Effect of transcranial direct current stimulation combined with pelvic muscle training in women: Randomized, controlled, double-blind, and clinical trial.

BACKGROUND: Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects. OBJECTIVE: To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women. STUDY DESIGN: 32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up. RESULTS: There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0). CONCLUSION: Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.

Investing in mental health during the first 1,000 days of life: Now and future.

COVID-19 has disrupted the mental health services in 93% of the countries worldwide. Approximately 130 countries are affected catastrophically by COVID-19, which limits access to mental health services. Most vulnerable are children, pregnant women, and adults with limited access to mental healthcare. In highlighting the importance of mobilising resources, the WHO has given leaders around the world an opportunity to galvanise efforts. Maternal and children's mental health are crucial factors that may have a lifelong impact. In a post-pandemic world, a renewed focus is required to develop sustainable policies and action plans to support new mothers and new-borns in the first 1,000 days of life. This viewpoint shares a reflective discourse on contextualising the need of investment in mental health in times of crisis and global pandemic and what needs to be catered to in the near future.

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists.

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

Knowledge, Attitude, and Practice of Women in Slums of Pimpri, Chinchwad, Pune, Maharashtra, India, regarding Usage of Mishri.

INTRODUCTION: Mishri is one of the form of smokeless tobacco, which is a roasted, powdered preparation made by baking tobacco on a hot metal plate until it is uniformly black, after which it is powdered. It is noted that mishri use is more commonly used by the women of low socioeconomic status, hence the need was felt to conduct this study among women mishri users of slums. Also, the consequences of mishri use are little known, hence an effort is made to find out its ill-effect on oral health. OBJECTIVE: To assess knowledge, attitude, and practice (KAP) among women using mishri regarding its effects on their oral and general health. MATERIALS AND METHODS: A 6-month KAP study was conducted among 100 women who were using mishri. Snowball sampling was used. Oral examination of the participants was also done for oral potentially malignant disorders, such as leukoplakia, erythroplakia, oral submucous fibrosis, and hyperkeratinized pouch. RESULTS: About 61% of the population used mishri for cleaning the teeth and others used it as quid; 0.85% of the total participants knew that the use of mishri may lead to precancerous lesions/conditions. Only 17% knew that mishri use can cause gum disease; 84% of the population was willing to quit the habit of using mishri. CONCLUSION: It is concluded that all the participants had poor knowledge. Attitude toward quitting mishri use was found to be good. About 4% of the participants reported about quitting the habit. CLINICAL SIGNIFICANCE: There is need to create awareness regarding harmful effects of mishri usage in this particular area to improve oral health status.

Self-medication practice among pregnant women in Wolaita Zone, Southern Ethiopia: An institutionally based cross-sectional study.

Background: Self-medication is a treatment based on symptoms without prescription and medical consultation. Despite being one of the critical practices that impose a harmful effect on the fetus and the woman herself, evidence on its practice and associated factors are not well-documented. This study, therefore, assessed the self-medication practice and associated factors among pregnant women in Wolaita Zone, Southern Ethiopia. Methods: An institutionally based cross-sectional study was conducted at public health institutions in Wolaita Zone, Southern Ethiopia by recruiting a total of 408 pregnant women using a systematic random sampling technique between March 2019 and April 2019. We used the Antenatal care (ANC) registry as a sampling frame. A pre-tested, structured, interviewer-administered questionnaire used to depict Self-medication practice and associated factors. Data entered using Epi-data and analyzed by SPSS 23.0. Results: The overall prevalence of self-medication was 14.9% (95% CI:11-18). The odds of using self-medication may decreased by 75% for women who were in their third trimester (AOR = 0.25, 95% CI: 0.10, 0.64). However, the odds of practicing increased by 13-folds among pregnant women reported earlier (previous) self-medication experience (AOR = 13.62, 95% CI: 6.66-27.84). Conclusion: The prevalence of self-medication was high in the current study setting. Women's gestational period (third trimester) and earlier self-medication experience were associated with their current self-medication practice.

Long-Acting Reversible Contraceptive Users' Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey.

