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There is an increasing by women only became prevalent in the second half of the 20th century. In developing countries, less comprehen Europe 760,086 772,675 319,568 sive data are available. It is clear, however, Russia 290,000 86,000 2,200 that a great increase in smoking has taken place during the last decade in many coun Africa 274,624 85,989 187,208 tries. The increase is particularly dramatic in China, where more than 60% of adult China 2,000,000 80,000 10,000 men are estimated to smoke, representing India 525,000 100 104,862 almost one-third of the total number of smokers worldwide. The prevalence of Global 6,660,000 1,512,638 1,484,144 smoking among women in most develop ing countries is still low, although in many Table 2. In some regions, such as Africa and India, the export countries young women are taking up the of tobacco is a major source of income. In India and its neighbouring coun tries, smokeless tobacco is widely used and bidi? smoking is also common, this being the cheapest form of smoking avail able. Non-smokers are exposed to environmen tal tobacco smoke, the extent of exposure being determined primarily by whether family members smoke and by workplace conditions. The amount of tobacco smoke inhaled as a consequence of atmospheric pollution is much less than that inhaled by an active smokers [5]. Cancer risk Tobacco smoking is the main known cause of human cancer-related death worldwide. For a smoker, lung cancer risk is related to the parameters of tobacco smoking in accordance with the basic principles of chemical carcinogene sis: risk is determined by the dose of car cinogen, the duration of administration and the intensity of exposure. In respect of these determinants of lung cancer risk, women are at least as susceptible as men. An increase in risk of lung cancer (relative to a non-smoker) is consistently evident at the lowest level of daily consumption, and Fig. Hence, the annual death rate from lung cancer among 55-64 year-olds who smoked 21-39 cigarettes daily is about three times higher for those who started smoking at age 15 than for those who started at age 25. Smoking of black Within many communities, smoking, and lung cancer will sweep the developing tobacco cigarettes represents a greater hence lung cancer, are sharply related to world in the coming decades [8]. Between communities In addition to lung cancer, smoking causes smoking of blond cigarettes. Similarly, fil worldwide, incidence of lung cancer varies cancers of the larynx, oral cavity, pharynx, tered and low-tar cigarettes entail a lower dramatically. High rates are observed in oesophagus, pancreas, kidney and bladder risk for most tobacco-related cancers than parts of North America, while developing [2] (Table 2. A maximal cigarette smoking but, for example, cigar data summarized above establish causa impact of lung cancer occurs when the and pipe smoking present a greater risk for tion? because of the consistency of results, population has attained a maximal preva cancer of the oral cavity than does ciga the strength of the relationship, its speci lence of smoking that has continued rette smoking. For cancer of the bladder ficity, the temporal sequence between throughout most of the life span of the and kidney, risks vary with the duration and exposure and disease and the dose? smokers.
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The following 14 recommendations have been suggested: cold fan, ice water and treating smaller areas at a time. Photoactivation of bacteria Photoinactivation of Gram-positive and Gram-negative bacteria is based on the accumulation of photosensitizers in significant amounts in or at the cytoplasmic membrane, the critical target for inducing irreversible damage to bacteria. It has been established that Gram-positive bacteria are very sensitive to the photosensitizing action of anionic or neutral photosensitizers absorbing visible light. Subsequently, singlet oxygen is produced which results in bacterial destruction (Arakane et al. This formation of porphyrins further increases at higher temperatures (Ramstad et al. Light therapy and Acne Vulgaris Sun exposure is reported to have a beneficial effect on acne by up to 70% of the patients (Cunliffe 1989). Sunlight has been reported to have an anti-inflammatory action in acne, possibly by its effect on follicular Langerhans cells (Cunliffe et al. In order to define the most effective wavelengths for treating acne with visible light, Sigurdsson et al. In their landmark study in the year 2000, the authors reported statistically significant clearance of acne for 10 weeks after a single treatment and for 20 weeks after four treatments. They used red laser light for photoactivation; however, they found contrasting results, i. The postulated mechanism of photodynamic therapy of acne is the photodestruction of P. The most common treatment protocols for light treatment of acne are based on either red or blue light. Red Light Although it has a lower extinction coefficient, red light has better penetration in the skin than blue light. Red light may also have anti-inflammatory properties by influencing cytokinase 16 release from macrophages (Young et al. Blue Light Theoretically blue light has the most effective wavelength for photoactivation of f P. In the clinic the practitioners must sacrifice penetration depth for absorption efficiency and vice versa. There are studies showing a therapeutic effect of blue light in the treatment of Acne Vulgaris (Morton et al. Phototherapy with mixed blue (450 nm) and red light (660nm) has been proposed to be more effective than blue light alone for treating mild to moderate acne, probably by combining antibacterial and anti-inflammatory actions (Papageorgiou et al.
