with indirect costs included disease-related early retirement, other socio-economic and lifestyle factors, coronary interventions, risk stratum, and medical history. Conclusion The considerable economic burden associated with hypercholesterolemia indicates the need to assess long-term cost-effectiveness of health care programs in patients with this disorder. ClinicalTrials.gov Identifier: NCT00379249.     

Dental health of disabled children in Singapore

The oral health status of the disabled has generally been poorer than the general population as the treatment and care afforded to them has been minimal. This paper examines the relationship of the various types of disabilities to dental health status. The dental status of a random sample of 322 disabled children aged between 6 and 18 years was assessed. The children had various disabilities: intellectual, hearing, visual, and musculo-skeletal. Most differences in the prevalence and severity of the dental conditions assessed among the children in the various disability groups were not significant. However, in comparison with normal schoolchildren aged 6 to 18, the disabled children had higher levels of disease and received less dental attention.