Objectives To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use.

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

The 12 women who won the Nobel Prize in Medicine or Physiology: [errata] / As 12 mulheres laureadas com o Prêmio Nobel de Medicina ou Fisiologia: [errata]

Introduction: the Nobel Prize is one of the highest academic honors in the world. Since its first edition, in 1901, until 2021, there have been hundreds of winners. In the Medicine or Physiology category, chosen by the Karolinska Institute in Stockholm, Sweden, 112 awards have been given to 224 laureates, among them, only 12 (5.4%) women. Aims and source of data: with the aim of reviewing the biographies, characteristics, and peculiarities of each woman awarded the Nobel Prize for Medicine or Physiology. Data were analyzed from the following sources: the Award page, websites of the institutions to which some of them have been or are affiliated, books with biographies of Nobel laureates in Medicine or Physiology, and articles in the PubMed database. Summary of findings: the average age when receiving the award was 63.4 years. The most recurrent country of origin was the United States of America, also responsible for the largest number of institutions to which the laureates were affiliated at the time of the award. The academic training of the laureates was quite diverse, ranging among medicine, chemistry, physics, biology, pharmacy, psychology and natural sciences. Five of the 12 laureates did not have children. Comments: the origins and trajectories, although plural, have points in common, such as a fascination with science since childhood and the need to overcome additional barriers throughout their education, because of their sex. Conclusion: investments on a global scale are necessary to increase equity between sexes.

Introdução: o prêmio Nobel é uma das maiores honrarias acadêmicas do mundo. Desde a sua primeira edição, em 1901, até 2021, já foram centenas de vencedores. Na categoria Medicina ou Fisiologia, escolhido pelo Instituto Karolinska em Estocolmo, na Suécia, foram entregues 111 prêmios para 224 laureados, dentre eles, apenas 12 (5,4%) mulheres. Objetivos e métodos: com o objetivo rever as biografias, características e peculiaridades, de cada mulher laureada com o prêmio Nobel de Medicina ou Fisiologia, foram analisados dados provenientes da página do prêmio; de sites das instituições às quais algumas delas foram ou são afiliadas; em livros com biografias dos laureados com o prêmio Nobel de Medicina ou Fisiologia; e artigos na base de dados PubMed. Síntese dos dados: a média de idade ao receber o prêmio foi de 63,4 anos. O país de origem mais recorrente foi os Estados Unidos da América; também é o local que abriga o maior número de instituições às quais as laureadas estavam filiadas no momento da premiação. A formação acadêmica das laureadas foi bastante diversa, variando entre: medicina, química, física, biologia, farmácia, psicologia e ciências naturais. Cinco das 12 laureadas não tiveram filhos. Conclusão: fazem-se necessários investimentos em escala global para aumentar a equidade entre os gêneros.

Gestação: implicações na vida da gestante / Pregnancy: implications for the pregnant woman's life / Embarazo: implicaciones para la vida de la embarazada

Objetivo: analisar a gestação e suas implicações na vida da gestante. Método: revisão bibliográfica integrativa seguindo os pressupostos de Ludke e André, e abordagem qualitativa. Resultados: No presente estudo, foram analisados 16 (dezesseis) artigos científicos, que atenderam aos critérios de inclusão previamente estabelecidos, onde foram encontrados 8 (oito) na base de dados SCIELO, 2 (dois) artigos na BVS e outros 6 (seis) em Revistas de Enfermagem, a seguir, apresenta-se um panorama geral dos artigos analisados. Conclusão: cada mulher externaliza seus sentimentos de descoberta de gravidez de forma diferente, algumas ficam animadas e sentem prazer, outras ficam tristes e receosas com o que está por vir. É importante instigar a enfermagem a interagir e auxiliar a parturiente de forma abrangente.

