RESUMEN
Ovarian cancer continues to be a silent killer. Most women have advanced disease at the time of diagnosis. Intensive efforts to develop effective screening strategies have not so far met with success. There is a need to re-visit the potential of prevention strategies. In 1971, the author submitted a hypothesis for a possible relationship between incessant ovulation and development of epithelial ovarian cancer. Subsequent research from different disciplines opened new frontiers to be explored for prevention in the general population and in high-risk groups, and for opportunistic interventions. The protective effect of oral contraceptive pills has been well documented. Widespread use of the pill in the past several decades is credited with a fall in the incidence of ovarian cancer in the general population, countering the effect of low parity. Removing the barriers against contraceptive access and satisfying the still unmet contraceptive need could expand the protective coverage. Enhanced understanding of the biological mechanisms involved in process of ovulation offers the promise of non-hormonal pharmacologic suppression of follicle rupture for women who have risk factors and do not need contraception. The evidence for a possible origin of epithelial cancer in the fimbria of the Fallopian tube presents an opportunity for preventive intervention, during hysterectomy, where salpingectomy alone may provide protection while one or both ovaries are conserved. Finally, the incessant ovulator egg-laying hen has demonstrated its potential as an experimental model for chemoprevention of epithelial ovarian cancer.
RESUMEN
Reproductive health has been receiving increasing recognition and attention. Its elements are included as 3 of the 8 Millennium Development Goals adopted by the world government community, and it is considered essential for reaching the other goals. Reproductive health problems still account for a major share of the burden of disease, particularly in women. The 57th World Health Assembly adopted a reproductive health strategy to accelerate progress towards the attainment of international development goals and targets. A research component is indispensable. The research community is called upon to enhance the responsiveness and potential impact of its contribution. Ten propositions are submitted.
Asunto(s)
Salud Global , Programas Gente Sana/organización & administración , Medicina Reproductiva/organización & administración , Investigación/organización & administración , Causas de Muerte , Niño , Protección a la Infancia , Costo de Enfermedad , Femenino , Política de Salud , Prioridades en Salud , Necesidades y Demandas de Servicios de Salud , Indicadores de Salud , Humanos , Difusión de la Información , Relaciones Interinstitucionales , Masculino , Bienestar Materno , Región Mediterránea/epidemiología , Morbilidad , Política , Salud de la Mujer , Organización Mundial de la SaludRESUMEN
Reproductive health has been receiving increasing recognition and attention. Its elements are included as 3 of the 8 Millennium Development Goals adopted by the world government community, and it is considered essential for reaching the other goals. Reproductive health problems still account for a major share of the burden of disease, particularly in women. The 57th World Health Assembly adopted a reproductive health strategy to accelerate progress towards the attainment of international development goals and targets. A research component is indispensable. The research community is called upon to enhance the responsiveness and potential impact of its contribution. Ten propositions are submitted
Asunto(s)
Investigación , Fertilidad , Enfermedades de Transmisión Sexual , Resultado del Embarazo , Directrices para la Planificación en Salud , Servicios de Salud ReproductivaAsunto(s)
Manuales como Asunto , Reproducción , Sociedades Médicas , Ginecología , Humanos , ObstetriciaAsunto(s)
Parto Obstétrico/mortalidad , Parto Obstétrico/normas , Países en Desarrollo , Mortalidad Materna , Atención al Paciente/normas , Calidad de la Atención de Salud/organización & administración , Derechos de la Mujer/organización & administración , Actitud del Personal de Salud , Femenino , Humanos , Motivación , EmbarazoRESUMEN
The practice better described as female genital cutting (FGC) is of long standing in some communities, and has spread to non-traditional countries by immigration. It is of varying degrees of invasiveness, often including clitoridectomy, but all raise health-related concerns, which can be of considerable physical and/or psychological severity, and compromise gynecological and obstetric care. The practice is not based on a requirement of religious observance, although parents usually seek it for their daughters in good faith. It is directed to the social control of women's sexuality, in association with preservation of virginity and family honor. FGC is becoming increasingly prohibited by law, in countries both of its traditional practice and of immigration. Medical practice prohibits FGC. In compromising women's health and negating their sexuality, FGC is a human rights abuse that physicians have a role in eliminating by education of patients and communities.
