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Wojtyła C, Bertuccio P, Giermaziak W, Santucci C, Odone A, Ciebiera M, Negri E, Wojtyła A, La Vecchia C. European trends in ovarian cancer mortality, 1990-2020 and predictions to 2025. Eur J Cancer 2023; 194:113350. [PMID: 37837925 DOI: 10.1016/j.ejca.2023.113350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990-2020 and predicted the number of deaths and rates by 2025. METHODS We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025. RESULTS Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010-2014 to 2015-2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (-7.0%) compared to Transitional countries (-2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27. CONCLUSIONS Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role.
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Affiliation(s)
- Cezary Wojtyła
- Women's Health Research Institute, Calisia University, 62-800 Kalisz, Poland.
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
| | | | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-189 Warsaw, Poland; Warsaw Institute of Women's Health, 00-189 Warsaw, Poland
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrzej Wojtyła
- Faculty of Health Sciences, Calisia University, 16 Kaszubska St., 62-800 Kalisz, Poland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Boydell V, Galavotti C. Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand. Stud Fam Plann 2022; 53:61-132. [PMID: 35119110 PMCID: PMC9303959 DOI: 10.1111/sifp.12182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention‐to‐use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer‐range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.
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Affiliation(s)
- Victoria Boydell
- School of Health and Social Care, University of Essex, Colchester, UK
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Nappi RE, Vermuyten N, Bannemerschult R. Missed opportunities in contraceptive counselling: findings from a European survey-based study with simulated patient consultation. EUR J CONTRACEP REPR 2021; 27:85-94. [PMID: 34860137 DOI: 10.1080/13625187.2021.2010040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Available evidence highlights unmet needs in contraceptive counselling practices. This study aimed to understand current practises and clinician behaviour across Europe. METHODS A novel, online approach was used to simulate contraceptive counselling discussions based on three, predefined patient types with a hidden need: poor compliance (patient X), headaches (Y) or desire for a hormone-free option (Z). Clinicians were asked to provide guidance about a contraceptive method for their randomly assigned patient at two time points: (1) after a simulated discussion, (2) after seeing a full patient profile. Descriptive statistical analyses included evaluation of the clinicians' counselling approach and a change in contraceptive recommendation thereof. RESULTS Out of 661 clinicians from 10 participating European countries, including obstetricians/gynaecologists, midwives and general practitioners, most failed to uncover patient X and Y's hidden needs (78.8% and 70.5%, respectively), whereas, 63.4% of clinicians uncovered patient Z's hidden need. Clinicians who uncovered their patients' hidden needs asked significantly more questions than those who did not (range of mean, 5.1-7.8 vs 1.5-2.2 respectively). Clinicians were more likely to recommend a change of prescription after seeing the full patient profile than after the simulated discussion (increase in prescription change, range: 12.3-30.2%), indicating that clinicians rely on patients speaking up proactively about any concerns. CONCLUSIONS Insufficient existing counselling practices result in missed opportunities for shared decision-making and discussion. Clinicians and contraceptive counselling services should empower women by introducing more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning.
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Affiliation(s)
- Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Didn't Plan One but got One: Unintended and sooner-than-intended Parents in the East and the West of Europe. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2021; 37:727-767. [PMID: 34421451 PMCID: PMC8333183 DOI: 10.1007/s10680-021-09584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/12/2021] [Indexed: 10/26/2022]
Abstract
The realisation rates of short-term childbearing intentions are known to be consistently lower in post-socialist countries than in the rest of Europe. However, the East-West differences in the outcomes of intentions to postpone or forego (further) childbearing have not been previously examined. We employ two panel waves of the Generations and Gender Survey in six countries (three from Eastern and three from Western Europe), and, based on the short- and long-term fertility intentions expressed by respondents at the first survey wave, we classify the births occurring between two waves as intended, sooner-than-intended, or unintended. We find that in our study population of non-teenage respondents who had the same partner at both survey waves and a child between the two survey waves, between around 10% (Western European countries) and 30% (Eastern European countries) experienced an unintended or a sooner-than-intended birth. The East-West divide is largely driven by the share of unintended parents which is clearly higher in the post-socialist countries. However, the geographical pattern fades away once we control for the anticipated costs of having a child. Our study gives insight into East-West differences in attitudes to childbearing and into how they affect reproductive behaviour. It also offers methodological improvements of cross-national panel surveys designed to examine childbearing intentions that would allow for a more accurate assessment of childbearing intendedness.
