Adverse Reproductive Health Effects Research Articles

Association Between Secondhand Smoke Exposure Among Women and the Implementation of Tobacco Control Measures on Campus: A Cross-Sectional Study in 50 Universities Across China.

Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China. 7469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policies reported the implementation of smoke-free policies on campus measured by: (1) no evidence of smoking and (2) the display of smoke-free signs in public places. Multivariate logistic regression models were applied using weighted survey data. SHS exposure among participants was 50.5% (95% CI = 44.2% to 56.9%). The adoption of a smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI = .71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI = .47 to 0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI = 1.42, 3.82; OR: 1.52; 95% CI = 1.15, 2.02, respectively). Exposure to SHS is prevalent among female college students in China. Successful implementation of a smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China. Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.

Effects of environmental health literacy-based interventions on indoor air quality and urinary concentrations of polycyclic aromatic hydrocarbons, volatile organic compounds, and cotinine: A randomized controlled trial

Indoor air pollution (IAP) caused by particulate matter (PM), aromatic and volatile chemicals is one of the leading causes of adverse reproductive health effects, such as infertility, decreased gestational age, and low birth weight. It is well documented that environmental health literacy (EHL) can promote reductions in IAP and the level of environmental pollutants in the body. We conducted randomized control trial to evaluate the effect of EHL-based intervention on the indoor air quality and urinary levels of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and cotinine in reproductive aged women in Korea. The concentration of indoor PM2.5, PM10, CO2, and total VOCs (measured with a personal air quality monitoring device) as well as the urinary concentrations of PAHs, VOCs, and cotinine were measured in an experimental (n = 32) and control group (n = 31). The geometric mean concentrations of 2-NAP, tt-MA, and cotinine were 4.74, 82.82, and 0.60 μg/L respectively. The EHL intervention resulted in significant differences between experimental and control groups in the level of tt-MA (z = −1.44, p = .031), cotinine (z = −1.07, p = .015) in urine and PM2.5 (z = 56.39, p < .01), PM10 (z = 57.85, p < .01), CO2 (z = 8.92, p < .01), and total VOCs (z = 10.11, p < .01) of indoor air, and the mean score of EHL (z = 6.30, p < .01). Our results show the value in developing EHL interventions to reduce exposure to air pollutants originating from indoor activity and daily-life materials. Further studies are required to find ways to optimize general EHL for use in populations around the world.

Effect of indomethacin on embryo implantation and histomorphology of uterus, ovary, kidney, and liver of rats

BackgroundThis study aimed to determine the effects of Indomethacin (IMC) treatment on embryo implantation and histomorphology of uterus, ovary, and other vital organs and its effective dosage in establishing embryo implantation dysfunction model in Sprague-Dawley (SD) rats. Materials and MethodsThe experiments were performed on 24 (6 × 4 groups) adult female SD rats aged 12 weeks old. G1 was the control group and received a normal diet with normal saline. However, on pregnancy days 3 (Pd3) and 4 (Pd4), G2, G3, and G4 were given normal saline and subcutaneously administered IMC twice daily at different doses of 4.33, 4.66 and 5.00 mg/kg body weight, respectively. The rats were euthanized on day 8 of pregnancy (Pd8). The uterus was excised and examined for signs of pregnancy, followed by tissue samples from liver, kidney, and ovary (for histomorphological examination using haematoxylin and eosin stain). ResultsAll IMC treatment doses disrupted the implantation process and caused a significant reduction in embryo development. Analysis for histopathological changes revealed that IMC doses above 4.33 mg/kg body weight caused more adverse reproductive health effects in rats. Vasoconstriction and micro vascularization were detected in the liver, while degenerative Bowman's capsules and inflammatory cells were observed in kidney sections from IMC-treated rats. ConclusionIMC therapy interfered with implantation and embryo development in rats, resulting in significant uterine vasoconstriction and atrophy, 4.33 mg/kg bwt dose appeared to be optimum to establish embryo implantation dysfunction in SD rats.

