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Effects of the etonogestrel contraceptive implant (Implanon®) on bone metabolism during lactation: a prospective study 依托孕酮避孕植入物(Implanon®)对哺乳期骨代谢影响的前瞻性研究
Q Medicine Pub Date : 2016-12-01 DOI: 10.1136/jfprhc-2015-101375
C. Iltemir Duvan, Y. Onaran, E. Aktepe Keskin, E. Yüce, B. Yanık, H. Kafalı, Nilgun Ozturk Turhan
Aim To evaluate the effects of the etonogestrel contraceptive implant (Implanon®) on bone metabolism in lactating women using markers for bone formation and resorption. Study design This single-centre, prospective cohort study was conducted in Turgut Ozal University Medical Faculty Obstetrics and Gynecology Department with healthy lactating women aged between 24 and 38 years to compare the effect on bone metabolism of 6 months’ use of either the implant or a non-hormonal contraceptive method. The study group (n=25) used an implant and the control group (n=25) used a non-hormonal contraceptive intrauterine device inserted 40 days’ postpartum. Bone metabolism differences at the time of insertion and after 6 months were assessed quantitatively by biochemical analysis of serum and urine samples. Results At baseline, serum levels of bone metabolism parameters were similar for the two groups. In the implant group, serum alkaline phosphatase (ALP) levels decreased (p=0.004) and total protein levels increased (p=0.045) at 6 months. In the control group, serum levels of bone metabolism parameters did not change at 6 months compared to baseline. However, serum levels of phosphorus (p=0.013) and ALP (p=0.003) decreased at 6 months compared to baseline. Conclusion Six months’ postpartum use of Implanon was found to have no deleterious impact on bone turnover in healthy lactating women.
目的应用骨形成和骨吸收指标,评价依托孕酮避孕植入物(Implanon®)对哺乳期妇女骨代谢的影响。这项单中心、前瞻性队列研究在Turgut Ozal大学医学院妇产科进行,研究对象为年龄在24 - 38岁之间的健康哺乳期妇女,目的是比较使用植入物和非激素避孕方法6个月对骨代谢的影响。研究组(n=25)使用植入物,对照组(n=25)使用产后40天植入的非激素避孕宫内节育器。通过血清和尿液的生化分析定量评估植入时和6个月后的骨代谢差异。结果在基线时,两组血清骨代谢参数水平相似。种植体组6个月时血清碱性磷酸酶(ALP)水平降低(p=0.004),总蛋白水平升高(p=0.045)。在对照组中,6个月时骨代谢参数的血清水平与基线相比没有变化。然而,与基线相比,6个月时血清磷(p=0.013)和ALP (p=0.003)水平下降。结论产后6个月使用Implanon对健康哺乳期妇女的骨转换无不良影响。
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引用次数: 3
Cervical grasping and stabilising forceps 颈椎抓稳钳
Q Medicine Pub Date : 2016-11-29 DOI: 10.1136/jfprhc-2016-101656
D. Horwell
I was very interested to read Speedie et al .'s report1 on their carefully conducted randomised trial of two stabilising forceps for the insertion of intrauterine contraception (IUC). Their finding that there is no significant difference in the pain experienced on application of single-toothed volsellum forceps and Littlewood forceps in the specific group of women selected, those with at least one vaginal delivery, is interesting, and was certainly worth establishing objectively. However, I was disappointed that the instrument selected by them as the comparator for the obviously ‘traumatic’ single-toothed volsellum was the Littlewood forceps rather than a commonly-used alternative, the Judd-Allis forceps.The Judd-Allis forceps (Figure 1A) is a lengthened form of the Allis forceps that …
我非常感兴趣地阅读了Speedie等人的报告,他们仔细进行了两种稳定钳用于宫内避孕(IUC)插入的随机试验。他们的发现是,在被选中的至少有一次阴道分娩的特定妇女群体中,使用单齿volsellum钳和Littlewood钳所经历的疼痛没有显著差异,这是有趣的,当然值得客观地建立起来。然而,令我失望的是,他们选择了利特尔伍德钳作为明显“创伤性”单齿大鼠的比较工具,而不是常用的替代品,贾德-阿利斯钳。Judd-Allis钳(图1A)是Allis钳的加长版。
