Rationale for the Study of the Human Sex Ratio in Population Studies of Polluted Environments

Cadernos De Saúde Pública / Ministério Da Saúde, Fundação Oswaldo Cruz, Escola Nacional De Saúde Pública. Mar-Apr, 2002  |  Pubmed ID: 11923884

The human secondary sex ratio remains a subject of substantial interest. The possibility has been raised that environmental chemical exposures have played a role in the changes associated with the sex ratio in a number of countries. The possibility that such an effect may be present is supported at least theoretically by the observation that clomiphene citrate, a drug used in the treatment of infertility with powerful estrogenic and anti-estrogenic properties, has profound effects on the sex ratio resulting in significantly fewer males at birth. Using a model of causality based on the clinical identification of adverse drug effect methodology one may improve the objectivity of the assessment of significant environmental exposures on this human reproductive outcome.

Evaluation of Satisfaction with Midwifery Care

Midwifery. Dec, 2002  |  Pubmed ID: 12473441

to determine if there were differences in women's satisfaction with maternity care given by doctors and midwives. In addition a simple, six-question, satisfaction questionnaire was to be tested.

Economic Evaluation in Obstetrics and Gynaecology: Principles and Practice

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Mar, 2003  |  Pubmed ID: 12610674

Greater attention in health care over the last 2 decades has been placed on determining how best to spend the resources available. Economic evaluation is a commonly used tool to compare health-care services and treatments on the basis of costs and benefits. However, the principles on which economic evaluations are based are not well understood, and guidelines for conducting such evaluations in practice are often not followed. This paper describes the overarching principle of opportunity cost, and highlights the implication that decision-making in health care should necessarily be based on both costs and benefits. Two notions of efficiency, technical and allocative, are also presented, and the important point is made that the specific type of economic evaluation chosen must be based not on the unit of benefit in the given study, as is commonly done, but rather on the type of efficiency being addressed. The 3 primary types of economic evaluation are outlined, and a common pitfall in economic evaluation, the incremental cost-effectiveness ratio, is critiqued. Finally, a number of methodological considerations when conducting economic evaluations in practice are presented.

The Weight of Chronic Pelvic Pain

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. May, 2004  |  Pubmed ID: 15151732

Myofascial Dysfunction in the Pelvis

Current Pain and Headache Reports. Dec, 2004  |  Pubmed ID: 15509458

Chronic pelvic pain is a potentially devastating condition that affects many women with severe consequences. A multifaceted condition, chronic pelvic pain enjoys a diverse etiology, a myriad of treatments, and a correspondingly irregular response to therapy. The condition can be associated with severe physical dysfunction in relation to voiding, defecation, and sexual function. Although emphasis has been placed on surgical approaches to therapy, there is increasing interest in alternative therapies, particularly using the principles of the treatment of myofascial dysfunction.

Longitudinal Assessment of PCBs and Chlorinated Pesticides in Pregnant Women from Western Canada

Environmental Health : a Global Access Science Source. 2005  |  Pubmed ID: 15927085

Maternal exposures to organochlorines prior to pregnancy are considered a risk to neonatal welfare, specifically in relation to neurocognitive functions. There is growing interest in the evaluation of maternal blood testing as a marker for fetal exposure as well as the variable geographic distribution of these priority chemicals.

Laparoscopy and Reported Pain Among Patients with Endometriosis

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. May, 2005  |  Pubmed ID: 16100643

To compare the effectiveness of sharp excision of endometriosis with sham surgical excision in alleviating endometriosis-associated pain for up to 1 year following surgery.

Consensus Guidelines for the Management of Chronic Pelvic Pain

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Aug, 2005  |  Pubmed ID: 16287011

To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates.

Consensus Guidelines for the Management of Chronic Pelvic Pain

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Sep, 2005  |  Pubmed ID: 19830953

To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates.

Maternal Lead Exposure and the Secondary Sex Ratio

Human Reproduction (Oxford, England). Jul, 2006  |  Pubmed ID: 16517560

A reduction in the secondary sex ratio may be associated with exposure to environmental toxicants. Little data exists relating this outcome to lead exposure, a well-known reproductive toxicant.

