1.  Peer Reviewed Title: Enhanced immunogenicity of an oral inactivated cholera vaccine in infants in Bangladesh obtained by zinc supplementation and by temporary withholding breast-feeding. Author: Ahmed T; Svennerholm AM; Al Tarique A; Sultana GN; Qadri F Source: Vaccine. 2009 Feb 25;27(9):1433-9. Abstract: The killed oral cholera vaccine Dukoral is recommended for adults and only children over 2 years of age, although cholera is seen frequently in younger children and there is an urgent need for a vaccine for them. Since decreased immunogenicity of oral vaccines in children in developing countries is a critical problem, we tested interventions to enhance responses to Dukoral. We evaluated the effect on the immune responses by temporarily withholding breast-feeding or by giving zinc supplementation. Two doses of Dukoral consisting of killed cholera vibrios and cholera B subunit were given to 6-18 months old Bangladeshi children (n=340) and safety and immunogenicity studied. Our results showed that two doses of the vaccine were safe and induced antibacterial (vibriocidal) antibody responses in 57% and antitoxin responses in 85% of the children. Immune responses were comparable after intake of one and two doses. Temporary withholding breast-feeding for 3 h before immunization or supplementation with 20 mg of zinc per day for 42 days resulted in increased magnitude of vibriocidal antibodies (77% and 79% responders, respectively). Administration of vaccines without buffer or in water did not result in reduction of vibriocidal responses. This study demonstrates that the vaccine is safe and immunogenic in children under 2 years of age and that simple interventions can enhance immune responses in young children. Language: English Keywords: BANGLADESH | RESEARCH REPORT | INFANT | CHOLERA | ZINC | HUMAN MILK | VACCINES | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE USE-EFFECTIVENESS | AUTOIMMUNE RESPONSE | SAFETY | Developing Countries | Asia, Southern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Bacterial and Fungal Diseases | Infections | Diseases | Metals | Vitamins and Minerals | Physiology | Biology | Lactation | Maternal Physiology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Contraceptive Effectiveness | Contraception | Family Planning | Antibodies | Immunologic Factors | Immunity | Immune System | Public Health Document Number: 341051 |
| 2. Title: [Of office hysteroscopy for the removal of intrauterine device. Literature review] Histeroscopia de consultorio para la extraccion de dispositivo intrauterino. Author: Alanis Fuentes J; Amoroso Hernandez MA Source: Ginecologia Y Obstetricia De Mexico. 2009 Apr;77(4):197-201. Abstract: OBJECTIVE: To review the literature related to the hysteroscopic techniques such as outpatient diagnostic and therapeutic tools for the extraction of foreign bodies in patients with intrauterine device. METHOD: We searched the main electronic databases were searched for those words: hysteroscopy and intrauterine device in articles related to the removal of intrauterine devices by hysteroscopy. RESULTS: The loss or translocation of IUD is a common problem resulting from the large number of women who have applied. The importance of early diagnosis is to avoid, such as the inappropriate position of the device promotes an unwanted pregnancy, genital bleeding and injury to adjacent organs such as bowel and bladder. The assessment by ultrasound or X-rays, or both, allowing the device to locate and determine the desirability or otherwise of outpatient hysteroscopy (in practice) without anesthesia and with low morbidity for the patient or, well, resorting to other methods, and laparoscopy in the operating room. CONCLUSIONS: Hysteroscopy is an effective procedure for recovering intrauterine foreign bodies or hidden in properly selected patients. Language: Spanish Keywords: GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | HYSTEROSCOPY | IUD | CONTRACEPTIVE REMOVAL | CONTRACEPTIVE USE-EFFECTIVENESS | PROGRAM EFFECTIVENESS | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Treatment | Contraceptive Effectiveness | Program Evaluation | Programs | Organization and Administration Document Number: 342313 |
| 3. Title: Oral contraceptives in migraine. Author: Allais G; Gabellari IC; De Lorenzo C; Mana O; Benedetto C Source: Expert Review of Neurotherapeutics. 2009 Mar;9(3):381-93. Abstract: Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear. The newest combined oral contraceptive formulations are generally well tolerated in migraine without aura, and the majority of migraine without aura sufferers do not show any problems with their use; nevertheless, the last International Classification of Headache Disorders identifies at least two entities evidently related to the use of combined oral contraceptives: exogenous hormone-induced headache and estrogen-withdrawal headache. As regards the safety, even if both migraine and combined oral contraceptive intake are associated with an increased risk of ischemic stroke, migraine without aura per se is not a contraindication for combined oral contraceptive use. Other risk factors (tobacco use, hypertension, hyperlipidemia, obesity and diabetes) must be carefully considered when prescribing combined oral contraceptives in migraine without aura patients, in particular in women aged over 35 years. Furthermore, the exclusion of a hereditary thrombophilia and of alterations of coagulative parameters should precede any decision of combined oral contraceptive prescription in migraine patients. Language: English Keywords: ITALY | RESEARCH REPORT | CLIENTS | WOMEN | MIGRAINE | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE SAFETY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | Europe, Southern | Europe | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Vascular Diseases | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Safety | Public Health | Health | Contraceptive Effectiveness Document Number: 330561 |
