Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 5 Articles
Background. Oral lesions may constitute the first clinical manifestation in secondary syphilis, but detailed descriptions in HIV-infected individuals are scarce. Objective. To describe the clinical characteristics of oral secondary syphilis in HIV-infected patients and its relevance in the early diagnosis of syphilis. Methods. Twenty HIV/AIDS adult subjects with oral secondary syphilis lesions presenting at two HIV/AIDS referral centers in Mexico City (2003ââ?¬â??2011) are described. An oral examination was performed by specialists in oral pathology and medicine; when possible, a punch biopsy was done, and Warthin-Starry stain and immunohistochemistry were completed. Intraoral herpes virus infection and erythematous candidosis were ruled out by cytological analysis. Diagnosis of oral syphilis was confirmed with positive nontreponemal test (VDRL), and, if possible, fluorescent treponemal antibody test. Results. Twenty male patients (median age 31.5, 21ââ?¬â??59 years) with oral secondary syphilis lesions were included. Oral lesions were the first clinical sign of syphilis in 16 (80%) cases. Mucous patch was the most common oral manifestation (17, 85.5%), followed by shallow ulcers (2, 10%) and macular lesions (1, 5%). Conclusions. Due to the recent rise in HIV-syphilis coinfection, dental and medical practitioners should consider secondary syphilis in the differential diagnosis of oral lesions, particularly in HIV-infected patients....
Background: Japan has consistently shown a low fertility rate, which has been lower than the replacement level\r\nsince 1974, and represents one of the least fertile countries in the world. This study was designed to determine the\r\nfamily size preference of and its effect on Japanese women.\r\nMethods: We conducted a questionnaire survey among women who visited the obstetrics and gynecology\r\ndepartment of 18 hospitals and clinics in the Hyogo Prefecture, Japan, between October 2011 and February 2012.\r\nAll the women were categorized according to age group and area of residence, and the survey results were\r\nstatistically analyzed using a t test.\r\nResults: A total of 1616 women were included in this study. There was no significant difference between the mean\r\ndesired and actual marital ages (26.70 and 26.67 years, respectively). The mean desired number of children was 2.55,\r\nwhich was significantly more than the mean actual number of children (1.77) in all generations. The mean desired\r\nand actual numbers of children were more in the rural areas (2.73 and 2.09, respectively) than in the urban (2.54\r\nand 1.70, respectively) and semi-urban areas (2.49 and 1.60, respectively). The mean number of family members was\r\nsignificantly greater in the rural areas (3.84) than in the urban (3.25) and semi-urban areas (3.05).\r\nThe most important concern among women who had never delivered a baby was childbearing itself, followed by\r\nthe expenses related to pregnancy and childbearing.\r\nConclusions: The family size preference of the women in our study was higher than the actual numbers of\r\nchildren. The fertility intentions were low among the younger women but high among those living in rural areas\r\nwith larger families....
Background: Over the last three decades, cesarean section (CS) rates have been rising around the world despite\r\nno associated improvement in maternal and perinatal mortality and morbidity. The role of womenââ?¬â?¢s preferences for\r\nmode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult\r\nto assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this\r\nqualitative study, our objective was to understand womenââ?¬â?¢s preferences and motivational factors for mode of\r\ndelivery. This information will inform the development and design of an assessment aimed at understanding the\r\nrole of the womenââ?¬â?¢s preferences for mode of delivery.\r\nMethods: We conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in\r\nBuenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant\r\nwomen aged 18ââ?¬â??35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies\r\nresulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy,\r\nwithout an indication of elective cesarean section, and who are not health professionals. FGDs and interviews\r\nfollowed a pre-designed guide based on the health belief model and social cognitive theory of health decisions\r\nand behaviors.\r\nResults: Most of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was\r\nviewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with\r\nvaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred\r\ndecisions to medical staff in the presence of medical indication.\r\nConclusions: These findings converge with quantitative and qualitative studies showing that women prefer\r\ntowards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from womenââ?¬â?¢s\r\npreferences and reasons are discussed....
Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in\r\nthe short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on\r\nwhere the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly\r\nwhat sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system.\r\nMDSR systems are not yet established in most countries and have potential added value for policy making and\r\naccountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and\r\nconfidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national\r\nretrospective estimates periodically generated from academia or United Nations organizations but on routine\r\ncounting, investigation, sub national data analysis, long term investments in vital registration and national health\r\ninformation systems. Establishing effective maternal death surveillance and response will help achieve MDG 5,\r\nimprove quality of maternity care and eliminate maternal mortality (MMR = 30 per 100,000 by 2030)....
While infertility is a global challenge for millions of couples, low income countries have particularly high rates, of up\r\nto 30%. Infertility in these contexts is not limited to its clinical definition but is a socially constructed notion with\r\nvarying definitions. In highly pronatalistic and patriarchal societies like Pakistan, women bear the brunt of the social,\r\nemotional and physical consequences of childlessness. While the often harsh consequences of childlessness for\r\nPakistani women have been widely documented, there is a dearth of exploration into the ways in which prescribed\r\ngender roles inform the experiences of childlessness among Pakistani women and men. The aim of this study was\r\nto explore and compare how gender ideologies, values and expectations shape women�s and men�s experiences of\r\ninfertility in Pakistan. Using an interpretive descriptive approach, in-depth interviews were conducted with 12\r\nwomen and 8 men experiencing childlessness in Punjab, Pakistan from April to May 2008. Data analysis was\r\nthematic and inductive based on the principles of content analysis. The experience of infertility for men and\r\nwomen is largely determined by their prescribed gender roles. Childlessness weakened marital bonds with\r\ngendered consequences. For women, motherhood is not only a source of status and power, it is the only avenue\r\nfor women to ensure their marital security. Weak marital ties did not affect men�s social identity, security or power.\r\nWomen also face harsher psychosocial, social, emotional and physical consequences of childlessness than men.\r\nThey experienced abuse, exclusion and stigmatization at the couple, household and societal level, while men only\r\nexperienced minor taunting from friends. Women unceasingly sought invasive infertility treatments, while most\r\nmen assumed there was nothing wrong with themselves. This study highlights the ways in which gender roles and\r\nnorms shape the experiences associated with involuntary childlessness for men and women in Punjab, Pakistan.\r\nThe insight obtained into the range of experiences can potentially contribute to deeper understanding of the social\r\nconstruction of infertility and childlessness in pronatalistic and patriarchal societies as well as the ways in which\r\ngender ideologies operationalise to marginalise women....
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