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Peer Reviewed

Title: Change and stability in parent-child contact in five western countries.
Author: Kalmijn M; de Vries J
Source: European Journal of Population. 2009 Aug;25(3):257-276.
Abstract: Although much is known about changes in the conjugal family, little is known about trends in contact between parents and adult (independently living) children. Using unique survey data, we study changes in contact with the mother and the father in five western countries over a 15-year period (Austria, West Germany, Great Britain, the United States, and Italy). We describe changes and we examine the role of compositional changes in the trend. We find no evidence for a decline in intergenerational contact, in contrast to notions of individualism. In two countries, there has been an increase in contact with the mother and in three countries no net trend is observed. Contact with the father has not changed. Other forms of contact (e.g., telephone contact) have increased. Some compositional changes have had a downward pressure on the trend, leading to a decline in contact (i.e., rising education, declining church attendance), but these pressures have been compensated by counteracing compositional changes (declining sibsize) and by behavioral changes.
Language: English
Keywords:
UNITED KINGDOM | UNITED STATES OF AMERICA | GERMANY | AUSTRIA | ITALY | RESEARCH REPORT | PARENTS | CHILDREN | FAMILY LIFE | BONDING | CHANGES | BEHAVIOR CHANGE | Developed Countries | Europe, Western | Europe | North America | Americas | Europe, Central | Europe, Southern | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Interpersonal Relations | Behavior | Social Change
Document Number: 339897

Title: Persistence of nevirapine in breast milk and plasma of mothers and their children after single-dose administration.
Author: Kunz A; Frank M; Mugenyi K; Kabasinguzi R; Weidenhammer A; Kurowski M; Kloft C; Harms G
Source: Journal of Antimicrobial Chemotherapy. 2009 Jan;63(1):170-7.
Abstract: OBJECTIVES: Nevirapine is widely used in the developing world for the prevention of mother-to-child transmission (PMTCT) of HIV. A single mutation in the HIV genome is sufficient to lead to significant nevirapine resistance. Persistence of low-level drug concentrations in body compartments can foster resistance formation. In this study, concentration-time courses of nevirapine after single-dose administration were analysed over an extended post-partum period. PATIENTS AND METHODS: Breast milk and plasma samples of 62 HIV-positive Ugandan mother-child pairs who had received single-dose nevirapine were collected at delivery and 1, 2 and 6 weeks post-partum. Nevirapine concentrations were quantified by LC/tandem-mass-spectrometry using a quantification limit of 15 ng/mL, and a population pharmacokinetic (PK) analysis was performed. RESULTS: Concentration-time profiles in breast milk, maternal plasma and child plasma showed similar shapes. At week 1, median nevirapine concentrations were 164 ng/mL in maternal plasma, 114 ng/mL in breast milk and 183 ng/mL in child plasma. The population PK model predicted nevirapine concentrations>10 ng/mL (IC50 for nevirapine) for 13 days in breast milk, 14 days in maternal plasma and 18 days in child plasma in 80% of the samples. CONCLUSIONS: Nevirapine concentrations were present for 2-3 weeks in the three compartments. The concentrations are probably sufficiently high to protect most breastfed children from HIV transmission during the first 2 weeks. The long presence of slowly decreasing levels of nevirapine is likely to induce resistance formation. Post-natal addition of antiretrovirals for 1 week only, as recommended in the current PMTCT guidelines, will not suffice to avoid nevirapine resistance formation.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | MOTHERS | INFANT | POSTPARTUM | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | DRUGS | BREASTFEEDING | HUMAN MILK | ADMINISTRATION AND DOSAGE | TREATMENT | Europe, Central | Europe | Developed Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Lactation | Maternal Physiology | Physiology | Biology
Document Number: 329752

Title: Intrinsic clotting factors in dependency of age, sex, body mass index, and oral contraceptives: definition and risk of elevated clotting factor levels.
Author: Luxembourg B; Schmitt J; Humpich M; Glowatzki M; Seifried E; Lindhoff-Last E
Source: Blood Coagulation and Fibrinolysis. 2009 Jul 17;
Abstract: Elevated clotting factors have been demonstrated to be a risk factor for venous thromboembolism (VTE). The aim of our study was to investigate the impact of age, sex, body mass index, and oral contraceptives on the clotting factor activities of factors VIII, IX, XI, and XII and their impact on the cutoff definition and risk of VTE associated with elevated clotting factors. Factor VIII, IX, XI, and XII activities were measured in 499 blood donors and 286 patients with VTE. Age and body mass index predicted significantly and independently the clotting factor activities of factors VIII, IX, and XI, whereas use of oral contraceptives predicted factor IX, XI, and XII levels. Percentiles of clotting factor activities, which are often used for the cutoff definition of elevated clotting factors, varied due to the effect of age, body mass index, and oral contraceptives. The adjusted odds ratios for VTE were 10.3 [95% confidence interval (CI) 5.1-20.7], 6.1 (95% CI 3.1-12.0), and 3.3 (95% CI 1.9-5.8) for elevated factors VIII, IX, and XI, respectively. Furthermore, our study demonstrates for the first time that elevated factor XII is associated with an increased risk of VTE (adjusted odds ratio 2.9, 95% CI 1.6-5.3).
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLIENTS | BLOOD DONORS | AGE FACTORS | BODY WEIGHT | ORAL CONTRACEPTIVES | THROMBOEMBOLISM | RISK FACTORS | Europe, Central | Europe | Developed Countries | Program Activities | Programs | Organization and Administration | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Embolism | Vascular Diseases | Diseases
Document Number: 342216

Title: Why use of dienogest for the first contraceptive pill with estradiol?
Author: Mueck AO; Seeger H; Buhling KJ
Source: Gynecological Endocrinology. 2009 Aug 11;:1-5.
Abstract: Dienogest (DNG) has the essential properties of an effective progestogen for use in a new contraceptive pill using estradiol valerate as estrogenic component - it inhibits ovulation and protects against endometrial proliferation. DNG is a derivative of norethisterone (NET), but has a cyanomethyl- instead of an ethinyl-group in C17 position which may offer a variety of benefits regarding hepatic effects. The similarity to NET is reflected in the high endometriotropy and in similar pharmacokinetics like short plasma half-live and high bioavailability. However, DNG also elicits properties of progesterone derivatives like neutrality in metabolic and cardiovascular system and considerable antiandrogenic activity, the latter increased by lack of binding to SHBG as specific property of DNG. It has no glucocorticoid and antimineralocorticoid activity and has no antiestrogenic activity with the consequence that possible beneficial estradiol effects should not be antagonized. This may be of special importance for the tolerability and safety of the first pill with estradiol valerate instead of ethinylestradiol, although well-designed postmarketing studies are still ongoing to demonstrate what can be expected on the basis of pharmacology.
Language: English
Keywords:
GERMANY | CRITIQUE | ORAL CONTRACEPTIVES, PHASIC | LOW-DOSE PROGESTINS | ESTRADIOL | CONTRACEPTIVE SAFETY | ENDOMETRIAL EFFECTS | HEPATIC EFFECTS | CENTRAL NERVOUS SYSTEM EFFECTS | MENSTRUAL CYCLE | HORMONE REPLACEMENT THERAPY | Europe, Central | Europe | Developed Countries | Oral Contraceptives, Combined | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Safety | Public Health | Health | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Central Nervous System | Menstruation | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342487