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Our eight-page questionnaire covered in detail the freestanding, in different regions of the country and in states reasons why the respondent chose to terminate her preg with differing restrictions on access to and Medicaid re nancy. If sen to represent varying city sizes and to capture a cross you have more than one reason, please list them all, start section of abortion patients. Multiple responses were allowed, and a space was ed 30?60 minutes and were anonymous. Finally, women were asked interview period began at the end of the structured survey about their demographic and social characteristics. We purposively sampled 11 facilities from the universe of known abortion providers that perform 2,000 or more Data Analysis abortions per year; such facilities performed 56% of all abor We used chi-square tests to examine differences in reasons tions in the United States in 2000. Multivariate sen to be broadly representative, rather than strictly sta logistic regression models re? In addition, we at least one facility in each of the nine major geographic di conducted a factor analysis of the closed-ended and write visions de? Census Bureau, and chose fa in reasons and subreasons to identify logical groupings. We therefore periods, parental consent regulations and use of state Med weighted? Of the 11 sites originally chosen, one clinic de 2004 survey was not nationally representative, individual clined to participate and was replaced by a similar facility. Because the sampling design in the questionnaire was pretested at a clinic that was not volved 11 primary sampling units, we used statistical tech part of the sample to assess how well women understood niques that accounted for the clustered design to calculate the informed consent process and the survey questions. Staff at the selected facilities asked women arriving for *In 1987, the question about ability to afford a baby did not offer speci? The most common a pregnancy termination to participate in the survey and, responses were used to create the options for the 2004 version. Percentage of women in various surveys of abortion patients, by selected of gestation, and 85% were at fewer than 13 weeks. Black 31 45 32 26 26 Fifty percent of women were below 200% of the federal Hispanic 19 11 20 7 13 poverty level in the 1987 survey of reasons, while in 2004, <9 weeks? gestation 61 39 u 55 50 <13 weeks? gestation 85 58 u 87 86 60% were below this level. We conducted all analyses using dren, and two-thirds were living below 200% of the feder Stata version 8. Marital status was similar between the two sam Of the 1,209 respondents, 4% gave no reasons and were ples. Furthermore, almost half of the women than of the others were nonwhite and had children. The audiocassettes of the in-depth interviews were pro fessionally transcribed, and the research team listened to every Reasons for Abortion tape while reviewing the transcription. Among the structured survey respon ed, and any information that could potentially identify re dents, the two most common reasons were having a baby spondents was removed. The edited transcripts were sys would dramatically change my life? and I can?t afford a baby tematically coded using categories based on the project focus now? (cited by 74% and 73%, respectively?Table 2).
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It also usually yields less complete detail on each case and underestimates the number of congenital anomalies that occur. In addition, because reported information is not validated, it could also overestimate certain congenital anomalies. Hybrid case ascertainment Hybrid case ascertainment refers to a combination of passive case ascertainment of most types of congenital anomalies, with active case ascertainment of specifc congenital anomalies, or for a percentage of all reported congenital anomalies as a quality control tool. For example, a surveillance programme can conduct active ascertainment of neural tube defects to gather more detailed case information in a more timely manner, but carry out passive ascertainment of all other congenital anomalies under surveillance. Similarly, a programme can use passive reporting with active follow-up verifcation of certain congenital anomalies. Regardless of the method selected for case ascertainment (active or passive), each participating hospital can identify a champion? who is committed to the programme. This could help to ensure more complete participation of the diferent hospital units and services participating in the surveillance programme. Also, the role of this leader could 19 be to train other personnel (such as doctors, nurses and technicians) on how to identify cases, record the information and oversee the information fow, so as to maintain an ongoing and active quality control on the quantity and completeness of information. Case fnding Congenital anomalies surveillance programmes can decide the sources from which cases will be identifed (see Fig. Case fnding Data sources Using multiple sources may improve the completeness of case ascertainment by identifying cases that are not available from only one individual source. Additionally, it may improve the quality of the data, as having multiple sources may increase the amount and level of information available for a given case. For example, a diagnosis may not be possible in the delivery unit but may be established by specialists in the paediatric unit and further confrmed by laboratory tests. While the use of multiple data sources is more time consuming and delays the process of gathering information, it can improve overall case ascertainment and data quality. Using a single source for case ascertainment does not allow for ascertainment of the majority of fetuses or neonates with a congenital anomaly in most settings. Source: Birth Defects Surveillance Programme Puerto Rico Department of Health, and Auxiliary Secretariat for Planning and Development, San Juan, Puerto Rico. Case inclusion Each surveillance programme decides which congenital anomalies to include. A programme may choose to include all major congenital anomalies, while another programme may decide to include selected congenital anomalies, according to the needs of the country (see Fig. As discussed in Chapter 4, one consideration is to start with a small number of easily recognizable congenital anomalies and then expand to include additional anomalies, as a programme gains experience and resources. From a quality standpoint, checkboxes alone are typically insufcient to achieve high data quality, both in initial data abstraction and in case review. However, if a country has the resources to collect data electronically, a checkbox could be useful as a frst step, if there is a drop-down menu with more options to categorize the congenital anomaly.
