Pub Date : 2022-03-17DOI: 10.1080/13625187.2022.2045936
S. Zaami, Michael Stark, F. Signore, G. Gullo, E. Marinelli
Abstract Purpose Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways. Materials and Methods A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010–2021 period. Results Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data. Conclusions Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others.
癌症诊断和治疗的进步带来了大量的年轻癌症幸存者，尽管一些干预措施有时可能会威胁到生育能力。鉴于其复杂性和多学科性质，作者旨在评估基于证据的癌症生育咨询如何能够为女性癌症患者充分实现，这需要彻底的咨询和同意途径。材料和方法在PubMed/MEDLINE、Web of Science、Scopus、EMBASE和Google Scholar等数据库中检索生育力保存、生殖咨询、肿瘤生育、癌症幸存者等关键词，以确定2010-2021年期间相关的有意义的文献来源。结果咨询工作应遵循国际准则，避免产生医学法律后果。尽管大多数保健机构都支持保留生育能力，但保健机构的实际情况往往反映出在肿瘤生育过程中存在一些挥之不去的困难。癌症生育咨询应促进获得保留生育能力的程序。为了最好地达到这一目的，应该以符合道德和法律标准的方式实施，以便患者能够根据全面和相关的数据做出明智的决定。咨询需要植根于肿瘤学家、生殖内分泌学家、心理健康咨询师和临床研究人员的密切合作。提供生育服务的基础是维护个人自主权的道德义务，这在自由社会中是必不可少的，除非行使这种自主权可能对怀孕的儿童或他人构成危险。
{"title":"Fertility preservation in female cancer sufferers: (only) a moral obligation?","authors":"S. Zaami, Michael Stark, F. Signore, G. Gullo, E. Marinelli","doi":"10.1080/13625187.2022.2045936","DOIUrl":"https://doi.org/10.1080/13625187.2022.2045936","url":null,"abstract":"Abstract Purpose Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways. Materials and Methods A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010–2021 period. Results Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data. Conclusions Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"38 1","pages":"335 - 340"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89489627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-03DOI: 10.1080/13625187.2022.2039910
Dennis Munetsi, William J Ugarte
Abstract Purpose Health care professionals’ attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women’s lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals’ attitudes and behaviours towards comprehensive abortion care between 2015 and 2020. Materials and methods The study inductively explored Ethiopian and Tanzanian health care professionals’ behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting. Results Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment. Conclusions The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.
{"title":"Intervening factors in health care professionals’ attitudes and behaviours towards comprehensive abortion care in the workplace: a comparative case study of Tanzania and Ethiopia","authors":"Dennis Munetsi, William J Ugarte","doi":"10.1080/13625187.2022.2039910","DOIUrl":"https://doi.org/10.1080/13625187.2022.2039910","url":null,"abstract":"Abstract Purpose Health care professionals’ attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women’s lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals’ attitudes and behaviours towards comprehensive abortion care between 2015 and 2020. Materials and methods The study inductively explored Ethiopian and Tanzanian health care professionals’ behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting. Results Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment. Conclusions The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"9 1","pages":"221 - 229"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82046184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-06DOI: 10.1080/13625187.2019.1695118
Rima Hammoud, Sirine Saleh, Doha Halawani, H. Mezher, Azza Abou El Naga, Bilal Azakir
Abstract Objectives: Unwanted pregnancy is sometimes associated with unsafe abortion, which may lead to maternal death. Pregnancy after unprotected sexual intercourse can be avoided by using emergency contraception (EC). Our study aimed to assess the knowledge and attitudes of reproductive-aged Lebanese women towards EC use. Methods: A descriptive cross-sectional study was conducted by interviewing randomly selected women aged between 15 and 49 years from the five major Lebanese governates. A pre-tested, pre-structured questionnaire was applied composed of three parts: (1) personal information, (2) knowledge about EC methods and (3) attitude towards EC. Results: We found that 78% of participants had never heard of EC. Among those who had heard of EC, only 29.3% had good knowledge about it. Knowledge about EC was not, however, associated with participants’ sociodemographic characteristics (i.e., age, marital status, educational level and background, occupation and occupational field and area of residence). There was a positive attitude towards EC among 57.3% of participants. Attitudes were statistically associated with level of education, area of residence and whether the respondent had ever heard of EC. Conclusion: Most Lebanese women of childbearing age lack knowledge about EC. There is a need to raise public awareness of EC.
