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PAŞALI KİLİT T, ONBAŞI K, ÖZYİĞİT F. Treatment Adherence Levels and Factors Affecting Adherence in Patients Receiving Osteoporosis Treatment. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.533942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yeam CT, Chia S, Tan HCC, Kwan YH, Fong W, Seng JJB. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int 2018; 29:2623-2637. [PMID: 30417253 DOI: 10.1007/s00198-018-4759-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
Abstract
The aim of this review was to identify factors that influence patients' adherence to anti-osteoporotic therapy. Factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis. Physicians need to be aware of these factors so as to optimize therapeutic outcomes for patients. INTRODUCTION To identify factors that influence patients' adherence to anti-osteoporotic therapy. METHODS A systematic review of literature was performed for articles published up till January 2018 using PubMed®, PsychINFO®, Embase®, and CINAHL®. Peer-reviewed articles which examined factors associated with anti-osteoporotic medication adherence were included. Classes of anti-osteoporotic therapy included bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate. Meta-analyses, case reports/series, and other systematic reviews were excluded. Identified factors were classified using the World Health Organization's five dimensions of medication adherence (condition, patient, therapy, health-system, and socio-economic domains). RESULTS Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9 to 95.4%. Twenty-four factors with 139 sub-factors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%). Condition-related factors that were associated with poorer medication adherence included polypharmacy, and history of falls was associated with higher medication adherence. Patient-related factors which were associated with poorer medication adherence included older age and misconceptions about osteoporosis while therapy-related factors included higher dosing frequency and medication side effects. Health system-based factors associated with poorer medication adherence included care under different medical specialties and lack of patient education. Socio-economic-related factors associated with poorer medication adherence included current smoker and lack of medical insurance coverage. CONCLUSION This review identified factors associated with poor medication adherence among osteoporotic patients. To optimize therapeutic outcomes for patients, clinicians need to be aware of the complexity of factors affecting medication adherence.
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Affiliation(s)
- C T Yeam
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - S Chia
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - H C C Tan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Y H Kwan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - W Fong
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J J B Seng
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Růžičková O, Killinger Z, Kasalický P, Hamilton L, Tyl R, Tomková S, Kalouche-Khalil L. Real-world Management of Women with Postmenopausal Osteoporosis Treated with Denosumab: A Prospective Observational Study in the Czech Republic and Slovakia. Adv Ther 2018; 35:1713-1728. [PMID: 30191465 PMCID: PMC6182647 DOI: 10.1007/s12325-018-0779-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 12/14/2022]
Abstract
Introduction Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fracture. In randomized controlled trials, denosumab has been shown to significantly reduce the fracture risk in women with osteoporosis. However, little is known about the real-world management of women who are prescribed denosumab. Methods This multicenter, prospective, observational real-world study in the Czech Republic and Slovakia evaluated the baseline characteristics and clinical management of women with postmenopausal osteoporosis prescribed denosumab for 24 months. Results A total of 600 women were included (300 in each country). In the Czech Republic and Slovakia, respectively, mean age at enrollment was 69.0 and 64.3 years, 67.7% and 30.0% of patients had a previous osteoporotic fracture, and 85.0% and 48.7% had previously received osteoporosis medication. In both countries, ‘low BMD T score’ and ‘a history of osteoporotic fracture’ were the main reasons for prescribing denosumab. Most patients received all four post-baseline denosumab injections (Czech Republic, 82.0%; Slovakia, 81.0%), and more than 98% of patients in both countries received all injections at the prescribing center. At 24 months, most patients experienced an increase in BMD T score for the lumbar spine, total hip, or femoral neck (Czech Republic, 69.7–91.7%; Slovakia, 67.1–92.9%). Adverse drug reactions were consistent with the known safety profile of denosumab. Conclusion Baseline characteristics of patients receiving denosumab in the Czech Republic and Slovakia reflect the reimbursement criteria for this agent in each country. The findings of our study in patients who are at high risk for fracture are consistent with the growing body of evidence demonstrating the effectiveness of denosumab in real-world clinical practice. Trial Registration ClinicalTrials.gov identifier, NCT01652690. Funding Amgen Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0779-9) contains supplementary material, which is available to authorized users.
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Akarırmak Ü, Koçyiğit H, Eskiyurt N, Esmaeilzadeh S, Kuru Ö, Yalçinkaya EY, Peker Ö, Ekim AA, Özgirgin N, Çalış M, Rezvani A, Çevikol A, Eyigör S, Şendur ÖF, İrdesel J. Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:415-23. [PMID: 27524671 PMCID: PMC6197458 DOI: 10.1016/j.aott.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/30/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Abstract
Objective In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. Methods A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. Results On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. Conclusion Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.