Objective: to analyze the management and its conclusions in the pregnant woman's life. Method: integrative literature review following the assumptions of Ludke and André, and a qualitative approach. Results: In this study, 16 (sixteen) scientific articles were formed, which met the advanced inclusion criteria, where 8 (eight) were found in the SCIELO database, 2 (two) articles in the VHL and another 6 (six) in Nursing Journals, below, presents an overview of the distribution articles. Conclusion: each woman externalizes her feelings of pregnancy discovery differently, some are excited and feel pleasure, others are sad and afraid of what is to come. It is important to encourage nursing to interact and assist the parturient in a comprehensive way.

Objetivo: analizar el manejo y sus conclusiones en la vida de la gestante. Método: revisión integradora de la literatura siguiendo los supuestos de Ludke y André, y un enfoque cualitativo. Resultados: En este estudio se conformaron 16 (dieciséis) artículos científicos, los cuales cumplieron con los criterios de inclusión avanzada, donde se encontraron 8 (ocho) en la base de datos SCIELO, 2 (dos) artículos en la BVS y otros 6 (seis) en Enfermería. Revistas, a continuación, presenta una descripción general de los artículos de distribución. Conclusión: cada mujer exterioriza sus sentimientos de descubrimiento del embarazo de manera diferente, algunas están emocionadas y sienten placer, otras están tristes y temerosas de lo que está por venir. Es importante fomentar que la enfermería interactúe y asista al parturient de manera integra.

The 12 women who won the Nobel Prize in Medicine or Physiology / As 12 mulheres laureadas com o Prêmio Nobel de Medicina ou Fisiologia

Introduction: the Nobel Prize is one of the highest academic honors in the world. Since its first edition, in 1901, until 2021, there have been hundreds of winners. In the Medicine or Physiology category, chosen by the Karolinska Institute in Stockholm, Sweden, 112 awards have been given to 224 laureates, among them, only 12 (5.4%) women. Aims and source of data: with the aim of reviewing the biographies, characteristics, and peculiarities of each woman awarded the Nobel Prize for Medicine or Physiology. Data were analyzed from the following sources: the Award page, websites of the institutions to which some of them have been or are affiliated, books with biographies of Nobel laureates in Medicine or Physiology, and articles in the PubMed database. Summary of findings: the average age when receiving the award was 63.4 years. The most recurrent country of origin was the United States of America, also responsible for the largest number of institutions to which the laureates were affiliated at the time of the award. The academic training of the laureates was quite diverse, ranging among medicine, chemistry, physics, biology, pharmacy, psychology and natural sciences. Five of the 12 laureates did not have children. Comments: the origins and trajectories, although plural, have points in common, such as a fascination with science since childhood and the need to overcome additional barriers throughout their education, because of their sex. Conclusion: investments on a global scale are necessary to increase equity between sexes.

Introdução: o prêmio Nobel é uma das maiores honrarias acadêmicas do mundo. Desde a sua primeira edição, em 1901, até 2021, já foram centenas de vencedores. Na categoria Medicina ou Fisiologia, escolhido pelo Instituto Karolinska em Estocolmo, na Suécia, foram entregues 111 prêmios para 224 laureados, dentre eles, apenas 12 (5,4%) mulheres. Objetivos e métodos: com o objetivo rever as biografias, características e peculiaridades, de cada mulher laureada com o prêmio Nobel de Medicina ou Fisiologia, foram analisados dados provenientes da página do prêmio; de sites das instituições às quais algumas delas foram ou são afiliadas; em livros com biografias dos laureados com o prêmio Nobel de Medicina ou Fisiologia; e artigos na base de dados PubMed. Síntese dos dados: a média de idade ao receber o prêmio foi de 63,4 anos. O país de origem mais recorrente foi os Estados Unidos da América; também é o local que abriga o maior número de instituições às quais as laureadas estavam filiadas no momento da premiação. A formação acadêmica das laureadas foi bastante diversa, variando entre: medicina, química, física, biologia, farmácia, psicologia e ciências naturais. Cinco das 12 laureadas não tiveram filhos. Conclusão: fazem-se necessários investimentos em escala global para aumentar a equidade entre os gêneros.

Age-specific patterns of association between breast cancer and risk factors in black women, ages 20 to 39 and 40 to 54.