Optimized extraction and analysis methods using liquid chromatography-tandem mass spectrometry for zearalenone and metabolites in human placental tissue

Zearalenone and its metabolites, a group of endocrine disrupting mycotoxins, have been linked to adverse reproductive health effects. They cross the placental barrier, potentially reaching the fetus. In this study, we adapted and optimized our protocol previously used for urine, to measure these mycotoxins in human placentas. We combined a supported liquid extraction step using Chem Elut cartridges with solid phase extraction on Discovery® DSC-NH2 tubes. The optimized extraction efficiencies were between 68 and 80% for all metabolites. Analysis was performed by UHPLC-HRMS using a Betasil™ Phenyl-Hexyl column eluted with a gradient of acetonitrile-methanol-water. The chromatography method separated all analytes in under 15 min. Validation experiments confirmed the method's sensitivity, with LODs ranging from 0.0055 to 0.011 pg/mg tissue. The method was linear over a range of 0.0025–1.5 pg/mg tissue with R2 values ≥ 0.994. Precision and accuracy calculations ranged from 4.7–7.9% and 0.6–6.7% respectively. The method was then successfully applied to a subset of placenta samples (n = 25) collected from an ongoing prospective birth cohort. Interestingly, 92% of the samples contained at least one measurable zearalenone metabolite, providing initial indication of potentially widespread exposure during pregnancy.

Bisphenol S Increases Cell Number and Stimulates Migration of Endometrial Epithelial Cells.

To determine whether bisphenol S (BPS), a common substitute for bisphenol A (BPA), induces cell proliferation and migration in human endometrial epithelial cells (Ishikawa) and adult mouse uterine tissues. Human endometrial Ishikawa cells were exposed to low doses of BPS (1 nM and 100 nM) for 72 hours. Cell proliferation was assessed through the viability assays MTT and CellTiter-Glo®. Wound healing assays were also used to evaluate the migration potential of the cell line. The expression of genes related to proliferation and migration was also determined. Similarly, adult mice were exposed to BPS at a dose of 30 mg/kg body weight/day for 21 days, after which, the uterus was sent for histopathologic assessment. BPS increased cell number and stimulated migration in Ishikawa cells, in association with the upregulation of estrogen receptor beta (ESR2) and vimentin (VIM). In addition, mice exposed to BPS showed a significantly higher mean number of endometrial glands within the endometrium. Overall, in vitro and in vivo results obtained in this study showed that BPS could significantly promote endometrial epithelial cell proliferation and migration, a phenotype also observed with BPA exposure. Hence, the use of BPS in BPA-free products must be reassessed, as it may pose adverse reproductive health effects to humans.

Exposure to Polycyclic Aromatic Hydrocarbons and adverse reproductive outcomes in women: current status and future perspectives.

Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous, toxic environmental chemicals that can cause adverse reproductive health effects. The objectives of this mini-review are to highlight the adverse reproductive outcomes due to PAH exposure with the main focus on polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) and to provide perspectives on future research needs. We reviewed studies that have reported the adverse reproductive outcomes associated with PAHs exposures in women through a comprehensive search of bibliographic databases and gray literature sources. In addition, potentially modifiable sources of exposure to PAHs and associated reproductive outcomes were also investigated. A total of 232 papers were retrieved through a comprehensive search of bibliographic databases, out of which three studies met the eligibility criteria and were included in the review. Results showed that exposure to PAHs is associated with adverse reproductive outcomes defined as PCOS, POF, and reproductive hormone imbalance. Sources of PAH exposure associated with adverse reproductive outcomes include active and passive tobacco smoking, specific cooking methods, and pesticides. Future studies are warranted to examine the mechanisms by which PAHs result in adverse reproductive endpoints in women. Further, environmental exposures that are potentially modifiable such as exposure to tobacco smoke, may contribute to PAH exposure, and these exposures should be targeted in future policies and interventions.

Magnitude and determinants of intimate partner violence against women in East Africa: multilevel analysis of recent demographic and health survey

BackgroundViolence against women is a significant public health problem, and human rights abuse, and is associated with multiple adverse physical, mental, sexual, and reproductive health effects. The current study aimed to determine the magnitude of intimate partner violence (IPV) and its determinant factors in East African countries.MethodsWe utilized the most recent demographic and health survey data from 11 East African countries, which was comprised of a weighted sample of 55,501 ever-married women. A multilevel multivariable logistic regression analysis was applied. We used an adjusted odds ratio with a 95% CI and a p value ≤ 0.05 in the multilevel logistic model to declare significant factors associated with IPV.ResultsThe overall prevalence of all forms of IPV in East African countries was 32.66% [95% CI 32.27, 33.05], with the highest IPV occurring in Uganda (14.93%) and the lowest IPV recorded in Comoros (0.87%). In the multivariable multilevel logistic regression model, women’s education, residence, sex of household head, current pregnancy, husband drinking alcohol, attitude towards wife-beating husband controlling behavior, and women’s decision-making autonomy were significantly associated with IPV.ConclusionThe risk factors noted above increase the likelihood of a woman experiencing IPV. Therefore, we recommend establishing effective health and legal response services for IPV, raising awareness of the existing legislation service and improving its application, strengthening legislations on purchasing and selling of alcohol, strengthening joint (both husband and wife) decision-making power by empowering women, improving the educational level of women, and establishing measures to break the culture of societal tolerance towards IPV.

