Adults Of Reproductive Age Research Articles

Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide. We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available. Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4-20·7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6-19·8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8-24·3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2-76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries. Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women. Center for AIDS Research at Johns Hopkins and the Center for Public Health and Human Rights at the JHU Bloomberg School of Public Health.

High sex ratio as a correlate of depression in Chinese men

There is a large and increasing excess of men in China, especially in poor rural areas, with millions now unable to marry. The study aimed to determine whether these high sex ratios influence the prevalence of depression. The study was a cross-sectional survey, using a self-completion questionnaire, administered to adults of reproductive age in localities with widely varying sex ratios in three provinces: Zhejiang, Yunnan and Guizhou. Depression was measured using the Chinese version of the Beck Depression Inventory (BDI). A total of 7435 men and women aged 19-40 completed questionnaires. Moderate or severe depression was found in 17.6% of men and 17.0% of women, and suicide thoughts and wishes in 18.0% and 20.0% respectively. Independent correlates for depression and suicide ideation in men were high local sex ratio, rural residence, low education and poor economic status. Very high local sex ratio was the strongest independent determinant of depression in men. These include (1) selection bias: with just three provinces and a purposive sampling strategy, (2) reporting bias: the BDI score is arguably a crude measure for a complex psychological condition, and the veracity of responses to sensitive questions cannot be guaranteed, (3) information bias: county-level sex ratio figures may underestimate the actual sex ratio, especially in rural areas. Very high sex ratios in parts of China are contributing to depression and suicidal tendencies in men, and women, but especially unmarried men. Proactive measures need to be taken to identify and treat vulnerable individuals.

Multiple Sclerosis and Pregnancy: Maternal Considerations

Multiple sclerosis (MS) is the most commonly acquired neurological disorder affecting young adults of reproductive age with approximately a 3:1 female-to-male ratio. Pregnancy is not contraindicated in MS but remains to be an issue that raises many questions. Although relapse rates tend to increase in the first 3 months postpartum, pregnancy does not seem to be a detriment to the long-term progression of MS and has a protective effect on reducing relapses, especially during the third trimester. MS does not appear to affect fertility or increase the risk of congenital anomalies or pregnancy complications. There has been some evidence that maternal treatment with β interferons, the most commonly used disease-modifying therapies in MS, may cause adverse reproductive outcomes, prompting the US FDA to issue warnings about their use at conception and during pregnancy.

Predation by <i>Dugesia polychroa</i> (Platyhelminthes: Tricladida) prevents the establishment of <i>Physa acuta</i> (Gastropoda: Pulmonata) in hard-substratum habitats

Despite half a century of research on planarian-gastropod interactions, the population-level impact of planarian predation on littoral pulmonates is not well known. We have quantified the predation of the common lacustrine planaria Dugesia polychroa Schmidt on the ubiquitous snail Physa acuta Drap., a potential keystone grazer in benthic littoral communities, in a high-replicate laboratory experiment. Planarian predation pressure was maintained constant, and experimental populations of P. acuta were size-structured simulating young-rich small groups (re)colonising the habitat (e.g. after release from predation). D. polychroa caused a quick (week 2) reduction in the density of hatchlings and juveniles, followed by significant reduction in the numbers of young (at the onset of reproductive age) and larger, reproductive-age adults (week 3). Planarias did not have any effect on the size of reproductive-age large adults, but oviposition decreased significantly in week 2, and all P. acuta populations in planarian-present aquaria went extinct within six weeks. Dugesiidinduced extinction mainly occurred by precluding population turnover. The results strongly suggest that active predation by D. polychroa on P. acuta can be high under some environmental conditions, effectively preventing the (re)establishment of small, colonising populations of P. acuta in hard-substratum habitats.