Peer Reviewed

Title: Efficacy of a combined oral contraceptive containing 0.030 mg ethinylestradiol/2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/2 mg cyproterone acetate.
Author: Palombo-Kinne E; Schellschmidt I; Schumacher U; Graser T
Source: Contraception. 2009 Apr;79(4):282-9.
Abstract: BACKGROUND: Acne is a multifactorial disease characterized by androgenic stimulation of sebaceous glands. Therefore, combined oral contraceptives (COCs) containing anti-androgenic progestogens are suitable candidates for acne treatment. This study aimed to show that a COC containing the anti-androgen dienogest (DNG) is superior to placebo and not inferior to a COC containing the potent anti-androgen cyproterone acetate (CPA) in improving mild to moderate acne. STUDY DESIGN: Healthy women between 16 and 45 years old with mild to moderate facial acne were randomly assigned to receive ethinylestradiol (EE)/DNG (n=525), EE/CPA (n=537) or placebo (n=264) for six cycles in a multinational, multicenter, three-arm, double-blind and randomized trial. The primary efficacy variables were the percentages of change (from baseline to cycle 6) in inflammatory and total lesion count and the percentage of patients with acne improvement according to the Investigator Global Assessment. RESULTS: All primary analyses proved that EE/DNG was superior to placebo and non-inferior to EE/CPA (p<.05). For inflammatory lesions, the reduction (+/-SD) rates were -65.6+/-29.9% for EE/DNG, -64.6+/-31.2% for EE/CPA and -49.4+/-41.0% for placebo. For total lesions, the reduction rates were -54.7+/-26.3% for EE/DNG, -53.6+/-27.5% for EE/CPA and -39.4+/-33.6% for placebo. The percentages of patients with improvement of facial acne were 91.9% for EE/DNG, 90.2% for EE/CPA and 76.2% for placebo. CONCLUSION: EE/DNG was superior to placebo, in spite of the prominent placebo effects, and as effective as EE/CPA in the treatment of mild to moderate acne, thus proving a valid option for the treatment of acne in women seeking oral contraception.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | ACNE | ORAL CONTRACEPTIVES | ETHINYL ESTRADIOL | TREATMENT | Europe, Central | Europe | Developed Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Dermatitis | Diseases | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330559

Title: Is induced abortion a risk factor in subsequent pregnancy?
Author: Voigt M; Henrich W; Zygmunt M; Friese K; Straube S; Briese V
Source: Journal of Perinatal Medicine. 2009;37(2):144-9.
Abstract: OBJECTIVE: To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics. PATIENTS AND METHODS: Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for. RESULTS: There was an overall trend towards an increased rate of preterm delivery at or=2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P<0.0001). CONCLUSION: The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | WOMEN | PARITY | ABORTION | PREMATURE BIRTH | PREGNANCY COMPLICATIONS | RISK FACTORS | LOW BIRTH WEIGHT | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Fertility Measurements | Fertility | Population Dynamics | Fertility Control, Postconception | Family Planning | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Health | Birth Weight | Body Weight | Physiology | Biology
Document Number: 331182 Notification

Peer Reviewed

Title: The effects of two monophasic oral contraceptives containing 30 mcg of ethinyl estradiol and either 2 mg of chlormadinone acetate or 0.15 mg of desogestrel on lipid, hormone and metabolic parameters.
Author: Winkler UH; Sudik R
Source: Contraception. 2009 Jan;79(1):15-23.
Abstract: BACKGROUND: This study was conducted to compare the effects of two monophasic oral contraceptives (OCs) containing ethinyl estradiol (EE) 30 mcg+either chlormadinone acetate (CMA) 2 mg (Belara) or 0.15 mg desogestrel (Marvelon) on lipid, hormone and other relevant metabolic parameters. STUDY DESIGN: Markers of lipid and carbohydrate metabolism, and reproductive hormone levels, were measured in 45 subjects randomly assigned to 6 months of treatment with one of the two OCs. The cortisol response to adrenocorticotrophic hormone (ACTH) stimulation was also evaluated. RESULTS: In both treatment groups, triglycerides, high-density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo) AI and Apo AII levels increased; low-density lipoprotein cholesterol (LDL-C) and the LDL-C/HDL-C ratio decreased; and total cholesterol and lipoprotein(a) were unchanged during treatment. Effects on HDL-C, Apo AI, LDL-C and the LDL-C/HDL-C ratio were more evident in the EE 30 mcg+CMA 2 mg group. Follicle-stimulating hormone, luteinizing hormone and androgen levels decreased and sex hormone-binding globulin levels increased in both groups. Both OCs increased basal cortisol levels and cortisol response to ACTH. Oral contraceptive did not have a clinically significant impact on carbohydrate metabolism. CONCLUSIONS: Both low-dose monophasic OCs had comparable effects on lipid, hormone and metabolic parameters during six cycles of treatment in healthy female subjects. There was some evidence of a beneficial effect on atherogenic cardiovascular risk markers, which was slightly more pronounced with EE 30 mcg+CMA 2 mg.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | COMPARATIVE STUDIES | ORAL CONTRACEPTIVES | ETHINYL ESTRADIOL | DESOGESTREL | METABOLIC EFFECTS | CARBOHYDRATE METABOLIC EFFECTS | TREATMENT | Europe, Central | Europe | Developed Countries | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330540

10.