Heavy Load Carrying and Symptoms of Pelvic Organ Prolapse among Women in Tanzania and Nepal: An Exploratory Study.

Heavy load carrying of water, firewood, and sand/stones is a ubiquitous activity for women living in developing countries. Although the intra-abdominal pressure associated with heavy load carrying is hypothesized to increase the risk of pelvic organ prolapse (POP) among women, relevant epidemiologic data are lacking. We conducted a comparative study involving two exploratory cross-sectional studies among convenience samples of women carrying heavy loads, with different characteristics: (1) as part of their activities for daily living, in Shinyanga region, Tanzania; and (2) working as sand miners in Pokhara, Nepal. Women were categorized has having “low” or “high” load-carrying exposures based on the measured weights of the loads being carried at the time of the survey, as well as on self-reported duration and frequency of load carrying. A summary score for lower abdominal discomfort suggestive of POP was generated using questions from the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Women with higher load carrying exposures had on average higher discomfort scores in both Tanzania (adjusted prevalence difference (PDa) = 3.7; 95% CI: −3.8–11.3; p = 0.33) and Nepal (PDa = 9.3; 95% CI: −4.9–23.6; p = 0.18). We identified trends suggestive of an association between increasing heavy load carrying exposures and symptoms of lower abdominal discomfort. Our findings underscore the need for larger epidemiologic studies of the potential adverse reproductive health effects of heavy load carrying activities on women in developing countries.

Street Vendors in Kampala, Uganda: Traffic-related Air Pollution Exposure and Adverse Health Experiences.

BACKGROUND: Health effects due to street vending have limited epidemiological research. Street vending is a dominant occupation in developing cities and individuals engaged in this venture are exposed to high levels of traffic related air pollution (TRAP) per mode of operation. OBJECTIVE: To establish the TRAP exposure experiences of street vendors in Kampala and associated adverse respiratory, cardiovascular, reproductive and musculoskeletal health effects. METHODS: A cross-sectional study was conducted among 418 street vendors operating in commercial areas of Kampala. Exposure to TRAP was categorized as low, moderate and high on the basis of street vending activity levels and self-reported traffic density in vending areas. Low-cost air sensors were used to monitor air quality in the vending areas over a three-day period with levels of PM2.5 found to exceed the WHO recommended levels. RESULTS: Street vendors that reported high traffic density in vending areas had 2.68(95%CI: 1.47, 4.88), 2.91(95%CI: 1.18, 7.14) and 1.79(95%CI: 1.03, 3.11) increased odds of cough and catarrh, compared to their counterparts who reported low traffic density in vending areas. Moderate vending activity levels were associated with 2.25(95%CI: 1.00, 5.05) increased odds of sharp chest pains compared to low vending activity levels. Street vendors who reported moderate and high traffic density in vending areas had 3.00(95%CI: 1.23, 7.36) and 4.24(95%CI: 1.73, 10.38) increased odds of difficulty in walking. Moderate TRAP exposure was associated with 1.76(95%CI: 1.11, 2.79), 1.02(95%CI: 1.02, 2.70) and 2.17(95%CI: 1.09, 4.31) increased odds of catarrh, sneezing and difficulty in kneeling respectively. CONCLUSION: street vending and air pollution exposure was found to be associated with various adverse health outcomes in this population. Genome-wide association studies exploring the biological mechanisms of respiratory and cardiovascular injury from exposure to air pollution among street vendors is recommended to help better tailor treatment and preventive strategies.

Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa.

IntroductionSome observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman’s risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk.MethodsA mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in South Africa to estimate how changes in method mix could impact HIV‐ and reproductive health‐related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use.ResultsIn South Africa, the HIV‐related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infection of 1.1 or greater. A reduction in DMPA use among HIV‐positive women would have no benefit in terms of HIV infections, but would incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health outcomes is the proportion of women who switch away from DMPA to no contraceptive method.ConclusionsIf there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.