| 4. Peer Reviewed Title: Return to fertility after cessation of a continuous oral contraceptive. Author: Barnhart K; Mirkin S; Grubb G; Constantine G Source: Fertility and Sterility. 2009 May;91(5):1654-6. Abstract: OBJECTIVE: To evaluate the return to fertility among women planning to become pregnant after the use of a continuous regimen of levonorgestrel 90 microg and ethinyl E(2) 20 microg. DESIGN: Descriptive analysis of pregnancy outcomes after participation in a contraceptive trial. SETTING: Multicenter trial. SUBJECT(S): Participants in a phase 3 contraceptive trial who discontinued to become pregnant. INTERVENTION(S): Eligible subjects were contacted at 3 and 12 months after treatment discontinuation to determine if and when they had conceived. MAIN OUTCOME MEASURE(S): Kaplan-Meier analysis displaying the time until conception after oral contraceptive discontinuation. RESULT(S): In the phase 3 trial, 34 of 2,134 subjects cited a desire for pregnancy as a reason for discontinuation. Of these, 4 were already pregnant before stopping treatment, 4 initiated other contraception, and 5 were lost to follow-up. Of the remaining 21 subjects at risk of pregnancy, the pregnancy rate was 57% at 3 months, 81% at 12 months, and 86% (18 of 21) (95% confidence interval 64% to 97%) at 13 months after discontinuation of treatment. CONCLUSION(S): These findings suggest that a continuous oral contraceptive with levonorgestrel 90 microg and ethinyl E(2) 20 microg does not delay the return to fertility. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | ORAL CONTRACEPTIVES, LOW-DOSE | REVERSIBILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Clinical Research | Research Methodology | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Effectiveness Document Number: 341245 |
| 5. Title: Virologic and immunologic responses to antiretroviral therapy among HIV-1 and HIV-2 dually infected patients: case reports from Abidjan, Cote d'Ivoire. Author: Borget MY; Diallo K; Adje-Toure C; Chorba T; Nkengasong JN Source: Journal of Clinical Virology. 2009 May;45(1):72-5. Abstract: In four of five HIV-1 and HIV-2 dually infected patients treated with efavirenz-based therapy, viral load was undetectable for HIV-1 only, with limited increase in CD4+ counts. Both viral loads were undetectable and CD4+ counts increased in one patient treated with protease inhibitor regimen. Specific guidelines for treating HIV-dually infected patients are needed that should avoid the use of non-nucleoside reverse transcriptase inhibitors. Language: English Keywords: COTE D'IVOIRE | RESEARCH REPORT | CASE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV | INFECTIONS | ANTIRETROVIRAL THERAPY | CONTRACEPTIVE USE-EFFECTIVENESS | LABORATORY PROCEDURES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Contraceptive Effectiveness | Contraception | Family Planning | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342661 |
| 6. Title: Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. Author: Chowdhury JR; Chaudhuri S; Bhattacharyya N; Biswas PK; Panpalia M Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):119-125. Abstract: Objectives: Our objective was to compare intramuscular (i.m.) magnesium sulfate with a low dose intravenous (i.v.) magnesium sulfate regimen in prevention of convulsion recurrence and maternal deaths in women with eclampsia. Methods: This prospective trial was conducted in Nilratan Sircar Medical College, India from January 2001 to December 2005. All women with a clinical diagnosis of eclampsia were included in the trial. Magnesium sulfate (4 gm) was given as an i.v. loading dose, followed by either i.m. injections as recommended by Pritchard or low dose i.v. infusions (0.6 gm/h). Primary measures of outcome were recurrence of convulsions and maternal death. Secondary measures of outcome were potentially life threatening events, events related to labor and delivery as well as perinatal mortality and morbidity. Results: Of the 630 women participating in the trial, 480 women received i.m. magnesium sulphate according to the Pritchard regimen and 150 women were subjected to a low dose i.v. regimen ofmagnesium sulphate. There was no significant difference in recurrence of convulsion (3.3% in the i.m. and 2% in the i.v. groups P = 0.586). Maternal deaths were not significantly lower in the i.v. group than the i.m. group (5% in the i.m. and 3.3% in the i.v. groups, P = 0.506) There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality. Conclusion: Low dose i.v. magnesium sulfate regimen is equally effective in prevention of convulsion recurrence and maternal deaths in eclamptic women when compared with an i.m. magnesium sulfate regimen. Language: English Keywords: INDIA | RESEARCH REPORT | COMPARATIVE STUDIES | PREECLAMPSIA | PREGNANCY COMPLICATIONS | DRUGS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 340214 |
| 7. Title: [Efficacy and safety of drospirenone-ethinylestradiol on contraception in healthy chinese women: a multicenter randomized controlled trial] Author: Fan GS; Bian ML; Cheng LN; Cao XM; Huang ZR; Han ZY; Jing XP; Li J; Wu SY; Xiong CL; Xiong ZA; Yue TF Source: Zhonghua Fu Chan Ke Za Zhi. 2009 Jan;44(1):38-44. Abstract: OBJECTIVE: To evaluate the contraception efficacy, mode of bleeding, side effects and other positive effects of drospirenone-ethinylestradiol (Yasmin) in healthy Chinese women. METHODS: This was a multicenter, randomized, control study of 768 healthy Chinese women who consulted about contraception. The subjects were randomized into Yasmin group (30 microg ethinylestradiol plus 3 mg drospirenone, 573 cases) or desogestrel group (30 microg ethinylestradiol plus 150 microg desogestrel, 195 cases) with the ratio of 3:1. Each individual was treated for 13 cycles. Further visits were required at cycle 4, cycle 7, cycle 10 and cycle 13 of treatment Weight, height, body mass index were evaluated at each visit. The menstrual distress questionnaire (MDQ) was given to the women at baseline, visit 3 (cycle 7) and visit 5 (after cycle 13). RESULTS: The values of basal features were similar between two groups (P > 0.05). The Pearl index (method failure) of Yasmin was 0. 208/hundred women year which was lower than that of desogestrel (0. 601/hundred women year). The mode of bleeding was similar between two groups after trial without showing any significant difference. According to MDQ subscale, the improvement of water retention and increasing appetite during inter-menstrual period and water retention and general well-being during menstrual period in the Yasmin group (-0.297, -0.057, 0.033, 0.150 respectively) was more obvious than that in the desogestrel group (-0.108, 0.023, 0.231, -0.023 respectively) with a significant difference (P < 0.05). Some other values which improved in both two groups, especially the improvement of breast tenderness and pain and skin abnormality in Yasmin group (18.0%, 89/494; 12.6%, 62/494) was more distinct than that in desogestrel group (11.3%, 19/168; 5.4%, 9/168). The mean weight increased in desogestrel group (0.57 kg) while it decreased in Yasmin group (-0.28 kg) with a significant difference (P < 0.01). CONCLUSIONS: Both Yasmin and desogestrel have good efficacy on contraception and similar modes of menstrual bleeding. Yasmin is better than desogestrel in terms of weight control and premenstrual syndrome of oral contraceptive. Language: Chinese Keywords: CHINA | RESEARCH REPORT | WOMEN | PEARL'S FORMULA | BODY WEIGHT | BODY HEIGHT | MENSTRUATION DISORDERS | DESOGESTREL | ETHINYL ESTRADIOL | TREATMENT | TESTING | Asia, Eastern | Asia | Developing Countries | Demographic Factors | Population | Contraceptive Use-Effectiveness | Contraceptive Effectiveness | Contraception | Family Planning | Physiology | Biology | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Research Methodology Document Number: 341804 |
