1
Ciroiions from rhe literature /International Journal of Gynecology & Obstetrics 55 (19%) 81-91 89 Findings. An increase in the number and duration of episodes of paroxysmal SVT was observed on day 28 as compared to day 7 of the menstrual cycle. A significant positive correlation was found between plasma progesterone and number of episodes and duration of SVT (5.6 [2.2] rig/ml; r = 0.83, P = 0.0004;and r = 0.82, P = 0.0005), while a significant inverse correlation was found between plasma 176estradiol and number of episodes and duration of SVT (155 [22] pg/ml; r = -0.89, P < 0.0001; and r = -0.81, P = 0.0007).Interpretation. Women with parox- ysmal SVT and normal menses exhibit a cyclical variation in the occurrence of the arrhythmia with their menstrual cycle. There is a closecorrelation between the episodesof paroxysmal SVT and the plasma concentrations of ovarian hormones. These data suggest that changes in plasma levels of ovarian hormones (and their interaction) may be of importance in determining episodes of arrhythmia in such patients. The mechanismsof these effects are unknown. BlLoding rod exclmiom after allocation in randomised controlled trilb: survey of puMisbed parallel group trials in obstetrics and w-WY Schulz K.F.; Grimes D.A.; Altman D.G.; Hayes R.J. USA BR MED J 1996312/7033 (742-744) Objective. To assess the methodological quality of approach- es to blinding and to handling of exclusions as reported in ran- domized trials from one medical specialty. Design. Survey of published, parallel-group, randomized, controlled trials. Data sources.A random sample of I IO reports in which allocation was described as randomized from the 1990and 1991 volumes of four journals of obstetrics and gynecology. Main outcome measures. The adequacy of the descriptions of double blinding and exclusions after randomization. Results. Although 31 trials reported being double-blind, about twice as many could have been. Of the 31 trials only eight (26%) provided information on the protection of the allocation schedule and only five (16%) provided some written assuranceof successful implementation of double blinding. Of 38 trials in which the authors provided sufficient information for readers to infer that no exclusions after randomization had occurred, six (16%) reported adequate allocation concealment and none stated that an intention-to- treat analysis had been performed. That compared with I4 (27%)and six (12%), respectively, for the 52 trials that reported exclusions.Conclusions. Investigators could have double blind- ed more often. When they did double blind, they reported poorly, and rarely evaluated it. Paradoxically, trials that reported exclusions seemed generally of a higher methodological standard than those that had no apparent ex- clusions. Exclusions from analysis may have been made in some of the trials in which no exclusions were reported. Editors and readersof reports of randomized trials should understand that flawed reporting of exclusions may often provide a misleading impression of the quality of the trial. Prepaacy, abortioa ad birth rates among US adolescents - 1980, I!385 alal 1990 Spits A.M.; Velebil P.; Koonin L.M.; Strauss L.T.; Goodman K.A.; Wingo P.; Wilson J.B.; Morris L.; Marks J.S. USA J AM MED ASSOC 1996275113 (989-994) Objective. To analze pregnancy, abortion and birth rates among US adolescent girls in 1980,1985 and 1990. Design. Ret- rospective analysis of trends in data on pregnancies, abortions and births. Population. US adolescent girls aged 13-19 years. Main outcome measures.Pregnancy, abortion and birth rates (with and without adjustment for sexual experience) among teenage girls aged 15-19 years and girls under I5 years. Re- sults. Although pregnancy rates among all teenage girls l5- 19 years old remained fairly stable from 1980 to 1985, they in- creased by 9% during the last half of the decade, totaling 95.9 pregnancies per 1000 teenage girls l5- 19years old by 1990. Be- cause rates of sexual experience increased even faster, preg- nancy rates among sexually experienced teens aged 15-19 actually declined between 1980and 1990by approxiately 8%. Abortion rates among these teens remained stable during the l98Os, with 35.8 and 36.0 abortions per 1000 in 1980 and 1990, respectively. As with overall pregnancy rates, abortion rates among thesesexually experienced teenagegirls declined during the 1980s. Between 1980and 1985,birth rates among teenage girls aged 15-19 years declined by 4%, but they increased by 18% during the latter half of the decade,totaling 59.9 births per 1000 inJl990. Among these sexually experienced teenagers, birth rates also declined between 1980and 1985and then in- creasedover the next 5 years. In 1990,pregnancies and abor- tions among girls younger than I5 years accounted for only 3% of all adolescent pregnancies and abortions. However, the number of births among these younger adolescents increased by 15% over the decade.In that age group, trends in pregnancy, abortion and birth rates over the decade were similar to those for older teens. However, during the late l98Os, the abortion rate declined and the pregnancy rate remained stable, resulting in a 26% increasein the birth rate. Conclusions. Despite efforts to reduceadolescent pregnancy in the United States, pregnancy and irth rates for that group continue to be the highest among developed countries. Considering that 95% of adolescent preg- nanciesare unintended, increasedefforts to prevent thesepreg- nancies are warranted. Maternal immunization with Haemopbilns injliwtzae type b poIysaWtctam protein conjugate vaccine in the Gambia Mulholland K.; Suara R.O.; Siber G.; Roberton D.; Jaffar S.; N’Jie J.; Baden L.; Thompson C.; Anwaruddin R.; Dinan L.; Glexen W.P.; Francis N.; Fritxell B.; Greenwood B.M. CHE J AM MED ASSOC 1996275/15 (1182-1188) Objective. To evaluate maternal responses to Hemophilus in- /luen.zae type b (Hib) polysaccharide-tetanus protein conjugate vaccine (polyribosylribitol phosphate-tetanus or PRP-T) given to pregnant Gambian women, the transplacental transfer of antibody and the effect of maternal immunization on infant responsesto the vaccine. Design. An open, randomized im- munogenicity study. Setting. A busy urban health center in the Gambia. Study participants. A total of 451 pregnant women enrolled during the third trimester of pregnancy. Intervention. Study participants were randomized to three groups. in one group, mothers were given PRP-T during the third trimester and their infants were given PRP-T at 2, 3 and 4 months of age. In the secondgroup, mothers received PRP-T and infants were

