Attitude toward contraception and abortion among Curaçao women. Ineffective contraception due to limited sexual education?

Background In Curaçao is a high incidence of unintended pregnancies and induced abortions. Most of the induced abortions in Curaçao are on request of the woman and performed by general practitioners. In Curaçao, induced abortion is strictly prohibited, but since 1999 there has been a policy of connivance. We present data on the relevance of economic and socio-cultural factors for the high abortion-rates and the ineffective use of contraception. Methods Structured interviews to investigate knowledge and attitudes toward sexuality, contraception and abortion and reasons for ineffective use of contraceptives among women, visiting general practitioners. Results Of 158 women, 146 (92%) participated and 82% reported that their education on sexuality and about contraception was of good quality. However 'knowledge of reliable contraceptive methods' appeared to be - in almost 50% of the cases - false information, misjudgements or erroneous views on the chance of getting pregnant using coitus interruptus and about the reliability and health effects of oral contraceptive pills. Almost half of the interviewed women had incorrect or no knowledge about reliability of condom use and IUD. 42% of the respondents risked by their behavior an unplanned pregnancy. Most respondents considered abortion as an emergency procedure, not as contraception. Almost two third experienced emotional, physical or social problems after the abortion. Conclusions Respondents had a negative attitude toward reliable contraceptives due to socio-cultural determined ideas about health consequences and limited sexual education. Main economic factors were costs of contraceptive methods, because most health insurances in Curaçao do not cover contraceptives. To improve the effective use of reliable contraceptives, more adequate information should be given, targeting the wrong beliefs and false information. The government should encourage health insurance companies to reimburse contraceptives. Furthermore, improvement of counseling during the abortion procedure is important

Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curacao

Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curacao, where induced abortion is severely restricted by law. Methods In a prospective study 330 women received 200 mg mifepristone and were instructed to take four tablets (800 mg) of misoprostol via the buccal route 24-36 h later, at home. One week later, follow-up took place. Results The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64-70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea. Conclusion Home administration of buccal misoprostol 24-36 h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curacao, where induced abortion is legally restricted

Induced abortion is not associated with a higher likelihood of depression in Curacao women

Objective To investigate the risk of developing a depression after induced abortion. Methods A prospective cohort study conducted in Curacao which involved 92 women having an induced abortion and 37 women delivering after an unplanned or unwanted pregnancy, who served as controls. All participants completed the Center of Epidemiological Studies Depression (CES-D) scale before and two to three weeks after the abortion or delivery. Results Following the abortion, significantly fewer women were at risk of depression (30%) as compared to when still pregnant (60%). Mean depression scores were significantly lower after-than before the procedure. The likelihood of depression post-abortum (30%) was similar to that after delivery of an unplanned/unwanted child (22%). Even though women in the abortion group more often reported having suffered from depression in the past than controls, they were not at greater risk of depression after their pregnancy had ended. Conclusion Curacao women's risk of developing a depression following an (early) induced abortion is not greater than that after carrying to term an unplanned/unwanted pregnancy. We recommend that the results of this study be taken into account in case the Curacao government should consider legalisation of induced abortion in the near futur

Assessing locomotion deficiency in broiler chicken Medida de deficiência locomotora em frango de corte

