Assessment Of Reproductive Health Research Articles

Reproductive health and endocrine disruption in breast cancer care

OBJECTIVE: Yearly in the United States, about 692,000 women are newly diagnosed with various types of cancers, with breast being the most common. 10% were in the reproductive age group. When concerned about survival, reproductive health is overlooked. The main objectives of this study was to incorporate a reproductive health assessment tool into breast cancer care for women in childbearing age group, follow the reproductive health algorithm for each patient, and follow laboratory markers for fertility during study period.

Oncocontraception in breast cancer care.

e19679 Background: Based on a case series of patients, the need for providers to address pregnancy as it relates to the diagnosis of breast cancer was realized. Equally as important as the emphasis on intended pregnancy is the prevention of unintended pregnancy during cancer treatment. Thus, the growing interest in oncofertility calls for a developed algorithm for reproductive health management. The objective was to incorporate and investigate the implementation of a reproductive health assessment tool in breast cancer care for women of childbearing age (18-55) and to study outcome measures to determine the tool effectiveness. Methods: This prospective observational study was executed by providing training on reproductive health in the context of cancer care for oncology staff in the breast cancer clinic. Referral lines for various components of reproductive health care were developed. The reproductive health algorithm was developed for each patient according to their reproductive goals. Women with newly diagnosed with breast cancer were eligible for this study. Eleven patients were enrolled and will continue to be followed through the end of the study. We are in the second of a three year study. Baseline surveys, lab data and subsequent treatment plans were recorded and implemented. Results: All participants received contraception/family planning counseling. Before study entry, only 4 out of 11 (36%) women presented with long-term contraception (LTC). Of the 7 others, 2 had become pregnant post-diagnosis, 1 had a miscarriage days prior to diagnosis, 2 were abstinent, and 2 used condoms. Eight of 11 (73%) had completed childbearing at study entry. After algorithm implementation, LTC use increased to 64% (n = 7). Four (36%) used Paraguard IUD and 3 (27%) had permanent sterilizations. The others used abstinence (n = 3, 27%) and one used condoms (9%). Women who completed childbearing increased to ten (91%). Fertility preservation counseling referral was made for the woman interested in future childbearing. Conclusions: The reproductive health algorithm allows patients to gain perspective of their reproductive goals in light of their diagnosis, enhancing options for management of those goals, minimizing unintended pregnancies, and increasing efficiency of cancer treatment. No significant financial relationships to disclose.

A report on the reproductive health of women after the massive 2008 Wenchuan earthquake

To evaluate the reproductive health of women in the aftermath of the 2008 Richter scale 8.0 Wenchuan earthquake in China. Gynecologists surveyed 170 women using a questionnaire inquiring about symptoms of reproductive tract infection, menstruation disorders, satisfaction with sexual life, and desire for fertility. The rates of symptoms of lower genital tract infection were higher after than before the earthquake (50.0% vs 26.5%), as were the rates for pelvic inflammatory disease (35.9% vs 19.4%) and menstruation disorders (51.8% vs 22.4%) (P<0.05 for all). At the same time, the women's satisfaction with their sexual life was markedly decreased; 89.4% of them said they would not pursue a plan to become pregnant; and 67.1% said they would request pregnancy termination if they became pregnant. The findings of this first population-based assessment of reproductive health following the massive Wenchuan earthquake may help in shaping public health measures benefiting women surviving large-sale disasters.

Disruption of the Salmon Reproductive Endocrine Axis Through Prolonged Nutritional Stress: Changes in Circulating Hormone Levels and Identification of Differentially Expressed Ovarian Genes.