Simple Cardiac Shunts in Adults

Congenital heart disease affects up to 1% of the population 1 and is more common in females in both children and adults. With improving diagnostics and therapeutics, there is an increasing population of adults with congenital heart disease. This is because of both improved survival of children with congenital heart disease, 95% of whom reach adulthood, and new diagnoses of milder forms of congenital heartdiseaseinadults.Intheyear2000,thenumberofadults and children with congenital heart disease was nearly equal. 1,2 Congenital heart disease is increasingly being recognizedasagroupoflesionsofmultifactorialetiologywithboth genetic and noninherited factors playing a role in their development. 3-5 For adults of reproductive age, the presence of congenital heart disease has genetic implications regarding risk to future children and, for women, the additional risks related to pregnancy. Depending on their size and location, simple shunt lesions may remain asymptomatic during childhood and be initially diagnosed in adulthood. Not infrequently, new symptoms develop in adults as comorbidities, such as hypertension or lung disease, unmask the previously silent shunt physiology. Another common scenario is an adult imaged for an unrelatedindicationinwhomaserendipitousdiagnosisofashunt is made. Therefore, it is imperative that radiologists be familiarwiththeimagingfindingsofvariousshuntsaswellastheir clinical implications. In this article, we will review the radiographic imaging of simple shunts in adults, including typical chest radiographic findings and the roles of computed tomography (CT) and magnetic resonance (MR) in diagnosis and in guiding treatment. We will also address the relevant anatomy and physiology, diagnostic findings, and therapeutic options for adults with simple shunts, initially providing an overview. We will thenfurtherdetailthefeaturesuniquetospecificlesions,including atrial septal defect (ASD), patent foramen ovale (PFO), partial anomalous pulmonary venous return (PAPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA).

Delayed Child-Bearing

ObjectiveTo provide an overview of delayed child-bearing and to describe the implications for women and health care providers. OptionsDelayed child-bearing, which has increased greatly in recent decades, is associated with an increased risk of infertility, pregnancy complications, and adverse pregnancy outcome. This guideline provides information that will optimize the counselling and care of Canadian women with respect to their reproductive choices. OutcomesMaternal age is the most important determinant of fertility, and obstetric and perinatal risks increase with maternal age. Many women are unaware of the success rates or limitations of assisted reproductive technology and of the increased medical risks of delayed child-bearing, including multiple births, preterm delivery, stillbirth, and Caesarean section. This guideline provides a framework to address these issues. EvidenceStudies published between 2000 and August 2010 were retrieved through searches of PubMed and the Cochrane Library using appropriate key words (delayed child-bearing, deferred pregnancy, maternal age, assisted reproductive technology, infertility, and multiple births) and MeSH terms (maternal age, reproductive behaviour, fertility). The Internet was also searched using similar key words, and national and international medical specialty societies were searched for clinical practice guidelines and position statements. Data were extracted based on the aims, sample, authors, year, and results. ValuesThe quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). SponsorThe Society of Obstetricians and Gynaecologists of Canada. Recommendations1.Women who delay child-bearing are at increased risk of infertility. Prospective parents, especially women, should know that their fecundity and fertility begin to decline significantly after 32 years of age. Prospective parents should know that assisted reproductive technologies cannot guarantee a live birth or completely compensate for age-related decline in fertility. (II-2A)2.A fertility evaluation should be initiated after 6 months of unprotected intercourse without conception in women 35 to 37 years of age, and earlier in women > 37 years of age. (II-2A)3.Prospective parents should be informed that semen quality and male fertility deteriorate with advancing age and that the risk of genetic disorders in offspring increases. (II-2A)4.Women ≥ 35 years of age should be offered screening for fetal aneuploidy and undergo a detailed second trimester ultrasound examination to look for significant fetal birth defects (particularly cardiac defects). (II-1A)5.Delayed child-bearing is associated with increased obstetrical and perinatal complications. Care providers need to be aware of these complications and adjust obstetrical management protocols to ensure optimal maternal and perinatal outcomes. (II-2A)6.All adults of reproductive age should be aware of the obstetrical and perinatal risks of advanced maternal age so they can make informed decisions about the timing of child-bearing. (II-2A)7.Strategies to improve informed decision-making by prospective parents should be designed, implemented, and evaluated. These strategies should provide opportunity for adults to understand the potential medical, social, and economic consequences of child-bearing throughout the reproductive years. (III-B)8.Barriers to healthy reproduction, including workplace policies, should be reviewed to optimize the likelihood of healthy pregnancies. (III-C)

Awareness of Sickle Cell among People of Reproductive Age: Dominicans and African Americans in Northern Manhattan