Locomotion deficiencies in broiler production cause poor welfare and lead to change in drinking and feeding behavior with consequent loss in weight gain. This research aimed to assess locomotion deficiencies in broiler chicken by analyzing the vertical peak force on both feet during walk. A chamber was built with an inlet ramp, a horizontal walkway in the middle and an outlet ramp. In the walkway a thin mat with piezoelectric crystal sensors was placed to record the step vertical peak force of the feet while walking on the force platform. The measurement system consisted of a mat with electronic sensors and software that allowed real time recording of the forces and the processing and analysis of data. Footage was taken from two digital video cameras and used for gait scoring. Forty male broilers were chosen at random, grown under similar rearing conditions and farms, with age varying from 49 to 28 days (ten birds of same age) to be used in the trial. Measurement consisted of inducing the bird to walk on the force platform which automatically registered the peak vertical force of the steps. Results showed that the gait score increased with the weight and age of the birds. Peak force asymmetry was found for each foot, independent of age or gait score. Although not identified visually in the broilers, the peak vertical force values differed in both right and left feet leading to slow and uneven walking. Walking deficiency was more severe in older birds.<br>Deficiência em locomoção é hoje um dos problemas mais importantes na produção de frangos de corte. É causa de baixo bem-estar e leva a alteração no comportamento de bebida e alimentação, com conseqüente perda de ganho de peso. Mediram-se deficiências locomotoras em frango de corte por meio da análise do pico de força plantar vertical em ambas as patas, durante a caminhada. Foi construída uma câmara com uma rampa de entrada, uma área horizontal de passagem e uma rampa de saída. Na parte horizontal da área de passagem foi colocado um tapete fino, com elementos sensores de cristal piezoelétrico, para registrar o pico de força vertical das patas do frango quando este caminhava sobre a plataforma. O sistema de mensuração consistiu de um tapete com sensores eletrônicos e um programa computacional que permitiu o registro de forças em tempo real e o processamento e a análise de dados. Imagens de vídeo foram tomadas a partir de duas câmeras digitais para atribuir o gait score. Quarenta frangos machos foram aleatoriamente selecionados em condições similares de alojamento e da mesma granja, com idade variando de 49 a 28 dias (dez de cada idade) e usados no experimento. A medida consistiu em induzir a ave a caminhar sobre a plataforma de força que automaticamente registrava o pico de força da passada. O gait score aumentou com o peso e a idade das aves. Foi encontrada assimetria nos picos de força da cada pata, independente da idade ou gait score. Embora não tenha sido identificado visualmente nos frangos, o pico de força vertical é diferente tanto na pata direita quanto na esquerda, levando a um caminhar lento e desigual. A deficiência locomotora foi mais intensa em aves mais velhas

Sex Differences in Diagnosis, Treatment, and Cardiovascular Outcomes in Homozygous Familial Hypercholesterolemia

IMPORTANCE Homozygous familial hypercholesterolemia (HoFH) is a rare genetic condition characterized by extremely increased low-density lipoprotein (LDL) cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Heterozygous familial hypercholesterolemia (HeFH) is more common than HoFH, and women with HeFH are diagnosed later and undertreated compared to men; it is unknown whether these sex differences also apply to HoFH. OBJECTIVE To investigate sex differences in age at diagnosis, risk factors, lipid-lowering treatment, and ASCVD morbidity and mortality in patients with HoFH. DESIGN, SETTING, AND PARTICIPANTS Sex-specific analyses for this retrospective cohort study were performed using data from the HoFH International Clinical Collaborators (HICC) registry, the largest global dataset of patients with HoFH, spanning 88 institutions across 38 countries. Patients with HoFH who were alive during or after 2010 were eligible for inclusion. Data entry occurred between February 2016 and December 2020. Data were analyzed from June 2022 to June 2023. MAIN OUTCOMES AND MEASURES Comparison betweenwomen and men with HoFH regarding age at diagnosis, presence of risk factors, lipid-lowering treatment, prevalence, and onset and incidence of ASCVD morbidity (myocardial infarction [MI], aortic stenosis, and combined ASCVD outcomes) and mortality. RESULTS Data from 389 women and 362 men with HoFH from 38 countries were included. Women and men had similar age at diagnosis (median [IQR], 13 [6-26] years vs 11 [5-27] years, respectively), untreated LDL cholesterol levels (mean [SD], 579 [203] vs 596 [186]mg/dL, respectively), and cardiovascular risk factor prevalence, except smoking (38 of 266 women [14.3%] vs 59 of 217 men [27.2%], respectively). Prevalence of MI was lower in women (31 of 389 [8.0%]) than men (59 of 362 [16.3%]), but age at first MI was similar (mean [SD], 39 [13] years in women vs 38 [13] years in men). Treated LDL cholesterol levels and lipid-lowering therapy were similar in both sexes, in particular statins (248 of 276 women [89.9%] vs 235 of 258 men [91.1%]) and lipoprotein apheresis (115 of 317 women [36.3%] vs 118 of 304 men [38.8%]). Sixteen years after HoFH diagnosis, women had statistically significant lower cumulative incidence of MI (5.0% in women vs 13.7%in men; subdistribution hazard ratio [SHR], 0.37; 95%CI, 0.21-0.66) and nonsignificantly lower all-cause mortality (3.0% in women vs 4.1% in men; HR, 0.76; 95%CI, 0.40-1.45) and cardiovascular mortality (2.6% in women vs 4.1% in men; SHR, 0.87; 95%CI, 0.44-1.75). CONCLUSIONS AND RELEVANCE In this cohort study of individuals with known HoFH, MI was higher in men compared with women yet age at diagnosis and at first ASCVD event were similar. These findings suggest that early diagnosis and treatment are important in attenuating the excessive cardiovascular risk in both sexes.</p