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Affiliation(s)
- Ülkü Akarırmak
- İstanbul University, Cerrahpaşa School of Medicine, İstanbul, Turkey.
| | | | - Nurten Eskiyurt
- İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Ömer Kuru
- Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Ebru Yılmaz Yalçinkaya
- İstanbul Physical Therapy and Rehabilitation Training and Research Hospital, İstanbul, Turkey
| | - Özlen Peker
- Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | | | - Neşe Özgirgin
- Ankara Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Mustafa Çalış
- Erciyes University, School of Medicine, Kayseri, Turkey
| | - Aylin Rezvani
- Bezm-i Alem University, Faculty of Medicine, İstanbul, Turkey
| | - Alev Çevikol
- Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sibel Eyigör
- Ege University, Faculty of Medicine, İzmir, Turkey
| | | | - Jale İrdesel
- Uludağ University, School of Medicine, Bursa, Turkey
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Vytrisalova M, Touskova T, Ladova K, Fuksa L, Palicka V, Matoulkova P, Horak P, Stepan J. Adherence to oral bisphosphonates: 30 more minutes in dosing instructions matter. Climacteric 2015; 18:608-16. [DOI: 10.3109/13697137.2014.995164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fuksa L, Vytrisalova M. Adherence to denosumab in the treatment of osteoporosis and its utilization in the Czech Republic. Curr Med Res Opin 2015; 31:1645-53. [PMID: 26121231 DOI: 10.1185/03007995.2015.1065241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective was to analyze adherence and current trends in utilization and prescription practice patterns of the anti-RANKL monoclonal antibody denosumab in the treatment of postmenopausal osteoporosis (OP). METHODS The prescription-based database of the General Health Insurance Company of the Czech Republic that covers approximately 60% of the Czech population (6 million) was used as the data source. Medication possession ratio (MPR) and persistence were calculated for all patients (both OP medication-naïve and medication-experienced) with postmenopausal OP from the start of their therapy with denosumab 60 mg per ml subcutaneous injection within a period between September 2011, i.e. first denosumab availability, and May 2014. Clinical data such as fractures, co-morbidities and co-medication were not analyzed. RESULTS A total of 7904 women treated with denosumab were analyzed; 93.8% of patients were identified as compliant (MPR ≥0.8) while 6.2% were non-compliant (MPR < 0.8). Persistence (base case, i.e. refill gap ≤30 days) was 59.1% after 12 months and 34.8% after 24 months. By 2013, i.e. within 2 years, denosumab became the second most utilized and most costly drug after oral bisphosphonates. CONCLUSIONS Despite relatively high MPR and persistence rate observed in denosumab treatment, adherence enhancing strategies, focused on persistence in particular, are still needed. The uptake of denosumab has been rapid, its utilization keeps rising swiftly, and denosumab already represents a significant part of the osteoporosis therapy budget.
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Affiliation(s)
- Leos Fuksa
- a Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove , Charles University in Prague , Hradec Kralove , Czech Republic
| | - Magda Vytrisalova
- a Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove , Charles University in Prague , Hradec Kralove , Czech Republic
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Touskova T, Vytrisalova M, Palicka V, Hendrychova T, Fuksa L, Holcova R, Konopacova J, Kubena AA. Drug holidays: the most frequent type of noncompliance with calcium plus vitamin D supplementation in persistent patients with osteoporosis. Patient Prefer Adherence 2015; 9:1771-9. [PMID: 26719680 PMCID: PMC4689262 DOI: 10.2147/ppa.s88630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE All current recommendations include calcium and vitamin D (Ca-D) as an integrated part of osteoporosis treatment. The purpose of this pilot study was to analyze compliance with a fixed combination of Ca-D in women persistent with the treatment. PATIENTS AND METHODS An observational study was carried out in three osteocenters in the Czech Republic. Women with osteoporosis ≥55 years of age concurrently treated with oral ibandronate were eligible. Compliance was evaluated in a period of 3 months by Medication Event Monitoring System (MEMS), tablet count, and self-report. Nonpersistence was defined as a MEMS-based gap in the use of Ca-D to be 30 days or more. RESULTS A total of 73 patients were monitored, of which 49 patients were analyzed (target population). Based on MEMS, mean overall compliance was 71%; good compliance (≥80%) was observed in 59% of the patients. As many as 71% of the patients took drug holidays (≥3 consecutive days without intake); overall compliance of these patients was 59% and was slightly lower on Fridays and weekends. Patients without drug holidays were fully compliant (did not omit individual doses). Compliance differed according to daily time at which the patients mostly used the Ca-D. Afternoon/evening takers showed a mean overall compliance of 82% while morning/night takers only 51% (P=0.049). Based on MEMS, tablet count, and self-report, compliance ≥75% was observed in 59%, 100%, and 87% of the patients, respectively. Outcomes obtained by the three methods were not associated with each other. Undesirable concurrent ingestion of Ca-D and ibandronate was present only twice. CONCLUSION Despite almost perfect self-reported and tablet count-based compliance, MEMS-based compliance was relatively poor. Consecutive supplementation-free days were common; more than two-thirds of the patients took at least one drug holiday. This pilot study showed drug holiday to be the most important type of noncompliance with Ca-D in those who are persistent with the treatment.