{"title":"Knowledge and attitudes of Lebanese women of childbearing age towards emergency contraception","authors":"Rima Hammoud, Sirine Saleh, Doha Halawani, H. Mezher, Azza Abou El Naga, Bilal Azakir","doi":"10.1080/13625187.2019.1695118","DOIUrl":"https://doi.org/10.1080/13625187.2019.1695118","url":null,"abstract":"Abstract Objectives: Unwanted pregnancy is sometimes associated with unsafe abortion, which may lead to maternal death. Pregnancy after unprotected sexual intercourse can be avoided by using emergency contraception (EC). Our study aimed to assess the knowledge and attitudes of reproductive-aged Lebanese women towards EC use. Methods: A descriptive cross-sectional study was conducted by interviewing randomly selected women aged between 15 and 49 years from the five major Lebanese governates. A pre-tested, pre-structured questionnaire was applied composed of three parts: (1) personal information, (2) knowledge about EC methods and (3) attitude towards EC. Results: We found that 78% of participants had never heard of EC. Among those who had heard of EC, only 29.3% had good knowledge about it. Knowledge about EC was not, however, associated with participants’ sociodemographic characteristics (i.e., age, marital status, educational level and background, occupation and occupational field and area of residence). There was a positive attitude towards EC among 57.3% of participants. Attitudes were statistically associated with level of education, area of residence and whether the respondent had ever heard of EC. Conclusion: Most Lebanese women of childbearing age lack knowledge about EC. There is a need to raise public awareness of EC.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"12 1","pages":"28 - 32"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78359357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-28DOI: 10.1080/13625187.2019.1695117
Melinda Koo Andersson, T. Tydén
Abstract Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website www.reproduktivlivsplan.se for patient counselling. Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience. Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives. Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.
{"title":"Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website","authors":"Melinda Koo Andersson, T. Tydén","doi":"10.1080/13625187.2019.1695117","DOIUrl":"https://doi.org/10.1080/13625187.2019.1695117","url":null,"abstract":"Abstract Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website www.reproduktivlivsplan.se for patient counselling. Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience. Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives. Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"88 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83841604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-22DOI: 10.1080/13625187.2019.1688290
T. Wongwananuruk, Nalinee Panichyawat, Tachjaree Panchalee, P. Jirakittidul, S. Angsuwathana, Korakot Sirimai, Manopchai Thamkhantho, G. Chiravacharadej
Abstract Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP). Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment. Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs –0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs –0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups. Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.
摘要目的:比较30 μg炔雌醇(EE)和2 mg醋酸氯麦地那酮(CMA)组成的复方口服避孕药(COC)和30 μg EE和3 mg降螺酮(DRSP)组成的复方口服避孕药(COC)对女性体重的影响。方法:这项随机双盲对照试验(ClinicalTrials.gov NCT01608698)于2012年6月至2015年9月在泰国一家大学医院诊所进行。研究共纳入102名女性，其中99名随机分为EE/CMA组(n = 45)或EE/DRSP组(n = 54)。每位参与者治疗6个周期。在基线和第三和第六个治疗周期结束时记录体重和其他参数以及副作用。结果:EE/CMA组和EE/DRSP组从基线到第三周期的平均体重变化有显著差异(0.51±1.36 kg vs -0.43±1.56 kg;P = 0.003)和基线至第六个周期(1.00±1.84 kg vs -0.20±2.23 kg;p = .013)。体重指数和腰围的平均差值与体重的平均差值有相似的变化趋势。两组间副作用无显著差异。结论:与含有30µg EE/2 mg CMA的COC相比，含有30µg EE/3 mg DRSP的COC在6个月的时间内倾向于给体重带来更有利的变化，这与体重增加有关。