Sex Differences in Diagnosis, Treatment, and Cardiovascular Outcomes in Homozygous Familial Hypercholesterolemia

IMPORTANCE Homozygous familial hypercholesterolemia (HoFH) is a rare genetic condition characterized by extremely increased low-density lipoprotein (LDL) cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Heterozygous familial hypercholesterolemia (HeFH) is more common than HoFH, and women with HeFH are diagnosed later and undertreated compared to men; it is unknown whether these sex differences also apply to HoFH. OBJECTIVE To investigate sex differences in age at diagnosis, risk factors, lipid-lowering treatment, and ASCVD morbidity and mortality in patients with HoFH. DESIGN, SETTING, AND PARTICIPANTS Sex-specific analyses for this retrospective cohort study were performed using data from the HoFH International Clinical Collaborators (HICC) registry, the largest global dataset of patients with HoFH, spanning 88 institutions across 38 countries. Patients with HoFH who were alive during or after 2010 were eligible for inclusion. Data entry occurred between February 2016 and December 2020. Data were analyzed from June 2022 to June 2023. MAIN OUTCOMES AND MEASURES Comparison betweenwomen and men with HoFH regarding age at diagnosis, presence of risk factors, lipid-lowering treatment, prevalence, and onset and incidence of ASCVD morbidity (myocardial infarction [MI], aortic stenosis, and combined ASCVD outcomes) and mortality. RESULTS Data from 389 women and 362 men with HoFH from 38 countries were included. Women and men had similar age at diagnosis (median [IQR], 13 [6-26] years vs 11 [5-27] years, respectively), untreated LDL cholesterol levels (mean [SD], 579 [203] vs 596 [186]mg/dL, respectively), and cardiovascular risk factor prevalence, except smoking (38 of 266 women [14.3%] vs 59 of 217 men [27.2%], respectively). Prevalence of MI was lower in women (31 of 389 [8.0%]) than men (59 of 362 [16.3%]), but age at first MI was similar (mean [SD], 39 [13] years in women vs 38 [13] years in men). Treated LDL cholesterol levels and lipid-lowering therapy were similar in both sexes, in particular statins (248 of 276 women [89.9%] vs 235 of 258 men [91.1%]) and lipoprotein apheresis (115 of 317 women [36.3%] vs 118 of 304 men [38.8%]). Sixteen years after HoFH diagnosis, women had statistically significant lower cumulative incidence of MI (5.0% in women vs 13.7%in men; subdistribution hazard ratio [SHR], 0.37; 95%CI, 0.21-0.66) and nonsignificantly lower all-cause mortality (3.0% in women vs 4.1% in men; HR, 0.76; 95%CI, 0.40-1.45) and cardiovascular mortality (2.6% in women vs 4.1% in men; SHR, 0.87; 95%CI, 0.44-1.75). CONCLUSIONS AND RELEVANCE In this cohort study of individuals with known HoFH, MI was higher in men compared with women yet age at diagnosis and at first ASCVD event were similar. These findings suggest that early diagnosis and treatment are important in attenuating the excessive cardiovascular risk in both sexes.</p