Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities.

BACKGROUND: The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms. METHOD: Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls. RESULTS: Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls. CONCLUSIONS: Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.

Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study.

OBJECTIVES: Evidence from existing UK screening programmes indicates disparities in uptake rates between UK ethnic minorities and the white majority population. The aim of this study was to explore barriers to the uptake of flexible sigmoidoscopy (FS) screening among UK ethnic minority populations. Specifically, beliefs about bowel cancer, perceived barriers to the test and ideas about ways to increase uptake were investigated. METHODS: Nine focus groups were conducted with a total of 53 participants from African-Caribbean, Gujarati Indian, Pakistani and white British communities. The topic guide was based on the Health Belief Model. Discussions were subject to framework analysis. RESULTS: Most participants expressed limited awareness of bowel cancer and cited this as a barrier to screening attendance. Anxiety regarding the invasiveness of the test, the bowel preparation and fear of a cancer diagnosis were common barriers across all ethnic groups. Language difficulties, failure to meet religious sensitivities and the expression of culturally influenced health beliefs were all discussed as specific barriers to uptake. Ethnically tailored health promotion and general practitioner involvement were recommended as ways of overcoming such barriers. CONCLUSIONS: The study was the first attempt to qualitatively explore barriers to FS bowel cancer screening in UK ethnic minorities. Most barriers were shared by all ethnic groups but health educators should supplement approaches designed for the majority to incorporate the specific needs of individual minority groups to ensure equitable access.

[Characteristics of adolescent and adult young women diagnosed with human papilloma virus infection at the Center for Research on Human Reproduction (CIRH)]. / Características de las adolescentes y adultas jóvenes con diagnóstico de infección por virus de papiloma humano (IVPH) del Centro de Investigación en Reproducción Humana (CIRH).

We reviewed 239 charts of adolescents and young adults, who visited our clinic. The purpose was to know the incidence of the Human Papiloma Virus infection (HPVI), diagnosed by Pap's smears, and the relationship to a population with some gynecological and sociodemographic characteristics. The women age population was between 14-24 years old with a mean age of 19.9 years. Seventy (29.3%) were PIV positive and 169 (70.7%) negatives. About 75% among both groups (PIV + and -) began active sexual life between 15-19 years old. Among the women with 4 or more sexual partners, 55.6% were HPVI positive. About 60% of all women had never used any method before being admitted to the clinic. In this study there is no correlation between IVSA and HPVI. We do demonstrate that the greater the number of sexual partners, the highest the risk of a sexual acquired disease.

Effect of Depo-Provera or Microgynon on the painful crises of sickle cell anemia patients.

Forty-three homozygous (SS) female sickle cell anemic patients with a history of at least one painful crisis per month and desiring a reversible contraceptive were administered DMPA/3 months or Microgynon monthly. A third group of 16 surgically sterilized patients served as control. Patients were followed for 1 year to assess possible effects of the contraceptives on the patients' painful crises. No changes were observed in any of the groups in the hematological parameters. At the end of the study, 70% of the patients receiving DMPA were pain-free and only 16% of those still reporting painful crises rated them as intense. Patients receiving Microgynon also had an amelioration of the painful crises, although at a lower rate; after 12 months, 45.5% still experienced some crises. Although less marked than in the other groups, 50.5% of the control patients also reported an improvement of their painful crisis, which may be a result of closer medical care.

PIP: The effects of a combined oral contraceptive (Microgynon 30, containing ethinyl estradiol and levonorgestrel) and a progestogen-only injectable contraceptive (Depo-Provera) on the intensity and frequency of painful crises were investigated in 43 homozygous sickle cell anemia patients at the World Health Organization Collaborative Center for Research in Human Reproduction in Panama. Only women with a history of at least one painful crisis per month were enrolled. The patients were randomly assigned to receive Depo-Provera (n = 13) or Microgynon (n = 14) for 12 months; the remaining 16 patients--surgically sterilized controls-- received no treatment. No changes were recorded throughout the study period in any of the three groups in hematological parameters. In addition, there were no pregnancies or treatment-related side effects. In the Depo-Provera group, the percentage of patients with painful crises diminished steadily from 50% at 3 months to 30% at 12 months. Moreover, 84% of painful episodes experienced by Depo-Provera acceptors were characterized as moderate or mild. Among women in the Microgynon group, the rate of painful crises dropped from 72.7% at 3 months to 45.5% at 12 months. Controls also reported a 50.5% decline in painful crises, presumably as a result of increased individual attention from medical staff. These findings suggest that Depo-Provera can be safely and effectively used for contraceptive purposes in sickle cell anemic patients, with a concomitant beneficial effect on painful crises.

[Workshop on sexuality and its effectiveness as an alternative to sexual education directed to adolescents]. / Taller de sexualidad y afectividad como una alternativa de educacion sexual dirigida a adolescentes.

