Risk Factors For Late Presentation Research Articles

Analysis of risk factors for late presentation in a cohort of HIV-infected patients in Dresden: positive serology for syphilis in MSM is a determinant for earlier HIV diagnosis

Late HIV presentation is still a health concern, even in industrialised countries. Data concerning this problem in Eastern Germany are scarce. We investigated associated factors in a cohort of HIV-infected patients in Dresden, Germany, including syphilis serology as a proxy for sexual risk behaviour. A retrospective cohort study on 348 patients presenting for the first time in our treatment centre from 1986 to 2010 was undertaken. Risk factors of late (CD4 cells <350/μl) and very late (CD4 cells <200/μl) presentation either to care or to diagnosis were identified by means of logistic regression analyses. Of 348 classifiable patients, 54% were late and 33.9% were very late presenters to care. In a subgroup of 260 patients with recent HIV diagnosis, 50.4% were late and 31.2% were very late presenters to diagnosis. Age >24years was a significant independent factor associated with late or very late presentation, but not male gender, originating from high-prevalence countries (HPC) or years of presentation. Being MSM alone was not associated with early or late HIV presentation, but MSM with positive TPHA or TPPA showed a lower risk of late presentation, predominantly in those presenting late to diagnosis [odds ratio (OR) 0.42, p=0.048]. A positive syphilis screening test seems to be a determinant for lower risk of late presentation to HIV care and diagnosis in MSM. The presence and awareness of sexually transmitted infections (STIs) such as syphilis may lead to earlier utilisation of HIV health care and, thus, promote earlier HIV diagnosis. HIV prevention strategies should focus more on STIs and not only on HIV.

Socioeconomic status as a risk factor for late presentation of glaucoma in Canada

ObjectiveTo evaluate the effect of socioeconomic status on late presentation of glaucoma. DesignProspective, multicentre, cross-sectional study. ParticipantsNewly diagnosed open-angle glaucoma. MethodsEligible subjects with newly diagnosed open-angle glaucoma underwent a comprehensive ocular examination and were classified as mild, moderate, or advanced according to the Canadian Ophthalmological Society glaucoma guidelines. Socioeconomic status was estimated by linking the subjects’ postal code to the median household income in the 2006 Canadian population census at the level of dissemination areas. Five equal income groups ranging from the lowest to the highest income quintile were considered and compared regarding the frequency and proportion of moderate or advanced glaucoma. ResultsA total of 290 subjects were included in the analysis; 151 (52.1%) had mild, 79 (26.9%) moderate, and 60 (21.0%) advanced disease at initial diagnosis. Patients with newly diagnosed glaucoma were less likely to come from the poorest neighborhood areas (16.21%) when compared with an expected one fifth (20%) of patients presented in each of the 5 social economic groups (P = 0.56). Compared with people from the poorest neighborhood areas, people from the richest neighborhood areas had a marginally lower risk for having moderate or advanced glaucoma at first presentation (prevalence ratio 0.66, 95% confidence interval: 0.43–1.02, P = 0.06). This association was stronger among those≥65 years old (P = 0.006). ConclusionsTo the best of our knowledge, this is the first study in Canada to provide evidence that socioeconomic deprivation is associated with greater severity of glaucoma at presentation, specifically for those≥65 years old. Consideration should be given to targeting poor neighborhood areas for glaucoma education, screening, or both.