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A new Ministry of Plan Implementation that reported directly to the prime minister was put in charge of formulating and implementing national population policy. Finally, the government planned to amend the tax laws to limit deductions for children (Min istry of Plan Implementation and Westinghouse Health Systems 1983). A seminar titled Family Planning above Party Politics? was held on the occasion of the visit by the needs assessment mission (Ministry of Plan Implementation 1980). In pursuit of these policies, the government set up 25 district population committees, each led by the head of a district administration, whose members represented relevant min istries and departments and included field officers, to monitor population policy (Ministry of Plan Implementation and Westinghouse Institute for Resource Devel opment 1988). Completion of the Demographic Transition, 1966?the Present the original demographic targets formulated in 1966 and abandoned in 1970?71 were not met in 1976. Measurement of the principal traditional methods, rhythm, condom, and withdrawal, varied by survey, and this accounts for the inconsistent results in total traditional method use, and therefore in total use. However, use of modern methods follows a reg ular trend, and does so for each individual method. As noted earlier, the first estimate of the prevalence of contraceptive use carried out in late 1969 using program acceptor and follow-up survey data suggested a cur rent modern-method user rate of 5 to 6 percent. Except for condom acceptors in the public sector, reliable data on the use of traditional methods such as rhythm or withdrawal were not available at that time (Wright 1970b). It also suggested that, at least for the pill, the reach of the social marketing program was perhaps less extensive than it had been in the mid-1970s. Even though the program failed to reach its acceptor and demographic targets by 1976, the evidence suggests a decline in marital fertility during the prior 10-year period. Induced abortion, illegal during this period, and later, is likely to have increased as the economic pressure for smaller families intensified and approval of family planning increased (Potts 1978). No direct information is available on this issue, but hospital morbidity and mortality data may be indicative. For example, hos pitalization for complications attributed to induced abortion increased by more than 30 percent between 1970 and 1985. Fortunately, hospital mortality associated with these cases decreased over the period (Ministry of Health 1985). Abhayaratne and Jayawardene (1967) point out that use of the traditional methods may have been far more extensive than thought. To the extent that this is true, they may have played an important role in keeping the historic crude birthrates lower than might have been expected, and also contributed to the early marital fertility decline in the late 1960s and early 1970s (Caldwell and others 1987). The total fertility rate is two births per woman, slightly below replace ment level. Had not large numbers of Indian Tamils been repatriated in the years after 1964 and had not many Sri Lankan Tamils left after 1983 to escape ethnic conflict, the total popula tion would have been significantly higher. Even with strong popular approval of family planning and, by Asian stan dards, an exceptionally privileged developmental setting, as demonstrated by the pro vision of a broadly based, free education system open to both men and women; a national health system; and subsidized food, the prevailing ethnic politics made the work of extending family planning contentious. Because the many hysterical pro nouncements on family planning and the feared extinction of the Sinhalese race were almost never contradicted at any official level, clear decision making and progress in extending family planning in the field was often paralyzed from 1965 to the mid-1970s. Family planning pre sented special problems, because ethnic politics were in conflict, because professional leadership in the field was only weakly committed to prevention, and because serv ices were excessively medicalized.
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