8.  Title: ECP handbook: introducing and mainstreaming the provision of emergency contraceptive pills in developing countries. Author: Hossain SM; Khan ME; Vernon R; Keesbury J; Askew I Source: Washington, DC, Population Council, 2009. v, 25 p. (USAID Contract No. HRN A-00-98-00012-00William and Flora Hewlett Foundation Project No. 2007-1124) Abstract: The intended audience for this handbook includes reproductive health (RH) program managers and government and NGO policy makers. It can be used in countries where ECPs are not currently available, as well as in contexts where the intention is to expand or mainstream access to existing ECP services. The handbook: Recognizes the different needs of diverse segments of the population, and places additional emphasis on targeting ECP services to "special groups," which include rape survivors and adolescents; Seeks to present an overall process that can be adapted to specific contexts and that is based on documented successful experiences in a range of contexts; Guides policymakers and program managers through the continuum of ECP programming: from needs assessments and operations research, to registration, to training, logistics, and ultimately mainstreaming through nationwide scaling-up. The handbook contains four sections: Introduction and Background describes the existing situation of ECP programmingaround the globe: Addressing the Needs of Specific Populations describes programming approaches designed for specific populations; Introducing and Mainstreaming ECPs describes five chronological steps for making ECP programming an integral component of a national RH program; The Bibliography lists useful resources for ECP programming. Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | YOUTH | WOMEN | EMERGENCY CONTRACEPTION | RAPE | SIDE EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | CONTRACEPTIVE AGENTS, PROGESTIN | PROGRAM ACCESSIBILITY | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Crime | Social Problems | Sociocultural Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraceptive Agents, Female | Contraceptive Agents | Program Evaluation | Programs | Organization and Administration Document Number: 315212 |
| 9. Title: Virological response to highly active antiretroviral therapy in patients infected with human immunodeficiency virus type 2 (HIV-2) and in patients dually infected with HIV-1 and HIV-2 in the Gambia and emergence of drug-resistant variants. Author: Jallow S; Alabi A; Sarge-Njie R; Peterson K; Whittle H; Corrah T; Jaye A; Cotten M; Vanham G; McConkey SJ; Rowland-Jones S; Janssens W Source: Journal of Clinical Microbiology. 2009 Jul;47(7):2200-8. Abstract: Drug design, antiretroviral therapy (ART), and drug resistance studies have focused almost exclusively on human immunodeficiency virus type 1 (HIV-1), resulting in limited information for patients infected with HIV-2 and for those dually infected with HIV-1 and HIV-2. In this study, 20 patients, 12 infected with HIV-2 and 8 dually infected with HIV-1 and HIV-2, all treated with zidovudine (ZDV), lamivudine (3TC), and lopinavir-ritonavir (LPV/r), were followed up longitudinally for about 3 years. For 19/20 patients, viral loads were reduced to undetectable levels; the patient whose viral load remained detectable reported adverse effects associated with LPV/r that had caused him to stop taking all the drugs. HIV-2 strains containing mutations in both the protease and the reverse transcriptase gene that may confer drug resistance were observed in two patients with viral rebound, as early as 130 days (4.3 months) after the initiation of therapy. We conclude that the combination of ZDV, 3TC, and LPV/r is able to provide efficient and durable suppression of HIV-1 and HIV-2 for as long as 3 years in HIV-2-infected and dually infected patients. However, the emergence of HIV-1 and HIV-2 strains containing drug-resistant mutations can compromise the efficacy of this highly active ART. Language: English Keywords: GAMBIA | RESEARCH REPORT | LONGITUDINAL STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 342659 |
| 10. Title: [The impact of a new low dose oral contraceptive containing drospirenone on lipid profile, carbohydrate metabolism and hepatic function] Wplyw stosowania nowej, nisko-estrogenowej tabletki antykoncepcyjnej zawierajcej Author: Katarzyna SS; Stanislaw R; Katarzyna S Source: Ginekologia Polska. 2009 Feb;80(2):99-102. Abstract: INTRODUCTION: Application of older generations of progestins used in oral contraceptives may increase the risk of cardiovascular diseases (CVD) because of negative impact on lipids parameters. Drospirenone is a unique progestin that blocks the aldosterone receptor, demonstrates antiandrogenic activity and potentially decreases the risk of CVD. OBJECTIVES: The aim of the study was to estimate the impact of low dose oral contraceptive containing 20 microg ethinyloestradiol and 3.0 mg drospirenone on lipid parameters, carbohydrate metabolism and hepatic function. MATERIAL AND METHODS: 22 women in mean age 25.9 +/- 4.3 years, mean BMI (body mass index) 21.9 +/- 2.3 kg/m2 without contraindication to hormonal contraception using tablets containing 20 microg ethinylestradiol and 3.0 mg drospirenone during 12 cycles. Total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG), glucose (GLU) and hepatic parameters were assessed before and after 3, 6 and 12 cycles of the treatment using enzymatic methods. RESULTS: We observed statistically significant increase of CHOL level in normal ranges from 172.4 +/- 22.5 mg/dl before treatment to 185.6 +/- 25.3 mg/dl after 12 cycles and HDL level from 63.7 +/- 10.8 mg/dl to 70.6 +/- 14.4 mg/dl. No statistically significant differences were observed in LDL and TG concentrations, glycaemia and hepatic function parameters after 12 cycles of the therapy. CONCLUSION: The treatment with new low dose oral contraceptive containing 20 microg ethinylestradiol and 3.0 mg drospirenone does not induce adverse changes in lipids parameters and hepatic function. Language: Polish Keywords: RESEARCH REPORT | WOMEN | CONTRACEPTIVE USAGE | ORAL CONTRACEPTIVES | ORAL CONTRACEPTIVES, LOW-DOSE | ETHINYL ESTRADIOL | CONTRACEPTIVE USE-EFFECTIVENESS | IMPACT | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Methods | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Effectiveness | Communication Document Number: 330929 |