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引用次数: 0
A pan-London approach to patient group directions in sexual health services: from aspiration to reality 性健康服务中病人群体指导的泛伦敦方法:从愿望到现实
Q Medicine Pub Date : 2016-11-29 DOI: 10.1136/jfprhc-2016-101621
Angela Bussey, K. French
A patient group direction (PGD) is a legal mechanism1 that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for the condition described in the PGD without the need for a prescription or an instruction from a prescriber. Using a PGD is not a form of prescribing.2Whilst prescribing remains the preferred option for the majority of care,2 sexual health services have been dependent on this legal mechanism to supply and administer medicines in the absence of timely access to a prescriber for many years.For example, medicines may be supplied by registered nurses or pharmacists to people attending for contraception or for other unscheduled care in a sexual health clinic or in a community pharmacy for a discrete treatment episode, such as emergency contraception or treatment for chlamydia.Whilst nurses and pharmacists may now train to become independent non-medical prescribers in their own right, many services still rely on PGDs to deliver the service.Prior to 2011, contraceptive and sexual health service providers in London developed their own PGDs. It became apparent from discussions with lead nurses and doctors within the services that there were problems due to the many different versions being used and the human resource needed to develop/review PGDs on a regular basis. There was a risk of inconsistent standards of care and risks associated with practice where nurses employed in more than one organisation had to work to different PGDs. At that time, it was calculated that there were at least 30 versions of each PGD. …
患者群体指导(PGD)是一种法律机制,允许由指定的授权卫生专业人员向需要治疗PGD中所述病症的明确定义的患者群体提供和/或管理一种或多种特定药物,而无需处方或处方者的指示。使用PGD不是处方的一种形式。2虽然处方仍然是大多数护理的首选选择,2性健康服务多年来一直依赖这一法律机制来供应和管理药物,因为无法及时获得处方者。例如,注册护士或药剂师可向在性健康诊所或社区药房就诊的人提供药物,以进行避孕或其他计划外护理,以进行离散治疗,如紧急避孕或衣原体治疗。虽然护士和药剂师现在可能会接受培训,成为独立的非医疗处方者,但许多服务仍然依赖博士学位来提供服务。2011年以前,伦敦的避孕和性健康服务提供者制定了自己的避孕指导手册。从与服务部门的首席护士和医生的讨论中可以明显看出,由于使用了许多不同的版本,并且需要人力资源定期开发/审查PGDs,因此存在问题。存在护理标准不一致的风险,并且在多个组织雇用的护士必须为不同的PGDs工作时,存在与实践相关的风险。根据当时的计算,每个PGD至少有30个版本。...
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引用次数: 1
‘Repeat abortion’, a phrase to be avoided? Qualitative insights into labelling and stigma “重复堕胎”,一个应该避免的词?定性洞察标签和柱头
Q Medicine Pub Date : 2016-11-29 DOI: 10.1136/jfprhc-2016-101487
Lesley Hoggart, V. Newton, L. Bury
Background In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion.
近年来,国际上越来越关注确定与“重复堕胎”有关的风险因素,并制定可能降低堕胎率的公共卫生举措。这篇文章借鉴了一项关于英格兰和威尔士年轻女性堕胎经历的研究。这项研究的委托对象是经历过一次以上堕胎的妇女。除了根据参与者自己的叙述探索与堕胎有关的耻辱之外,我们还研究了可能影响妇女堕胎后生殖行为的因素。研究设计混合方法研究:对430名年龄在16-24岁的女性进行定量调查,并对36名进行过一次或多次堕胎的女性进行深度定性访谈。本文关注的是两组年轻女性的定性数据:我们采访过两次的女性(n=17)和经历过不止一次意外怀孕的女性(n=15)。结果定性研究结果表明,妇女的避孕史和生育生活的复杂性,因此,除了没有使用避孕措施或没有有效使用避孕措施的明显观察外,建立不止一次堕胎的因果模式固有的困难。然而,经历过一次以上堕胎的妇女表现出更强烈的堕胎羞耻感。这篇文章认为,根据以往的情况对堕胎妇女进行不同的分类是没有帮助的。对于多次堕胎的妇女来说,这也可能是有害的,并会产生更多的耻辱。
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引用次数: 21
The War on Women: And the Brave Ones Who Fight Back 对妇女的战争:和勇敢的反击者
Q Medicine Pub Date : 2016-11-28 DOI: 10.1136/jfprhc-2016-101675
S. de Silva