{"title":"Comparison of change in body weight between contraception containing 30-μg ethinylestradiol/2-mg chlormadinone acetate or 30-μg ethinylestradiol/3-mg drospirenone: a randomised controlled trial","authors":"T. Wongwananuruk, Nalinee Panichyawat, Tachjaree Panchalee, P. Jirakittidul, S. Angsuwathana, Korakot Sirimai, Manopchai Thamkhantho, G. Chiravacharadej","doi":"10.1080/13625187.2019.1688290","DOIUrl":"https://doi.org/10.1080/13625187.2019.1688290","url":null,"abstract":"Abstract Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP). Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment. Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs –0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs –0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups. Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"1 1","pages":"43 - 48"},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86525020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-02DOI: 10.1080/13625187.2019.1682544
Thea K. Kleinschmidt, Jonathan R. Bull, V. Lavorini, S. Rowland, J. Pearson, E. B. Scherwitzl, R. Scherwitzl, K. Danielsson
Abstract Purpose: This study aims to compare the accuracy of fertile window identification with the contraceptive app Natural Cycles against the Rhythm Method and Standard Days Method (SDM). Materials and methods: Menstruation dates, basal body temperature (BBT), and luteinising hormone (LH) test results were collected anonymously from Natural Cycles app users. The fraction of green days (GDs) and wrong green days (WGDs) allocated by the various algorithms was determined over 12 cycles. For comparison of Natural Cycles and the Rhythm Method, 26,626 cycles were analysed. Results: Natural Cycles’ algorithms allocated 59% GDs (LH, BBT) in cycle 12, while the fraction of WGDs averaged 0.08%. The Rhythm Method requires monitoring of six cycles, resulting in no GDs or WGDs in cycle 1–6. In cycle 7, 49% GDs and 0.26% WGDs were allocated. GDs and WGDs decreased to 43% and 0.08% in cycle 12. The probabilities of WGDs on the day before ovulation with Natural Cycles were 0.31% (BBT) and 0% (LH, BBT), and 0.80% with the Rhythm Method. The probability of WGDs on the day before ovulation was 6.90% with the SDM. Conclusions: This study highlights that individualised algorithms are advantageous for accurate determination of the fertile window and that static algorithms are more likely to fail during the most fertile days
{"title":"Advantages of determining the fertile window with the individualised Natural Cycles algorithm over calendar-based methods","authors":"Thea K. Kleinschmidt, Jonathan R. Bull, V. Lavorini, S. Rowland, J. Pearson, E. B. Scherwitzl, R. Scherwitzl, K. Danielsson","doi":"10.1080/13625187.2019.1682544","DOIUrl":"https://doi.org/10.1080/13625187.2019.1682544","url":null,"abstract":"Abstract Purpose: This study aims to compare the accuracy of fertile window identification with the contraceptive app Natural Cycles against the Rhythm Method and Standard Days Method (SDM). Materials and methods: Menstruation dates, basal body temperature (BBT), and luteinising hormone (LH) test results were collected anonymously from Natural Cycles app users. The fraction of green days (GDs) and wrong green days (WGDs) allocated by the various algorithms was determined over 12 cycles. For comparison of Natural Cycles and the Rhythm Method, 26,626 cycles were analysed. Results: Natural Cycles’ algorithms allocated 59% GDs (LH, BBT) in cycle 12, while the fraction of WGDs averaged 0.08%. The Rhythm Method requires monitoring of six cycles, resulting in no GDs or WGDs in cycle 1–6. In cycle 7, 49% GDs and 0.26% WGDs were allocated. GDs and WGDs decreased to 43% and 0.08% in cycle 12. The probabilities of WGDs on the day before ovulation with Natural Cycles were 0.31% (BBT) and 0% (LH, BBT), and 0.80% with the Rhythm Method. The probability of WGDs on the day before ovulation was 6.90% with the SDM. Conclusions: This study highlights that individualised algorithms are advantageous for accurate determination of the fertile window and that static algorithms are more likely to fail during the most fertile days","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"32 1","pages":"457 - 463"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88386800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-02DOI: 10.1080/13625187.2019.1682134
A. M. Teunissen, A. Merry, I. Devies, F. Roumen
