Incidence of new-onset autoimmune disease in girls and women with pre-existing autoimmune disease after quadrivalent human papillomavirus vaccination: a cohort study

OBJECTIVE

To assess whether quadrivalent human papillomavirus (qHPV) vaccination is associated with increased incidence of new-onset autoimmune disease in girls and women with pre-existing autoimmune disease.

METHODS

This register-based open cohort study included all girls and women between 10 and 30 years of age in Sweden in 2006-2012 diagnosed with at least one of 49 prespecified autoimmune diseases (n = 70 265). Incidence rate ratios were estimated for new-onset autoimmune disease within 180 days of qHPV vaccination using Poisson regression adjusting for, country of birth, parental country of birth, parental income and parental education.

RESULTS

A total of 70 265 girls and women had at least one of the 49 predefined autoimmune diseases; 16% of these individuals received at least one dose of qHPV vaccine. In unvaccinated girls and women, 5428 new-onset autoimmune diseases were observed during 245 807 person-years at a rate of 22.1 (95% CI 21.5-22.7) new events per 1000 person-years. In vaccinated girls and women, there were 124 new events during 7848 person-years at a rate of 15.8 (95% CI 13.2-18.8) per 1000 person-years. There was no increase in the incidence of new-onset autoimmune disease associated with qHPV vaccination during the risk period; on the contrary, we found a slightly reduced risk (incidence rate ratio 0.77, 95% CI 0.65-0.93).

CONCLUSION

In this nationwide study, qHPV vaccination was not associated with increased incidence of new-onset autoimmune disease in girls and women with pre-existing autoimmune disease.

[Few teenage pregnancies in Sweden--a comparison between five Western industrialized countries. Support from and attitudes in the society explain the differences]

Cross-national comparisons of teenage sexual and reproductive behavior in five Western industrialized countries show vast differences in teenage pregnancy rates and birthrates. The lowest rates are found in Sweden and France, moderate rates in Canada and Great Britain, and the highest in the USA. Since age and frequency of sexual activity are similar across countries, the variations in pregnancy rate reflect young people's motivation and ability to prevent unwanted pregnancies. Sweden and France offer the most positive attitudes to sexuality combined with a clear expectation that teenagers can make responsible decision about sexuality and delay childbearing. Societal acceptance of teenage sexuality is reflected in open-minded sexuality education and easy access to contraceptive services. In contrast the official message in USA is to delay childbearing until marriage by abstinence only, and use of contraceptives is not supported. Differences in societal support for employment and education also played a major role.

Induced abortion in the Nordic countries: special emphasis on young women

BACKGROUND

To analyze the trends in legally induced abortions among women younger than 30 years in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden, since the liberalized abortion laws came into force.

METHODS

Data stem from national registrations of vital events. Some have been published in the national vital statistics while others have been retrieved for this study. General and age-specific abortion rates are used to analyze the trends. Further, an index has been calculated by dividing the age-specific abortion rates by the Nordic average.

RESULTS

The analysis reveals an overall reduction in the general abortion rates in the Nordic countries, apart from Iceland. The rates have been highest in Denmark and Sweden and lowest in Finland since the early 1980s. In the mid-1980s, the abortion rates increased among 15-19-year-old women in Sweden and among 20-24-year-old women in Denmark, Norway and Sweden, followed by a reduction. In Iceland the very low age-specific abortion rates for all age groups under 30 years at the beginning of the study period increased and Iceland had the highest rate for 15-19-year-old women in the late-1990s.

CONCLUSIONS

The relatively low abortion rates in Finland demonstrate effective preventive efforts, although the recent increase challenges further studies on the relationship between abortion rates and counseling activities. The rise in abortion rates in Iceland indicate a need for improved sex education, contraceptive services and availability of contraceptive methods for young people.

Family planning practices before and after childbirth in Lusaka, Zambia

A total of 408 randomly selected normally delivered women who had given birth to healthy infants were recruited from a postnatal ward at the University Teaching Hospital (UTH) in Lusaka, Zambia. Family planning practices before and after pregnancy and delivery were investigated among 376 of these women. The interviews were conducted in their homes or at the postpartum clinic at the UTH at the end of puerperium. The remaining 32 women, mainly primiparae, were lost to follow-up. Thirty four percent of the women had used a family planning method before the present childbirth. Most of those (90%) had used modern methods. Women with eight and more years of education used modern contraceptive methods more often than those with less education. One year after delivery, 64% of the women were using modern or traditional family planning methods. Of those who used traditional methods, 15% relied on lactational amenorrhoea. Of those who did not use any method, 39% indicated that their husbands did not allow them. Fifty-six per cent of the teenagers stated that they had no knowledge of family planning, whereas 84% of the single teenagers had not used contraceptives before. In view of this, teenagers and single mothers need a special focus in the development of family planning programmes. We also recommend that more research should focus on views of both men and women on contraceptive use.

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

STUDY OBJECTIVES

To describe the utilisation of reproductive health services (family planning, antenatal care, and delivery services) and the socioeconomic determinants for utilisation of health services.

DESIGN

This was a cross sectional survey, using a multistage sampling technique.

SETTING

Tien Hai district, Thai Binh Province, Vietnam. Altogether 1132 mothers with children under 5 years of age were interviewed about antenatal, delivery, and family planning services utilisation during a five year period (1987-92).

MAIN RESULTS

Seventy per cent of the women used contraceptive methods, with the intrauterine device being the most common. The use of the intrauterine device was positively associated with the number of children alive but not with other sociodemographic factors in the mothers. Thirty per cent of the women had attended an antenatal clinic for check ups during their last pregnancy. It was found that mothers with fewer deliveries, higher education, and who were Buddhist or of no religion had utilised antenatal services more frequently than the others. Seventy five per cent of the mothers in this study had been assisted by health professionals at their last delivery. Those mothers with fewer deliveries, higher education, who were Buddhist or had no religion, and had sufficient to eat were more likely to have their births attended by health professionals.

CONCLUSIONS

In spite of a relatively high education level in the population and services which are generally available, there was an under utilisation of antenatal and delivery care and there was no equal opportunity for different groups of mothers to use these services. Family planning services were, however, frequently used and were used to the same extent by different groups of mothers. Except for abortion, alternatives to the intrauterine device method were rarely available. If pregnancies are to be protected in an efficient way in rural Vietnam, reproductive health care must be strengthened and efforts should be made to reach the women who are not using these services at present.