| 11. Title: Editorial fair play and emergency contraception [letter] Author: Kauffman RP Source: Southern Medical Journal. 2009 May;102(5):551. Abstract: With pleasure and a sense of academic responsibility, I accepted an invitation to submit an editorial addressing a paper by Galvin and Fagan in the January 2009 issue of Southern Medical Journal. Subsequently, I read with interest a thoughtful second editorial which addressed not only the investigation by Galvin and Fagan but also commented on my editorial. A second perspective is fair enough, of course, given that emergency contraception (EC) is viewed with controversy by some. In the spirit of robust debate, I offer the following comments that I would have included in my original editorial had the opportunity been granted. Jones and Stammers ventured that I "bravely risk tautology" by stating that EC does not act at the postimplantation level. In response, I would ask that they be able to offer reasonable evidence-based data that it does. Instead, they provided only speculation. Considerable evidence supports inhibition of ovulation as EC's mechanism of action,while implantation prevention remains unsubstantiated. Nonhuman primate and murine models have failed to demonstrate a postfertilization effect by levonorgestrel-containing EC. While I agree that human data would be welcomed, this task will prove methodologically and statistically daunting given that most fertilized ova do not implant in vivo under normal conditions. The American College of Obstetricians and Gynecologists (ACOG) Practice Guideline (on which my statement concerning EC's mechanism of action was plainly referenced) is based on best available medical evidence. ACOG recommendations are regularly updated when better evidence arises. One could only wish for the same equanimity from governmental regulatory agencies cued by ideological communities. Jones and Stammers quibble with the meaning of "efficacy," but their contention that EC is ineffective is little more than cherry-picking the literature. The recent Cochrane Database Systematic Review of the 81 randomized, controlled trials concluded that EC does work although mifepristone is more effective than levonorgestrel (Plan B®) or the Yuzpe method. In fact, the Cochrane Plain Language Summary concludes, "Mifepristone and levonorgestrel are very effective with few adverse effects . . .." Confounders, some known and others more obscure, may explain the relative lack of benefit of EC in some published trials. Scientific debate is healthy and necessary, and it is imperative that medical journals assure that the discussion is sound and bidirectional. (full-text) Language: English Keywords: UNITED STATES OF AMERICA | TEXAS | CRITIQUE | EMERGENCY CONTRACEPTION | LEVONORGESTREL | RU-486 | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Effectiveness Document Number: 341207 |
| 12. Peer Reviewed Title: Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Author: Kaunitz AM; Meredith S; Inki P; Kubba A; Sanchez-Ramos L Source: Obstetrics and Gynecology. 2009 May;113(5):1104-16. Abstract: OBJECTIVE: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION: This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials that included 390 women (levonorgestrel intrauterine system, n=196; endometrial ablation, n=194) were retrieved. Three studies pertained to first-generation endometrial ablation (manual hysteroscopy) and three to second-generation endometrial ablation (thermal balloon). Study characteristics and quality were recorded for each study. Data on the effect of treatment on pictorial blood loss assessment chart scores were abstracted, integrated with meta-analysis techniques, and presented as weighted mean differences. Both treatment modalities were associated with similar reductions in menstrual blood loss after 6 months (weighted mean difference, -31.96 pictorial blood loss assessment chart score [95% confidence interval (CI), -65.96 to 2.04]), 12 months (weighted mean difference, 7.45 pictorial blood loss assessment chart score [95% CI, -12.37 to 27.26]), and 24 months (weighted mean difference, -26.70 pictorial blood loss assessment chart score [95% CI, -78.54 to 25.15]). In addition, both treatments were generally associated with similar improvements in quality of life in five studies that reported this as an outcome. No major complications occurred with either treatment modality in these small trials. CONCLUSION: Based on the meta-analysis of six randomized clinical trials, the efficacy of the levonorgestrel intrauterine system in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation up to 2 years after treatment. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | BLEEDING | LEVONORGESTREL | IUD | ENDOMETRIAL EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Usage | Contraceptive Effectiveness Document Number: 341342 |
| 13. Title: Contraception for women. Evidence based counselling [letter] Author: Lyus R Source: BMJ. 2009;339:b3869. Abstract: This letter focuses on contraceptive choices for women. It disagrees with the review emphasizing on failure rates of hormonal contraceptive pills and wonders why there was not an analysis on a more effective method such as intrauterine devices. Language: English Keywords: UNITED KINGDOM | CRITIQUE | CONTRACEPTIVE METHODS | CONTRACEPTION FAILURE | COUNSELING | THEORETICAL EFFECTIVENESS | CONTRACEPTIVE METHOD ACCEPTABILITY | INFORMED CHOICE | Developed Countries | Europe, Western | Europe | Contraception | Family Planning | Contraceptive Usage | Clinic Activities | Program Activities | Programs | Organization and Administration | Contraceptive Effectiveness Document Number: 342930 |
