Estetrol review: profile and potential clinical applications.

In this review paper, the existing information on the human fetal steroid estetrol (E4) has been summarized. In the past, E4 was considered as a weak estrogen and interest disappeared. However, recent new research has demonstrated that E4 is a potent, orally bioavailable, natural human fetal selective estrogen receptor modulator, since it acts in the rat as an estrogen on all tissues investigated except breast tumor tissue, where it has estrogen antagonistic properties in the presence of estradiol. Based on its safety data, its pharmacokinetic properties, its pharmacological profile and the results of first human studies, E4 may be suitable as a potential drug for human use in applications such as hormone replacement therapy (vaginal atrophy, hot flushes), contraception and osteoporosis. Additional areas worth exploring are the treatment of breast and prostate cancer, hypoactive sexual desire disorder and topical use (wrinkles) in women, auto-immune diseases, migraine, cardiovascular applications and the treatment of selected obstetric disorders.

The AMPPA network as a successful model for public-private or private-private partnership.

In 1997, the Rockefeller Foundation and the Ernst Schering Research Foundation (a subsidiary of Schering AG, Germany, on a non-profit basis) mounted a multi-year global collaborative effort, involving a network of top-level research institutions to intensify research on the regulation of the male reproductive system with special emphasis on post-testicular activity, utilizing new approaches in molecular pharmacology (application of molecular pharmacology for post-testicular activity (AMPPA) network). The new venture proved a success as a public-private sector partnership, as a collaborative scientific program, and as an approach to identify new targets applicable and suitable for drug finding for male fertility regulation.

Contraception and society.

When an idea meets the exigencies of an epoch, it becomes stronger than any form of political power and it becomes the common property of humankind. Such an idea was the development of contraceptives. In retrospect, the invention of contraceptives was as fundamental for the evolution of humankind as the invention of the wheel; today more than 550 million couples are using contraceptive methods. The large-scale use of contraceptives triggered the most powerful social revolutions of a century in reproductive health and gender equity, and substantially contributed to an unparalleled demographic change, characterized by a rapid aging of populations. One of the important reasons for population aging is a significant decline in fertility rates, resulting in gradually changing population structures with fewer and fewer children and more and more elderly persons. The causes underlying these demographic changes are complex and manifold; they reflect major societal changes of historical dimensions. Many of our institutions cater increasingly for a population structure that no longer exists. There is therefore an increasing need for institutional reforms in social security, health care, housing and education. In addition, several surveys conducted in the developed world have indicated an erosion of confidence in our basic institutions, e.g. courts and justice, the Church and Parliament. Whereas modem sociologists are concerned about an increase in crime, decrease in trust and depleted social capital, one can also observe an accelerated perception of our global destiny and a re-awakening of the moral impulse with a strong demand for increased transparency in public affairs. Also, various global communities have assumed a growing importance. It can be predicted that international professional communities, such as the European Society of Contraception, will play an increasingly important future role in influencing policies in general and health policies in particular. because of their profound commitment to the improvement of the human condition by the judicious use of new scientific information.

The demographic revolution and our common future.

The global population reached two billion people in 1927 and six billion in 1999. If the medium variant projection of the United Nations were to materialize, the Earth's population would reach nine billion in 2054. However, such a brave new world will be inhabited by a brave old humankind; in 2050, 16.4% of the world population and 27.6% of the European population are projected to be 65 years and above, and in 14 countries, including nine European ones, more than 10% of the total population will be 80 years or older. The United Nations also project a world-wide decline in the number of children and in total fertility, and by 2050, there will be more elderly than children in several parts of the world, particularly in Europe. It seems likely that many of our classical institutions, for instance healthcare -- unless reformed -- will cater increasingly for the needs of a population structure that no longer exists. The World Health Organization projects that by the year 2020, global health trends will be dominated by the ageing of the world population, the HIV/AIDS epidemic, tobacco-related mortality and declining child mortality. Furthermore, the leading causes of disease burden will be heart disease, depression and traffic accidents. How can we meet the giant challenges of the 21st century? In the view of the author, the most rational remedy must be a quantum leap in research in general and in medical research in particular.