Sickle cell disease is a chronic condition that is characterized by severe anemia, painful crises, and organ dysfunction. In the U.S.A., sickle cell is a health burden typically associated with African Americans. Dominicans constitute the largest Latino group in New York City (N.Y.C.) and have the second overall highest prevalence of sickle trait-one in 20 births, compared to one in 12 African American births. We aimed to document the prevalence of sickle within the largely Dominican and African American community of Northern Manhattan (Washington Heights, Inwood, Harlem), assess and compare knowledge about sickle disease and carrier status in young adults of reproductive age between African Americans and Dominicans, and elicit preferred sources of health information. N.Y. State Newborn Screening data in Northern Manhattan were analyzed by zip code. A brief oral survey was administered to 208 parents of young children-150 Dominicans and 58 African Americans. Significant differences were seen in knowledge about sickle-27% of Dominican parents surveyed correctly defined sickle cell disease as an inherited blood disorder, compared to 76% of African Americans (p < 0.001). Only 7% of African Americans did not know their own trait status, compared to 43% of Dominicans (p < 0.001). Parents were better informed if they or family members were affected by sickle conditions. Participants from both groups prefer receiving information from doctors and online. A separate group of 168 predominantly Dominican youth, ages 14-24, demonstrated knowledge levels similar to that of Dominican parents. These results suggest that many of reproductive age in a N.Y.C. community affected by sickle conditions frequently lack basic relevant information, with larger information gaps among Dominicans. Expanded efforts are warranted to inform young adults of diverse affected communities.

Ovarian Reserve in Young Women of Reproductive Age with Crohnʼs Disease

Crohn's disease (CD) mainly affects young adults of reproductive age. Whereas a large amount of data is available concerning pregnancy in young CD women, no study has been conducted on their ovarian reserve status. This study aimed to investigate the potential effect of CD on ovarian reserve in young women in remission, as reflected by serum anti-Müllerian hormone (AMH). This retrospective case-control study was conducted in the University Hospital of Nantes, France. Serum levels of AMH were retrospectively measured in 50 women with CD in remission and in 163 control women with normal ovarian reserve, matched by age. No statistical difference was found between mean serum AMH levels in CD and control women. Serum AMH levels remained comparable between CD and control women <30 years, but they were significantly lower in CD women ≥ 30 years compared to the control group. Furthermore, the negative correlation between age and AMH level tended to be more pronounced in CD than control women. Multivariate analysis of CD patients' clinical and demographic characteristics showed that serum AMH level was influenced by disease location, with a colonic location of the disease being independently associated with a high risk of altered ovarian reserve. Women with CD do not have severe ovarian reserve alterations compared to a control population. However, age ≥ 30 years and a colonic location of the disease could be associated with an accelerated loss of follicles. These data could encourage gastroenterologists to inform CD women of the risk of delaying childbirth.

Patterns and predictors of current cigarette smoking in women and men of reproductive age-Ecuador, El Salvador, Guatemala, and Honduras

To estimate smoking prevalence by gender, describe patterns of cigarette use, and identify predictors of current smoking in reproductive-age adults in four Latin American countries. Self-reported smoking was examined using data from Reproductive Health Surveys of women aged 15-49 years in Ecuador (2004), El Salvador (2002-2003), Guatemala (2002), and Honduras (2001), and of men aged 15-59 years in El Salvador, Guatemala, and Honduras for the same years. Current smoking was assessed by demographic characteristics, and independent associations were examined using logistic regression. Data were weighted to be nationally representative of households with reproductive-age women and men. Current smoking prevalence ranged from 2.6% (Guatemala) to 13.1% (Ecuador) for women and from 23.1% (Guatemala) to 34.9% (El Salvador) for men. In Ecuador, 67.6% of female smokers were non-daily users; in other countries, daily use was more prevalent than non-daily use for both men and women. In daily users, the median number of cigarettes smoked per day ranged from 1.9 (Ecuador, Honduras) to 2.3 (Guatemala) for women and from 2.1 (Guatemala) to 3.6 (Honduras) for men. In bivariate analysis, smoking prevalence in all countries was highest in women who lived in urban areas, were previously married, and/or had high socioeconomic status. Risk factors for smoking varied by country and gender. National tobacco control programs in these countries should aggressively target high-risk populations (reproductive-age men) and maintain low prevalence in low-risk populations (reproductive-age women). More research is needed to understand addiction patterns in non-daily smokers.

Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: Evidence from the demographic and health surveys

This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003–2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers’ HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention.

Awareness and Knowledge of HIV Counselling and Testing among Adults of Reproductive Age in Osun State Nigeria

Awareness and Knowledge of HIV Counselling and Testing among Adults of Reproductive Age in Osun State Nigeria

Ethical Issues Surrounding Fertility Preservation in Cancer Patients

Fertility preservation is a newly developed branch of reproductive medicine aimed at preserving the potential for genetic parenthood in adults of reproductive age or children, who are at risk of sterility before undergoing anticancer treatments. Except for embryo and semen freezing, all the available options to preserve fertility are considered experimental and thus, they raise ethical issues. In this study, we reviewed the informed consent and the risk-benefit analysis of offering experimental procedures for both adults and children when they are in vulnerable situations. In particular, children represent a special category of patients and their assent to treatment to be sought at anytime should be possible. Overall, there should be no ethical objections to offer these services as they are offered with the scope of preserving future fertility.