Data from the 1980 to 1982 population-based Cancer and Steroid Hormone case-control study of women 20 to 54 years old afforded the opportunity to investigate risk factors for breast cancer among black women younger than 40 years (177 patients and 137 control subjects) and to compare the results to black women 40 to 54 years old (313 patients and 348 control subjects). Information on exposure variables was obtained by in-person interviews. The logistic regression results indicated that the risk of breast cancer among black women younger than 40 years was nearly three times greater for those who used oral contraceptives for more than 10 years relative to never-users (odds ratio, 2.8; 95% confidence interval, 1.2 to 6.8) and more than four times greater for severely obese women (body mass index > or = 32.30 kg/m2) relative to women whose relative weights were less than 24.90 kg/m2. Patterns of association for the two age groups were similar for surgical menopausal, age at first full-term pregnancy, and multiple births, but differed for age at menarche.

PIP: In this case control study among Black American women, the findings showed that differences in breast cancer risk between Black women aged 20-39 years and Black women aged 40-54 years are related to age at menarche, oral contraceptive use, and family history of breast cancer. An inverse relationship was found with age at menarche and a positive relationship with duration of oral contraceptive use among women 20-39 years. The logistic model with all variables included revealed that increased risk was related to an increasing Body Mass Index (BMI) as an adult, lack of breast feeding under the age of 25 years, and the duration of oral contraceptive use among women aged under 40 years. BMI had a stronger impact among women aged under 40 years when BMI at age 18 years was included. Both age groups showed reduced risk with surgical menopause. The final logistic regressions indicated that younger women with menarche at under the age of 12 years had 50% less breast cancer risk than younger women with menarche at 14 years or older. Severely obese younger women had four times the breast cancer risk as women weighing under 24.90 kg/m squared. For women who used oral contraceptives for 10 years or more, the adjusted odds ratio was 2.8 compared to never-users. This finding was unique. Age at initiation of use was unrelated. Results suggested that older women with a family history of breast cancer or with menarche at 13 years and younger had a higher relative risk; early age at menarche was a protection against breast cancer only among younger women. Breast feeding before the age of 25 years may affect risk of breast cancer among women under 40 years of age. Education was unrelated. The findings indicate the importance of examining within race differences by sociocultural differences and reproductive life style choices. Data were obtained from the CASH study by the Centers for Disease Control on 490 women aged 20-54 years who had been diagnosed with primary breast cancer between December 1, 1980 and December 31, 1982 and 485 controls.

Biocultural perspectives on women's health.

PIP: During the 1997 meeting of the American Association for the Advancement of Science, a session was devoted to biocultural perspectives on women's health in developing countries. The topics covered included female circumcision conducted as part of the traditional wedding ceremony of the Rendille people of Kenya and the deleterious effect of sociocultural factors such as acceptance of premarital sexual intercourse and early child-bearing on the health of adolescent girls in West Africa. A study in Bangladesh sought information on women's health during pregnancy and lactation. Using 19,000 paired questionnaires and urine samples from 493 women representing all reproductive states, pregnancy-related sickness (such as nausea and vomiting) was correlated to hormone levels, maternal age, and fetal loss. Preliminary results contradict a popular belief that incidence of pregnancy-related sickness is associated with a lowered risk of early fetal loss. Another study in Bangladesh revealed that previous research indicating that women in Bangladesh experience menopause eight years sooner than US women was inaccurate. The two-year earlier onset of menopause found in Bangladesh is likely caused by stress-related anovulation. A preliminary literature review has also shown that Bangladeshi women lack significant amounts of phytoestrogens in their diet. Improved knowledge of biocultural factors is sought as a prerequisite for improving medical treatment in developed and developing countries.^ieng

Menstruation and reproduction in women with polychlorinated biphenyl (PCB) poisoning: long-term follow-up interviews of the women from the Taiwan Yucheng cohort.