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Affiliation(s)
- Tereza Touskova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Magda Vytrisalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
- Correspondence: Magda Vytrisalova, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Heyrovskeho 1203, 500 05 Hradec Kralove, Czech Republic, Tel +420 49 506 7648, Fax +420 49 506 7161, Email
| | - Vladimir Palicka
- Osteocentre, Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tereza Hendrychova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Leos Fuksa
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Radka Holcova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jana Konopacova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Ales Antonin Kubena
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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Mendoza N, Sánchez-Borrego R, Villero J, Baró F, Calaf J, Cancelo MJ, Coronado P, Estévez A, Fernández-Moya JM, González S, Llaneza P, Neyro JL, del Pino J, Rodríguez E, Ruiz E, Cano A. 2013 Up-date of the consensus statement of the Spanish Menopause Society on postmenopausal osteoporosis. Maturitas 2013; 76:99-107. [PMID: 23827473 DOI: 10.1016/j.maturitas.2013.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/29/2013] [Accepted: 05/31/2013] [Indexed: 12/12/2022]
Abstract
Postmenopausal osteoporosis is a major female health problem that increases morbidity, mortality and healthcare system costs. Considering that gynecologists are the primary health practitioners involved in the treatment of women with osteoporosis in our country, a panel of experts from the Spanish Menopause Society met to establish a set of criteria and procedures for the diagnosis and treatment of this disease based on the best available evidence and according to the model proposed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to elaborate clinical practice guidelines and to classify the quality of the evidence and the strength of the recommendations. These recommendations should be a reference to gynecologist and other health professionals involved in the treatment of postmenopausal women.
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Affiliation(s)
- Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Granada, Spain.
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Ability to follow anti-reabsorptive drug treatment in postmenopausal women with reduced bone mass. Menopause 2011; 18:531-6. [PMID: 21242816 DOI: 10.1097/gme.0b013e3181fda7e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Studies show that adherence to osteoporosis treatment and prevention is low, which could interfere with therapeutic response. The aim of this study was to evaluate the ability of women to follow a treatment for osteoporosis with different anti-reabsorptives in relation to the prescribed regimen, dose, indications, and mode of ingestion. METHODS A cross-sectional study that included postmenopausal women all undergoing medicated treatment because of densitometric diagnosis of osteopenia or osteoporosis was carried out by means of the MedTake questionnaire. A total of 227 women at a menopause clinic were studied. The following were evaluated: sociodemographic characteristics, other illnesses, use of concomitant medication, use of medication for osteoporosis, length of use, and ability to follow the treatment in relation to the prescribed regimen, dose, indication, and mode of ingestion. RESULTS The ability to follow the treatment as evaluated by the MedTake was below 80% for most of the women. No significant difference was found between the daily or weekly bisphosphonate users and those taking raloxifene. The factors associated with inadequate treatment were the following: being 70 years or older (odds ratio [OR], 5.62; 95% CI, 1.23-25.64), being illiterate (OR, 10.14; 95% CI, 2.14-48.12), use of other medications (OR, 0.33; 95% CI, 0.15-0.76), and shorter length of use of medication for osteoporosis (OR, 5.67; 95% CI, 2.27-14.16). CONCLUSION The ability to follow a treatment involving different anti-reabsorptive medications for osteoporosis is high relative to mode of ingestion, coingestion, and indication and low in relation to knowledge of the correct dose. Low ability is associated with advanced age, being illiterate, not using other medications, and shorter treatment time.
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Costa-Paiva L, Gomes DC, Morais SS, Pedro AO, Pinto-Neto AM. Knowledge about osteoporosis in postmenopausal women undergoing antiresorptive treatment. Maturitas 2011; 69:81-5. [PMID: 21420262 DOI: 10.1016/j.maturitas.2011.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 01/26/2011] [Accepted: 02/08/2011] [Indexed: 11/19/2022]
Abstract
UNLABELLED A good understanding and knowledge of osteoporosis is a prerequisite for the success of preventive measures as well as treatment adherence. OBJECTIVE To assess knowledge about osteoporosis in postmenopausal women with osteoporosis or osteopenia undergoing antiresorptive treatment. SUBJECTS AND METHODS A cross-sectional study was based on a sample of 232 postmenopausal women with osteopenia or osteoporosis diagnosed by bone density studies and seen at the Menopause Outpatient Clinic at Caism/Unicamp. Women's knowledge of osteoporosis was assessed by means of the OPQ (Osteoporosis questionnaire), a 20-item questionnaire about osteoporosis in areas of general information, risk factors, consequences and treatment. RESULTS The average age of the women was 61.6 years (±8.2 years) and the average time since menopause was 16.8 years. The average knowledge score obtained by the OPQ was 3.78. The average score for correct answers was 9.8 points, while the average score for incorrect answers was 6 points and 'don't know' answers was 4.1 points. Bivariate analysis showed the variables most closely associated with greater knowledge: education (p<0.01), reading (p<0.02), socioeconomic status (p<0.03), means of acquiring osteoporosis medication (p<0.02), and absence of comorbidities (p<0.04). On multiple regression analysis, the factors which remained associated with better knowledge were higher education, higher socioeconomic status scores and absence of comorbidities. CONCLUSION Knowledge of osteoporosis in postmenopausal women diagnosed with the disease was limited. Level of education was a strong predictor of knowledge.
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Affiliation(s)
- Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology of the Unicamp Medical School, Campinas, São Paulo, Brazil.
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