Peer Reviewed

Title: Effects of two combined oral contraceptives containing ethinyl estradiol 30 mug combined with either gestodene or drospirenone on hemostatic parameters, lipid profiles and blood pressure.
Author: Yildizhan R; Yildizhan B; Adali E; Yoruk P; Birol F
Source: Archives of Gynecology and Obstetrics. 2009 Jan 6;:[7] p.
Abstract: OBJECTIVE: The aim of this study is to compare the effect of ethinyl estradiol 0.03 mg/gestodene 0.075 mg (EE/GSD) with ethinylestradiol 0.03 mg/drospirenone 3 mg (EE/DRSP) administered according to conventional 21/7 regimen on body mass index (BMI), blood pressure (BP), lipid metabolism and hemostatic parameters. METHOD: In this study, 160 healthy women were randomized to EE/GSD mg or EE/DRSP for 12 months. Mean differences in BMI, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C), total cholesterol (TC) levels and BP compared to baseline were assessed. RESULTS: One hundred and forty-five (89%) of the women completed all 12 treatment cycles. The subjects randomly assigned into two treatment groups. Group EE/GSD (n = 71) and group EE/DRSP (n = 72). In group B, BMI values were significantly lower than baseline at the sixth cycle. DRSP/EE had more favorable effects on BP than GSD/EE with the mean systolic and diastolic BPs remaining lower in the DRSP/EE group. The difference between the two preparations was not statistically significant at the end of the study. TC levels remained similar in both groups throughout the study period. In both groups LDL-C levels decreased, triglyceride and HDL-C levels significantly increased from baseline levels. These changes result in increasing HDL-C/LDL-C ratio, demonstrating anti-atherogenic effect. Menstrual cycle patterns and the incidence of adverse events were similar between groups. The duration of withdrawal bleeding decreased during the study for both groups and was similar. CONCLUSION: The EE/DRSP regimen provides good cycle control with reliable contraceptive efficacy and low incidence of adverse events. Compared with the EE/GSD preparation, the EE/DRSP preparation demonstrated a more favorable effect on BMI and BP with the mean BMI and mean BP remaining lower than baseline mean. The new formulation may be especially beneficial for women susceptible to body weight gain and rise in BP.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | LABORATORY PROCEDURES | WOMEN | ORAL CONTRACEPTIVES | ETHINYL ESTRADIOL | CHOLESTEROL | GESTODENE | CONTRACEPTIVE SAFETY | BODY WEIGHT | Europe, Central | Europe | Developed Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Lipids | Physiology | Biology | Contraceptive Agents, Progestin | Safety | Public Health
Document Number: 329673

11.

Title: Medical treatment of hirsutism.
Author: Blume-Peytavi U; Hahn S
Source: Dermatologic therapy. 2008 Sep-Oct;21(5):329-39.
Abstract: Hirsutism is usually the result of an underlying adrenal, ovarian, or central endocrine abnormality mainly due to polycystic ovary syndrome but may also be idiopathic or drug induced. The aim of medical treatment of hirsutism is to rectify any causal hormonal balance, slow down or stop excessive hair growth, and improve the aesthetic appearance of hirsutism, thereby positively affecting the patient's quality of life. Today, for the majority of women, a monotherapy with oral contraceptives that have antiandrogenic activity is recommended as a first-line treatment for hirsutism. Combining an oral contraceptive pill with an antiandrogen is recommended if clinical improvement of hirsutism is insufficient after 6-9 months' monotherapy. In women who present with hirsutism, hyperandrogenism, and insulin resistance, insulin sensitizers are effective for the hirsutism as well as the hyperinsulinemia, hyperandrogenism, and infertility but there is no convincing evidence that they are effective for hirsutismalone. Topical eflornithine is a medical therapy that can be a useful adjuvant for hirsutism when used in conjunction with systemic medications or with laser/photoepilation.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | WOMEN | HIRSUTISM | HAIR DISEASES | ENZYMES AND ENZYME INHIBITORS | ORAL CONTRACEPTIVES | TREATMENT | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Signs and Symptoms | Diseases | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 329645

12.

Title: GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy.
Author: Blumenfeld Z; von Wolff M
Source: Human Reproduction Update. 2008 Nov-Dec;14(6):543-52.
Abstract: BACKGROUND: For preserving fertility in women during chemotherapy, the character of invasive techniques, such as ovarian cryopreservation and other techniques, await further experience. Meanwhile, non-invasive techniques have attempted to minimize the gonadotoxic effect of chemotherapy, by using gonadotrophin-releasing hormone-analogues (GnRH-a) or oral contraceptives (OC). METHODS: We performed a computerized MEDLINE search to identify articles published on fertility preservation using GnRH-a or OCs. RESULTS: Nine human-controlled studies reported the use of GnRH-a and four reported the use of OCs in parallel to chemotherapy. All nine studies analysing the effect of GnRH-a found lower rates of premature ovarian failure (POF) in patients receiving GnRH-a compared with the controls. Summarizing the studies resulted in 11.1% incidence of POF in patients who received GnRH-a compared with 55.5% incidence in the controls. Evidence using the fertility preserving effect of OC is limited. Two studies showed lower POF rates in OC-treated patients. The summarized data revealed a POF rate of 13.2% in patients who received OCs compared with that of 29.8% in the controls. CONCLUSIONS: The published clinical studies provide evidence, but do not prove statistically, that GnRH-a co-treatment reduces gonadotoxicity. Owing to the retrospective and non-randomized nature of most of the studies, definite conclusions concerning the reduction of POF by GnRH-a can still not be unequivocally drawn. As GnRH-a and OC have no serious side effects and as GnRH-a can even reduce chemotherapy-induced complications, such as severe menometrorrhagia, GnRH-a are considered by many clinicians as a clinically useful co-treatment in chemotherapy. The published clinical studies on OC also suggest a possible effect on the reduction of POF under certain conditions.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | ORAL CONTRACEPTIVES | FERTILITY | GONADOTROPINS | TOXICITY | SIDE EFFECTS | TREATMENT | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Hormones | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 329621

13.

14.

Title: Urogenital infections in reproductive medicine.
Author: Dieterle S
Source: Andrologia. 2008 Apr;40(2):117-119.
Abstract: Urogenital infections with Chlamydia trachomatis belong to the most prevalent sexually-transmitted bacterial diseases. In women, they can cause chronic salpingitis with subsequent tubal infertility and ectopic pregnancies. In men, C. trachomatis can cause urethritis, prostatitis and epididymitis. Urogenital infections can be symptomatic or asymptomatic. Symptomatic urogenital infections might impair male fertility. In vitro, C. trachomatis affects sperm motility and viability. However, there is no clear evidence that asymptomatic urogenital infections have an adverse effect on male fertility. Because C. trachomatis can be sexually transmitted and lead to female infertility, it is also of significance in male infertility work-up. Because of their high sensitivity, nucleic acid amplification tests should be used to examine first-void urine specimens. Both partners should be treated. The role of Ureaplasma urealyticum in reproductive medicine has been discussed controversially. There is no evidence that U. urealyticum has a significant impact on female or male infertility. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | MEN | CHLAMYDIA | UROGENITAL EFFECTS | INFERTILITY | REPRODUCTIVE HEALTH | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Urogenital System | Physiology | Biology | Reproduction | Health
Document Number: 325934

15.