Environmental stressors (e.g., reduced food availability, hypoxia, endocrine disrupting chemicals) are known to disrupt endocrine function of fish, potentially delaying the age of puberty and affecting gamete quality. Assessing the reproductive health of fish in early stages of gametogenesis using histological and hormonal indices provides useful information, but has limited prognostic value for future reproductive potential. Our long-term aim is to develop tools for monitoring environmental impacts on ovarian growth in fish using large-scale ovarian gene expression analyses. However, little is known about the regulation of gonadal gene expression during previtellogenic oocyte growth in either healthy growing fish or fish exposed to environmental conditions that have been shown to disrupt the reproductive endocrine system and inhibit gonadal growth. The goal of this study was to identify genes that are specifically up- or down-regulated in the previtellogenic ovary of coho salmon when ovarian growth is impaired by prolonged fasting. Two year-old fish were individually tagged and fasted over a 17-week period, which resulted in less than 20% loss of body weight. Prolonged fasting caused regression of the ovaries and disrupted the reproductive endocrine axis, as fasted salmon showed significantly lower gonad weights, oocyte diameters, and plasma estradiol-17β (E2) levels relative to fed animals by week 14. Further, a higher proportion of atretic oocytes was observed in ovaries of fasting fish at week 14 and numbers increased by week 17. Reciprocal suppression subtractive hybridization (SSH) cDNA libraries using ovaries from fed and fasted animals at week 14 were generated. A total of 480 clones were sequenced per library and their putative identity determined by comparing sequences to the NCBI and fish EST databases. The library representing genes up-regulated in the fed ovary included steroidogenesis related genes, such as steroidogenic acute regulatory protein (star), 3β-hydroxysteroid dehydrogenase (hsd3b), P450-aromatase (cyp19a1a), and TGF-β superfamily members, such as anti-Mullerian hormone (amh) and inhibin (inha). The library representing genes up-regulated in the fasted ovary included genes that have been associated with apoptosis, such as programmed cell death protein 4 (pdcd4), lipopolysaccharide-induced TNF factor (litaf), cullin 3 (cul3), and kruppel-like factor 6 (klf6). The genes described above were examined with quantitative PCR and results confirmed that the SSH libraries were enriched in transcripts differentially expressed between ovaries of fed and fasted salmon. This study has revealed ovarian genes that are important to normal ovarian development and those that are affected by nutritional stress and may relate to apoptosis/atresia within the ovary. Ultimately, this and subsequent studies should provide new tools that will enable molecular based assessment of fish reproductive health. This research was funded by Washington Sea Grant project number R/B-49. (poster)

Reproductive health assessment for women with cancer: a pilot study

The purpose of this study was to pilot a survey instrument and to develop descriptive data about the reproductive goals of reproductive-aged women (15-44 years) with cancer. This was a cross-sectional pilot survey study of 20 women who were diagnosed with various types of cancers at the oncology clinic of Stroger Hospital of Cook County, Chicago, from January-July 2006. Of the 20 patients whose cases were surveyed, the mean age was 36.6 years, and 90% of the women had breast cancer. Ten percent of patients would continue pregnancy, if they became pregnant while receiving treatment. Contraception was used by 55% of patients (n = 11), of whom 55% of the women (n = 6) were using abstinence. The result of this pilot study demonstrates the need for reproductive health counseling in women with cancer; the range of discussion must include fertility interest, contraception, and fertility preservation.

HIV Infection Among Internally Displaced Women and Women Residing in River Populations Along the Congo River, Democratic Republic of Congo

We conducted a reproductive health assessment among women aged 15-49 years residing in an internally displaced persons (IDP) camp and surrounding river populations in the Democratic Republic of Congo. After providing informed consent, participants were administered a behavioral questionnaire on demographics, sexual risk, reproductive health behavior, and a history of gender based violence. Participants provided a blood specimen for HIV and syphilis testing and were referred to HIV counseling and testing services established for this study to learn their HIV status. HIV prevalence was significantly higher among women in the IDP population compared to women in the river population. Sexually transmitted infection symptoms in the past 12 months and a history of sexual violence during the conflict were associated with HIV infection the river and IDP population, respectively. Targeted prevention, care, and treatment services are urgently needed for the IDP population and surrounding host communities during displacement and resettlement.