| 14. Peer Reviewed Title: Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. Author: Mankowski JL; Kingston J; Moran T; Nager CW; Lukacz ES Source: Obstetrics and Gynecology. 2009 May;113(5):1052-7. Abstract: OBJECTIVE: To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage. METHODS: A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05. RESULTS: For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16). CONCLUSION: For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ABORTION | OBSTETRICAL SURGERY | CONTRACEPTIVE USE-EFFECTIVENESS | PAIN | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Effectiveness | Contraception | Signs and Symptoms | Diseases Document Number: 341343 |
| 15. Peer Reviewed Title: Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. Author: Medley A; Kennedy C; O'Reilly K; Sweat M Source: AIDS Education and Prevention. 2009 Jun;21(3):181-206. Abstract: The authors conducted a systematic review and meta-analysis of peer education interventions in developing countries published between January 1990 and November 2006. Standardized methods of searching and data abstraction were used. Merged effect sizes were calculated with random effects models. Thirty studies were identified. In meta-analysis, peer education interventions were significantly associated with increased HIV knowledge (odds ratio [OR]: 2.28; 95%, confidence interval [CI]:1.88, 2.75), reduced equipment sharing among injection drug users (OR: 0.37; 95% CI: 0.20, 0.67), and increased condom use (OR: 1.92; 95% CI: 1.59, 2.33). Peer education programs had a nonsignificant effect on sexually transmitted infections (OR: 1.22; 95% CI: 0.88, 1.71). Meta-analysis indicates that peer education programs in developing countries are moderately effective at improving behavioral outcomes but show no significant impact on biological outcomes. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | CONTRACEPTIVE USE-EFFECTIVENESS | PEER EDUCATORS | EDUCATIONAL ACTIVITIES | HIV PREVENTION | INTERVENTIONS | PROGRAM EVALUATION | Contraceptive Effectiveness | Contraception | Family Planning | Education | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 342062 |
| 16. Peer Reviewed Title: Reduced morbidity and mortality in the first year after initiating highly active anti-retroviral therapy (HAART) among Ugandan adults. Author: Miiro G; Todd J; Mpendo J; Watera C; Munderi P; Nakubulwa S; Kaddu I; Rutebarika D; Grosskurth H Source: Tropical Medicine and International Health. 2009 May;14(5):556-63. Abstract: OBJECTIVE: To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility. METHODS: Between 1999 and 2006, we collected morbidity data from a community-based cohort of HAART-eligible patients, comparing patients initiating HAART and those non-HAART. Patients aged 15 years or older visited the clinic every 6 months and when ill. Baseline data on patients' characteristics, WHO stage, haemoglobin and CD4+ T-cell counts, along with follow-up data on morbidity (new, recurrent and drug-related), were collected for the first year after initiating HAART or becoming HAART-eligible. We estimated the overall effect of HAART on morbidity; adjusted for the effect of cotrimoxazole prophylaxis by Mantel-Haenszel methods. A negative binomial regression model was used to assess rate ratios (RR) after adjustment for other confounders, including cotrimoxazole. RESULTS: A total of 219 HAART patients (median age 37 years; 73% women; 82% using cotrimoxazole prophylaxis, median haemoglobin 11.7 g/dl and median CD4+ 131 cells/microl) experienced 94 events in 127 person-years. 616 non-HAART patients (median age 33 years; 70% women; 26% using cotrimoxazole prophylaxis, median haemoglobin 11.2 g/dl and median CD4+ 130 cells/microl) experienced 862 events in 474 person-years. The overall morbidity during the first year of HAART was 80% lower than among non-HAART patients (adjusted RR = 0.20, 95% CI: 0.12-0.34). Cotrimoxazole prophylaxis also reduced morbidity (adjusted RR = 0.65, 95% CI: 0.45-0.94). CONCLUSION: These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis. Language: English Keywords: UGANDA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ADULTS | MORTALITY | MORBIDITY | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | CONTRACEPTIVE USE-EFFECTIVENESS | LABORATORY PROCEDURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 342743 |
| 17. Peer Reviewed Title: Frequency of discontinuation of contraceptive use: results from a French population-based cohort. Author: Moreau C; Bouyer J; Bajos N; Rodriguez G; Trussell J Source: Human Reproduction. 2009 Feb 27;24(6):1387-1392. Abstract: BACKGROUND Despite the widespread use of highly effective contraceptive methods in France, one in every three pregnancies is unintended. Among women experiencing an unintended pregnancy leading to an abortion, half had changed their contraceptive method in the 6 months preceding the abortion, in most cases switching to a less-effective method or to no method at all. This study provides estimates of method-specific contraceptive discontinuation rates for any reason and for method-related reasons among French women. METHODS The data were drawn from the COCON survey (2000-2004), a population-based French prospective cohort, comprising a representative sample of 2863 women aged 18-44. We estimated Kaplan-Meier life-table probabilities of contraceptive discontinuation during the 4 years of follow-up and tested for differences by intrauterine device (IUD) type and pill composition. RESULTS Probabilities of contraceptive discontinuation for method-related reasons varied widely by method: IUDs were associated with the lowest probabilities of discontinuation (11% within 12 months, 30% within 4 years), followed by the pill (22% and 48%, respectively). Discontinuation rates were significantly higher for all other methods (condoms, withdrawal, fertility awareness methods and spermicides). We found no differences in discontinuation rates by the type of IUD (levonorgestrel-IUD versus copper-IUD) and increasing rates of pill discontinuation with decreasing dosage in estrogen. CONCLUSIONS Contraceptive discontinuation rates among French women are substantially lower than those reported for US women. Comparing the determinants of contraceptive discontinuation and the role of healthcare providers in helping women make these changes would improve our understanding of the reasons for such variation. Language: English Keywords: FRANCE | RESEARCH REPORT | COHORT ANALYSIS | WOMEN | CONTRACEPTIVE USAGE | USER COMPLIANCE | CONTRACEPTIVE USE-EFFECTIVENESS | Europe, Western | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Behavior | Contraceptive Effectiveness Document Number: 330496 |