Peer Reviewed

Title: Germany: Family diversity with low actual and desired fertility.
Author: Dorbritz J
Source: Demographic Research. 2008 Jul 1;19(17):557-598.
Abstract: Germany is a low-fertility country with a rapidly ageing population, and will remain so for the foreseeable future. There are several reasons for this trend. Germany is among the countries with the highest rates of childlessness in the world, and childlessness has become widely accepted. This is illustrated by changes in living arrangements. A broad range of living arrangements has been added to the basic model of marriage with children; namely, single living, non-marital cohabitation, lone parenthood, patchwork families and living apart together. A culture of individualism has spread in Germany which forms the basis for widespread decisions against family formation. The desired number of children has become low and family policy is considered to be a failure in terms of its influence on fertility. German family policy has had a traditional orientation centred on monetary support to families and on the promotion of the male breadwinner model. Women have been largely forced to choose between familyand work, and leave the labour market when a child is born. The still prevailing concept of family policy does not help to reduce the pressure to choose between work and family life, and thus makes it easier to decide not to have children, especially for highly educated women. A change in family policy is needed which will enable couples to choose between the breadwinner-housewife and the reconciliation model. Gradually, this change is starting to take place. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | LOW FERTILITY POPULATION | NULLIPARITY | FAMILY AND HOUSEHOLD | FAMILY SIZE, DESIRED | SOCIOCULTURAL FACTORS | GENDER RELATIONS | Europe, Central | Europe | Developed Countries | Fertility | Population Dynamics | Demographic Factors | Population | Parity | Fertility Measurements | Family Size | Family Characteristics | Gender Issues
Document Number: 327725

16.

Peer Reviewed

Title: Ovulation inhibition with four variations of a four-phasic estradiol valerate / dienogest combined oral contraceptive: Results of two prospective, randomized, open-label studies.
Author: Endrikat J; Parke S; Trummer D; Schmidt W; Duijkers I
Source: Contraception. 2008 Sep;78(3):218-225.
Abstract: Attempts to improve the tolerability of combined oral contraceptives (COCs) have included the substitution of ethinylestradiol (EE) with 17�-estradiol (E2). However, this has proved unsatisfactory, specifically in terms of cycle control. To improve upon the poor cycle control seen previously, E2 [in the form of estradiol valerate (E2V); 1 mg of E2V contains 0.76 mg of E2] was combined with dienogest (DNG) in a novel four-phasic regimen. In the current studies, the ovulation-inhibition potency of four variations of this regimen was assessed. Two randomized, open-label, Phase II studies were performed. The first study compared two regimens (Regimens 1A and 2A) with similar dosages of DNG but different lengths of application. Having established in Study 1 that the length of application of Regimen 2A was most suitable, but that the dosages of DNG were too low for effective ovulation inhibition, a second study, which compared two regimens (Regimens 2B and 2C) with similar lengths of application but with increased dosages of DNG, was undertaken. The primary efficacy variable in both studies was the proportion of women with a Hoogland score of 5 or 6 during Cycle 2. The full analysis set comprised 192 and 203 women in Studies 1 and 2, respectively. In Study 1, 10 women (10.9%) in Regimen 1A and 6 women (6.4%) in Regimen 2A had a Hoogland score of 5 or 6. In Study 2, three women (3.1%) in Regimen 2B and one woman (1.0%) in Regimen 2C had a Hoogland score of 5 or 6. There were no safety concerns with any of the regimens. The results of these studies identified a four-phasic COC preparation comprising E2V/DNG that provides efficient ovulation inhibition. It is expected that this regimen will lead to an innovative COC containing E2 instead of EE. (author's)
Language: English
Keywords:
GERMANY | NETHERLANDS | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL TRIALS | ORAL CONTRACEPTIVES, COMBINED | ESTRADIOL | OVULATION SUPPRESSION | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | Europe, Central | Europe | Developed Countries | Europe, Western | Studies | Research Methodology | Clinical Research | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Mode of Action | Safety | Public Health | Health
Document Number: 328124

17.

Title: Demography as a push toward gender equality? Current reforms of German family policy.
Author: Henninger A; Wimbauer C; Dombrowski R
Source: Social Politics: International Studies in Gender, State and Society. 2008 Fall;15(3):287-314.
Abstract: This paper analyzes the policy objectives and (potential) outcomes of one of the recent reforms in German family policy, the new parenting benefit. The reform introduces not only a new policy instrument that puts a stronger focus on the labor-market activation of mothers but also a new policy objective: an attempt to raise the birth rate. We argue that this indicates a paradigm shift in German family policy, as it changes the interplay between (de)familialization, (de)commodification, and stratification. While the new paradigm offers better opportunities for highly qualified parents, it also leads to increasing social inequalities between families and, more specifically, mothers. (author's)
Language: English
Keywords:
GERMANY | LITERATURE REVIEW | FAMILY POLICY | BIRTH RATE | CHILD CARE | MATERNITY BENEFITS | PATERNITY BENEFITS | INCOME | GOVERNMENT PROGRAMS | Europe, Central | Europe | Developed Countries | Social Policy | Policy | Political Factors | Sociocultural Factors | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Child Rearing | Behavior | Microeconomic Factors | Economic Factors | Socioeconomic Factors | Programs | Organization and Administration
Document Number: 328177

18.

