Articles: disease.
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Randomized Controlled Trial Meta Analysis Comparative Study Clinical Trial
Another look at the Dalkon Shield: meta-analysis underscores its problems.
Numerous non-comparative clinical trials of the Dalkon Shield appear to provide ample evidence that the Dalkon Shield was an effective IUD; they seem to yield little evidence that it was a dangerous device, nor markedly different from its contemporaries. Equating the performance of the Dalkon Shield IUD to that of the Lippes Loop or of Copper IUDs is erroneous, however, with respect to rates of pregnancy, expulsion, pelvic infection, septic abortion, death with the device in situ, and tubal infertility. Randomized studies show the Dalkon Shield had approximately double the pregnancy rates of the Lippes Loop D or Copper IUDs (P < .05) and a significantly lower expulsion rate. ⋯ A five-fold increased risk of hospitalized pelvic infection among Dalkon Shield users found in the Women's Health Study resulted not from ascertainment bias, but was related to the fact that Dalkon Shield users had more severe hospitalized PID than did other hospitalized women with PID and IUD use. Following cessation of distribution and of use of the Dalkon Shield, and following the FDA's recommendation to remove IUDs in case of pregnancy, there have been no deaths reported among pregnant American women with an IUD in situ in a 15-year period. Neither the IUDs of today nor those in use during 1970-1974 are equitable to the Dalkon Shield [corrected].
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Multicenter Study Comparative Study
Asphyxia of the newborn in east, central and southern Africa.
Very scanty information is available in East, Central and Southern Africa on the incidence and risk factors associated with asphyxia of the newborn. A multicentre prospective study involving 4267 deliveries in eight countries was undertaken over a three month period, in maternity units of the central hospitals to determine the incidence; maternal, service and logistic risk factors for asphyxia of the newborn as determined by an abnormally low apgar score. 30% of births were by primigravida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight. ⋯ These should include identification of the at risk mother, proper referral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies for perinatal and neonatal care through research undertaken in the region. It is also concluded that the co-operation and joint effort between the obstetricians, paediatricians and the nursing staff who all contributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interventions.
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To examine the impact of HIV on infectiousness of pulmonary tuberculosis (TB). ⋯ HIV-positive patients with pulmonary TB may be less infectious than their HIV-negative counterparts and this may partly be explained by lower bacillary load in the sputum.
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A cluster survey on neonatal tetanus (NNT) mortality was conducted in Kano Metropolis, Northern Nigeria, to investigate epidemiological factors associated with NNT mortality. The survey was a two-stage cluster sampling technique and lasted for two weeks. A total of 2,623 live-births were recorded over a 12-month period. ⋯ Of the epidemiological factors investigated, only antenatal care, tetanus toxoid coverage, hospital delivery, poor cord management and traditional surgery showed significant association with NNT death. It is suggested that an appropriate community-specific prevention strategy for the region should include health education to improve utilisation of antenatal and hospital-delivery facilities, discourage traditional surgery and improve tetanus toxoid coverage. A case is also made for training and involvement of traditional birth attendants (TBAs) since most deliveries occurred outside hospitals and related facilities.
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In Latin America, induced abortion is the fourth most commonly used method of fertility regulation. Estimates of the number of induced abortions performed each year in Latin America range from 2.7 to 7.4 million, or from 10 to 27 percent of all abortions performed in the developing world. Because of restrictive laws, nearly all of these abortions, except for those performed in Barbados, Belize, and Cuba, are clandestine and unsafe, and their sequelae are the principal cause of death among women of reproductive age. ⋯ This article addresses how the epidemic of unsafe abortion might be challenged. Recommendations include providing safer outpatient treatment and strengthening family planning programs to improve women's contraceptive use and their access to information and to safe pregnancy termination procedures. In addition, existing laws and policies governing legal abortion can be applied to their fullest extent, indications for legal abortion can be more broadly interpreted, and legal constraints on abortion practices can be officially relaxed.