Reproductive health assessment in women with cancer: A pilot study

19660 Background: Many women in the reproductive age group are diagnosed with cancer. Reproductive health issues remain an important concern in caring for these women. Based on a case series in our institution and a review of the literature, we found a paucity of literature and clinical acumen regarding reproductive health issues. The purpose of this study was to pilot a survey instrument to develop descriptive data on the reproductive goals of reproductive aged women (15–44yrs) presenting with cancer. Methods: A cross- sectional pilot survey study of 20 selected women diagnosed with various types of cancers presenting to Hematology-Oncology clinic of John.H.Stroger Jr. Hospital of Cook County, Chicago, from January through July 2006. A survey instrument was developed and performed a reproductive health assessment. Patients were interviewed about their obstetric/menstrual history, contraceptive motivations and choices as well as future child bearing options. Results: Of the 20 patients with mean age of 36.6 years who were surveyed, 90 % had breast cancer. Child bearing was completed by 50%, 45% desired future childbearing, 5% were unsure. Contraception was used by 55 %( n=11) of patients out of which 55 %(n=6) were using abstinence, 45% denied the use of any contraception. Amongst the patients who received chemotherapy with radiation and chemotherapy without radiation, 75% and 72.7% respectively continued to menstruate. Ten percent would continue pregnancy, if they become pregnant while on treatment. Conclusions: The result of this pilot study demonstrates some insight into the reproductive health needs and concerns of women diagnosed with cancer. A reproductive health assessment should be performed on all cancer patients who are in the reproductive age group. We plan a large prospective study providing a larger database that may aid in developing treatment plan. No significant financial relationships to disclose.

Reproductive health problems and help seeking behavior among adolescents in urban India

To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. A sample of 300 urban school going adolescents between 11-14 years were chosen at random and assessed using four tools namely, self administered questionnaire : provision of adolescent friendly services; medical screening and focus group discussions. Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.

Integration of sexual and reproductive health services in KwaZulu-Natal, South Africa

An integrated sexual and reproductive health package is widely regarded as essential for meeting the needs of both men and women. The practical realities of integration in KwaZulu-Natal, South Africa, were examined from the perspective of both providers and clients. Only minorities of clients received any assessment of reproductive and sexual health needs over and above their main presenting need or problem. The majority would have welcomed such assessments and many were classified as being in need, particularly for advice and services with regard to sexually transmitted infections, including HIV. Most providers were positive about integration, but their ability to practice an active form of integration was limited by inadequate training and time constraints. While training defects can be remedied, the time constraints posed by heavy patient loads are less tractable. More skillful use of booking clerks or the introduction of lay counsellors are also possible solutions.

Assessment of obesity, lifestyle, and reproductive health needs of female citizens of Al Ain, United Arab Emirates.

This study was conducted to determine the reproductive and lifestyle characteristics in a representative sample (n = 535) of women in Al Ain, United Arab Emirates, to guide the development of health programmes for this population with rising affluence. A cross-sectional survey was carried out using the stratified two-stage sampling technique. Although most women were young, were pre-menopausal, did not smoke, reported good health status, and 84% (95% confidence interval [CI] 81-87%) reported being sufficiently active to meet expert recommendations, the prevalence of obesity (defined by body mass index > or = 30) was very high (35%; 95% CI 31-39%) and many (28%; 95% CI 24-32%) reported having a chronic disease. The prevalence of obesity was associated positively with age and negatively with education (p < 0.001 for both). Postmenopausal women had significantly more chronic diseases, reported poor health more often, were less physically active (p < 0.001 for all), and had a higher percentage of body fat (p = 0.002) compared to premenopausal women. Health services should emphasize the prevention and treatment of obesity and improving the general health status of postmenopausal women.