Title: Fertility rates following vasectomy reversal: importance of age of the female partner.
Author: Hinz S; Rais-Bahrami S; Kempkensteffen C; Weiske WH; Schrader M; Magheli A
Source: Urologia Internationalis. 2008;81(4):416-20.
Abstract: INTRODUCTION: Literature regarding the influence of maternal age on pregnancy rates with male partners who have undergone vasectomy reversal is sparse. With the tendency towards delayed childbirth, the increased use of vasectomy as means of family planning, and advances in reproductive techniques, this issue is very important for patient counseling. The aim of this study is to determine the importance of maternal age on pregnancy rates following vasectomy reversal. SUBJECTS AND METHODS: A retrospective analysis was performed on 212 patients who underwent vasectomy reversal by a single surgeon (W.H.W.). Patient characteristics of the male and the female partner were evaluated using the Fisher exact test and predictors of pregnancy were identified using multivariable logistic regression analyses. RESULTS: The mean age of the male patients was 40.4 years and the mean age of their female partners was 31.3 years. The postoperative vas patency rate was 93.4%, which resulted in a pregnancy rate of 72.2%. In univariate and multivariable analysis, the age of the female partner (p = 0.014 univariate and p = 0.010 multivariable) and Silber score (p = 0.028 univariate and p = 0.024 multivariable) were predictive of pregnancy following vasectomy reversal with age of the female partner >40 years being associated with lower pregnancy rates compared to those or=40 years is an independent predictor of a lower rate of pregnancy following vasectomy reversal but still compared favorably to published pregnancy rates following intracytoplasmatic sperm injection in patients aged 40 years and older. Therefore, vasectomy reversal should be the treatment of choice for patients with advanced maternal age desiring reinstated fertility following vasectomy.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | VASECTOMY | VAS REANASTOMOSIS | FERTILITY RATE | MATERNAL AGE | AGE FACTORS | Europe, Central | Europe | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Male Sterilization | Sterilization, Sexual | Family Planning | Sterilization Reversal | Reversible Sterilization | Birth Rate | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Parental Age | Population Characteristics
Document Number: 341438

19.
Title: Effect of an oral contraceptive with chlormadinone acetate on depressive mood : analysis of data from four observational studies.
Author: Huber JC; Heskamp ML; Schramm GA
Source: Clinical Drug Investigation. 2008;28(12):783-91.
Abstract: BACKGROUND and objective: Many women of reproductive age experience depressive mood symptoms such as sudden mood swings, irritability, nervousness, excitability and anxiety. Although not defined as a disease, these disturbing mental symptoms are associated with a considerable decrease in quality of life. Molecular pharmacology research over the last 20 years has shown that endogenous steroid hormones may interact with the CNS. Some of these hormones, i.e. the sex hormone progesterone and its 3alpha-reduced metabolites allopregnanolone (3alpha,5alpha-tetrahydroprogesterone) and epipregnanolone (3alpha,5beta-tetrahydroprogesterone, eltanolone), influence mood-balancing and anxiolytic effects via the gamma-aminobutyric acid receptor A (GABA(A)), a major inhibiting receptor of the CNS. Activation of GABA(A) receptor results in mood balancing, anxiolytic, antiepileptic and sedative actions. When oral contraception is considered, it should be taken into account that the various synthetic progestogens used may differ in their influence on mental state. For instance, there is strong clinical evidence of mood-balancing effects for the progesterone derivative chlormadinone acetate (CMA). The aim of these studies was to describe the clinical effects of CMA in combination with ethinylestradiol on depressive mood symptoms. METHODS: Data from four prospective, non-interventional observational studies involving nearly 50 000 women were analysed. The studies documented use of four, six and 12 treatment cycles of the 28-day conventional regimen, as well as providing data on extended cycle regimens. The women in these studies were prescribed CMA 2 mg and ethinylestradiol (EE) 0.03 mg according to gynaecologists' usual practice. RESULTS: Clinical data from the studies confirmed that intake of CMA 2 mg and EE 0.03 mg promotes emotional well-being and reduces mood swings. Improvement in depressive mood was documented after four, six and 12 treatment cycles of the conventional intake regimen as well as with an extended-cycle regimen of CMA/EE. CONCLUSION: CMA 2 mg combined with EE 0.3 mg improves symptoms of depressive mood. The high structural congruence between the endogenous GABA(A) modulator epipregnanolone and the CMA metabolite M-V suggests a direct GABAergic, mood stabilizing function of CMA. We propose a theoretical concept - the CMA-GABA(A) model - that could explain the positive psychotropic effect of CMA.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | DATA ANALYSIS | WOMEN | CHLORMADINONE ACETATE | ORAL CONTRACEPTIVES, SIDE EFFECTS | DEPRESSION | EMOTIONS | ETHINYL ESTRADIOL | CENTRAL NERVOUS SYSTEM EFFECTS | Europe, Central | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Mental Disorders | Diseases | Psychological Factors | Behavior | Contraceptive Agents, Estrogen | Central Nervous System | Physiology | Biology
Document Number: 329792

20.

Title: Local immunodiagnosis of pulmonary tuberculosis by enzyme-linked immunospot.
Author: Jafari C; Ernst M; Strassburg A; Greinert U; Kalsdorf B
Source: European Respiratory Journal. 2008 Feb;31(2):261-265.
Abstract: Lymphocytes are crucial in the immune defence against Mycobacterium tuberculosis (MTB) infection. The aim of the present study was to ascertain whether or not MTB-specific lymphocytes are selectively compartmentalised in the lungs of patients with minimal active pulmonary tuberculosis (PTB). Patients with smear-negative MTB-culture-confirmed PTB were prospectively recruited. Differential cell counts, immunophenotyping with monoclonal antibodies directed against the cell surface markers CD4, CD8, CD4CD45RA, CD4CD45R0, CD38, human leukocyte antigen DR, CD19, CD3, CD57 and CD16 and MTB-specific enzyme-linked immunospot assays of peripheral blood mononuclear cells and bronchoalveolar lavage (BAL) mononuclear cells with 6-kDa early secretory antigenic target and culture filtrate protein 10 were performed. Among 12 patients with culture-confirmed smear-negative PTB, no differences were found in the distribution of total CD4 or CD8 T-cells in peripheral blood or BAL fluid (BALF). Activated human leukocyte antigen-DR-positive cells, as well as memory CD4CD45R0-positive T-cells, were expanded among cells of the BALF. Compared with a group of control patients with alternative pulmonary pathologies, there was no significant difference in lymphocyte subpopulations. However, 6-kDa early secretory antigenic target- and culture filtrate protein 10-specific lymphocytes were more concentrated, with a median BALF:peripheral blood ratio of 9.9 and 8.9, respectively, in patients with PTB. Mycobacterium tuberculosis-specific T-cells are highly selectively compartmentalised at the site of infection in active pulmonary tuberculosis.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | CLIENTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES | IMMUNE SYSTEM | PULMONARY EFFECTS | Europe, Central | Europe | Developed Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 325762