BACKGROUND: In 1979 in Taiwan, about 2000 people were poisoned by cooking oil contaminated with heat-degraded polychlorinated biphenyls (PCBs). Victims developed chloracne and other symptoms; the illness is called Yucheng (oil disease). The chemicals persist in the victims' bodies and some are toxic to the female reproductive system in experimental animals. METHODS: In 1993-1994, we identified the living Yucheng women and neighbourhood controls and interviewed them about their reproductive experience. Of the 596 living Yucheng women aged 30-59 years, we found 368, and interviewed 356. We identified 329 controls, and interviewed 312. RESULTS: Of the Yucheng women, 16% reported abnormal menstrual bleeding compared to 8% (P < 0.05) of control women; 4.2% versus 1.7% reported a stillbirth since 1979 (P = 0.068). Other characteristics of the menses, fertility, frequency of intercourse, and age at menopause appeared unaffected. More of the Yucheng women reported that one of their offspring had died during childhood (10.2% versus 6.1%, P < 0. 05), and that they had decided to limit childbearing because of health problems (7% versus 2%, P = 0.01). CONCLUSIONS: These findings suggest that high level PCB/polychlorinated dibenzofuran (PCDF) exposure has some effect on female endocrine and reproductive function.

Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala.

BACKGROUND: A number of studies have reported associations between indoor biofuel air pollution in developing countries and chronic obstructive lung disease (COLD) in adults and acute lower respiratory infection (ALRI) in children. Most of these studies have used indirect measures of exposure and generally dealt inadequately with confounding. More reliable, quantified information about this presumed effect is an important pre-requisite for prevention, not least because of the technical, economic and cultural barriers to achieving substantial exposure reductions in the world's poorest households, where ambient pollution levels are typically between ten and a hundred times higher than recommended standards. This study was carried out as part of a programme of research designed to inform the development of intervention studies capable of providing quantified estimates of health benefits. METHODS: The association between respiratory symptoms and the use of open fires and chimney woodstoves ('planchas'), and the distribution of confounding factors, were examined in a cross-sectional study of 340 women aged 15-45 years, living in a poor rural area in the western highlands of Guatemala. RESULTS: The prevalence of reported cough and phlegm was significantly higher for three of six symptom measures among women using open fires. Although this finding is consistent with a number of other studies, none has systematically examined the extent to which strong associations with confounding variables in these settings limit the ability of observational studies to define the effect of indoor air pollution adequately. Very strong associations (P < 0.0001) were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated (P < 0.05). Thus, while 82% of open fire users had dirt floors and only 18% cement or tile floors, the situation was reversed for plancha users, only 16% of whom had dirt floors. CONCLUSIONS: Confounding presents a substantial problem for observational studies of indoor air pollution and health, although there is a reasonable case for believing that the observed association is causal. Intervention studies are required for stronger evidence of this association, and more importantly, to determine the size of health benefit achievable through feasible exposure reductions.

PIP: The authors investigated the association between respiratory symptoms and the use of open fires and chimney woodstoves, as well as the distribution of confounding factors, in a cross-sectional study of 340 women aged 15-45 years living in a poor rural area in the western highlands of Guatemala, and found a significantly higher prevalence of reported cough and phlegm for 3 of 6 symptom measures among women using open fires. When considering confounding factors, very strong associations were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated. 82% of open fire users had dirt floors, with the remaining 18% having cement or tile floors, while only 16% of chimney woodstove users had dirt floors.

Mental health of the mothers of malnourished children.

BACKGROUND: The objective of this study is to measure the association between protein-energy malnutrition (PEM) in children and their mothers' mental health, in a low income area in the city of Embú, São Paulo, Brazil. METHODS: A case-control study was performed. Cases were 60 moderately and severely malnourished children (Gomez criteria) selected from two primary health care units. Controls consisted of 45 eutrophic children attending the same units. The main outcome measure was for the mothers to present a mental health score > 6 according with the 'Adult Psychiatric Morbidity Questionnaire' (QMPA), a psychiatric screening instrument. RESULTS: Of mothers of children with PEM, 63% and 38% of mothers in the control group were QMPA positive: odds ratio (OR) = 2.8 (95% confidence interval [CI]: 1.2-6.9). Of PEM children, 27% had low birthweight (LBW = < 2500 g) and 6% of the control group had LBW. Interactions were found between: mothers' mental health and number of children (with > or = 4 children: OR = 20.0 [95% CI: 2.1-274.2], with < or = 3 children: OR = 1.6 [95% CI: 0.6-4.5), as well as mothers' mental health and maternal age (in women > 30: OR = 12.5 [95% CI: 2.0-93.4], in women < or = 30: OR = 1.5 [95% CI: 0.5-4.4]. CONCLUSIONS: Mothers of children with PEM showed a higher rate of mental disturbances than mothers of eutrophic children. Unlike LBW, maternal age and number of children interact with mothers' mental health, increasing the association. Management of poor mental health may lead to mothers being better caretakers of their children and this may have a positive impact on PEM.