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Alvarez A, Benjaminsen Borch K, Rylander C. Reproductive Factors, Use of Exogenous Hormones, and Pancreatic Cancer Incidence: The Norwegian Women and Cancer Study. Clin Epidemiol 2021; 13:67-80. [PMID: 33574711 PMCID: PMC7872864 DOI: 10.2147/clep.s268556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of pancreatic cancer is increasing worldwide and characterized by a particularly low survival rate. Studies have reported weak and inconsistent evidence for associations among reproductive factors, use of exogenous hormones, and pancreatic cancer incidence in women. Purpose To investigate relationships between reproductive factors, exogenous hormones, and the rate of pancreatic cancer incidence in a large population-based prospective cohort of women in Norway. Methods We used data from the Norwegian Women and Cancer study on 588 incident cases of pancreatic cancer diagnosed among 165,419 women, with mean follow-up of 18.7 years. Cox proportional-hazard models were used to estimate HRs and 95% CIs for associations of interest. Results Cumulative breastfeeding duration >24 months was associated with 63% decreased incidence of pancreatic cancer compared to no breastfeeding. We observed an inverse linear dose–response trend between cumulative breastfeeding duration and pancreatic cancer incidence, which was confirmed in parous women and ever-smokers. Higher age at first birth and menopause were inversely associated with pancreatic cancer incidence, though with less precise effect estimates. Current use of oral contraceptives was associated with a doubling of pancreatic cancer incidence, but the analysis was hampered by a small number of cases. There was no evidence of any associations between age at menarche, parity or use of menopausal hormone therapy, and incidence of pancreatic cancer. Conclusion Our results suggest a potential protective effect of breastfeeding duration against pancreatic cancer incidence. Inconsistent results for the other reproductive factors suggested no important role of estrogens in pancreatic cancer etiology.
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Affiliation(s)
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Le Guen M, Rouzaud-Cornabas M, Panjo H, Rigal L, Ringa V, Moreau C. The French pill scare and the reshaping of social inequalities in access to medical contraceptives. SSM Popul Health 2020; 11:100606. [PMID: 32551357 PMCID: PMC7292912 DOI: 10.1016/j.ssmph.2020.100606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
While the consequences of various "pill scares" have been relatively well-documented in the public health literature revealing a drop in pill use and a rise in unplanned pregnancies and abortion rates, researchers rarely considered that these controversies would affect women contraceptive practices differently according to their social background. Indeed, social differentiations in reaction to "pill scares" could contribute to reinforce the social gradient in the use of contraceptive methods and choice of visiting the health professionals who prescribe them. These could contribute to an increase in health inequalities on access to contraceptive methods. Using data from three state nationally representative cross-sectional surveys conducted in France in 2010, 2013 and 2016, we studied the changes in women's contraceptive uses around the French "pill scare" that occurred in 2012-2013. We focused on the changes in the use of all contraceptives available under medical prescription (called medical contraceptives) on one hand, and on each specific method (pill, IUD, implant, patch or vaginal ring, and female sterilization) on the other hand according to the women's social background. We saw a social gradient in contraceptives changes. The decline in the use of contraceptive methods available under medical prescription was particularly marked for women from lower and higher classes in which we observe a decrease in pill use between 2010 and 2013, whereas it was observed only between 2013 and 2016 among middle class women. Moreover, while some women from upper class shifted from pill to IUD between 2010 and 2013, this was not the case for their less privileged counterparts. As a consequence, it seems that the French "pill scare" led to the reshaping of social inequalities in access to medical contraceptives.
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Affiliation(s)
- Mireille Le Guen
- Centre for Demographic Research, Université catholique de Louvain, Place Montesquieu 1, L2.08.03, B-1348 Louvain-la-Neuve, Belgium
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
- Institut National d’Études démographiques, 9 Cours des Humanités, F-93300 Aubervilliers, France
| | - Mylène Rouzaud-Cornabas
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
| | - Henri Panjo
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
| | - Laurent Rigal
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
- Institut National d’Études démographiques, 9 Cours des Humanités, F-93300 Aubervilliers, France
| | - Virginie Ringa
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
- Institut National d’Études démographiques, 9 Cours des Humanités, F-93300 Aubervilliers, France
| | - Caroline Moreau
- Soins primaires et prévention, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Villejuif, France
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
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Götmark F, Andersson M. Human fertility in relation to education, economy, religion, contraception, and family planning programs. BMC Public Health 2020; 20:265. [PMID: 32087705 PMCID: PMC7036237 DOI: 10.1186/s12889-020-8331-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. Methods We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. Results In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. Conclusions These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.
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Affiliation(s)
- Frank Götmark
- Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden.
| | - Malte Andersson
- Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden
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Geist C, Cole WM. Beyond geography: Cultural zones and global patterns of modern-method contraceptive use. Health Care Women Int 2019; 41:382-396. [PMID: 31600116 DOI: 10.1080/07399332.2019.1672170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To increase understanding of global variation in contraceptive use, we classify countries into "cultural zones" based on religious traditions and geographical regions. Using data for 156 countries, we model modern contraceptive use rates as a function of cultural zones, geographic regions, economic development, women's education, and time. We find that cultural zones explain modern-method contraceptive use better than geographic regions alone, even when adjusting for economic development, women's education, and time. We argue that practitioners and researchers should make use of cultural zones as a tool for understanding cross-national variation in sexual and reproductive health outcomes.
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Affiliation(s)
- Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Wade M Cole
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
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Rossier C, Corker J. Contemporary Use of Traditional Contraception in sub-Saharan Africa. POPULATION AND DEVELOPMENT REVIEW 2017; 43:192-215. [PMID: 29307923 PMCID: PMC5749414 DOI: 10.1111/padr.12008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Dereuddre R, Van de Velde S, Bracke P. Gender inequality and the ‘East-West’ divide in contraception: An analysis at the individual, the couple, and the country level. Soc Sci Med 2016; 161:1-12. [DOI: 10.1016/j.socscimed.2016.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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