21.
Title: Effects of an oral contraceptive containing chlormadinone and ethinylestradiol on acne-prone skin of women of different age groups: an open-label, single-centre, phase IV study.
Author: Kerscher M; Reuther T; Bayrhammer J; Schramm G
Source: Clinical Drug Investigation. 2008;28(11):703-11.
Abstract: BACKGROUND AND OBJECTIVE: Acne-prone skin, a common skin condition not only in adolescents but also in adults, can significantly influence the affected individual's quality of life. The aim of this open-label, prospective, single-centre, phase IV study was to investigate the effects of an oral contraceptive containing chlormadinone 2 mg and ethinylestradiol 0.03 mg (Belara) on the physiology of acne-prone facial skin in healthy women aged 18-37 years. METHODS: Forty-four Caucasian women requesting hormonal contraception divided into two age groups (group A: 18-27 years; group B: 28-37 years) were treated with chlormadinone/ethinylestradiol for six menstrual cycles. During each treatment phase, each subject took one tablet per day for 21 consecutive days, followed by a 7-day pill-free interval. Medication was commenced on the first day of menses. Changes in skin parameters were evaluated in terms of the clinical sum score (the primary outcome variable, calculated from the number of comedones, the number of papules/papulopustules, and the sebum secretion state), the evaluation of the pore size using standardized photography, and a range of biophysical in vivo measurements, assessed at baseline, after 12 weeks and after 24 weeks. RESULTS: In both age groups, facial skin condition as quantified by the clinical sum score improved significantly after three and six treatment cycles, with reduced numbers of acne lesions (comedones and papules/papulopustules) and a reduction in seborrhoea. Moreover, there was a statistically significant decrease in pore size. Biophysical evaluations confirmed favourable effects of the medication on diverse skin parameters. Skin surface pH remained within the normal physiological range and there was an improvement in epidermal barrier function (as manifested by decreased transepidermal water loss from the skin of the forehead). Stratum corneum hydration increased in both age groups and the lipid content of the skin surface on the forehead decreased significantly after three treatment cycles in subjects aged 28-37 years. Ultrasound measurements verified that there was no retention of water within the dermis. There was no difference between the two age groups. CONCLUSION: For the first time, improvements in several facial skin parameters during treatment with a combined oral contraceptive (chlormadinone/ethinyl-estradiol) were quantified by biophysical methods and a clinical sum score. The highly statistically significant improvements in clinical findings and various biophysical skin parameters observed in this study suggest that the antiandrogenic oral contraceptive chlormadinone/ethinylestradiol may be a major therapy option in women with acne-prone skin who request hormonal contraception.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | WHITES | ETHINYL ESTRADIOL | ORAL CONTRACEPTIVES, COMBINED | ACNE | DERMATOLOGICAL EFFECTS | TREATMENT | AGE FACTORS | Europe, Central | Europe | Developed Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods | Dermatitis | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 329816

22.

Title: Sexually transmitted infections: Impact on male fertility
Author: Ochsendorf FR
Source: Andrologia. 2008 Apr;40(2):72-75.
Abstract: The impact of sexually transmitted diseases (STD) on male fertility is strongly dependent on the local prevalence of the STDs. In Western countries STD-infections are of minor relevance. In other regions, i.e. Africa or South East Asia, the situation appears to be different. Acute urethritis could not be associated with male infertility. Chronic infections (gonorrhoea) can cause urethral strictures and epididymo-orchitis. Chlamydia trachomatis and Neisseria gonorrhoea can be transmitted to the female partner and cause pelvic inflammatory disease with tubal obstruction. Ureaplasma urealyticum may impair spermatozoa (motility, DNA condensation). Trichomonas vaginalis has, if any, only minor influence on male fertility. The relevance of viral infections (HPV, HSV) for male infertility is not resolved. Any STD increases the chances of transmission of the human immunodeficiency virus (HIV). The HIV infection is associated with infectious semen and the risk of virus transmission. Semen quality deteriorates with the progression of immunodeficiency. Special counselling of serodiscordant couples is needed. STDs should be treated early and adequately to prevent late sequelae for both men and women. (author's)
Language: English
Keywords:
GERMANY | GLOBAL | LITERATURE REVIEW | MEN | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | FERTILITY | HIV INFECTIONS | SEMEN | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Reproductive Tract Infections | Infections | Diseases | Measurement | Research Methodology | Population Dynamics | Viral Diseases | Seminal Vesicles | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology
Document Number: 325813

23.

Peer Reviewed

Title: Differential interleukin-6 messenger ribonucleic acid expression and its distribution pattern in eutopic and ectopic endometrium.
Author: Salmassi A; Acil Y; Schmutzler AG; Koch K; Jonat W
Source: Fertility and Sterility. 2008 May;89 Suppl 3:1578-1584.
Abstract: The objective was to evaluate the concentration and distribution pattern of interleukin-6-producing cells in ectopic and eutopic endometrium. The design used was the collection of both tissues at the proliferative cycle phase. The setting was the university endocrinology and laparoscopy program. Twelve samples from six women were obtained at operative laparoscopy in the proliferative phase of each woman's cycle. The intervention(s) were paired sampling of ectopic (n = 6) and eutopic endometrium (n = 6). Concentration of IL-6 messenger RNA (mRNA) was measured by real-time RT-PCR, and its distribution was determined by in situ RT-PCR. In vitro RT-PCR analysis showed distinct bands at 234 bp and 115 bp for IL-6 mRNA in eutopic and ectopic endometrium and in placenta as positive control. Real-time RT-PCR indicated significantly higher expression of IL-6 in tissue with endometriosis than in tissue without. In all 12 samples subjected to in situ RT-PCR, positive signals of IL-6 mRNA were observed in cytoplasm of epithelial and stroma cells of ectopic and eutopic endometrium tissue. The significant IL-6 mRNA increase in endometriosis compared with in eutopic endometrium may play a role in the development of endometriosis and may provide new directions for endometriosis research. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ENDOMETRIOSIS | LAPAROSCOPY | LABORATORY PROCEDURES | IN VITRO | Europe, Central | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Diseases | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses
Document Number: 327231

24.