| 18. Peer Reviewed Title: Virological suppression achieved with suboptimal adherence levels among South African children receiving boosted protease inhibitor-based antiretroviral therapy. Author: Muller AD; Myer L; Jaspan H Source: Clinical Infectious Diseases. 2009 Jan 1;48(1):e3-5. Abstract: Sixty-six children who were receiving antiretroviral treatment were assessed for treatment adherence and virological outcome to compare boosted protease inhibitor-based regimens with nonnucleoside reverse-transcriptase inhibitor-based regimens. Children who were receiving protease inhibitor-based regimens demonstrated higher rates of virological suppression, even with poor treatment adherence (<80%). In children, boosted protease inhibitors seem to be more forgiving of poor adherence than do nonnucleoside reverse-transcriptase inhibitors. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | LABORATORY PROCEDURES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 329722 |
| 19. Title: Examination of a simple model of condom usage and individual withdrawal for the HIV epidemic. Author: Musgrave J; Watmough J Source: Mathematical Biosciences and Engineering. 2009 Apr;6(2):363-76. Abstract: Since the discovery of HIV/AIDS there have been numerous mathematical models proposed to explain the epidemic of the disease and to evaluate possible control measures. In particular, several recent studies have looked at the potential impact of condom usage on the epidemic [1, 2, 3, 4]. We develop a simple model for HIV/AIDS, and investigate the effectiveness of condoms as a possible control strategy. We show that condoms can greatly reduce the number of outbreaks and the size of the epidemic. However, the necessary condom usage levels are much higher than the current estimates. We conclude that condoms alone will not be sufficient to halt the epidemic in most populations unless current estimates of the transmission probabilities are high. Our model has only five independent parameters, which allows for a complete analysis. We show that the assumptions of mass action and standard incidence provide similar results, which implies that the results of the simpler mass action model can be used as a good first approximation to the peak of the epidemic. Language: English Keywords: CANADA | RESEARCH REPORT | MATHEMATICAL MODEL | CONDOM USE | CONTRACEPTIVE USE-EFFECTIVENESS | HIV PREVENTION | PROGRAM EVALUATION | Developed Countries | North America, Northern | Americas | Theoretical Models | Research Methodology | Risk Reduction Behavior | Behavior | Contraceptive Effectiveness | Contraception | Family Planning | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 331022 |
| 20. Peer Reviewed Title: Effects of Mirena (levonorgestrel-releasing intrauterine system) and Ortho Gynae T380 intrauterine copper device on lipid metabolism--a randomized comparative study. Author: Ng YW; Liang S; Singh K Source: Contraception. 2009 Jan;79(1):24-8. Abstract: BACKGROUND: This study aims to assess the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) on lipid metabolism in an Asian population using Ortho Gynae T380 copper containing (nonhormonal) intrauterine device (IUD) as a control. STUDY DESIGN: Ninety-two healthy women requesting IUD for contraception were randomly allocated to the two groups and were followed up at 6-, 12- and 18-month intervals. Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-I (Apo A-I) and apolipoprotein B were measured pre insertion and at each visit following insertion. RESULTS: There was a marginally significant reduction in TC level in the LNG-IUS group. HDL-C showed a significant reduction in the LNG-IUS group at 6 months but reverted back to its preinsertion value by 1 year. TG, LDL-C and the cholesterol ratios remained stable. Levels of Apo A-I and B also showed no significant reduction in both groups, and their ratios remained stable and insignificant. CONCLUSION: In this randomized comparative study among our local Asian population, it is assuring to note that the LNG-IUS does not have any adverse effects on lipid metabolism. Language: English Keywords: ASIA | RESEARCH REPORT | CONTRACEPTIVE USE-EFFECTIVENESS | COMPARATIVE STUDIES | WOMEN | ASIANS | LIPIDS | CONTRACEPTIVE AGENTS, PROGESTIN | IUD | IUD, COPPER RELEASING | LEVONORGESTREL | METABOLIC EFFECTS | Developing Countries | Contraceptive Effectiveness | Contraception | Family Planning | Studies | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Physiology | Biology | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Methods Document Number: 330539 |
| 21. Title: The Shanghai ring: two case reports and review of literature. Author: Padavala J; Ashraf M Source: Journal of Obstetrics and Gynaecology. 2009 Jan;29(1):67-8. Abstract: The intrauterine device (IUD) is the world's most widely used method of reversible contraception, used by nearly 160 million women, over 2/3 of them being in China. The IUD has evolved a long way from the stem pessaries described in 1902, the Grafenburg ring in 1929, the plastic IUDs in 1960s (Lippes Loop, Margulies Spiral, Saf-T-Coil), the copper devices in the 1970s to the latest era of hormone impregnated IUDs like Mirena. With increasing immigration into the UK from all over the world, we need to familiarize ourselves with various unusual IUDs used in other countries. This report includes two such cases from China. Language: English Keywords: CHINA | RESEARCH REPORT | LITERATURE REVIEW | CLIENTS | WOMEN | IUD | IUD, COPPER RELEASING | IUD SIDE EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Eastern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Effectiveness Document Number: 341986 |