Late presentation for HIV diagnosis: a single‐centre experience

Purpose of the studyAntiretroviral therapy reduces mortality and morbidity in HIV‐infected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. All international guidelines (IAS 2010, EACS 2011, DHHS 2012) tend to recommend starting ART in patients with high CD4 cell count. Some challenges need to be met before reaching this goal, particularly HIV‐infected patients with late presentation‐diagnosis. The objective of this study was to determine the frequency of and demographic features associated with delayed presentation to care in our centre.MethodsAll patients, newly diagnosed with HIV between January 2007 and December 2011 and on follow‐up in our AIDS Reference Centre, were included. ‘Late presenter patient’ was defined as patient with CD4 count&lt;350/mm3 at the time of diagnosis. Demographic (age, sex, ethnicity, migration) and clinical characteristics (transmission, CD4 cell count, viral load, CDC stage) were collected. We then compared these features with those identified in our centre between 1997‐2006.Summary of resultsOf the 601 patients diagnosed between 1997–2006, 57.1% were late presenters for HIV diagnosis. Among the 359 patients included between 2007–2011, 42.9% patients were late presenters. Demographic characteristic are summarized in Table 1. In the univariate analysis, patient age &gt;50 years, female sex, immigrant status and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, patients aged &gt;50 and migrant women were the only independent risk factors for late presentation. Except gender, other risk factors remain identical to those that were identified in our centre between 1997–2006 [1]. Characteristics of patients with late presentation (CD4 &lt; 350/mm3) for HIV diagnosis between 2007–2011 Total n total 359 n (%) 154 (42.9) p value OR (95% CI) Adjusted OR (95% CI) Age, years &lt; 30 64 21 (32.8) 1.00 1.00 30–39 135 52 (38.5) 1.28 (0.68–2.40) 1.27 (0.66–2.44) 40–49 95 41 (43.1) 1.55 (0.80–3.01) 1.66 (0.83–3.32) &gt; 50 65 40 (61.5) &lt; 0,001 3.27 (1.59–6.74) 2.84 (1.25–6.41) Sex Female 103 54 (52.4) 1.00 1.00 Male 256 100 (39) 0,021 0.58 (0.36–0.92) 0.92 (0.48–1.75) Origine non‐migrant 141 45 (31.9) 1.00 1.00 Migrant 218 109 (50) &lt; 0,001 2.13 (1.37–3.32) 1.70 (1.02–2.83) HIV transmission MSM 164 49 (29.8) 1.00 1.00 Heterosexual 191 102 (53.4) &lt; 0,001 2.68 (1.73–4.17) 1.84 (0.99–3.41) ConclusionA considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been identified clearly. In order to be able to treat all patient at high CD4 cell counts as recommended in all guidelines, we need to develop policies focused directly to categories of people at high risk of late presentation.Conflict of interestNone. All co‐authors have participated in, and agree with the content and conclusions. This work is original and does not infringe any copyright.AcknowledgementA. Sasse, Institut de Santé Publique, Belgium

Treatment response to LPV/r‐based HAART in HIV‐infected patients aged &gt;60 years ‐ data from the STAR/STELLA cohorts