Metal Oxide Coated Cell Culture Arrays for Rapid Biological Screening

Journal of Biomedical Materials Research. Part A. Dec, 2007  |  Pubmed ID: 17559130

The biointerface of metallic alloy implants is a spontaneously formed metal oxide layer. This study presents a novel method for creating titanium oxide xerogel coated microplates for high-throughput biological screening that overcomes several limitations of using bulk metal samples to study oxides. Metal-organic precursors were used to evaluate the influence of Al, V, Ca, and P doped smooth and textured titanium oxide xerogel coatings on the bioresponse of human fibroblasts to increase understanding of the soft tissue sealing around transepithelial devices. Coatings made of titanium n-butoxide were characteristically smooth, while those of titanium isopropoxide were micro- and nanofeatured. Screening consisted of WST-1 proliferation assay, calcein AM cell number and viability assay, and a modified cell seeding efficiency and centrifugation adhesion assay. Small variations in initial attachment and centrifugation adhesion of human fibroblasts were observed among the coatings and comparable to tissue-culture treated polystyrene. Proliferation and viability at 24 and 48 h were reduced by the 10 and 20% vanadium additions. Metal oxide coated microplates are adaptable to the investigation of a wide range of metal-organic derived chemistries and the influence of oxide texture, and level of oxide crystallinity and oxide grain size on the biological responses of cells.

Endocrine Disruptors and Spontaneous Premature Labor: a Case Control Study

Environmental Health : a Global Access Science Source. 2007  |  Pubmed ID: 18005447

Premature labor is a poorly understood condition. Estrogen is thought to play a key role and therefore the labor process may be affected by endocrine disruptors. We sought to determine whether or not an environmental toxicant, DDE, or dietary derived endocrine disruptors, daidzein and genistein, are associated with spontaneous preterm labor.

Women's Pain Experience Predicts Future Surgery for Pain Associated With Endometriosis

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Dec, 2007  |  Pubmed ID: 18053384

A previous randomized controlled trial from 1991 to 1993 comparing excision of endometriosis with sham surgery demonstrated no difference in reported pain after blinding between the excision and sham groups for one year. Overall, when both groups were considered, there was a significant reduction in pain one year postoperatively. This trial was done to determine the predictors of subsequent surgery.

Peripartum Hysterectomy: 1999 to 2006

Obstetrics and Gynecology. Mar, 2008  |  Pubmed ID: 18310378

To estimate the rate of peripartum hysterectomy over the last 8 years in Calgary, the primary indication for peripartum hysterectomy (defined as any hysterectomy performed within 24 hours of a delivery), and whether there was an increase in the rate of peripartum hysterectomy during that time.

Meeting Report: Measuring Endocrine-sensitive Endpoints Within the First Years of Life

Environmental Health Perspectives. Jul, 2008  |  Pubmed ID: 18629319

An international workshop titled "Assessing Endocrine-Related Endpoints within the First Years of Life" was held 30 April-1 May 2007, in Ottawa, Ontario, Canada. Representatives from a number of pregnancy cohort studies in North America and Europe presented options for measuring various endocrine-sensitive endpoints in early life and discussed issues related to performing and using those measures. The workshop focused on measuring reproductive tract developmental endpoints [e.g., anogenital distance (AGD)], endocrine status, and infant anthropometry. To the extent possible, workshop participants strove to develop or recommend standardized measurements that would allow comparisons and pooling of data across studies. The recommended outcomes include thigh fat fold, breast size, vaginal cytology, AGD, location of the testis, testicular size, and growth of the penis, with most of the discussion focusing on the genital exam. Although a number of outcome measures recommended during the genital exam have been associated with exposure to endocrine-disrupting chemicals, little is known about how predictive these effects are of later reproductive health or other chronic health conditions.

Diagnostic and Operative Laparoscopy in Alberta 1994-2006

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Nov, 2008  |  Pubmed ID: 19126287

Laparoscopic surgery has become an important procedure in the diagnosis and management of pelvic pathology. Whether or not repeat laparoscopic procedures, sometimes repeated several times, are of real benefit is unclear. This study was designed to quantify the experience of one province during the period 1994-2006 to explore patterns of laparoscopic surgery.

Intravenous Nitroglycerin for External Cephalic Version: a Randomized Controlled Trial

Obstetrics and Gynecology. Sep, 2009  |  Pubmed ID: 19701035

To estimate whether treatment with intravenous nitroglycerin for uterine relaxation increases the chance of successful external cephalic version.