| 22. Title: Fertility awareness-based methods: another option for family planning. Author: Pallone SR; Bergus GR Source: Journal of the American Board of Family Medicine. 2009 Mar-Apr;22(2):147-57. Abstract: Modern fertility awareness-based methods (FABMs) of family planning have been offered as alternative methods of family planning. Billings Ovulation Method, the Creighton Model, and the Symptothermal Method are the more widely used FABMs and can be more narrowly defined as natural family planning. The first 2 methods are based on the examination of cervical secretions to assess fertility. The Symptothermal Method combines characteristics of cervical secretions, basal body temperature, and historical cycle data to determine fertility. FABMs also include the more recently developed Standard Days Method and TwoDays Method. All are distinct from the more traditional rhythm and basal body temperature methods alone. Although these older methods are not highly effective, modern FABMs have typical-use unintended pregnancy rates of 1% to 3% in both industrialized and nonindustrialized nations. Studies suggest that in the United States physician knowledge of FABMs is frequently incomplete. We review the available evidence about the effectiveness for preventing unintended pregnancy, prognostic social demographics of users of the methods, and social outcomes related to FABMs, all of which suggest that family physicians can offer modern FABMs as effective means of family planning. We also provide suggestions about useful educational and instructional resources for family physicians and their patients. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PREGNANCY, UNWANTED | PREGNANCY RATE | FERTILITY | FAMILY PLANNING | CONTRACEPTIVE USE-EFFECTIVENESS | AWARENESS | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Reproductive Behavior | Population Dynamics | Demographic Factors | Population | Fertility Measurements | Contraceptive Effectiveness | Contraception | Knowledge | Sociocultural Factors | Diseases Document Number: 330464 |
| 23. Title: Cross-referral between HIV counselling and testing centres and smear microscopy centres in Tamil Nadu. Author: Ramachandran R; Chandrasekaran V; Muniyandi M; Jaggarajamma K; Bagchi A; Sahu S Source: International Journal of Tuberculosis and Lung Disease. 2009 Feb;13(2):221-5. Abstract: BACKGROUND: The combined tuberculosis and human immunodeficiency virus (TB-HIV) epidemic demands effective and urgent action. OBJECTIVE: To assess the effectiveness of the system of referral of TB suspects from the integrated HIV counselling and testing centres (ICTCs) to the designated microscopy centres (DMCs) in Tamil Nadu, and to identify reasons for dropping out. DESIGN: ICTC counsellors identified TB suspects among clients (excluding pregnant women and children) in six districts of Tamil Nadu in 2007 and referred them to DMCs, irrespective of their HIV status. From the records at ICTCs and DMCs, we collected information on the number of referrals to the DMCs, TB suspects attending DMCs and smear-positive TB cases with or without HIV. Clients who did not attend the DMCs were interviewed to elicit reasons for dropping out. RESULTS: Of 18329 clients counselled, 1065 (6%) were identified as TB suspects and referred to DMCs. Of these, 888 (83%) attended and 177 (17%) dropped out; 81% of the drop-outs were interviewed. Reasons for dropping out were multiple: 51% were due to the health system, 62% due to the disease and 62% due to personal reasons. Twelve per cent of DMC attendees were smear-positive. CONCLUSION: The ICTC-to-DMC referral system makes a significant contribution to the detection of TB cases. Reasons for dropping out were multiple, but are correctable. This study also probes into current policies on programme coordination and recommends strategies for strengthening the collaboration between the TB and HIV programmes. Language: English Keywords: INDIA | RESEARCH REPORT | CONTRACEPTIVE USE-EFFECTIVENESS | DROPOUTS | TUBERCULOSIS | HIV INFECTIONS | REFERRAL AND CONSULTATION | VOLUNTARY COUNSELING AND TESTING | Asia, Southern | Asia | Developing Countries | Contraceptive Effectiveness | Contraception | Family Planning | Programs | Organization and Administration | Infections | Diseases | Viral Diseases | Program Activities | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330746 |
| 24. Title: Mirena(R) (Levonorgestrel intrauterine system): A successful novel drug delivery option in contraception. Author: Rose S; Chaudhari A; Peterson CM Source: Advanced Drug Delivery Reviews. 2009 May 12; Abstract: This manuscript serves as a review of Mirena(R), the levonorgestrel intrauterine system (LNG IUS) as a very successful drug delivery system. The LNG IUS has a very high contraceptive efficacy rate, and low rates of patient discontinuation. In addition to its contraceptive benefits, most users experience a decrease in menstrual bleeding over the five years of use. LNG IUS has also been used for management of menorrhagia, dysmenorrhea, adenomyosis, and endometrial hyperplasia in some cases. The LNG IUS provides long term efficacy, high rates of compliance, rapid return to fertility, and minimal adverse effects during use. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | IUD | PROGESTERONE | MENORRHAGIA | ENDOMETRIAL EFFECTS | IUD, COPPER RELEASING | CONTRACEPTION | LEVONORGESTREL | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Contraceptive Methods | Family Planning | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Menstruation Disorders | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Effectiveness Document Number: 341256 |
| 25. Title: Contraceptive hormone use and cardiovascular disease. Author: Shufelt CL; Bairey Merz CN Source: Journal of the American College of Cardiology. 2009 Jan 20;53(3):221-31. Abstract: Contraceptive hormones, most commonly prescribed as oral contraceptives (OCs), are a widely utilized method to prevent ovulation, implantation, and, therefore, pregnancy. The Women's Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting a review of the safety, efficacy, and side effects of other forms of hormone therapy. A variety of basic science, animal, and human data suggests that contraceptive hormones have antiatheromatous effects; however, relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion, and arrhythmogenesis. Newer generation OC formulations in use indicate no increased myocardial infarction risk for current users, but a persistent increased risk of venous thromboembolism. There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the nonoral routes (transdermal and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy, and other vascular diseases, including migraines, prior to use. Existing data are mixed with regard to possible protection from OCs for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | HORMONES | ORAL CONTRACEPTIVES | HORMONE REPLACEMENT THERAPY | CARDIOVASCULAR EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | RISK BEHAVIOR | RISK FACTORS | SCREENING | Developed Countries | North America | Americas | Demographic Factors | Population | Endocrine System | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Behavior | Examinations and Diagnoses Document Number: 329606 |