The past, present and future.

My generation has seen more progress in science and technology than all preceding generations together. We have also witnessed several intellectual, technological, medical and social revolutions spearheaded by the contraceptive revolution and followed by those in reproductive health, gender equity, information, communication, globalization, international assistance, etc. The results of the first contraceptive revolution were spectacular, by 1990 some 900 million couples used contraception, which became a global lifestyle. When this revolution lost momentum, a new departure took place: the Rockefeller Foundation's Contraception-21 initiative. The major achievements of this initiative are presented in this volume. All papers represent a significant contribution also to the ultimate objective: the achievement of human dignity for every woman. The revolutions mentioned above profoundly changed the world and our perception of it. They will also assist humankind in deconstructing the deterministic worldview of past centuries and replacing it with a science-driven anthropocentric philosophy.

From the contraceptive to the anthropocentric revolution (Gregory Pincus in memoriam).

The author has seen more progress in science and technology than all scientists of all preceding periods together since the dawn of history and has witnessed a number of powerful revolutions (e.g. scientific, information, postindustrial, globalization, environmental, contraceptive, reproductive health, gender equity and demographic) that have profoundly changed the world and our perception of it. The contraceptive revolution started off this irreversible process with spectacular results. By 1990, contraception had become a global lifestyle for more than 900 million couples. It also resulted in subsequent revolutions in reproductive health and gender equity in a new world with a dramatically changed population structure with fewer and fewer children and more and more elderly. These revolutions will assist humankind in the 21st century in deconstructing the deterministic world view of past centuries and replacing it with a science-driven anthropocentric world view.

Women and the third and fourth age.

In 1900, the world population was less than 1.7 billion people; the United Nations projects that in 2000 it will be 6.2, and in 2020, 7.9 billion. The proportion of the elderly (65 years and over), will increase from 5.1% (1950) to 6.8% by the year 2000 and to 8.8% by 2020, when out of an elderly population of 796 million people, 124 million are projected to be 80 years and over. Due to an increasing gender inequality in life expectation, the majority of the elderly will be women. An aged population is a basically new feature in the history of humanity, the implications of which are-as yet-incompletely understood. It is clear, however, that the last years of life are accompanied by an increase in disability and sickness, with very high demands for health and social services. Hence, the soaring elderly population will raise major social, economic and ethical issues worldwide and may strain to the limit the ability of health, social and economic infrastructures of many countries. It may also result in an increasingly large proportion of humanity (the elderly in general and elderly women, in particular) living in absolute poverty. The demographic, health, socioeconomic and ethical dimensions of the problem are discussed with particular emphasis on the situation of elderly women and a plea is made for greatly increased medical and socioeconomic research.

In search of human dignity: gender equity, reproductive health and healthy aging.

This paper analyzes the nine pillars of human dignity (sufficient food, potable water, shelter, sanitation, health services, healthy environment, education, employment and personal security), which humankind tries to establish by following nine approaches to reality (scientific, cultural, religious, ethical, economical, ecological, socio-critical, philosophical and political) in a world drastically changed by nine revolutions (demographic, scientific, technological, communication, global identity, environmental, contraceptive, reproductive health and gender equity). The author's generation participated in these revolutions and contributed to the global intellectual process by which gender equity and reproductive health assumed a central role in world affairs. A rapidly aging world population constitutes another major challenge. Its likely impact on the very fundaments of our future social, economical, health and even political infrastructures is--as yet--incompletely comprehended by the international community. The International Federation of Gynecology and Obstetrics (FIGO) has and will continue to have an indispensable role in assisting humankind to reach its ultimate goal : human dignity.

The third age, the Third World and the third millennium.