Purpose of the studyIn Germany, older age is described as a risk factor for late presentation of HIV disease (defined as&lt;200 CD4/μL or AIDS at diagnosis). We describe treatment outcomes with respect to age distribution at the time of antiretroviral therapy (ART) initiation in the multicentre, observational, ongoing STAR and STELLA cohorts, which included patients (pts) initiated on LPV/r‐based ART.MethodsThis analysis included ART‐naïve HIV+ pts with a minimum of 48 weeks follow‐up. Time to virologic response (defined as HIV1‐RNA &lt;50 c/mL) and time to CD4 cell increase of at least 100/μL were calculated using Kaplan‐Meier analyses. Virologic response rates at week 48 were evaluated using 2 approaches: i) defining discontinuations for virologic or immunologic failure, side effects, noncompliance, or death as failures (ITT) and ii) as‐treated (AT) analysis excluding discontinuations for reasons other than virologic failure.Summary of results1011 ART‐naïve pts were included (85% men; median age 43 years [y]). Baseline (BL) characteristics and treatment response rates are shown in Table 1. The overall prevalence of advanced immunodeficiency with&lt;200 CD4/μL at ART initiation was 48%:*Comparison across groups64% in pts aged &gt;60 y and 31%–49% in the younger age groups (see Table 1). Across age groups, 43%–60% of pts had pretreatment HIV1‐RNA levels&gt;100,000 c/mL. Median times to virologic response (Figure 1) and response rates at week 48 did not differ across age groups in either analysis, nor did immunologic outcomes. Median times to+100/μL CD4 increase were between 11.1 and 15.3 weeks. CD4 increase at week 48 was lower in pts &gt;60 y compared to patients of younger age categories (165/μL vs 211/μL; P=ns). However, these differences between age groups did not reach statistical significance, even when stratified by baseline CD4 count&lt;vs=200/μL. Over the first 48 weeks of therapy, clinical and laboratory adverse events (AEs) of grade 3 or 4 were spontaneously reported in 9.6% of pts in the=60 y group and 4.5% of pts in the &gt;60 y group (P=0.194). In addition, 11.3 % of pts =60 and 14.9% of pts &gt;60 y discontinued therapy prior to week 48 due to treatment related AEs (P=0.427). Age, y ≤30 &gt;30–40 &gt;40–50 &gt;50–60 &gt;60 P value Statistical tests* N 68 321 411 144 67 Male, % 69 80 89 89 88 P&lt;0.001 χ2 Median time since diagnosis, y (IQR) 0.79 (0.21–2.98) 0.67 (0.09–3.23) 0.32 (0.06–3.24) 0.35 (0.06–2.27) 0.10 (0.05–0.69) P=0.015 Kruskal‐Wallis BL HIV1‐RNA&gt;100,000 c/mL, % 43 49 56 60 48 P=0.038 χ2 BL median CD4 count, cells/μL 256 208 203 212 121 P=0.001* Kruskal‐Wallis BL CD4 count&lt;200/μL, % 31 47 49 48 64 BL CD4 count200–350/μL, % 47 36 33 31 31 BL CD4 count&gt;350/μL, % 22 17 18 21 5 Median CD4 count at wk 48, 1/μL 446 416 412 392 361 P=0.033* Kruskal‐Wallis Median time to+100/μL CD4 increase, wk 11.1 12.1 12.1 12.9 15.3 P=0.754 log‐rank Median change in CD4 at wk 48, 1/μL 234 214 214 180 165 P=0.113* Kruskal‐Wallis Median time to HIV1‐RNA&lt;50 c/mL, wk 25.1 25.6 25.9 25.1 35.0 P=0.496 log‐rank Wk 48 HIV1‐RNA&lt;50 c/mL, % ITT 63.2 69.8 69.6 68.1 61.2 P=0.556 χ2 Wk 48 HIV1‐RNA&lt;50 c/mL, % AT 75.4 82.1 80.1 77.8 78.9 P=0.755 χ2 ConclusionsIn the STAR/STELLA cohorts, pts aged &gt;60 y had high rates of late presentation, with two‐thirds of patients with CD4 cell counts&lt;200/μL. Nevertheless, older pts did not differ significantly from younger pts regarding immunologic and virologic response after initiation of LPV/r‐based therapy. image

Barriers to Initiation of Pediatric HIV Treatment in Uganda: A Mixed-Method Study

Although the advantages of early infant HIV diagnosis and treatment initiation are well established, children often present late to HIV programs in resource-limited settings. We aimed to assess factors related to the timing of treatment initiation among HIV-infected children attending three clinical sites in Uganda. Clinical and demographic determinants associated with early disease (WHO clinical stages 1-2) or late disease (stages 3-4) stage at presentation were assessed using multilevel logistic regression. Additionally, semistructured interviews with caregivers and health workers were conducted to qualitatively explore determinants of late disease stage at presentation. Of 306 children initiating first-line regimens, 72% presented late. Risk factors for late presentation were age below 2 years old (OR 2.83, P = 0.014), living without parents (OR 3.93, P = 0.002), unemployment of the caregiver (OR 4.26, P = 0.001), lack of perinatal HIV prophylaxis (OR 5.66, P = 0.028), and high transportation costs to the clinic (OR 2.51, P = 0.072). Forty-nine interviews were conducted, confirming the identified risk factors and additionally pointing to inconsistent referral from perinatal care, caregivers' unawareness of HIV symptoms, fear, and stigma as important barriers. The problem of late disease at presentation requires a multifactorial approach, addressing both health system and individual-level factors.