Controlled Release of Vanadium from Titanium Oxide Coatings for Improved Integration of Soft Tissue Implants

Journal of Biomedical Materials Research. Part A. Jul, 2009  |  Pubmed ID: 18496866

This study evaluates the potential of titanium oxide coatings for short-term delivery of vanadium for improved wound healing around implants. Titanium and vanadium oxides are bioactive agents that elicit different bioresponses in cells, ranging from implant integration and reduction of inflammation to modulation of cell proliferation and morphology. These oxides were combined in biomaterial coatings using metal-organic precursors and rapidly screened in cell-culture microplates to establish how vanadium-loading influences cell proliferation and morphology. Twenty-eight-day elution studies indicated that there was a controlled release of vanadium from stable titanium oxide matrices. Elution profiles were mathematically modeled for vanadium loading of 20-1.25% up to a period of 28 days. Scanning electron microscopy and energy dispersive spectroscopy of the coatings indicated that the vanadium was present as a nanoscale dispersion and not segregated micron-scale islands. The study confirmed that the observed bioresponse of cells was modulated by the soluble release of vanadium into the surrounding medium. Controlled release of vanadium from titania coatings may be used to influence soft-tissue integration of implants by modulating cell proliferation, attachment, inflammation, and wound healing dynamics.

Rapid Screening, in Vitro Study of Metal Oxide and Polymer Hybrids As Delivery Coatings for Improved Soft-tissue Integration of Implants

Journal of Biomedical Materials Research. Part A. Mar, 2010  |  Pubmed ID: 19301265

Metal-organic chemistry allows for molecular mixing and creation of a range of submicron phase-separated structures from normally brittle metal oxides and flexible polymers with improved bioactivity and delivery properties. In this study, we used a high throughput platform to investigate the influence of organic metal oxide doping of polydimethylsiloxane (PDMS) coatings on cellular bioactivity and controlled release of vanadium compared with titanium oxide coatings without additional PDMS. Metal-organic-derived titanium and or vanadium was doped into PDMS and used to form a coating on the bottom of cell culture microplates in the absence of added water, acids, or bases. These hybrid coatings were rapidly screened to establish how titanium and vanadium concentration influences cell proliferation, adhesion, and morphology. We demonstrate that titanium doping of PDMS can be used to improve cell proliferation and adhesion, and that vanadium doping caused a biphasic dose response in proliferation. A 28-day vanadium and titanium elution study indicated that titanium was not released, but the presence of PDMS in coatings increased delivery rates of vanadium compared with titania coatings without polymer. Hybrid coatings of titanium-doped polymers have potential for improving wound healing dynamics, soft-tissue integration of medical implants, and use as controlled delivery vehicles.

Myofascial Pain in the Adolescent

Current Opinion in Obstetrics & Gynecology. Oct, 2010  |  Pubmed ID: 20739884

Whereas in the recent past pain in the child and adolescent was directed to cancer management, there is increasing interest in pain in children and adolescents in relation to nonmalignant conditions. Additionally, there is an emerging literature related to disorders of myofascial function as a cause of pain.

Annual Repeat Rates of Laparoscopic Surgery: a Marker of Practice Variation

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. Sep-Oct, 2010  |  Pubmed ID: 20833984

Use of laparoscopy is an area of interest owing to a previous report of significant numbers of repeat laparoscopic surgery in some women in Alberta, Canada. It was hypothesized that analyzing individual-woman rates of annual repeat procedures documents potential overuse of laparoscopic surgery. Administrative data concerning yearly individual specific laparoscopy experiences were obtained from Alberta Health and Wellness for the years 1996 to 2007. Rates of repeat diagnostic and operative laparoscopic procedures were determined for each fiscal year and analyzed using statistical process control methods. The rate of reoperation for an individual woman for both procedures has "special causes" of variation. Rates of reoperation within the fiscal year varied significantly. The reasons could include operating room access, initial clinical enthusiasm for new surgery, changing surgical skills, and changing processes in decision making. The presence of such variation will require policy initiatives to address high rates of annual repeat procedures.

Endometriosis and Abdominal Myofascial Pain in Adults and Adolescents

Current Pain and Headache Reports. Oct, 2011  |  Pubmed ID: 21755274

Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders.

Tranquil Estuary

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstétrique Et Gynécologie Du Canada : JOGC. Aug, 2011  |  Pubmed ID: 21954507

Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

Pain Research and Treatment. 2011  |  Pubmed ID: 22135736

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.