Per- and poly-fluoroalkyl substances (PFASs) in follicular fluid from women experiencing infertility in Australia

Per- and poly-fluoroalkyl substances (PFASs) have been widely used and detected in human matrices. Evidence that PFAS exposure may be associated with adverse human reproductive health effects exists, however, data is limited. The use of a human matrix such as follicular fluid to determine chemical exposure, along with reproductive data will be used to investigate if there is a relationship between PFAS exposure and human fertility. ObjectiveThis study aims to: (1) assess if associations exist between PFAS concentrations and/or age and fertilisation rate (as determined in follicular fluid of women in Australia who received assisted reproductive treatment (ART)); and (2) assess if associations exist between PFAS concentrations and infertility aetiology. MethodsFollicular fluids were originally collected from participants who underwent fully stimulated ART treatment cycles at an in vitro fertilisation (IVF) clinic in the period 2006–2009 and 2010–11 in Queensland, Australia. The samples were available for analysis of 32 PFASs including perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoic acid (PFNA) using high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). 97 samples were matched with limited demographic data (age and fertilisation rate) and five infertility factors (three known female factors): 1) endometriosis, 2) polycystic ovarian syndrome (PCOS), and 3) genital tract infections - tubal/pelvic inflammation disease; as well as 4) male factor, and 5) idiopathic or unknown from either males or females. SPSS was used for linear regression analysis. ResultsPFASs were detected in all follicular fluid samples with the mean concentrations of PFOS and PFOA, 4.9, and 2.4 ng/ml, respectively. A lower fertilisation rate was observed at higher age when age was added as a covariate, but there was no relationship between PFAS concentrations and fertilisation rate. There were few statistically significant associations between PFAS concentrations in follicular fluid and infertility factors. Log-transformed PFHxS concentrations were lower in females with endometriosis (factor 1) than in women who had reported ‘male factors’ as a reason of infertility, while PFHpA was higher in women who had infertile due to female factors (factor 1–3) compared to those who had infertile due to male factor. ConclusionPFASs were detected in follicular fluid of Australian women who had been treated at an IVF clinic. PFAS exposure found in follicular fluids is linked to increased risk of some infertility factors, and increased age was associated with decreased fertilisation rate in our data. But there was no relationship between PFAS and ferlitisation rate. Further large-scale investigations of PFAS and health effects including infertility are warranted.

Prediction of adverse male reproductive health effects by integrating in vitro data and physiologically-based kinetic modelling

Prediction of adverse male reproductive health effects by integrating in vitro data and physiologically-based kinetic modelling

ACOG Committee Opinion No. 747 Summary: Gynecologic Issues in Children and Adolescent Cancer Patients and Survivors.

The diagnosis of cancer in females younger than 20 years is rare, with the incidence of 17 cases per 100,000 individuals per year in the United States. Although advancements in cancer therapy have dramatically improved childhood cancer survival, gynecologists should be aware of the increased risk of adverse reproductive health effects from each type of therapy. Cancer and its treatment may have immediate or delayed adverse effects on reproductive health. Gynecologists may be consulted for the following issues: pubertal concerns; menstrual irregularities; heavy menstrual bleeding and anemia; sexuality; contraception; ovarian function, including fertility preservation; breast and cervical cancer screening; hormone therapy; and graft-versus-host disease. Approximately 75% of pediatric cancer survivors experience at least one late effect on their health or quality of life. Vigilance in screening and observation on behalf of the health care provider with respect to menstrual irregularities, weight changes, sexual health, growth abnormalities, and bone density are important. In addition to pretreatment fertility conservation counseling, sexually active young women should be thoroughly educated about the risks of becoming pregnant during cancer treatment and strongly encouraged to use effective contraception; contraceptive choices should be discussed with the oncology team. A multidisciplinary approach to cancer survival care is encouraged. This Committee Opinion has been updated to include current data on sexuality and contraception, sexual dysfunction, risk of graft-versus-host disease after stem cell transplant, and updated references and recommendations for fertility preservation.

ACOG Committee Opinion No. 747: Gynecologic Issues in Children and Adolescent Cancer Patients and Survivors.