Strategic assessment of reproductive health in the Lao People’s Democratic Republic

The status of women’s reproductive health remains a serious problem in the Lao People’s Democratic Republic. Although data on reproductive health are generally scarce, the maternal mortality ratio has been estimated to be 656 per 100,000 live births (Ministry of Public Health and United Nations Children’s Fund (MOPH and UNICEF), 1998). Estimates of total fertility rates vary from 4.7 children per woman for urban women to 7.8 for rural women (National Statistical Centre (NSC) and the Lao Women’s Training Centre (LWTC), 1995). Only limited data exist on the incidence of reproductive tract infections (RTIs and sexually transmitted infections (STIs), but anecdotal evidence suggests that the magnitude of these problems is likely to be great. The data from the sentinel surveillance system show generally low prevalence rates for HIV, but only limited testing has been carried out and a more comprehensive sentinel surveillance system has only recently been put into place. Abortion and adolescent reproductive health remain politically sensitive issues. A report from a small-scale survey conducted by the Japanese Organization for International Cooperation in Family Planning (JOICFP) in three districts showed that the abortion rate was 101.1 per thousand pregnancies (Podhisita and others, 1997). Early marriage and pregnancy in adolescence are the norm in the Lao People’s Democratic Republic, The Fertility and Birth Spacing Survey (NSC and LWTC, 1995) estimated that the median age at first birth for all married women was 20.5 years.

A strategic Assessment of Reproductive Health in the Lao World Health Organization

A strategic Assessment of Reproductive Health in the Lao World Health Organization

Seeking women's voices: Setting the context for women's health interventions in two rural counties in Yunnan, China

If interventions to improve health are truly to benefit women, they must be developed from the start with a critical understanding of women's own perceptions of their health problems and needs, and how these concerns are linked to other facets of women's lives. To obtain such understanding, it is crucial for health planners to seek out women in the communities where they live, to encourage them to speak in their own voices about their health and lives, and to be genuinely committed to listening to what the women have to say. This paper presents results of focus group discussions with village women in two rural counties in Yunnan, China. The data are derived from 28 focus group discussions conducted by the Women's Reproductive Health and Development Program in Yunnan as part of a comprehensive assessment of reproductive health needs in poorer, more remote areas of the two counties. The discussions were held to ascertain what village women themselves feel to be their most pressing health problems, and how these relate to work, family, social status and their use of health services. Results show how women's health and their use of health services are rightly interwined with their labor roles, harsh environmental conditions and oppressive poverty. Widespread breakdowns in the village-level primary health care network lead village women to express a profound lack of confidence in local health services. The findings have several implications for planning and implementation. Demands on women's scarce time need to be explicitly considered when designing health education activities and health service delivery. The tight intertwining of women's health, labor, poverty and harsh environmental conditions call for integrating reproductive health strategies with other efforts to improve women's social status, increase their educational and occupational opportunities, and alleviate their labor burdens.

A pilot program of contraceptive continuation in six school-based clinics

Few school-based health centers (SBHC) in the United States dispense contraceptives on-site and little is known about contraceptive continuation in these health centers. An 11-month contraceptive continuation pilot project offering monthly reproductive health assessment and counseling to students enrolled in Baltimore school clinics was evaluated. One hundred-forty-three women voluntarily enrolled in the study over a seven month period. A monthly contraceptive calendar was developed to collect data on contraceptive use, pregnancy and STD risk, sexual behavior and parental support for contraceptive use. Physical assessment was provided as needed to assess the presence of STD's or pregnancy. Data were analyzed for the month prior to enrollment in the program and eleven months after entry into the program. Both contraceptive (OCP) use and abstinence increased over the course of the program. Condom use remained at approximately 30% with frequent use of OCP's and condoms, condoms or abstinence. Program drop-out was common. Thirteen students became pregnant while enrolled in the program and 35% of the students were diagnosed with one or more sexually transmitted diseases. Partner-switching was common, although two or more partners within any one month was rare. Monthly follow-up provided through SBHCs can improve contraceptive use although dropout rate and contraceptive failure remain high.