Abstract Objective: To investigate differences in continuation rates between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS) and factors associated with early removal. Methods: Study design: Retrospective consecutive cohort design. Cohort: Women with the insertion of the LNG-IUS for contraceptive or therapeutic use from 1 January 2006 through 1 January 2009 at the Zuyderland Medical Centre, The Netherlands, with a follow-up of 5 years. The continuation period and reasons of early removal were noted. Univariable and multivariable analysis were performed. Results: Follow-up was possible in 2481 women, 1855 (74.8%) in the contraception group, and 626 (25.2%) in the therapy group. Multivariable Cox proportional hazards models showed, that therapeutic use was associated with an increased risk of early removal of the LNG-IUS (HR 1.23; 95% CI 1.08–1.41), as was having one child (HR 1.20; 95% CI 1.04–1.38), and a decreased risk with advancing age (HR 0.96; 95% CI 0.95–0.97). In both groups, an unacceptable bleeding pattern and adverse events were the main reasons of early removal, resulting in very low continuation rates over the years. Conclusion: Therapeutic use, having one child and a younger age are independent risk factors of early removal of the LNG-IUS, in contrast with previous LNG-IUS use which is associated with a lower risk. In both the contraception group and the therapy group, the main reasons for LNG-IUS discontinuation are continuation with a new LNG-IUS, and no more need for an LNG-IUS (for contraception or therapy). An unacceptable bleeding pattern or adverse events are associated with the lowest continuation rates in both groups.
摘要目的:探讨左炔诺孕酮释放宫内系统52 mg (LNG-IUS)在避孕和治疗方面的持续率差异及早期停用的相关因素。方法:研究设计:回顾性连续队列设计。队列:2006年1月1日至2009年1月1日在荷兰祖德兰医疗中心插入LNG-IUS用于避孕或治疗的妇女，随访5年。指出了提前撤职的延续期限和原因。进行单变量和多变量分析。结果:随访2481例，其中避孕组1855例(74.8%)，治疗组626例(25.2%)。多变量Cox比例风险模型显示，治疗使用与早期移除LNG-IUS的风险增加相关(HR 1.23;95% CI 1.08-1.41)，生育一个孩子也是如此(HR 1.20;95% CI 1.04-1.38)，随着年龄的增长，风险降低(HR 0.96;95% ci 0.95-0.97)。在两组中，不可接受的出血模式和不良事件是早期切除的主要原因，导致多年来的持续率非常低。结论:治疗性使用、有一个孩子和年龄较小是早期拔除LNG-IUS的独立危险因素，而以前使用LNG-IUS的风险较低。在避孕组和治疗组中，LNG-IUS停药的主要原因是继续使用新的LNG-IUS，不再需要使用LNG-IUS(用于避孕或治疗)。不可接受的出血模式或不良事件与两组中最低的延续率相关。
{"title":"Differences in continuation rates and early removal between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg","authors":"A. M. Teunissen, A. Merry, I. Devies, F. Roumen","doi":"10.1080/13625187.2019.1682134","DOIUrl":"https://doi.org/10.1080/13625187.2019.1682134","url":null,"abstract":"Abstract Objective: To investigate differences in continuation rates between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS) and factors associated with early removal. Methods: Study design: Retrospective consecutive cohort design. Cohort: Women with the insertion of the LNG-IUS for contraceptive or therapeutic use from 1 January 2006 through 1 January 2009 at the Zuyderland Medical Centre, The Netherlands, with a follow-up of 5 years. The continuation period and reasons of early removal were noted. Univariable and multivariable analysis were performed. Results: Follow-up was possible in 2481 women, 1855 (74.8%) in the contraception group, and 626 (25.2%) in the therapy group. Multivariable Cox proportional hazards models showed, that therapeutic use was associated with an increased risk of early removal of the LNG-IUS (HR 1.23; 95% CI 1.08–1.41), as was having one child (HR 1.20; 95% CI 1.04–1.38), and a decreased risk with advancing age (HR 0.96; 95% CI 0.95–0.97). In both groups, an unacceptable bleeding pattern and adverse events were the main reasons of early removal, resulting in very low continuation rates over the years. Conclusion: Therapeutic use, having one child and a younger age are independent risk factors of early removal of the LNG-IUS, in contrast with previous LNG-IUS use which is associated with a lower risk. In both the contraception group and the therapy group, the main reasons for LNG-IUS discontinuation are continuation with a new LNG-IUS, and no more need for an LNG-IUS (for contraception or therapy). An unacceptable bleeding pattern or adverse events are associated with the lowest continuation rates in both groups.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"88 1","pages":"449 - 456"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77309800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.1080/13625187.2019.1682135
S. F. Bento, R. Pacagnella, A. Faúndes, K. S. de Pádua, K. Fernandes, Danielle Miyamoto Araújo, I. Fahl, Maria José Duarte Osis, G. A. Duarte
Abstract Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs. Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know. Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation. Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.