The diagnosis of cancer in females younger than 20 years is rare, with the incidence of 17 cases per 100,000 individuals per year in the United States. Although advancements in cancer therapy have dramatically improved childhood cancer survival, gynecologists should be aware of the increased risk of adverse reproductive health effects from each type of therapy. Cancer and its treatment may have immediate or delayed adverse effects on reproductive health. Gynecologists may be consulted for the following issues: pubertal concerns; menstrual irregularities; heavy menstrual bleeding and anemia; sexuality; contraception; ovarian function, including fertility preservation; breast and cervical cancer screening; hormone therapy; and graft-versus-host disease. Approximately 75% of pediatric cancer survivors experience at least one late effect on their health or quality of life. Vigilance in screening and observation on behalf of the health care provider with respect to menstrual irregularities, weight changes, sexual health, growth abnormalities, and bone density are important. In addition to pretreatment fertility conservation counseling, sexually active young women should be thoroughly educated about the risks of becoming pregnant during cancer treatment and strongly encouraged to use effective contraception; contraceptive choices should be discussed with the oncology team. A multidisciplinary approach to cancer survival care is encouraged. This Committee Opinion has been updated to include current data on sexuality and contraception, sexual dysfunction, risk of graft-versus-host disease after stem cell transplant, and updated references and recommendations for fertility preservation.

Iron oxide nanoparticles modulate heat shock proteins and organ specific markers expression in mice male accessory organs

With increased industrial utilization of iron oxide nanoparticles (Fe2O3-NPs), concerns on adverse reproductive health effects following exposure have been immensely raised. In the present study, the effects of Fe2O3-NPs exposure in the seminal vesicle and prostate gland were studied in mice. Mice were exposed to two different doses (25 and 50 mg/kg) of Fe2O3-NPs along with the control and analyzed the expressions of heat shock proteins (HSP60, HSP70 and HSP90) and organ specific markers (Caltrin, PSP94, and SSLP1). Fe2O3-NPs decreased food consumption, water intake, and organo-somatic index in mice with elevated iron levels in serum, urine, fecal matter, seminal vesicle and prostate gland. FTIR spectra revealed alterations in the functional groups of biomolecules on Fe2O3-NPs treatment. These changes are accompanied by increased lactate dehydrogenase levels with decreased total protein and fructose levels. The investigation of oxidative stress biomarkers demonstrated a significant increase in reactive oxygen species, nitric oxide, lipid peroxidation, protein carbonyl content and glutathione peroxidase with a concomitant decrement in the glutathione and ascorbic acid in the male accessory organs which confirmed the induction of oxidative stress. An increase in NADPH-oxidase-4 with a decrease in glutathione-S-transferase was observed in the seminal vesicle and prostate gland of the treated groups. An alteration in HSP60, HSP70, HSP90, Caltrin, PSP94, and SSLP1 expression was also observed. Moreover, accumulation of Fe2O3-NPs brought pathological changes in the seminal vesicle and prostate gland of treated mice. These findings provide evidence that Fe2O3-NPs could be an environmental risk factor for reproductive disease.

Environmental Origins of Methylmercury Accumulated in Subarctic Estuarine Fish Indicated by Mercury Stable Isotopes.

Methylmercury (MeHg) exposure can cause adverse reproductive and neurodevelopmental health effects. Estuarine fish may be exposed to MeHg produced in rivers and their watersheds, benthic sediment, and the marine water column, but the relative importance of each source is poorly understood. We measured stable isotopes of mercury (δ202Hg, Δ199Hg, and Δ201Hg), carbon (δ13C), and nitrogen (δ15N) in fish with contrasting habitats from a large subarctic coastal ecosystem to better understand MeHg exposure sources. We identify two distinct food chains exposed to predominantly freshwater and marine MeHg sources but do not find evidence for a benthic marine MeHg signature. This is consistent with our previous research showing benthic sediment is a net sink for MeHg in the estuary. Marine fish display lower and less variable Δ199Hg values (0.78‰ to 1.77‰) than freshwater fish (0.72‰ to 3.14‰) and higher δ202Hg values (marine: 0.1‰ to 0.57‰; freshwater: -0.76‰ to 0.15‰). We observe a shift in the Hg isotopic composition of juvenile and adult rainbow smelt (Osmerus mordax) when they transition between the freshwater and marine environment as their dominant foraging territory. The Hg isotopic composition of Atlantic salmon (Salmo salar) indicates they receive most of their MeHg from the marine environment despite a similar or longer duration spent in freshwater regions. We conclude that stable Hg isotopes effectively track fish MeHg exposure sources across different ontogenic stages.