Asunto(s)
Circuncisión Femenina , África , Circuncisión Femenina/efectos adversos , Circuncisión Femenina/ética , Circuncisión Femenina/legislación & jurisprudencia , Cultura , Femenino , Humanos , Complicaciones del Trabajo de Parto/etiología , Embarazo , Religión y MedicinaRESUMEN
The neglected tragedy of maternal mortality is a health scandal of our time. Motherhood can be made safe for all women and obstetricians have a global social responsibility to make it happen. Ten propositions are outlined: safe motherhood is to be recognized as a woman's human right; a woman's life is to be considered worth saving; life-saving emergency obstetric care is to made accessible to all women when they need it; all deliveries are to be attended by skilled birth attendants; all pregnant women are to have access to prenatal care; motherhood must be a voluntary woman's choice; making motherhood safe for all women is to be an international commitment; lack of resources in developing countries is not to be accepted as an excuse for inaction; women, North and South should mobilize for women's right to life; and our profession should act without national frontiers. The challenge is great, but so also is the reward.
Asunto(s)
Mortalidad Materna , Bienestar Materno , Femenino , HumanosRESUMEN
The health of the girl child is a concern for obstetrician-gynecologists. Pediatric gynecologic conditions deserve special attention. The obstetric performance of the adult woman depends in large part on the health and healthcare of the girl child. Gender discrimination against the girl child violates her human rights and adversely impacts on her health and her life. The profession has a social responsibility to advocate for the girl child's right to health.
Asunto(s)
Rol del Médico , Salud de la Mujer , Derechos de la Mujer , Adolescente , Adulto , Niño , Abuso Sexual Infantil , Circuncisión Femenina , Educación , Femenino , Ginecología , Encuestas Epidemiológicas , Humanos , Obstetricia , Prejuicio , Factores Sexuales , Trabajo SexualRESUMEN
PIP: This article reviews the 1952 paper by Dugald Baird on preventive medicine in obstetrics, and comments on its significance from a modern day perspective. It notes that the paper is a public health classic in the sense that it attempts to bring back the social perspective to the practice of medicine. It also highlights the impact of social factors on the health of mothers and children and gives voice to women's perceptions of modern medical practice. Over the past few decades, it has been shown that poverty is not an insurmountable barrier to health when the policies are right; that gender is a health determinant; and that improvement in perinatal health needs more than improvement in socioeconomic conditions. In view of such, there is evidence that most health professionals are willing to concede that a major proportion of ill health results from socioeconomic factors and that there are limitations to what modern medicine can achieve without social interventions. However, there is no consensus discerned on the implication of these facts for the health profession. The need for the profession to study the effect on health of actions taken or not taken outside the health sector and to disseminate this information is highlighted.^ieng
Asunto(s)
Atención a la Salud/organización & administración , Salud Pública , Necesidades y Demandas de Servicios de Salud , Indicadores de SaludRESUMEN
A Contraception-21 strategy was adopted by the Rockefeller Foundation in 1993. The objective of the strategy is to mobilize and lift up the whole field of contraceptive research, to develop novel contraceptive approaches for the next century. The premise of the strategy is that, in spite of technological advances in the past few decades, current contraceptive choices are still inadequate to meet present and rapidly expanding future needs, particularly in developing countries. The central theme of the strategy is that it should be driven by the unmet needs of women, and not by a demographic imperative or by scientific opportunity alone. Two essential requirements are: mobilization of the science, particularly the new advances in cell and molecular biology, to provide the needed tools; and mobilization of industry to provide the needed resources.
Asunto(s)
Anticoncepción , Servicios de Planificación Familiar , Salud de la Mujer , Países en Desarrollo , Femenino , Fundaciones , Humanos , Sector Privado , Sector Público , Apoyo a la Investigación como Asunto , Estados UnidosRESUMEN
The world government community made a commitment in 1994 to make reproductive health care universally available no later than the year 2015. The commitment has been confirmed by a special session of the United Nations General Assembly in July 1999. The commitment has to be backed up by resources, and the health profession has to provide the know-how. Social action will also be needed. Progress has been made, but challenges remain.