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Page 1: Pregnancy, abortion and birth rates among US adolescents — 1980, 1985 and 1990

Ciroiions from rhe literature /International Journal of Gynecology & Obstetrics 55 (19%) 81-91 89

Findings. An increase in the number and duration of episodes of paroxysmal SVT was observed on day 28 as compared to day 7 of the menstrual cycle. A significant positive correlation was found between plasma progesterone and number of episodes and duration of SVT (5.6 [2.2] rig/ml; r = 0.83, P = 0.0004; and r = 0.82, P = 0.0005), while a significant inverse correlation was found between plasma 176estradiol and number of episodes and duration of SVT (155 [22] pg/ml; r = -0.89, P < 0.0001; and r = -0.81, P = 0.0007). Interpretation. Women with parox- ysmal SVT and normal menses exhibit a cyclical variation in the occurrence of the arrhythmia with their menstrual cycle. There is a close correlation between the episodes of paroxysmal SVT and the plasma concentrations of ovarian hormones. These data suggest that changes in plasma levels of ovarian hormones (and their interaction) may be of importance in determining episodes of arrhythmia in such patients. The mechanisms of these effects are unknown.

BlLoding rod exclmiom after allocation in randomised controlled trilb: survey of puMisbed parallel group trials in obstetrics and

w-WY Schulz K.F.; Grimes D.A.; Altman D.G.; Hayes R.J. USA BR MED J 1996 312/7033 (742-744)

Objective. To assess the methodological quality of approach- es to blinding and to handling of exclusions as reported in ran- domized trials from one medical specialty. Design. Survey of published, parallel-group, randomized, controlled trials. Data sources. A random sample of I IO reports in which allocation was described as randomized from the 1990 and 1991 volumes of four journals of obstetrics and gynecology. Main outcome measures. The adequacy of the descriptions of double blinding and exclusions after randomization. Results. Although 31 trials reported being double-blind, about twice as many could have been. Of the 31 trials only eight (26%) provided information on the protection of the allocation schedule and only five (16%) provided some written assurance of successful implementation of double blinding. Of 38 trials in which the authors provided sufficient information for readers to infer that no exclusions after randomization had occurred, six (16%) reported adequate allocation concealment and none stated that an intention-to- treat analysis had been performed. That compared with I4 (27%) and six (12%), respectively, for the 52 trials that reported exclusions. Conclusions. Investigators could have double blind- ed more often. When they did double blind, they reported poorly, and rarely evaluated it. Paradoxically, trials that reported exclusions seemed generally of a higher methodological standard than those that had no apparent ex- clusions. Exclusions from analysis may have been made in some of the trials in which no exclusions were reported. Editors and readers of reports of randomized trials should understand that flawed reporting of exclusions may often provide a misleading impression of the quality of the trial.