Risk Factors for Late Presentation for Care among HIV-Infected Patients in Guadeloupe: 1988-2009

Objective: The objective of this study was to identify the factors associated with presentation for care with CD4 cell count ≥ 500/ mm3, n=627) patients were included between 1 January 1988 and 31 December 2009. Factors associated with late presentation (CD4 count <200 cells/μL) were assessed using descriptive statistics and ordered multivariable logistic regression. Results: At the time of diagnosis, 40.21% of patients had than less 200 CD4 lymphocytes/mm3. Age older than 30 years OR: 1.55[1.14-2.10], p=0.005, male gender OR: 1.83[1.58-2.12], p<0.0001, access to care before 1992 OR: 1.56[1.03-2.02], p=0.038 and alcohol use OR: 8.80[2.26-34.36], p=0.002 were independently associated with a low CD4 cell count. Conclusion: The findings of this study (underline the need to expand HIV testing beyond the usual facilities) may be of value in helping to achieve earlier access to treatment in HIV-infected patients in order to minimize the individual risk of morbidity and mortality.

Profiles of women presenting for abortions in Singapore: focus on teenage abortions and late abortions

Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions. In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged <20 years were compared with those ≥ 20 years old using Chi-square test if the assumptions for Chi-square test were met; otherwise, Fisher's exact test was carried out. Logistic regression was used to investigate the risk factors for second trimester termination of pregnancy. 2109 women presented for induced abortions, of which 1998 had single abortion throughout the course of the study. The mean age of women with single abortion was 29.1 years (sd 7). In the group of women with single abortion, 182 (9.1%) were teenage abortions. In contrast to women ≥ 20 years of age, pregnant teenagers were more likely not to have used any contraception (51.1% vs. 25.2%) and more likely to present late for abortions (39.6% vs. 15.9%). Other risk factors for late presentation for abortions include Malay ethnicity, singlehood, nulliparity and lack of prior usage of contraception. Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem.

HIV-Infected Late Presenter Patients

HIV-Infected Late Presenter Patients

Combining Qualitative and Quantitative Evidence to Determine Factors Leading to Late Presentation for Antiretroviral Therapy in Malawi

BackgroundTreatment seeking delays among people living with HIV have adverse consequences for outcome. Gender differences in treatment outcomes have been observed in sub-Saharan Africa.ObjectiveTo better understand antiretroviral treatment (ART) seeking behaviour in HIV-infected adults in rural Malawi.MethodsQualitative interviews with male and female participants in an ART cohort study at a treatment site in rural northern Malawi triangulated with analysis of baseline clinical and demographic data for 365 individuals attending sequentially for ART screening between January 2008 and September 2009.Results43% of the cohort presented with late stage HIV disease classified as WHO stage 3/4. Respondents reported that women's frequency of testing, health awareness and commitment to children led to earlier ART uptake and that men's commitment to wider social networks of influence, masculine ideals of strength, and success with sexual and marital partners led them to refuse treatment until they were sick. Quantitative analysis of the screening cohort provided supporting evidence for these expressed views. Overall, male gender (adjusted OR 2.3, 95% CI1.3–3.9) and never being married (adjusted OR 4.1, 95% CI1.5–11.5) were risk factors for late presentation, whereas having ≥3 dependent children was associated with earlier presentation (adjusted OR 0.31, 95% CI0.15–0.63),compared to those with no dependent children.ConclusionGender-specific barriers and facilitators operate throughout the whole process of seeking care. Further efforts to enrol men into care earlier should focus on the masculine characteristics that they value, and the risks to these of severe health decline. Our results emphasise the value of exploring as well as identifying behavioural correlates of late presentation.

