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Unuma K, Sato H, Wen S, Makino Y, Hirakawa A, Uemura K. The proportion of false-positives in positive Seratec® prostate-specific antigen SemiQuant test results in postmortem screening for seminal fluid. Leg Med (Tokyo) 2023; 62:102243. [PMID: 36965350 DOI: 10.1016/j.legalmed.2023.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Prostate-specific antigen (PSA) tests are used in forensics to conduct rapid screening for semen in vaginal swab samples from alleged victims of sexual abuse. Although PSA membrane tests have been applied to autopsy specimens, no study has evaluated predictors of false-positive test results in relation to factors such as age, cause of death, postmortem interval, drugs, and alcohol. This study describes the results obtained with the Seratec® PSA SemiQuant Kit test in 283 deceased women, with or without a history of sexual assault. Overall, 18.4% (52/283) of the vaginal swab samples tested positive for PSA. However, 63.5% (33/52) of the PSA-positive vaginal swab samples had no sperm detected. The proportion of false-positives in positive PSA results was 94.4% in those aged over 60 years. Multivariate logistic regression for PSA-positive samples showed that the proportion of false-positives in positive PSA results increased with the age of the deceased. However, the cause of death, postmortem interval, and presence of drugs or alcohol in the blood or urine of the deceased did not affect the PSA determination. These results show that PSA membrane tests are relatively unreliable and can be misleading, especially when derived from vaginal swab samples of older women, obtained at autopsy. In forensic cases, positive PSA screening test results may have an impact on subsequent legal actions and criminal charges brought against the accused. These findings are important for both forensic pathologists and the police to ensure accurate screening of older women in cases of suspected sex crimes.
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Affiliation(s)
- Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Hiroyuki Sato
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shuheng Wen
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yohsuke Makino
- Departmen of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Hormonal IUD is the major hormonal contraceptive method used among women aged 40-49 years: Data from the 2015-16 Tromsø Study, Norway. Eur J Obstet Gynecol Reprod Biol 2023; 280:93-97. [PMID: 36442379 DOI: 10.1016/j.ejogrb.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aims to investigate hormonal contraceptive (HC) use and user characteristics in women aged 40-49 years in Norway, as little is known on use of HCs in this age segment. MATERIAL AND METHODS This prevalence study included 2296 women aged 40-49 years who participated in the 2015-16 Tromsø Study, which collected self-reported sociodemographic information and data from a wide range of validated health questionnaires. The participants had been sexually active the last 12 months prior enrollment, were not pregnant, not trying to conceive, and had no prior fertility problems. We categorized use of HC into three groups; no HC use, hormonal IUD use and other HC use. Explanatory variables included demographic, educational, economic and general health variables. All analyses were performed in SPSS with chi-square test and logistic regression at significance level p < 0.05. RESULTS Nearly 50 % of the study sample reported HC use with hormonal IUD use as the major method (39.5 %/40-44 years; 43.4 %/45-49 years old women). There were no differences in HC use by partner status, educational level, or BMI. Though statistically significant, we found only minor differences in HC use by occupational status, gross household income, and general health status, with higher proportions of women with no paid work, the lowest income, and poor health status reporting no HC use. CONCLUSION The high HC use and the minor differences found across demographic and socioeconomic parameters indicate that HC use, and hormonal IUD use in particular, is widely used among middle-aged women living in the city of Tromsø.
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Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society. Maturitas 2022; 163:1-14. [DOI: 10.1016/j.maturitas.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
PURPOSE OF REVIEW This review considers how reproductive aging may impact the trajectory of menstrually related mood disorders (MRMDs) such as premenstrual dysphoric disorder and considers how the treatment of MRMDs might require adjustment as patients approach midlife. RECENT FINDINGS The early menopause transition is accompanied by important hormonal changes that may exacerbate existing MRMDs. Indeed, recent research confirms that an important subset of women experiences depressive mood in response to perimenopausal elevations in ovarian hormones. In addition, a subset of women with an MRMD may exhibit an increased mood sensitivity to the ovarian hormone withdrawal that accompanies the late menopause transition and early postmenopausal phase. Though additional research is needed to clarify the trajectory of premenstrual dysphoria in the menopause transition, there is reason to believe that health care providers should be vigilant for a potential worsening of symptoms in perimenopause for women with past or current premenstrual dysphoric disorder.
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Affiliation(s)
- Bethany Sander
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada.
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Abstract
Perimenopause represents a transition period of a woman's life during which physiological, affective, psychological, and social changes mark progression from a woman's fertile life to menopause, with wide sexual hormones fluctuations until the onset of hypergonadotropic hypogonadic amenorrhea. Contraception during menopause should not only avoid unwanted pregnancies, but also improve quality of life and prevent wide range of condition affecting this population. Hormonal contraceptives confer many noncontraceptive benefits for women approaching menopause: treatment of abnormal uterine bleeding, relief from vasomotor symptoms, endometrial protection in women using estrogen therapy, musculoskeletal protection, and mood disorders protection. The main point remains selecting the most adequate contraceptive option for each woman, considering her risk factor, comorbidities, and keeping in mind the possibility of continuing contraception until reaching menopause and even further, creating a bridge between perimenopause and menopause hormonal therapy. Correct perimenopause management should rely on individualized medical therapy and multidisciplinary approach considering lifestyle and food habits as part of general good health of a woman.