Hormonal contraception. Current status and future perspectives.

PIP: Hormonal contraception was pioneered by Gregory Pincus in the 1950s. Today, hormonal contraception is accepted as having a highly favorable benefit/risk profile. There is, however, a need for the development of new contraceptive methods to broaden the range of choices and enhance motivation and compliance in users. With the staggering rate of increase in the world's population, the number of contraceptive users in developing countries is expected to increase from 381 million in 1990 to 567 million in the year 2000. This will require substantial supplies of inexpensive contraceptives and the development of new and improved methods. The use of contraceptives is an asset to women's health, which can be jeopardized by the risks of pregnancy, as well as to the psychological and social well-being of mother and child. Oral contraceptives also have noncontraceptive health benefits such as protecting against endometrial cancer, uterine fibroids, menorrhagia, benign breast disease, anemia, ovarian cancer, functional ovarian cysts, dysmenorrhea, ectopic pregnancy, salpingitis, and bone loss. The new low-dose formulations are considered to be very safe for most healthy, nonsmoking women of reproductive age. Therefore, current research efforts are focused on new delivery methods, such as vaginal rings, rather than on the development of new hormonally active steroids. Nonoral contraceptive methods which avoid first-pass effects on the liver are being developed or improved. These include implants, vaginal rings, vaginally applied pills, and progestogen-containing IUDs. Contraceptive research is also focusing on immunologic interference with the hypothalamic-pituitary-gonadal axis in both men and women. This may spawn as yet unforseen methods of molecular modulation of sperm-ovum interactions which would result in the inhibition of implantation.^ieng

Dissemination of HIV: how serious is it for women, medically and psychologically?

PIP: In the US, women comprise the population group with the most rapidly increasing rate of human immunodeficiency virus (HIV) infection, yet these women--predominantly poor and Black or Hispanic--must face the added trauma of discrimination in the health care system. Even the clinical case definition of acquired immunodeficiency syndrome (AIDS) fails to include recurrent pelvic inflammatory disease, recurrent vulvovaginal candidiasis, and cervical carcinoma in situ, thereby excluding thousands of women from AIDS-related entitlements. Essential for HIV-infected women is empowerment to facilitate sound decision making about choice of partners, barrier contraception, pregnancy, abortion, and breast feeding. The vast majority of women with sex partners in high-risk groups do not use condoms, in part because of fear of loss of the relationship or withdrawal of financial support. HIV-positive women are especially in need of condom use to prevent further transmission and unwanted pregnancy. Pregnancy in HIV-positive women is associated with a 30% chance that the infant will acquire the infection and alarming increases in the ranks of the 20,000 US children already orphaned by AIDS. Nonetheless, the right of HIV-infected women to bear children should be protected, and these women should be given the option of artificial insemination of washed semen and Cesarean section delivery to reduce the risk of transmission to partner and child. Finally, because substance abusing women are not always able to make appropriate decisions about their sexual practices, drug treatment on demand and comprehensive outreach programs for HIV-infected women at shelters, the streets, and shooting galleries must be implemented.^ieng

Women's health.

Although women live longer than men, new evidence indicates women bear a disproportionately heavy burden of disease. The effect of disease on economic productivity of women in developing countries has been largely ignored. Infections are often causes of disease in women, including those that affect reproductive health. Although men and women usually experience similar rates of many diseases, rates of exposure and treatment vary between men and women. If untreated, factors adversely affecting women's health in one stage compound women's ill health in succeeding stages.

