Articles: health.
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A prospective study of genital infection was conducted in four inner-city family-planning clinics. Fifteen per cent of routine attenders had symptoms and signs of vaginal infection and many more women attended primarily because of symptoms. Among the women with both signs and symptoms, 70% had positive laboratory findings, Trichomonas vaginalis, Candida albicans and bacterial vaginosis being equally prevalent. ⋯ Neisseria gonorrhoeae was isolated from 4% of women with, and 1% of those without, symptoms. We believe that it is worthwhile to investigate patients presenting to family-planning clinics with vaginal symptoms. No single specimen was found ideal for all pathogens, a cervical swab is better for gonococci and also for T. vaginalis but a vaginal swab is needed for candida and bacterial vaginosis.
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Am. J. Obstet. Gynecol. · Feb 1990
Clinical guides to preventing ethical conflicts between pregnant women and their physicians.
We provide a justification for preventive ethics in obstetric practice. Four clinical guides to resolving ethical conflicts between pregnant women and their physicians can be identified: (1) informed consent as an ongoing dialogue between the pregnant woman and her physician, (2) negotiation as a clinical strategy, (3) respectful persuasion as a clinical strategy, and (4) the proper use of ethics committees.
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Comparative Study
Do the benefits of breastfeeding outweigh the risk of postnatal transmission of HIV via breastmilk?
Conflicting recommendations have been offered about whether HIV+ mothers should breastfeed. Since there is a strong precedent for US infant feeding practices to be imitated in developing countries, a model was constructed to estimate infant mortality if the CDC admonition for HIV+ mothers not to breastfeed were upheld in less developed settings. ⋯ The infant mortality associated with HIV infection acquired through breastfeeding is estimated to be lower than the mortality associated with the diseases of infancy that would result if breastmilk were withheld. The difference in these estimates is greater in areas with high baseline levels of infant mortality.
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The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost?
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A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. ⋯ An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.