Prepaacy, abortioa ad birth rates among US adolescents - 1980, I!385 alal 1990 Spits A.M.; Velebil P.; Koonin L.M.; Strauss L.T.; Goodman K.A.; Wingo P.; Wilson J.B.; Morris L.; Marks J.S. USA

J AM MED ASSOC 1996 275113 (989-994) Objective. To analze pregnancy, abortion and birth rates

among US adolescent girls in 1980,1985 and 1990. Design. Ret- rospective analysis of trends in data on pregnancies, abortions and births. Population. US adolescent girls aged 13-19 years. Main outcome measures. Pregnancy, abortion and birth rates (with and without adjustment for sexual experience) among teenage girls aged 15-19 years and girls under I5 years. Re- sults. Although pregnancy rates among all teenage girls l5- 19 years old remained fairly stable from 1980 to 1985, they in- creased by 9% during the last half of the decade, totaling 95.9 pregnancies per 1000 teenage girls l5- 19 years old by 1990. Be- cause rates of sexual experience increased even faster, preg- nancy rates among sexually experienced teens aged 15-19 actually declined between 1980 and 1990 by approxiately 8%. Abortion rates among these teens remained stable during the l98Os, with 35.8 and 36.0 abortions per 1000 in 1980 and 1990, respectively. As with overall pregnancy rates, abortion rates among these sexually experienced teenage girls declined during the 1980s. Between 1980 and 1985, birth rates among teenage girls aged 15-19 years declined by 4%, but they increased by 18% during the latter half of the decade, totaling 59.9 births per 1000 inJl990. Among these sexually experienced teenagers, birth rates also declined between 1980 and 1985 and then in- creased over the next 5 years. In 1990, pregnancies and abor- tions among girls younger than I5 years accounted for only 3% of all adolescent pregnancies and abortions. However, the number of births among these younger adolescents increased by 15% over the decade. In that age group, trends in pregnancy, abortion and birth rates over the decade were similar to those for older teens. However, during the late l98Os, the abortion rate declined and the pregnancy rate remained stable, resulting in a 26% increase in the birth rate. Conclusions. Despite efforts to reduce adolescent pregnancy in the United States, pregnancy and irth rates for that group continue to be the highest among developed countries. Considering that 95% of adolescent preg- nancies are unintended, increased efforts to prevent these preg- nancies are warranted.

Maternal immunization with Haemopbilns injliwtzae type b poIysaWtctam protein conjugate vaccine in the Gambia Mulholland K.; Suara R.O.; Siber G.; Roberton D.; Jaffar S.; N’Jie J.; Baden L.; Thompson C.; Anwaruddin R.; Dinan L.; Glexen W.P.; Francis N.; Fritxell B.; Greenwood B.M. CHE J AM MED ASSOC 1996 275/15 (1182-1188)

Objective. To evaluate maternal responses to Hemophilus in- /luen.zae type b (Hib) polysaccharide-tetanus protein conjugate vaccine (polyribosylribitol phosphate-tetanus or PRP-T) given to pregnant Gambian women, the transplacental transfer of antibody and the effect of maternal immunization on infant responses to the vaccine. Design. An open, randomized im- munogenicity study. Setting. A busy urban health center in the Gambia. Study participants. A total of 451 pregnant women enrolled during the third trimester of pregnancy. Intervention. Study participants were randomized to three groups. in one group, mothers were given PRP-T during the third trimester and their infants were given PRP-T at 2, 3 and 4 months of age. In the second group, mothers received PRP-T and infants were