We present the experience accumulated during 3 years of having performed 10 workshops related to the topics of Sexuality and Affection, offered to 175 adolescents between the ages of 13 and 19 years, from public schools within the Panamá, City Metropolitan Area and who correspond to different socioeconomical strata. Analytical information provided from the results of two questionnaires related to knowledge about the two topics, applied prior to and after the workshops is also offered.

Taller de sexualidad y afectividad como una alternativa de educacion sexual dirigida a adolescentes / Workshop on sexuality and its effectiveness as an alternative to sexual education directed to adolescents

We present the experience accumulated during 3 years of having performed 10 workshops related to the topics of Sexuality and Affection, offered to 175 adolescents between the ages of 13 and 19 years, from public schools within the Panamá, City Metropolitan Area and who correspond to different socioeconomical strata. Analytical information provided from the results of two questionnaires related to knowledge about the two topics, applied prior to and after the workshops is also offered

Síndrome de hiperestimulación ovárica / Ovarian hyperstimulation syndrome

The author discusses the etiology and pathophysiology of the Ovarian Hyperstimulation Syndrome (OHS) and its relationship with Polycystic Ovarian Disease, in which it occurs more frequently. He presents the clinical histories of five patients who, in a period of two years, developed this syndrome in three different degrees of severity, while undergoing therapy for ovulatory infertility. The clinical history of one patient, who developed the most severe manifestations of OHS, is discussed in detail. The author emphasizes the difficulties that can be faced in trying to prevent the OHS, particularly because of probably inherited characteristics which may explain why not all patients with the same risk factors develop the OHS

[Ovarian hyperstimulation syndrome]. / Síndrome de hiperestimulación ovárica.

The author discusses the etiology and pathophysiology of the Ovarian Hyperstimulation Syndrome (OHS) and its relationship with Polycystic Ovarian Disease, in which it occurs more frequently. He presents the clinical histories of five patients who, in a period of two years, developed this syndrome in three different degrees of severity, while undergoing therapy for ovulatory infertility. The clinical history of one patient, who developed the most severe manifestations of OHS, is discussed in detail. The author emphasizes the difficulties that can be faced in trying to prevent the OHS, particularly because of probably inherited characteristics which may explain why not all patients with the same risk factors develop the OHS.

[The history of family planning among women who opt for surgical sterilization in the Social Security Fund of Panama]. / Historia de la planificación familiar en las mujeres que optan por la esterilización quirúrgica en la Caja de Seguro Social de Panamá.

In this study, the previous history of family planning and prior usage of contraceptive methods are analyzed, in a sample of 175 women who voluntarily opted for surgical sterilization as a permanent method of fertility regulation, in the Panamanian Social Security System. A questionnaire was applied during the second trimester of pregnancy, by which information would be gathered in regard to knowledge, usage and adverse effects of the contraceptive methods used prior to the intervention. Results showed that 99% of the sample had heard, on some occasion about oral contraceptives (OC) and, in lesser proportion to intrauterine devices (IUD), barrier methods and hormonal inyectables. The first contraceptive method used, and the one of longest usage, was the combined OC, of which 43% begun between 17 and 25 years of age. In contrast, 7.4% initiated contraception with IUD, from the age of 26 years. The health personnel constituted the major source of recommendation for contraceptive usage and, despite the fact that 37% of the sample did not use contraception prior to the last pregnancy, over half of the subjects responded that combined OC were considered as the most secure method.

Historia de la planificación familiar en las mujeres que optan por la esterilización quirúrgica en la Caja de Seguro Social de Panamá / The history of family planning among women who opt for surgical sterilization in the Social Security Fund of Panama

In this study, the previous history of family planning and prior usage of contraceptive methods are analyzed, in a sample of 175 women who voluntarily opted for surgical sterilization as a permanent method of fertility regulation, in the Panamanian Social Security System. A questionnaire was applied during the second trimester of pregnancy, by which information would be gathered in regard to knowledge, usage and adverse effects of the contraceptive methods used prior to the intervention. Results showed that 99% of the sample had heard, on some occasion about oral contraceptives (OC) and, in lesser proportion to intrauterine devices (IUD), barrier methods and hormonal inyectables. The first contraceptive method used, and the one of longest usage, was the combined OC, of which 43% begun between 17 and 25 years of age. In contrast, 7.4% initiated contraception with IUD, from the age of 26 years. The health personnel constituted the major source of recommendation for contraceptive usage and, despite the fact that 37% of the sample did not use contraception prior to the last pregnancy, over half of the subjects responded that combined OC were considered as the most secure method

[Cervical cerclage]. / Cerclaje cervical.

The author studies the result of cervical cerclage carried out by him on seven multi-pregnant women (between 10-28 weeks gestation, of whom five had not borne any children) and on one woman who is pregnant for the first time (twins, at 12 weeks gestation) because of threatened abortion which usually would occur in the second trimester of the pregnancy, due to shortening and premature opening of the cervical os which leads to the protrusion of the membranes with interruption of the pregnancy. The author describes his patients' symptoms and signs, the week of pregnancy at which the operation was performed, vaginally, the urgent conditions which prompted the operation, the frequency of abortion and the condition of the child at the end of the pregnancy.