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Affiliation(s)
- Libera Troìa
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Simona Martone
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Giuseppe Morgante
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
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Affiliation(s)
- Dinah F. Meyer
- Department of Psychology, Muskingum University, New Concord, Ohio, USA
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Lambert M, Begon E, Hocké C. [Contraception for women after 40: CNGOF Contraception Guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:865-872. [PMID: 30424983 DOI: 10.1016/j.gofs.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy's risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed. OBJECTIVE The objective of this review was to elaborate some guidelines for clinical practice regarding contraception's prescription for women over 40. METHODS A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS). RESULTS No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks. CONCLUSIONS Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.
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Affiliation(s)
- M Lambert
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
| | - E Begon
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - C Hocké
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
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Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:806-822. [PMID: 30429071 DOI: 10.1016/j.gofs.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide national clinical guidelines focusing on intrauterine contraception. METHODS A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
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Affiliation(s)
- F Vidal
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
| | - L Paret
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France
| | - Y Tanguy le Gac
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Guerby
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
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Kim CS, Tikhonov D, Merjanian L, Balica AC. Contraception pathway: application for midlife women. Womens Midlife Health 2017; 3:10. [PMID: 30766710 PMCID: PMC6299969 DOI: 10.1186/s40695-017-0029-3] [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: 02/24/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To create a system where evidence based medicine can be applied to accommodate every woman's needs by designing a contraceptive pathway that can be utilized by any healthcare provider, regardless of the patient's age, and to offer appropriate counseling in order to maximize patient outcomes, especially for the midlife woman. METHODS United States Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC) was used as the framework for these recommendations for a contraceptive care pathway that can be incorporated into care for midlife women. DISCUSSION By utilizing a total office approach that includes the scheduler, receptionist, medical assistant, nurse and health care provider as members of a team, the entire spectrum of the patient population in need of contraception from teenagers to midlife can be captured. Specifically for midlife women the need for an effective form of contraception may be overlooked as fecundity declines in this age group. This paper will highlight the use of this pathway for midlife women.
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Affiliation(s)
- Chi-Son Kim
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901 USA
| | - Deanna Tikhonov
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901 USA
| | - Lena Merjanian
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901 USA
| | - Adrian C Balica
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901 USA
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Johnson-Mallard V, Kostas-Polston EA, Woods NF, Simmonds KE, Alexander IM, Taylor D. Unintended pregnancy: a framework for prevention and options for midlife women in the US. Womens Midlife Health 2017; 3:8. [PMID: 30766709 PMCID: PMC6299952 DOI: 10.1186/s40695-017-0027-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/05/2017] [Indexed: 12/15/2022] Open
Abstract
Recently unintended pregnancies have been described as "a new kind of mid-life crisis." Given the high prevalence of unwanted or mistimed pregnancy in the US, we examined the sexual and reproductive health patterns of sexually active midlife women. An examination of the prevalence of unintended pregnancy among midlife women revealed a gap in data indicating unmet sexual and reproductive health needs of midlife women. The application of a framework for primary, secondary and tertiary prevention for unintended pregnancy may assist with guiding care for women and identifying implications for reproductive health policy and potential political interference as they relate to sexual and reproductive health in midlife women.
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Affiliation(s)
- Versie Johnson-Mallard
- Department of Family, Community, and Health System Science, Robert Wood Johnson Nurse Faculty Scholar Alum, University of Florida, College of Nursing, Gainesville, FL USA
| | - Elizabeth A. Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, Interim Associate Dean for Diversity, Equity, and Inclusion, University of Washington School of Nursing, Seattle, WA USA
| | | | | | - Diana Taylor
- UCSF School of Nursing, Research Faculty, Advancing New Standards in Reproductive Health Program (ANSIRH), UCSF Bixby Center for Global Reproductive Health, University of California, San Francisco, CA USA
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Di Bella ZIKDJ, Bianchi AMHDM, Araujo FFD, Sartori MGF, Girão MJBC. Contraception and family planning at the extreme of reproductive life - climacteric. Rev Assoc Med Bras (1992) 2016; 62:454-7. [PMID: 27656856 DOI: 10.1590/1806-9282.62.05.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Menopause is an endocrine phenomenon characterized by gradual estrogen decline. This is a stage in a woman's life in which contraception is extremely important as the risks associated with pregnancy and childbirth increase, both maternal issues associated with higher incidence of comorbidities and issues related to fetal abnormalities, mitochondrial abnormalities, or genetic syndromes. On the other hand, there is a growing number of women who have postponed motherhood and need effective contraception, but without prolonging the return to fertility. Long-acting reversible contraceptives (LARCs), low-dose oral hormonal contraceptives and non-oral contraceptives are preferred. The levonorgestrel-releasing intrauterine system is a very good alternative that can maintain endometrial protection after menopause. Definitive methods such as tubal ligation and vasectomy are options for couples that already have their offspring. In this review, we present evidence for contraceptive indication and the effects of hormonal methods on climacteric including options for contraception, control of bleeding during perimenopause and of climacteric symptoms, as well as the transition from such methods to hormone therapy if indicated.
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Affiliation(s)
- Zsuzsanna Ilona Katalin de Jármy Di Bella
- PhD - Coordinator of the Sector of Family Planning and Adjunct Professor of the Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Fabio Fernando de Araujo
- PhD - Coordinator of the Sector of Family Planning, and Affiliate Professor of the Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil
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Goldstein SR. Ovarian conservation at the time of hysterectomy for benign disease: where is the pendulum now? Climacteric 2014; 17:721-2. [PMID: 25399702 DOI: 10.3109/13697137.2014.968417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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