{"title":"The abstract versus the concrete: differing opinions of medical residents in obstetrics and gynaecology about abortion and punishment of abortion","authors":"S. F. Bento, R. Pacagnella, A. Faúndes, K. S. de Pádua, K. Fernandes, Danielle Miyamoto Araújo, I. Fahl, Maria José Duarte Osis, G. A. Duarte","doi":"10.1080/13625187.2019.1682135","DOIUrl":"https://doi.org/10.1080/13625187.2019.1682135","url":null,"abstract":"Abstract Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs. Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know. Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation. Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"4 1","pages":"494 - 500"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84391761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-15DOI: 10.1080/13625187.2019.1675624
P. Lowe, K. Pilcher, H. Pattison, V. Whittaker, Claire Robertson, J. Ross
Abstract Objectives: The internet has changed the organisation of sex work. The risk of sexually transmitted infections has frequently been a research focus, but less is known about sex workers’ use of contraception for pregnancy prevention. The aim of this research was to gain a better understanding of contraceptive preferences and provider interactions of online sex workers. Methods: Data were obtained from a multi-methods study of sex workers in the UK who advertise on the internet and have sexual contact with clients, particularly in the Birmingham and Solihull areas. The study comprised an online survey among 67 participants and eight qualitative interviews. Results: Reported high rates of condom use with clients led to sex workers considering pregnancy prevention to be a personal rather than an occupational issue. Disclosure of sex working to health professionals is often seen as unnecessary and/or undesirable due to concerns about stigma. A clear distinction between contraceptive needs for commercial and non-commercial partners was evident. Conclusion: Service providers need to take account of both personal and commercial needs during contraceptive consultations and avoid making assumptions based on homogeneous understandings of sex work. Encouraging disclosure of sex work to facilitate appropriate discussions may need new approaches to combat privacy and stigma concerns.
{"title":"Pregnancy prevention and contraceptive preferences of online sex workers in the UK","authors":"P. Lowe, K. Pilcher, H. Pattison, V. Whittaker, Claire Robertson, J. Ross","doi":"10.1080/13625187.2019.1675624","DOIUrl":"https://doi.org/10.1080/13625187.2019.1675624","url":null,"abstract":"Abstract Objectives: The internet has changed the organisation of sex work. The risk of sexually transmitted infections has frequently been a research focus, but less is known about sex workers’ use of contraception for pregnancy prevention. The aim of this research was to gain a better understanding of contraceptive preferences and provider interactions of online sex workers. Methods: Data were obtained from a multi-methods study of sex workers in the UK who advertise on the internet and have sexual contact with clients, particularly in the Birmingham and Solihull areas. The study comprised an online survey among 67 participants and eight qualitative interviews. Results: Reported high rates of condom use with clients led to sex workers considering pregnancy prevention to be a personal rather than an occupational issue. Disclosure of sex working to health professionals is often seen as unnecessary and/or undesirable due to concerns about stigma. A clear distinction between contraceptive needs for commercial and non-commercial partners was evident. Conclusion: Service providers need to take account of both personal and commercial needs during contraceptive consultations and avoid making assumptions based on homogeneous understandings of sex work. Encouraging disclosure of sex work to facilitate appropriate discussions may need new approaches to combat privacy and stigma concerns.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"44 6 1","pages":"444 - 448"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78492713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-10DOI: 10.1080/13625187.2019.1675979
{"title":"Thank you to Reviewers, 2019","authors":"","doi":"10.1080/13625187.2019.1675979","DOIUrl":"https://doi.org/10.1080/13625187.2019.1675979","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"164 1","pages":"501 - 501"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77523681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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