Characteristics of Patients With Pulmonary Arterial Hypertension in a Pulmonary Hypertension Association-Accredited Comprehensive Care Center: A Contrast in Features When Compared With US National Registry Data.

Background Since the initial description in the 1980s, our understanding of the diversity of pulmonary arterial hypertension (PAH) has continued to evolve. In this study, we report the characteristics of patients seen in an academic medical center for PAH from August 2020 through November 2021 and contrast those with nationally reported data from the United States Pulmonary Hypertension Scientific Registry (USPHSR).  Study Design Investigators at the University of Utah Pulmonary Hypertension Program prospectively enrolled adult patients diagnosed with WHO Group 1 PAH, who were evaluated between August 2020 and November 2021 in a program-specific registry. Patient exposure and health histories were collected through structured interviews and questionnaires, along with clinical data and medication use. A total of 242 patients were enrolled in the University of Utah Pulmonary Hypertension Registry (UUPHR).  Results Of the 242 enrolled patients, the most common etiology was associated PAH (APAH), accounting for 71.1% of the population. The second largest etiology was idiopathic PAH (IPAH) at 26.4%. The remaining patients were distributed between familial PAH (FPAH), pulmonary veno-occlusive disease (PVOD), and others. Of the total population classified as APAH, 39% of cases were noted as secondary to connective tissue disease (CTD) and 33% as toxin-induced. These represented 28% and 24% of the total population, respectively.  Conclusions In this US-based accredited academic medical center, the etiology of PAH in our patient population contrasts with national registry data. In the UUPHR, APAH, specifically CTD-PAH and toxin-associated PAH, accounts for the majority of patients with PAH. This contrasts with IPAH, which nationally is the most reported cause of PAH. Differences in our population may reflect the regional variation of the referral site, but it is noteworthy for its contrast with historically reported phenotypes.

Family planning in a sub-district near Kumasi, Ghana: side effect fears, unintended pregnancies and misuse of a medication as emergency contraception.

The Barekuma Collaborative Community Development Project (BCCDP) performed a study regarding family planning in communities in the Barekese sub-district near Kumasi, Ghana in July 2010. Eighty-five women, ages 15-49 years, in three communities were interviewed with a modified version of the 2008 Ghana Demographic and Health Survey. While virtually all women recognized at least one family planning method, half of all recent or current pregnancies were unintended and 20 percent of women had a previous abortion. Unexpectedly, 27 percent of women had misused norethisterone tablets (Primolut N or "N-tablets"), a synthetic progesterone, as emergency contraception. Women had a variety of concerns about family planning methods, including one-third having a fear of side effects for hormonal methods (particularly heart palpitations), as well as unfamiliarity with and particular aspects they did not like for most methods. However, women were interested in learning more about side effects as well as modern fertility awareness-based methods. There is an urgent need for interventions aimed at regulating and implementing the correct use of Primolut N tablets, addressing real and perceived side effects of family planning practices through properly trained community health nurses and introducing modern methods of fertility awareness such as Standard Days Method and the Two-day Method in the Barekese sub-district.