Apply the Precautionary Principle Concerning Combined Hormonal Contraception Use in Adolescents

Here I respond to Akers, Dhar, and Shah's (2016), Stubbs's (2016), Olshansky's (2016), and Kissling's (2016) commentaries on the article (Prior, 2016) in which I expressed concerns about the potential adverse long-term reproductive and bone health effects on normal adolescents’ maturation related to use of combined hormonal contraceptives (CHC) for contraception and/or treatment. Although Akers et al. (2016) take exception, the precautionary principle on which medical/pharmaceutical ethics is based challenges us to show that CHC is officially indicated and effective in randomized, double-blind, placebo-controlled trials with adolescents. Those who support current practices are obligated to provide young patients and their parents with evidence from large, population-based, prospective studies (or meta-analyses of longitudinal data) that adolescents who have used CHC develop the same menstrual cycle/ovulatory function, fertility, and reproductive lifespan and similar bone density and strength as peers who did not use CHC. Without this information there can be neither reproductive justice (Kissing, 2016), nor true choice. Why is this minimal, expected scientific data not available? It is likely that authors of practice guidelines for adolescent CHC contraceptive use and who advocate its “non-contraceptive benefits” have pro-estrogen cultural biases or conflicts of interests due to pharmaceutical industry connections. I agree with Olshansky (2016) that we should listen to adolescents’ concerns and use evidence-based and safe treatments for milder heavy bleeding and cramps. For heterosexual adolescents seeking contraception, we can suggest and explain the use of safer, yet effective, nonhormonal strategies, such as the copper IUD or a barrier plus full-dose vaginal spermicide.

Soy Intake Modifies the Relation Between Urinary Bisphenol A Concentrations and Pregnancy Outcomes Among Women Undergoing Assisted Reproduction

Experimental data in rodents suggest that the adverse reproductive health effects of bisphenol A (BPA) can be modified by intake of soy phytoestrogens. Whether the same is true in humans is not known. The purpose of this study was to evaluate whether soy consumption modifies the relation between urinary BPA levels and infertility treatment outcomes among women undergoing assisted reproduction. The study was conducted in a fertility center in a teaching hospital. We evaluated 239 women enrolled between 2007 and 2012 in the Environment and Reproductive Health (EARTH) Study, a prospective cohort study, who underwent 347 in vitro fertilization (IVF) cycles. Participants completed a baseline questionnaire and provided up to 2 urine samples in each treatment cycle before oocyte retrieval. IVF outcomes were abstracted from electronic medical records. We used generalized linear mixed models with interaction terms to evaluate whether the association between urinary BPA concentrations and IVF outcomes was modified by soy intake. Live birth rates per initiated treatment cycle were measured. Soy food consumption modified the association of urinary BPA concentration with live birth rates (P for interaction = .01). Among women who did not consume soy foods, the adjusted live birth rates per initiated cycle in increasing quartiles of cycle-specific urinary BPA concentrations were 54%, 35%, 31%, and 17% (P for trend = .03). The corresponding live birth rates among women reporting pretreatment consumption of soy foods were 38%, 42%, 47%, and 49% (P for trend = 0.35). A similar pattern was found for implantation (P for interaction = .02) and clinical pregnancy rates (P for interaction = .03) per initiated cycle, where urinary BPA was inversely related to these outcomes among women not consuming soy foods but unrelated to them among soy consumers. Soy food intake may protect against the adverse reproductive effects of BPA. As these findings represent the first report suggesting a potential interaction between soy and BPA in humans, they should be further evaluated in other populations.

Preparedness of frontline health workers for tobacco cessation: An exploratory study from two states of India.

Background:The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation.Materials and Methods:The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software.Results:Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat.Conclusions:A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation.

Systematic literature review of adverse reproductive outcomes associated with physiotherapists' occupational exposures to non-ionising radiation.

To review empirical research on adverse health and pregnancy outcomes associated with physiotherapists' occupational exposure to radiofrequency electromagnetic fields (RF EMFs) from shortwave (SWD) and microwave (MWD) diathermy devices. A systematic review of peer reviewed literature published from 1990 to 2010 in the English language searched in eight online bibliographic databases: CINAHL, EBSCOhost, ISI Web of Knowledge, Medline, OSH UPDATE, PubMed Central, ScienceDirect, and Scopus. Findings suggest that physiotherapists' occupational exposure to SWD was statistically significantly associated with delayed time to pregnancy (>6 months), still birth, altered gender ratio (low ratio of boys to girls), congenital malformations and low birth weight (<2,500 g) among physiotherapists' offspring. Physiotherapists' exposure to MWD was also found to be statistically significantly associated with spontaneous abortion. However, causal mechanisms for these statistical associations are unknown. The present systematic review has found these adverse reproductive outcomes and health effects associations with RF EMFs from therapeutic diathermy devices to be inconsistent. A number of studies did not find statistically significant results to replicate associations with such adverse outcomes, and therefore further research, preferably prospective studies of cohorts of physiotherapists, is warranted.