Bayesian salamanders: analysing the demography of an underground population of the European plethodontid Speleomantes strinatii with state-space modelling.

BackgroundIt has been suggested that Plethodontid salamanders are excellent candidates for indicating ecosystem health. However, detailed, long-term data sets of their populations are rare, limiting our understanding of the demographic processes underlying their population fluctuations. Here we present a demographic analysis based on a 1996 - 2008 data set on an underground population of Speleomantes strinatii (Aellen) in NW Italy. We utilised a Bayesian state-space approach allowing us to parameterise a stage-structured Lefkovitch model. We used all the available population data from annual temporary removal experiments to provide us with the baseline data on the numbers of juveniles, subadults and adult males and females present at any given time.ResultsSampling the posterior chains of the converged state-space model gives us the likelihood distributions of the state-specific demographic rates and the associated uncertainty of these estimates. Analysing the resulting parameterised Lefkovitch matrices shows that the population growth is very close to 1, and that at population equilibrium we expect half of the individuals present to be adults of reproductive age which is what we also observe in the data. Elasticity analysis shows that adult survival is the key determinant for population growth.ConclusionThis analysis demonstrates how an understanding of population demography can be gained from structured population data even in a case where following marked individuals over their whole lifespan is not practical.

The impact of sex, gender and pregnancy on 2009 H1N1 disease.

Children and young adults of reproductive age have emerged as groups that are highly vulnerable to the current 2009 H1N1 pandemic. The sex of an individual is a fundamental factor that can influence exposure, susceptibility and immune responses to influenza. Worldwide, the incidence, disease burden, morbidity and mortality rates following exposure to the 2009 H1N1 influenza virus differ between males and females and are often age-dependent. Pregnancy and differences in the presentation of various risk factors contribute to the worse outcome of infection in women. Vaccination and antiviral treatment efficacy also vary in a sex-dependent manner. Finally, sex-specific genetic and hormonal differences may contribute to the severity of influenza and the clearance of viral infection. The contribution of sex and gender to influenza can only be determined by a greater consideration of these factors in clinical and epidemiological studies and increased research into the biological basis underlying these differences.

Human predators outpace other agents of trait change in the wild

The observable traits of wild populations are continually shaped and reshaped by the environment and numerous agents of natural selection, including predators. In stark contrast with most predators, humans now typically exploit high proportions of prey populations and target large, reproductive-aged adults. Consequently, organisms subject to consistent and strong 'harvest selection' by fishers, hunters, and plant harvesters may be expected to show particularly rapid and dramatic changes in phenotype. However, a comparison of the rate at which phenotypic changes in exploited taxa occurs relative to other systems has never been undertaken. Here, we show that average phenotypic changes in 40 human-harvested systems are much more rapid than changes reported in studies examining not only natural (n = 20 systems) but also other human-driven (n = 25 systems) perturbations in the wild, outpacing them by >300% and 50%, respectively. Accordingly, harvested organisms show some of the most abrupt trait changes ever observed in wild populations, providing a new appreciation for how fast phenotypes are capable of changing. These changes, which include average declines of almost 20% in size-related traits and shifts in life history traits of nearly 25%, are most rapid in commercially exploited systems and, thus, have profound conservation and economic implications. Specifically, the widespread potential for transitively rapid and large effects on size- or life history-mediated ecological dynamics might imperil populations, industries, and ecosystems.

Stress‐Associated or Functional Hypothalamic Amenorrhea in the Adolescent

Stress-associated amenorrhea in the adolescent is likely similar to the disorder found in young reproductive-aged adults and is termed hypothalamic amenorrhea. The key defect is an abnormality in the secretion of gonadotropin-releasing hormone. This review examines the current studies that characterize the disorder and the plausible factor(s) that may account for the disturbances in gonadotropin-releasing hormone, and identifies directions for future research in this group of disorders.