Sue Lloyd-Roberts. London, UK: Simon & Schuster, 2016. ISBN-13: 978-1-471-15390-7. Price: £16.00. Pages: 320 (hardcover)Not long after the author's death (the journalist, Sue Lloyd-Roberts) in October 2015, I heard her daughter speaking about this book on Radio 4. The ideas behind the book, and its aim to report on the experiences of women worldwide, sounded compelling. However, I was apprehensive that reading the book would prove too disturbing. It is shocking, but also extraordinary, and I could not put it down.Sue Lloyd-Roberts writes transparently, based on the interviews that she conducted. Each chapter begins …
苏·劳埃德·罗伯茨。英国伦敦:西蒙与舒斯特出版社,2016年。ISBN-13:978-1-471-15390-7。价格:16.00英镑。第320页(精装本)作者(记者苏·劳埃德·罗伯茨)于2015年10月去世后不久,我听到她的女儿在第四广播电台谈论这本书。这本书背后的想法,以及它旨在报道世界各地女性的经历,听起来很有说服力。然而,我担心读这本书会太令人不安。这令人震惊,但也非同寻常,我无法放下。苏·劳埃德·罗伯茨(Sue Lloyd Roberts)根据她进行的采访,以透明的方式写作。每一章开始…
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引用次数: 1
Feasibility of using text message reminders to increase fulfilment of emergency contraception prescriptions by adolescents 使用短信提醒提高青少年执行紧急避孕处方的可行性
Q Medicine Pub Date : 2016-11-25 DOI: 10.1136/jfprhc-2016-101647
Tracey A. Wilkinson, Michelle R Berardi, Erin Crocker, Christina A Nordt, Michael Silverstein
Emergency contraception (EC) is a safe and effective form of pregnancy prevention after intercourse, but its efficacy decreases with time.1 ,2 Having EC in advance of need enables it to be taken soon after unprotected intercourse, thus maximising its effect. EC is available over-the-counter in the USA without age restrictions, but many clinicians provide EC in advance to their patients as a means of eliminating residual barriers to access.3–5In a randomised pilot study among sexually active women in an urban adolescent clinic, we examined the feasibility of using text messages as a convenient mechanism to remind adolescents to fulfil their advance EC …
紧急避孕(EC)是一种安全有效的性交后避孕方式,但其有效性随着时间的推移而降低。1,2提前服用避孕药可以在无保护性交后立即服用,从而使其效果最大化。在美国,EC是非处方药,没有年龄限制,但许多临床医生提前向患者提供EC,作为消除获取残留障碍的一种手段。3 - 5在一项随机试点研究中,我们在城市青少年诊所的性活跃妇女中,检验了使用短信作为一种方便的机制来提醒青少年完成他们的提前EC的可行性。
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引用次数: 3
Postponing menstruation: choices and concerns 推迟月经:选择和关注
Q Medicine Pub Date : 2016-11-25 DOI: 10.1136/jfprhc-2016-101438
D. Mansour
Since writing an editorial for this journal in 20141 I have been repeatedly asked about my views on postponing menstruation. Women in the 21st century want to avoid periods when on holiday yet have difficulty accepting highly effective, reversible forms of contraception which provide infrequent bleeding. Authors of a BMJ article published 16 years ago suggested that prescribing progestogens to delay periods was a lifestyle choice and should not be funded by the National Health Service.2 I am not sure I feel that strongly but I do think women need to know all options and any potential risks or side effects associated with each treatment – they may think twice.Only one drug is licensed to postpone menstruation in the UK and that is norethisterone. The Summary of Product Characteristics (SPC) state that at low dose’ (5 mg three times a day) norethisterone may be used to treat “metropathia haemorrhagica, premenstrual syndrome, postponement of menstruation, dysmenorrhoea, endometriosis and menorrhagia”.3 There is limited evidence to support these indications1 but it does delay the onset of …