Late presentation of HIV disease and its associated factors among newly diagnosed patients before and after abolition of a government policy of mass mandatory screening

To investigate the risk factors for late presentation in the Republic of Korea, where massive mandatory screening for HIV infection was conducted by the government until the late 1990s. Data over the period 1987-2008 were analyzed from HIV patients for whom records of CD4 cell counts within 3 months of HIV diagnosis were available. Using multivariate logistic regression analysis including demographic and clinical variables, we examined factors associated with late presentation, defined as having a CD4 cell count of less than 200 cells/mm(3) at the time of diagnosis. Of a total of 994 patients with a new diagnosis of HIV infection, 405 (41%) were late presenters. As the proportion of patients diagnosed by mandatory screening decreased over time (31% in 1987-1998 versus 8% in 1999-2008, P<0.001), the proportion of late presenters increased (31% in 1987-1998 versus 43% in 1999-2008, P=0.007). The independent risk factors for late presentation were older age (adjusted odds ratio [aOR], per increase of 10 years, 1.31; 95% confidence interval [CI], 1.15-1.49; P<0.001), male sex (aOR, 1.74; 95% CI, 1.03-2.95; P=0.040), negativity for VDRL (aOR, 1.58; 95% CI, 1.16-2.14; P=0.003), and diagnosis after 1999 (aOR, 1.64; 95% CI, 1.05-2.56; P=0.031). Older age, male sex, negativity for VDRL, and diagnosis after 1999, were associated with late presentation, and the proportion of late presenters increased after the mandatory testing policy was abolished.

Is glaucoma blindness a disease of deprivation and ignorance? A case-control study for late presentation of glaucoma in India.

Aim:The aim was to identify the presenting symptoms and social risk factors for late presentation of primary glaucoma in newly diagnosed cases.Materials and Methods:It was a case-control study in a tertiary eye care center in Maharashtra, India. Newly diagnosed patients with primary glaucoma were classified as cases (late presenters) where there was no perception of light in one eye or severe visual field loss affecting an area within 20° of fixation or a cup–disc (C:D) ratio ≥0.8 and controls (early presenters), presenting relative scotoma within 20° of fixation or a C:D ratio <0.8, but >0.5. All patients underwent a comprehensive ocular examination including gonioscopy, perimetry, and detailed family and social history. Occupation, education, and socioeconomic status were graded. SPSS version 12.0 was used, and univariate and multivariate logistic regression analysis was performed.Results:Gradual progressive painless loss of vision was the commonest symptom (175, 87.5%). Primary angle closure glaucoma was more common in females (P = 0.001) and lower socioeconomic groups (P = 0.05). Patients who were less educated were more likely to have late presentation of glaucoma (P < 0.001, odds ratio = 0.07; 95% CI, 0.02–0.25). Knowledge of family history of glaucoma (P = 0.80, odds ratio = 1.16; 95% CI, 0.36–3.71) and eye clinic attendance in past 2 years still resulted in late presentation (P = 0.45, odds ratio = 1.34, 95% CI, 0.63–2.82).Conclusion:Lack of education and awareness of glaucoma were major risk factors for late presentation.

Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009

BackgroundEarly diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.MethodsDemographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.ResultsOf the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).ConclusionLate presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.

Socioeconomic status and delayed presentation in rhegmatogenous retinal detachment

