The relationship between oral contraceptives and pelvic inflammatory disease: Policy implications and recommendations

One of the most widely accepted noncontraceptive benefits of oral contraceptive use is the reduction in the development of pelvic inflammatory disease (PID) and its sequelae in users. While much of the research over the past forty years has found an association between oral contraceptive use and reduced rates of PID [Senanayake, 1980], more recent studies have qualified and even challenged this widely held belief. [Henry-Suchet, 1997; Ness 1997; Ness, 2001] PID, an infection in the upper genital tract causing infertility and ectopic pregnancy, affects over one million women in the United States each year, exacting an enormous toll on women's reproductive and emotional health, as well as our economy. [CDC Factsheet, 2007] This thesis examines the public health implications of pelvic inflammatory disease and the use of oral contraceptives. Sixteen original studies are reviewed and analyzed, thirteen of which found a protective benefit with oral contraceptive use against PID and three more recent studies which found no protective benefit or association between oral contraceptive use and PID. Analysis of the research findings suggests a need for additional research, provider and patient education, and an increased government role in addressing the ongoing and significant public health concerns raised by current rates of Chlamydia- and gonorrheal-PID. ^

Use of tabletop exercises for disaster preparedness training

Background. In public health preparedness, disaster preparedness refers to the strategic planning of responses to all types of disasters. Preparation and training for disaster response can be conducted using different teaching modalities, ranging from discussion-based programs such as seminars, drills and tabletop exercises to more complex operation-based programs such as functional exercises and full-scale exercises. Each method of instruction has its advantages and disadvantages. Tabletop exercises are facilitated discussions designed to evaluate programs, policies, and procedures; they are usually conducted in a classroom, often with tabletop props (e.g. models, maps or diagrams). ^ Objective. The overall goal of this project was to determine whether tabletop exercises are effective teaching modalities for disaster preparedness, with an emphasis on intentional chemical exposure. ^ Method. The target audience for the exercise was the Medical Reserve Brigade of the Texas State Guard, a group of volunteer healthcare providers and first responders who prepare for response to local disasters. A new tabletop exercise was designed to provide information on the complex, interrelated organizations within the national disaster preparedness program that this group would interact with in the event of a local disaster. This educational intervention consisted of a four hour multipart program that included a pretest of knowledge, lecture series, an interactive group discussion using a mock disaster scenario, a posttest of knowledge, and a course evaluation. ^ Results. Approximately 40 volunteers attended the intervention session; roughly half (n=21) had previously participated in a full scale drill. There was an 11% improvement in fund of knowledge between the pre- and post-test scores (p=0.002). Overall, the tabletop exercise was well received by those with and without prior training, with no significant differences found between these two groups in terms of relevance and appropriateness of content. However, the separate components of the tabletop exercise were variably effective, as gauged by written text comments on the questionnaire. ^ Conclusions. Tabletop exercises can be a useful training modality in disaster preparedness, as evidenced by improvement in knowledge and qualitative feedback on its value. Future offerings could incorporate recordings of participant responses during the drill, so that better feedback can be provided to them. Additional research should be conducted, using the same or similar design, in different populations that are stakeholders in disaster preparedness, so that the generalizability of these findings can be determined.^

THE INCIDENCE OF PELVIC ENDOMETRIOSIS IN ROCHESTER, MINNESOTA, 1970-1979

The primary objectives of the study were to measure the incidence of pelvic endometriosis among white females of reproductive age (15-49 years) in Rochester, Minnesota, during the period 1970-1979 and to determine the risk of endometriosis by age, marital status, nun status, and educational attainment in this population. An historical prospective design was used. Incident (newly diagnosed) cases were identified from community medical records, and person-years of risk in the study population were estimated from census data.^ Almost two-thirds of the incident cases had surgically verified endometriosis, while the remainder were diagnosed by clinical findings alone. Incidence rates were prepared first with histologically confirmed cases only and then with the successive inclusion of less certain cases: surgically visualized, clinically probable, and clinically possible. On this basis, overall incidence rates were 108.8 to 246.9 newly diagnosed cases per 100,000 person-years. The incidence of pelvic endometriosis was lowest for women 15-19 years of age, increased markedly through age 44, and then declined for women 45-49 years of age. A significantly greater risk of pelvic endometriosis in never married women was detected only when the numerator was limited to histologically confirmed cases. Among never married women 20-49 years of age, no significant difference in the risk of pelvic endometriosis by nun status was detected, but a trend toward a lower incidence in nuns was observed. Women with education beyond high school had a significantly higher incidence of endometriosis than women with less education.^ Cases in the four diagnostic groups differed greatly by age and marital status but were similar with respect to virtually all other characteristics, once age differences were considered. Reproductive history characteristics described included: age of menarche; history of menopause; total pregnancies; ages of first pregnancy, marriage, and sexual intercourse; years from menarche to first intercourse; years of ovulatory cycling; difficulty becoming pregnant; and delay of the first pregnancy by choice. How these characteristics of incident cases differ from those of women free of endometriosis needs to be studied in future research. ^