Cerclaje cervical / Cervical cerclage

The author studies the result of cervical cerclage carried out by him on seven multi-pregnant women (between 10-28 weeks gestation, of whom five had not borne any children) and on one woman who is pregnant for the first time (twins, at 12 weeks gestation) because of threatened abortion which usually would occur in the second trimester of the pregnancy, due to shortening and premature opening of the cervical os which leads to the protrusion of the membranes with interruption of the pregnancy. The author describes his patients' symptoms and signs, the week of pregnancy at which the operation was performed, vaginally, the urgent conditions which prompted the operation, the frequency of abortion and the condition of the child at the end of the pregnancy

Lipid and hormonal profile of Panamanian women during the menstrual cycle.

Forty-one women of reproductive age were included in the study, to establish the variation of serum lipids during the menstrual cycle and simultaneously, to determine the physiological fluctuation of FSH, LH, prolactin (PRL), progesterone (P4) and estradiol (E2) concentration in serum, during the menstrual cycle. A significant decrease of total serum cholesterol (165.29 +/- 3.6 mg/dl) and triglycerides (108.99 +/- 9.65) occurred during the luteal phase, as compared with the follicular phase (176.16 +/- 3.51, 108.99 +/- 9.65). Changes were not observed with HDL-cholesterol during the cycle. On the other hand, FSH showed an initial rise (mean 5 IU/l) followed by a surge (10 IU/l) and a progressive fall toward the midcycle. In contrast LH secretion showed a steady increase with a maximal concentration at surge (32.1 IU/l). PRL mean value was observed, with a discrete increase after day 13 of the menstrual cycle, that was more noticeable at the end of the cycle. Forty-eight hours after the FSH and LH midcycle surge, elevation of progesterone was observed, with maximal concentration occurring on day 24 (23 nmol/l) and later on progesterone levels fell rapidly. Thirty-six to 24 h before the surge of LH and FSH at midcycle was observed the peak serum concentration of estradiol (1300 pmol/l) followed by a progressive fall. Changes in the concentration of serum lipids during the menstrual cycle are presumably due to a direct or indirect effect of physiological fluctuation of sex hormones.

[The premenstrual tension syndrome. The role of molimina]. / Síndrome de tensión premenstrual. Papel de las moliminas.

The author reviews the premenstrual syndrome, from its aetiological and physiopathological characteristics, as well as considerations in regards to its clinical manifestation and therapeutical possibilities. The concept of "molimina" and its hormonal characteristic is defined, as well as its manifestations within the PMS.

[Recurrent abortion. Analysis of the subject and report of a personal case study]. / Aborto recurrente. Evaluación del tema e informe de casuística personal.

The author presents the clinical course of twenty-two (22) women with history of recurrent abortions seen in his private practice in the last 15 years. The study includes the details of the obstetric history, the etiologic factor and the results obtained in this group of women who shared common reproduction problems. It is shown that in our midst the predominant etiologic factor was hormonal and that it was difficult to confirm the presence of a genetic factor. The varied therapy used in those patients involved a basic aspect which was the use of hormonal therapy as an adjunct to the different medico-surgical approaches used. The results obtained are analyzed and it is shown that pregnancy was achieved in 21 patients, with varied results. In three (3) patients, recurrent abortions occurred (without a live birth) and in one, no pregnancy was achieved.

Case-control study of idiopathic retinal detachment.

A case-control study of idiopathic, rhegmatogenous retinal detachment (IRD) was conducted to investigate potential risk factors for developing IRD. These included some factors reported previously, such as cardiovascular disease, and some not under suspicion, such as cigarette smoking and iris colour. Cases (n = 198) were incident cases of IRD who were hospitalized for surgical repair of their detachments. Controls (n = 655) were patients hospitalized for conditions unrelated to suspected risk factors for IRD. The risk of IRD appeared to increase with increasing age, and the relative risk for self-reported myopes, compared with non-myopes, was elevated (RR = 3.4, 95% CI = 2.3 - 5.0). The relative risk of IRD was decreased in current smokers (RR = 0.5, 95% CI = 0.3 - 0.8); although there was not a significant trend of decreasing relative risk with increasing amount smoked, the estimate was lowest in those who smoked most heavily. Risk did not appear to be related to gender, eye colour, history of myocardial infarction, or history of hypertension.

[Hyperprolactinemia. Reproductive consequences]. / Hiperprolactinemias. Repercusiones reproductivas.

The medical history of 9 patients interested in childbearing are studied. They all had a high prolactin level, infertility, alteration in the menstrual cycle and in the majority (8/9) breast secretion. The results obtained with the usage of Parlodel (by the oral route) complemented with ovulation induction are evaluated, as well as existing local restrictions to permit fulfilling the various diagnostic procedures, oriented to define the etiology of the above mentioned clinical entity.