自2014年为本刊撰写社论以来,我多次被问及对推迟月经的看法。21世纪的女性希望在度假时避免月经,但她们很难接受高效、可逆的避孕方式,因为这种避孕方式不会频繁出血。16年前发表在《英国医学杂志》上的一篇文章的作者建议,开孕激素来延缓月经是一种生活方式的选择,不应该由国家卫生服务机构资助。2我不确定我是否强烈地认为,但我确实认为女性需要了解所有的选择,以及每种治疗方法的潜在风险或副作用——她们可能会三思而后行。在英国,只有一种药物被许可延缓月经,那就是诺西酮。产品特性概要(SPC)指出,低剂量(5毫克,每天3次)的去甲睾酮可用于治疗“血液病、经前综合征、月经推迟、痛经、子宫内膜异位症和月经过多”支持这些迹象的证据有限,但它确实延缓了……
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引用次数: 0
Breastfeeding and postpartum contraception: dual priorities in the immediate postnatal period 母乳喂养和产后避孕:产后时期的双重优先事项
Q Medicine Pub Date : 2016-10-28 DOI: 10.1136/jfprhc-2016-101623
A. Thwaites, L. Bacon, J. Dickson
In a letter1 published in the July 2016 issue of this journal, the Breastfeeding Network's approach to postpartum contraception was advocated and described as: (i) avoidance of all hormonal contraception in the first 21 days postpartum; (ii) after that, a month's trial of the “mini-pill” to check milk supply is unaffected; and (iii) initiation of hormonal long-acting reversible contraception (LARC) methods (e.g. the subdermal implant), after this and only if breastfeeding is going well. The letter expresses concern among breastfeeding counsellors, based solely on anecdotal reports, regarding “the impact of hormonal contraception on milk supply” (including progestogen-only methods). The Breastfeeding Network's ‘Breastfeeding and Contraception’ factsheet2 asserts that initiation too early after delivery “may interfere with priming of prolactin receptors” and refers to anecdotal reports …
在本刊2016年7月刊上发表的一封信中,母乳喂养网络提倡产后避孕方法,并将其描述为:(i)在产后前21天避免所有激素避孕;(ii)在此之后,为期一个月的“迷你药丸”试验不受影响;(iii)开始激素长效可逆避孕(LARC)方法(如皮下植入),在此之后,只有在母乳喂养进展顺利的情况下。这封信表达了母乳喂养顾问的担忧,仅仅基于轶事报道,关于“激素避孕对乳汁供应的影响”(包括仅使用孕激素的方法)。母乳喂养网络的“母乳喂养和避孕”实况介绍2声称,在分娩后过早开始“可能会干扰催乳素受体的启动”,并引用了一些轶事报道……
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引用次数: 6
Come As You Are: The Surprising New Science That Will Transform Your Sex Life 你是谁:令人惊讶的新科学将改变你的性生活
Q Medicine Pub Date : 2016-10-14 DOI: 10.1136/jfprhc-2016-101638
S. Quilliam
Emily Nagoski. London, UK: Scribe Publications, 2015. ISBN-13: 978-1-925-22801-4. Price: £12.99. Pages: 432 (paperback)There are now literally thousands of books – my own among them – which aim to help women understand and make the most of their sexuality. This book, however, is special.Written by Emily Nagoski, formerly Director of Wellness Education at Smith College (Massachusetts, USA) and the Kinsey Institute (Indiana, USA), the book rises above most others for many reasons.The first is its range: the 400+ pages cover not only female physiology, sexual response, and ‘what to do in bed’, but also the emotional and relational underpinnings of sexuality; its social context; its pitfalls, its pleasures. A full set by any count and, as the book's cover claims, …
艾米丽Nagoski。伦敦,英国:Scribe出版社,2015。ISBN-13: 978-1-925-22801-4。价格:£12.99。现在有成千上万的书——我自己的书也在其中——旨在帮助女性理解和充分利用她们的性。然而,这本书很特别。艾米丽·纳格斯基是史密斯学院(美国马萨诸塞州)和金赛研究所(美国印第安纳州)的前健康教育主任,这本书在很多方面都超越了其他大多数书。首先是它的范围:这本400多页的书不仅涵盖了女性生理、性反应和“在床上该做什么”,还涵盖了性行为的情感和关系基础;它的社会背景;它的陷阱,它的快乐。无论如何,这是一本完整的书,正如书的封面所说,……
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引用次数: 24
Elizabeth (Libby) Wilson 1926-2016. 伊丽莎白(利比)威尔逊1926-2016。
Q Medicine Pub Date : 2016-10-01 DOI: 10.1136/jfprhc-2016-101624
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引用次数: 0
期刊
Journal of Family Planning and Reproductive Health Care
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