Editor, Low socioeconomic status (SES) is associated with late presentation in glaucoma (Ng et al. 2009) and anisometropic amblyopia (Smith et al. 1994). However, it was not a risk factor for presentation with lower levels of vision in patients with exudative age-related macular degeneration (AMD). (Acharya et al. 2009) The aim of our study was to evaluate the effect of SES on delayed presentation (with detached macula) of patients with rhegmatogenous retinal detachment (RRD). Consecutive patients with RRD presenting between January 2003 and December 2004 at two ophthalmology departments in Scotland and being operated on mainly by JRM and NL were included in this study; their medical records were retrospectively reviewed. The Scottish Index of Multiple Deprivation (SIMD) 2006 was used to assess the SES of patients. The effect of the overall SIMD ranks on delayed presentation was investigated using multiple regression analysis. SIMD quintiles were used in the regression model. Only one eye per patient was included. Age, gender, laterality, poor visual acuity (VA) in the fellow eye (<6/12), history of trauma and whether the patient was living in the area (Local Authority) served by the hospital at Glasgow or Aberdeen were tested as possible confounding factors using forward selection. Data were statistically analysed using spss Ver. 17.0 (SPSS Inc, Chicago, IL, USA). The study was approved by Local Ethics Committees (06/S0801/015). One hundred and thirty-three participants were included (Table 1). Only age and area were statistically associated with increased risk of presentation with a detached macula (p = 0.001 and p = 0.031 respectively). SES (for quintiles 1, p =0.566; quintile 2, p = 0.101; quintile 3, p = 0.406; quintile 4, p = 0.676; quintile 5, p = 0.699), laterality (p = 0.514), gender (p = 0.576), poor vision in the fellow eye (p = 0.747) or history of trauma (p = 0.082) were not statistically associated with presentation with macula-off RRD. In Ophthalmology, the SIMD has been used to explore links between deprivation and late presentation in glaucoma (Ng et al. 2009) and AMD (Acharya et al. 2009). It appears that socioeconomic deprivation may have an impact on time of presentation in ocular diseases which cause gradual visual deterioration, such as glaucoma and amblyopia but seems not to have an impact on conditions in which visual loss occurs rapidly, such as exudative AMD and RRD; the reasons remain unclear. Advanced age is consistently found an independent risk factor for late presentation in many ocular (Acharya et al. 2009; Ng et al. 2009) and systemic diseases and was also observed in the current study. This link may be because of a more conservative health seeking behaviour in the elderly. Late presentation may also occur as a result of a lack of awareness of the disease or its presenting symptoms. In glaucoma, mostly asymptomatic, the knowledge and awareness of the disease increases with the level of education and SES. In contrast, public awareness of RRD is low. Quintyn et al. 2006 looked at 100 consecutive patients admitted for RD repair and found that 70% had no knowledge of the condition. There was no significant difference in the public awareness of RRD according to the level of education. Similarly, Goezinne et al. 2009 prospectively interviewed 186 patients presenting with RRD; 50% presented late because of lack of awareness of symptoms of RRD. Health promotion strategies, including patient education about warning symptoms, particularly among the people who are at high risk (such as high myopes), are essential to achieve prompt presentation for treatment in patients with RRD. Based on the current study, these strategies should target patients of all socioeconomic levels but specially the elderly.

Profile of women presenting for abortions in Singapore at the National University Hospital

The study was conducted to profile women seeking abortions at the National University Hospital, with particular interest in the trend of teenage pregnancies with the aim of identifying risk factors for late presentation for abortions. All patients who underwent an abortion at our center from January 1, 1996 to December 31, 2000 were recruited. Data were entered into a prepared questionnaire during the mandatory pre-abortion counseling sessions and completed at the 6-week post-abortion follow-up. This was then keyed into a database (SPSS Version 10), and the results were analyzed. Multivariate analysis was used in identifying risk factors associated with late presentation for abortions. Chi-square analysis of variables was used where relevant. A total of 1370 women presented for induced abortions during the period of study. The mean age of women was 29.6 years. Most women were either homemakers (35.3%) or semi-skilled workers (28.5%) with at least a secondary school education (58.3%). The majority were married (75.5%). There was a significant trend in the proportion of single women seeking abortions, from 18.3% in 1996 to 27.8% in 2000 (p < 0.05). At the same time, the proportion of women presenting for repeat abortions also increased from 13.8% in 1996 to 33.2% in 2000 (p < 0.05). Teenage abortions made up 117 (8.5%) of the study group, of which 95% were single women. Significant proportions (52.1%) were students at the time of abortion. In contrast to women above 20 years of age, pregnant teenagers were more likely not to have used any contraception (67.1% vs. 37.3%) and more likely to present late for abortion (18.8% vs. 10.4%). Teenage pregnancies are a major risk factor for late presentation for abortions. This emphasizes the need for availability and easy access to early abortion counseling, and the need for sex education with use of contraception starting in schools, to reduce abortions among teenagers.

Retrospective analysis of risk factors for late presentation of chronic glaucoma

BACKGROUNDWhy some individuals present to the ophthalmologist in the early stages of chronic glaucoma but others present with very advanced visual field loss is a question which has received little...