| 26. Peer Reviewed Title: High failure rates of medical termination of pregnancy after introduction to a large teaching hospital. Author: Vitner D; Machtinger R; Baum M; Goldenberg M; Schiff E; Seidman DS Source: Fertility and Sterility. 2009 Apr;91(4 Suppl):1374-7. Abstract: The success rates of medical termination of pregnancy in two time periods (2000-2001 and 2002-2003) were compared to assess the effectiveness of medical abortion introduction to a large academic tertiary medical center. The success rates were markedly reduced over time (87.0% vs. 79.3%) probably owing to the difficulty in defining clear sonographic criteria for treatment failure and the complexity of a follow-up program implemented at a large teaching hospital by a broad staff with widely varying experience and knowledge of the new procedure. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | CONTRACEPTIVE USE-EFFECTIVENESS | KNOWLEDGE | ABORTION | HOSPITALS | TRAINING ACTIVITIES | Developed Countries | North America | Americas | Studies | Research Methodology | Contraceptive Effectiveness | Contraception | Family Planning | Sociocultural Factors | Fertility Control, Postconception | Health Facilities | Delivery of Health Care | Health | Training Programs | Education Document Number: 331190 Notification |
| 27. Title: Emergency contraception: the state of the art. Author: von Hertzen H; Godfrey EM Source: Reproductive Biomedicine Online. 2009;18 Suppl 1:28-31. Abstract: Emergency contraception, otherwise known as post-coital contraception, is part of the continuum of contraceptive methods that women and couples can use for pregnancy prevention. Although emergency contraception should not be used as a regular, plan-ahead contraceptive method, it gives a woman one last-ditch effort to prevent unwanted pregnancy. This paper reviews the history of emergency contraception, the need for further studies, and results of studies conducted at the World Health Organization. Various methods used for emergency contraception are discussed, as well as their efficacies and side effects. Language: English Keywords: UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | PREGNANCY | EMERGENCY CONTRACEPTION | FERTILITY CONTROL, POSTCOITAL | CONTRACEPTIVE USE-EFFECTIVENESS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Developed Countries | North America | Americas | Reproduction | Contraception | Family Planning | Contraceptive Effectiveness | Contraceptive Agents Document Number: 330740 |
| 28. Title: No such thing as an easy (or EC) fix -- not so fast [letter] Author: Westley E Source: Contraception. 2009 May;79(5):403. Abstract: This letter to the editor is focused on emergency contraception (EC) and is arguing against the statement that EC failed to produce a reduction in pregnancy rates. It discusses how little promotion has gone to EC and how only a small portion of women have access as well as states the benefits especially for women in settings where sexual coercion is high. Language: English Keywords: UNITED STATES OF AMERICA | GLOBAL | CRITIQUE | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Demographic Factors | Population | Contraception | Family Planning | Contraceptive Effectiveness Document Number: 342082 |
| 29. Title: [Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic] Interet de la Spiruline chez les personnes vivant avec le VIH a Bangui (RCA). Author: Yamani E; Kaba-Mebri J; Mouala C; Gresenguet G; Rey JL Source: Medecine Tropicale. 2009 Feb;69(1):66-70. Abstract: Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems. Language: French Keywords: AFRICA, CENTRAL | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | VITAMINS AND MINERALS | HIV INFECTIONS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | NUTRITION | Africa, Sub Saharan | Africa | Developing Countries | Viral Diseases | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 342434 |
| 30. Title: Intrauterine devices and intrauterine systems. Author: ESHRE Capri Workshop Group Source: Human Reproduction Update. 2008;14(3):197-208. Abstract: From a public health viewpoint, the intrauterine device (IUD) is the most widely used contraceptive method in the world. Prevalence rates range among countries from 2 to 80% of contraceptive users. During 5 years of IUD use, pregnancy occurs in less than 2 per 100 insertions. Bleeding and pain are the most common reasons for removal rates of 10% in the first year and up to 50% within 5 years. The contraceptive effects of IUDs may be due to a sterile inflammatory reaction in the endometrial cavity which interferes with sperm function, so that fertilization is less likely to occur. IUDs also interfere with implantation but the extent to which this contributes to their contraceptive action is unknown. In nulliparous women rates of expulsion and removal for bleeding and/or pain are higher than in parous women. Effective use of IUDs for up to 10 years has the same pregnancy rate as tubal interruption. Thus, the IUD may be an alternative to female sterilization, especially in younger women who are more likely to experience regret after sterilization. The levonorgestrel intrauterine system (LNG-IUS) reduces bleeding and dysmenorrhoea, provides superior effectiveness to copper IUDs, and may be a useful treatment for endometriosis or an alternative to hysterectomy for menorrhagia. (author's) Language: English Keywords: ITALY | RESEARCH REPORT | WOMEN | IUD | UTILIZATION OF HEALTH CARE | CONTRACEPTIVE PREVALENCE | CONTRAINDICATIONS | LEVONORGESTREL | CONTRACEPTIVE METHOD ACCEPTABILITY | COMPLICATIONS | SAFETY | CONTRACEPTIVE USE-EFFECTIVENESS | Europe, Southern | Europe | Developed Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Health Services | Delivery of Health Care | Health | Contraceptive Usage | Treatment | Medical Procedures | Medicine | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Diseases | Public Health | Contraceptive Effectiveness Document Number: 326133 |
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