Peer Reviewed

Title: Chronic isolated torsion of the left fallopian tube: A diagnostic dilemma.
Author: Schollmeyer T; Soyinka AS; Mabrouk M; Jonat W; Mettler L
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):87-90.
Abstract: Chronic tubal torsion is a rare clinical entity. A 15-year-old adolescent presented with an 18-month history of intermittent lower abdominal pain at our outpatient department after various preceding consultations with different physicians. She was asymptomatic and showed no abnormality on physical examination. Ultrasound findings revealed a cystic structure adjacent to the left ovary. Diagnostic laparoscopy showed a twisted and dilated left fallopian tube with thickened wall and adherence to the pelvic sidewall. Following detorsion, there was no evidence of reperfusion. Consequently, a left salpingectomy was performed. Chronic tubal torsion is a rare but possible differential diagnosis of current lower abdominal pain. Physicians should have a high index of suspicion. (author's)
Language: English
Keywords:
GERMANY | SUMMARY REPORT | CASE HISTORIES | FALLOPIAN TUBES | TUBAL EFFECTS | PAIN | EXAMINATIONS AND DIAGNOSES | ORAL CONTRACEPTIVES, COMBINED | ULTRASONICS | LAPAROSCOPY | SURGERY | Europe, Central | Europe | Developed Countries | Data Collection | Research Methodology | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Endoscopy | Physical Examinations and Diagnoses | Treatment
Document Number: 322619

25.
Title: Diagnostics and treatment of HIV-affected couples who wish to have children.
Author: Tandler-Schneider A; Sonnenberg-Schwan U; Gingelmaier A; Meurer A; Kremer H
Source: European Journal of Medical Research. 2008 Dec 3;13(12):546-51.
Abstract: In Germany, more than 56.000 people are currently infected with HIV, 19% of whom are women. Since 1996, the improved therapeutic options have substantially increased life expectancy so that individuals with HIV can now enjoy an almost normal life span. This has also opened up the possibility for people to develop long-term perspectives with regard to their education, career, and family planning. Since 75% of all infected individuals are of childbearing age (between 20 and 40 years old), they often desire to have children. Scientific data has shown worldwide that people with HIV do not differ from the general population on the frequency of the desire and the importance placed on having children. Specifically, this has been proven for Switzerland. In fulfilling the desire of HIV-positive individuals to have children multiple factors have to be considered, such as the course of the HIV-infection, the infection risk for the HIV-negative partner, and the risk of vertical HIV-transmission to the child. In addition, the fertility status and various socio-demographic factors, such as age and marital status, also play a role. For HIV-affected couples who desire to have children the following three variants can be recognized, each of which presents their own particular problems that have to be considered: If the man is HIV-positive, protection of the female HIV-negative partner, if the woman is HIV-positive, in addition to protection of the HIV-negative partner the infection risk for the child, and if both partners are HIV-positive, both the infection risk of the child and the avoidance of transfer of resistant viruses between partners. Each variant requires different strategies for consultation and intervention. Among HIV-affected couples desiring children there is a greater need for support in medical and psychosocial questions and often for reproductive medicine. This task needs to be addressed in an interdisciplinary setting; therefore, representatives from the above-mentioned organizations have committed themselves to formulating recommendations for medical consultation, diagnostics, and treatment of HIV-affected couples who desire to have children. These are designed to account for the individual life circumstances of people with HIV, to aid in medical and forensic decision-making, and to be used as a guideline for consultation in medical and psychosocial practices. (excerpt)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | COUPLES | PERSONS LIVING WITH HIV/AIDS | FAMILY SIZE, DESIRED | COUNSELING | PSYCHOSOCIAL FACTORS | EXAMINATIONS AND DIAGNOSES | FERTILITY | MOTHER-TO-CHILD TRANSMISSION | Europe, Central | Europe | Developed Countries | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Family Size | Clinic Activities | Program Activities | Programs | Organization and Administration | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population | Transmission | Infections
Document Number: 329812

26.

Peer Reviewed

Title: Systemic fetal inflammation and reduced concentrations of macrophage migration inhibitory factor in tracheobronchial aspirate fluid of extremely premature infants.
Author: Thomas W; Seidenspinner S; Kawczynska-Leda N; Kramer BW; Chmielnicka-Kopaczyk M
Source: American Journal of Obstetrics and Gynecology. 2008 Jan;198(1):64.e1-64.e6.
Abstract: Macrophage migration inhibitory factor is a proinflammatory mediator of innate immunity, enhances cell growth, and plays a role in preterm delivery. We speculated that funisitis, reflecting fetal systemic inflammation, would be associated with higher concentrations of macrophage migration inhibitory factor in airways of extremely premature infants. We measured macrophage migration inhibitory factor by enzyme linked immunosorbent assay in tracheobronchial aspirate fluid of 35 ventilated infants less than 30 weeks' gestational age, throughout the first week of life. Three groups were distinguished histologically: chorioamnionitis, funisitis, and control. Unexpectedly, funisitis was associated with significantly decreased macrophage migration inhibitory factor in tracheobronchial aspirate fluid on day 1 (P < .01) and levels remained lower than in the chorioamnionitis group thereafter. For the 35 patients in total, macrophage migration inhibitory factor steadily declined. Decreased macrophage migration inhibitory factor concentrations in airways of extremely premature infants with systemic fetal inflammation early in life might predispose them to pulmonary infection and interfere with maturation of the lung, contributing to adverse pulmonary outcome. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | LABORATORY PROCEDURES | INFANT, PREMATURE | PULMONARY EFFECTS | EXAMINATIONS AND DIAGNOSES | Europe, Central | Europe | Developed Countries | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology
Document Number: 323370

27.

Title: Risks of pregnancy and birth, birth presentation, and mode of delivery in relation to the age of primiparous women.
Author: Voigt M; Rochow N; Zygmunt M; Straube S; Schneider KT; Briese V
Source: Zeitschrift Fur Geburtshilfe Und Neonatologie. 2008 Dec;212(6):206-10.
Abstract: OBJECTIVES: The aim of this study was to analyse the age distribution of primiparous women and its influence on pregnancy and birth risks, presentation at birth and mode of delivery. STUDY DESIGN: We analysed the perinatal statistics of eight German federal states for the years 1998-2000. For our analysis we defined maternal age groups as follows: < 22, 22-32, > 32 years. RESULTS: We identified a total of 508,926 singleton pregnancies. 247,593 of these were delivered by primiparous women without preceding live or stillbirths. The mean age of the primiparas was 26.9 years. For older primiparas > 32 years the proportion with previous miscarriages and terminations of pregnancy was > 20 %. The risk of premature rupture of membranes, abnormal CTG and prolonged labour increased clearly with age. 91.0 % of women < 22 years and 84.5 % of women > 32 years had a normal cephalic presentation. Regarding the mode of delivery, 77.1 % (< 22 years) and 53.1 % (> 32 years) experienced spontaneous delivery, 14.5 % (< 22 years) and 32.3 % (> 32 years) had a Caesarean section. CONCLUSIONS: Older primiparas have a higher proportion of previous miscarriages and terminations of pregnancy. They more commonly experience pathological presentations and also more frequently require Caesarean section. This means that a delayed first pregnancy - an increasingly common phenomenon in Germany - goes along with an increased likelihood of birth risks, Caesarean sections and peripartal interventions. Older primiparous women constitute a special risk group which may require a more intense level of care.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | WOMEN | AGE FACTORS | CESAREAN SECTION | PREGNANCY, HIGH RISK | ABORTION, SPONTANEOUS | PREGNANCY COMPLICATIONS | Europe, Central | Europe | Developed Countries | Demographic Factors | Population | Population Characteristics | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases
Document Number: 342605

28.