Adverse reproductive effects of beer drinking

This short communication represents a systematic review of the literature about beer drinking during gestation. A Medline search was undertaken of articles based on the criterion that beer and pregnancy were in the abstract and central to the article. Manuscripts were to be published in English in peer review medical journals from 1981 to 2006. Beer is a commonly consumed alcoholic beverage among reproductive-age adults. Beer drinking males have an increased risk of contributing to pregnancy waste. Women consume beer before and after pregnancy recognition. Binge drinking appears to be a common drinking behavior, and those who binge drink have an increased risk of impaired fetal growth and offspring behavior. Beer consumption by lactating women might temporarily impair motor function of nursing infants. Evidence for potentiation of beer effects by congeners and by simultaneous use of substances of abuse is inconclusive.

A report of two linked studies of knowledge and attitudes to prenatal screening and testing in adults of reproductive age in Japan and the UK

Background prenatal screening for fetal abnormality is being offered routinely in many countries. The need for informed consent demands that the nature of screening is understood by prospective parents, but the opportunities for providing information early in pregnancy before decision-making may be limited. Objective to assess the knowledge about, and attitudes to, prenatal screening in adults of reproductive age in two countries. Design two groups of adults were surveyed using a specifically designed tool to assess knowledge about fetal abnormalities and potential screening tests, attitudes to screening and termination of pregnancy, and information required by parents before making decisions. Setting and participants 90 participants were surveyed in Japan, 72% of whom were pregnant or had a partner who was pregnant; 93 participants were surveyed in the UK, none of whom were pregnant. All respondents were aged between 18 and 45 years. Measurements demographic data were collected and analysed. Frequencies were calculated for each questionnaire response. A series of t-tests and χ 2 tests were used to assess differences between the two groups. Free-text data were analysed using content analysis. Findings overall knowledge of prenatal tests and the conditions for which screening is offered was low in both groups. Significant differences exist between the perception of the conditions for which screening or testing can be offered and the types of conditions that can actually be detected prenatally. Most respondents in both countries would consider termination of pregnancy for fetal abnormality. The information most frequently cited by respondents as important when deciding about testing were the chances of damage to the health of fetus, mother, or both. Key conclusions women and men of reproductive age in the groups studied are not well-prepared to make decisions about screening or testing in pregnancy. Implications for practice improvements in preconceptual education on prenatal screening and testing may be required to ensure prospective parents can make informed decisions in early pregnancy.

Assessing the Magnitude of the HIV/AIDS Epidemic in Burma

Estimates of the HIV/AIDS burden in Burma (Myanmar) are uncertain. Using data from the 1999 national HIV sentinel surveillance and available population data, we generated estimates of Burma's HIV burden in 1999. The 1999 sentinel surveillance included women attending antenatal clinics, male military recruits, blood donors, injecting drug users, patients of sexually transmitted disease clinics, and sex workers. We used data for women attending antenatal clinics and male recruits aged 20-29 years to estimate HIV prevalence among women and men, respectively. Data points were merged to give five regional estimates of prevalence for men and women. Census figures were used to obtain national population estimates of the numbers of Burmese living with HIV infection, along with confidence intervals (CIs). HIV prevalence varied by region, with the lowest rates in the West, intermediate rates in the central region, and highest rates in the North, East, and South. The highest rates were in the East (Shan State), with female prevalence of 3.0% (95% CI, 1.9-4.5). The total number of infected women nationwide was 218,300 (95% CI, 159,400-277,100), and that of men was 468,700 (95% CI, 343,300-594,200). We estimated HIV prevalence of at least 3.46% (95% CI, 2.72-4.19) among adults aged 15-44 years; 5700 infants were born with HIV infection in 1999. Burma has a generalized epidemic of HIV-1 in reproductive age adults. We estimated that there were 687,000 (95% CI, 541,100-832,900) Burmese adults living with HIV infection in 1999, or about one of every 29 adult citizens. This estimate is higher than the UNAIDS estimate for the same year of 530,000 adults and children living with AIDS, or a population prevalence of about one in 50 adults. HIV prevention and care programs are urgently needed in Burma.

Attitudes of the broader hearing, deaf, and hard-of-hearing community toward genetic testing for deafness.

To assess attitudes in a nonmedically and nonculturally influenced setting of reproductive-age adults toward genetic testing for deafness in newborns. Hearing, deaf, and hard-of-hearing individuals at a university completed questionnaires assessing attitudes toward genetic testing. Eighty-five percent of hearing (n = 133) and 62% of deaf/hard-of-hearing (n = 89) individuals would allow genetic testing for deafness in their own newborn. These results indicate an acceptance of newborn genetic testing for deafness by individuals in the broader community, regardless of hearing status.