PIP: This article discusses women's health in developing countries, urges improvements, identifies specific causes of death by age, and indicates future trends and effective strategies for improvements. A number of international conferences have been held to discuss women's health issues. Reference is made to the World Bank's "World Development Report for 1993" and the statistic that women suffer more disability than men. Women are considered to have a greater disease burden than men. Effective strategies include preventing or delaying births to women who do not desire any more children. Increased use of family planning and safe abortion might avert 100,000 maternal deaths each year due to pregnancy related causes and 200,000 maternal deaths due to unsafe abortion. Health services might be extended through use of non-health professionals who are trained as health providers. Well-trained traditional birth attendants and an effective referral system were found to be effective in northeast Brazil. The "safe motherhood" interventions of the World Bank are considered to be the most cost effective. Women need to take more responsibility for their own health. Women's disease burden can be reduced by safe motherhood strategies, safe birthing practices, pre- and postnatal care, ready access to quality family planning, safe abortion services, and treatment of sexually transmitted diseases. Women's health might improve with better access to safe water, good hygiene, and knowledge about safe cooking practices and about the maintenance of good health. Strategies must be directed to gender-specific causes of mortality by age group. Migration is expected to affect women's health status. Urban settings and destitute living conditions that force women into prostitution place women at greater risk of morbidity and mortality.

Mental and physical health effects of intimate partner violence on women and children.

The battering of female partners and the concomitant emotional abuse that is almost always part of the coercive control have significant mental and physical health consequences for the women who experience this type of violence. Children who live in households fraught with the conflict, violence, and unpredictable danger of domestic violence often witness the battering of their mothers and may also be victims of child abuse themselves. This article highlights current knowledge regarding the mental and physical health effects of intimate partner violence on women and their children, and discusses needed directions for screening, intervention, research, and changes in the health care system.

PIP: This article reviews the literature on the effects of domestic violence on women and children. The introduction notes that domestic violence affects millions of women in the US each year, significantly increasing their health problems and their use of the health care system. The next sections review the incidence of mortality related to such abuse and women's physical health sequelae from battering. Consideration of women's mental health consequences focuses on the traumatic response framework that has been developed to conceptualize the psychological effects of domestic violence. The article then considers studies of abuse during pregnancy. Next, the article turns to the children of battered women, noting how they often fit the description of traumatized children but that there have been no studies to date of the existence among them of post-traumatic stress disorder. After looking at studies that marked children's responses to traumatic events and the effects of domestic violence on the children, the review examines work that revealed developmental differences in children from violent homes. The article then points to several limitations in prior research in the area of domestic violence and highlights the lack of experimental evaluation of treatments or interventions. Next, research into possible opportunities for routine screening and intervention is considered. The article concludes by documenting the need for a change in the health care system so that it can respond appropriately to the needs of battered women.

The problem of post-partum fistulas in developing countries.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

PIP: In tropical environments, fistulas between the vagina and the bladder or rectum are common in postpartum women. This condition is most frequent in very young women from remote rural areas whose deliveries are attended by midwives untrained in the management of obstructed labor. As a result of the continuous seepage of urine and/or feces associated with this condition, women with fistulas face social ostracism. Thus, the prevention and adequate treatment of postpartum fistulas are important tasks for health services in the tropics. Unlike complicated transperitoneal procedures, a vaginal approach to fistula treatment does not require special surgical skills and can be performed under spinal anesthesia. 75-85% of first surgeries for postpartum fistula are successful (defined as no leakage of urine or feces and resumption of normal sexual relations). The success rate depends, however, on factors such as the exact localization and extension of the fistula, involvement of the urethra, the closing mechanism of the bladder, and the experience of the surgeon. Prevention of postpartum fistula requires good prenatal care, including the referral of primiparas with small or abnormal pelvic proportions to a hospital for delivery, and adequate maternity facilities, especially the availability of midwifery staff trained in vacuum extractor use and symphysiotomy performance.