Peer Reviewed

Title: Male condoms that break in use do so mostly by a "blunt puncture" mechanism.
Author: White ND; Hill DM; Bodemeier S
Source: Contraception. 2008 May;77(5):360-365.
Abstract: Published condom breakage studies typically report the percentage of failures but rarely provide any evidence on the mechanism of failure. Over a period of 7 years, broken condoms returned to a supplier (SSL, Durex) via consumer complaints were examined to determine the cause of failure. Also, some consumers who reported breakage but did not return condoms were sent a questionnaire on the causes of breakage. Finally, theories proposed for the mechanism of breakage were investigated on a laboratory coital model. Nearly 1000 (n=972) returned condoms made from natural rubber and polyurethane were examined. Visible features on those that were broken, were classified. Evidence combined from examining returns, questionnaire responses and the coital model strongly suggests a single predominant mechanism of failure we named "blunt puncture," where the tip of the thrusting male penis progressively stretches one part of the intact condom wall until it ultimately breaks. Blunt puncture appears to be the mechanism of breakage responsible for more than 90% of condom breakage not attributable to misuse. Knowledge of the main mechanism of breakage should help develop better user instructions, better test methods and, ultimately, better condoms. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CONTRACEPTION RESEARCH | CONDOM FAILURE | LABORATORY PROCEDURES | SEXUAL INTERCOURSE | LUBRICANTS | TESTING | Europe, Central | Europe | Developed Countries | Contraception | Family Planning | Condoms | Barrier Methods | Contraceptive Methods | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Ingredients and Chemicals | Measurement | Research Methodology
Document Number: 325974

29.

Peer Reviewed

Title: Efficacy, safety and sustainability of treatment continuation and results of an oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg chlormadinone acetate, in long-term usage (up to 45 cycles) - an open-label, prospective, noncontrolled, office-based Phase III study.
Author: Zahradnik HP; Hanjalic-Beck A
Source: Contraception. 2008 May;77(5):337-343.
Abstract: This open-label, noncontrolled study assessed the long-term efficacy and tolerability of the monophasic combined low-dose oral contraceptive (OC) ethinyl estradiol (EE) 30 mcg+chlormadinone acetate (CMA) 2 mg (Belara). In total, 781 women who had already taken EE 30 mcg+CMA 2 mg for 24 cycles in a previous Phase III study were assessed for up to 45 cycles. Over 23,033 cycles, the Pearl Index was 0.16 (95% confidence interval, 0.04-0.42). Approximately 86% of women had regular withdrawal bleeding in each cycle, while incidence of intracyclic bleedings (1.6-6.4%) and proportion of women with amenorrhea (4%) were low. The incidence of acne decreased from 13.8% to 5.7%, while rates of hirsutism, alopecia and seborrhea remained low (less than or equal to 4%) throughout this study. The most frequent adverse events were consistent with OC treatment, and no unexpected events occurred. No changes in mean blood pressure and pulse rate were observed during the study, and there were no clinically relevant changes in liver or hematological parameters, hemostasis or carbohydrate metabolism. The incidence of pathological findings in gynecological examination was low and decreased over time. EE 30 mcg+CMA 2 mg was an effective and well-tolerated OC, with beneficial effects on cycle stability, intracyclic bleeding, amenorrhea and signs of androgenization that were maintained during long-term treatment for up to 5 years. There was no evidence of an increased risk of thromboembolic events, atherogenic disease or cervical cancer, suggesting that 30 EE mcg+CMA 2 mg is highly suitable for long-term use. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL TRIALS | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | CHLORMADINONE ACETATE | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | CONTRACEPTION CONTINUATION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Europe, Central | Europe | Developed Countries | Clinical Research | Research Methodology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Contraceptive Usage
Document Number: 325972

30.

Peer Reviewed

Title: The effects of an oestrogen-free, desogestrel-containing oral contraceptive in women with cyclical symptoms: Results from two studies on oestrogen-related symptoms and dysmenorrhoea.
Author: Ahrendt HJ; Karck U; Pichl T; Mueller T; Ernst U
Source: European Journal of Contraception and Reproductive Health Care. 2007 Dec;12(4):354-361.
Abstract: The objectives were to evaluate the effects of an oestrogen-free oral contraceptive (Cerazette; 75 mcg/day desogestrel) in women with oestrogen-related symptoms during previous combined oral contraceptive (COC) use (ERS study) and in women with dysmenorrhoea (DYS study). Two similarly designed prospective, non-comparative multicentre observational studies were carried out in Germany. Altogether, 403 women with oestrogen-related symptoms during previous COC use and 406 women with dysmenorrhoea took Cerazette continuously. Symptom-related assessments were made at baseline and after 3-4 months, along with bleeding pattern and treatment satisfaction. In the ERS study, the four oestrogen-related symptoms studied resolved or improved in over 70% of women. Nausea improved/resolved most (92% of women), followed by breast tenderness (90%), oestrogen-related headache (84%) and oedema (74%). In the DYS study, dysmenorrhoea resolved or considerably improved in 93% of the study population. Correspondingly, useof analgesics dropped from 70% of women at baseline to 8% at study end. Adverse events were reported by 7-8% of both study populations and were mainly bleeding irregularities. Most women in both studies were satisfied with treatment (~90%) and wished to continue treatment after study completion (*85%). Cerazette in this study set-up improved oestrogen-related symptoms and dysmenorrhoea in women affected and treatment was well accepted. (author's)
Language: English
Keywords:
GERMANY | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | ESTROGENS | DESOGESTREL | ORAL CONTRACEPTIVES | ADMINISTRATION AND DOSAGE | SIDE EFFECTS | SIGNS AND SYMPTOMS | DYSMENORRHEA | Europe, Central | Europe | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Menstruation Disorders
Document Number: 322479


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