PIP: In the year 2000, world population will exceed 6200 million and life expectancy will be over 68 years. The UN population projections for the coming 20 years after 1996 range from a low of 7100 million to a high of 7800 million. Between 1950 and 1992, in developing countries, life expectancy at birth increased by 29 years in China, by 24 years in India and Indonesia, by 21 years in Bangladesh, and by 16 years in Brazil. The gender difference in life expectancy is only 1 year in India, but 6 years in a number of developed countries. Corresponding increases in Australia were from 12.2 to 14.7 years for men and from 14.9 to 18.8 years for women. By the year 2025, the UN projects that the elderly (65 years and older) will constitute 10% of the population in Asia and more than 20% in North America and Europe, whereas 1.8% of the population of Asia, 4.6% of North America, and 6.4% of Europe will be very old (80 years and older). By the year 2030, there may be 1200 million postmenopausal women around the world, 76% of them in the developing countries. During the period 1990-2025 the elderly population of Sweden will increase by 33%, whereas that of Indonesia will increase by 414%. Between 2000 and 2100, the global population aged 15 years or younger will gradually decrease from 31.4% to 18.3%, while the population aged 65 and over will increase from 6.8% to 21.6%. The persistence of poverty in developing countries combined with aging poses a formidable challenge because the majority of old people receive little special support. The epidemiological dimension of aging embraces mortality and morbidity. Each year 39 million people die in the developing world mainly from infectious and parasitic diseases, noncommunicable and communicable diseases, and injuries. In the developed countries 11 million die primarily from cardiovascular diseases and malignant neoplasms. In the developing countries noncommunicable diseases represent 87% of the disease burden resulting in increased isolation of the elderly. The ethical dilemma facing health care is poverty among the elderly.^ieng

Reproductive health: a rendezvous with human dignity.

PIP: In the field of reproductive health and population policy, seven levels of reality--scientific, economic, ecologic, religious, ethical, cultural, and political--converge. In the 1950s, family planning programs were informed by a demographic rationale; at present, a shift is taking place toward an emphasis on human rights and quality-of-life issues. Current discussions of reproductive health recognize the diversity of the special health needs of women before, during, and after the childbearing years. Also emerging is a more holistic approach to the 12 components of reproductive health: women's status, family planning, safe motherhood, abortion, reproductive tract infections and acquired immunodeficiency syndrome, infertility, nutrition, infant and child health, adolescent health and sexuality, harmful sexual practices, and environmental and occupational effects on reproductive health. Despite this awareness, defense spending continues to receive a higher priority from governments and international agencies than health. Essential are more gatherings such as the 1994 International Conference on Population and Development that seek to change the perceptions of international leaders through a process based on reason and intellectual interaction.^ieng

Research on human reproduction and the United Nations.

The Special Programme of Research, Development and Research Training in Human Reproduction was established in 1972 by the World Health Organisation to promote, co-ordinate, support, conduct and evaluate research on human reproduction with particular reference to the needs of developing countries. Today, the Programme is the main instrument of reproductive health research in the United Nations System. In addition to advising member state governments, the Programme supports research and development activities in the areas of technology assessment, development, introduction and transfer, epidemiological and social science research on reproductive health and essential national health research. Another important area of activity consists of strengthening the research capability of developing countries to enable them to address reproductive health problems of national relevance.

[Reproductive health at the threshold of the third millennium]. / Reprodukciós egészség a harmadik évezred küszöbén.

Attention is called to the extent and consequences of uncontrolled population growth. The concept of reproductive health is defined and the most important pillars are presented. These are the status of women, family planning, antenatal care, decreasing maternal mortality, termination of pregnancy, sexually transmitted diseases (AIDS), infertility, malignancies of the reproductive tract, nutrition, care of the newborn and children, adolescent sex, dangerous sexual practices, way of life and environment. The contradiction of increasing health costs and increasing poverty is exposed.