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Gertz AM, Soffi ASM, Mompe A, Sickboy O, Gaines AN, Ryan R, Mussa A, Bawn C, Gallop R, Morroni C, Crits-Christoph P. Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes. Front Glob Womens Health 2022; 3:815634. [PMID: 35663924 PMCID: PMC9157818 DOI: 10.3389/fgwh.2022.815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians. Methods A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined. Results For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93. Conclusions A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.
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Affiliation(s)
- Alida M. Gertz
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Atlang Mompe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Robert Gallop
- West Chester University, West Chester, PA, United States
| | - Chelsea Morroni
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Medical Research Council (MRC) University of Edinburgh Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Corno AF, Adebo DA, LaPar DJ, Salazar JD. Modern advances regarding interatrial communication in congenital heart defects. J Card Surg 2021; 37:350-360. [PMID: 34842296 DOI: 10.1111/jocs.16166] [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: 11/05/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interatrial communication, one of the most frequent congenital heart defects, represents an important intracardiac shunt between systemic and pulmonary circulations. Direction and magnitude of the interatrial shunting depends upon several features, including defect size, shape and location, pressure difference between right and left atrium, and difference in right and left ventricular compliance. METHODS In this review article, the presence or absence of interatrial communication, and its role, have been analyzed, as they can have a critical impact on the cardiovascular physiopathology, and the interatrial communication can prove to be either clinically harmful, useful or indispensable. Accordingly, the utility and role of the interatrial communication in modern congenital, pediatric and adult, disease has evolved, with modification of the indications to close, maintain patency, or create an interatrial communication. RESULTS The interatrial communication and shunting can be manipulated to maximize the oxygen delivery to the tissues, accordingly with the underlying congenital heart defect. While not always relevant to patients with bi-ventricular circulations, this becomes extremely important in children and adults with complex congenital heart defects. CONCLUSIONS With improving long-term survival for the vast majority of congenital heart patients, an advanced understanding of the role and utility of the interatrial communication, and of all the possibilities of its manipulation, is essential to improve the patient outcomes.
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Affiliation(s)
- Antonio F Corno
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Dilachew A Adebo
- Department of Pediatric and Congenital Cardiology, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Damien J LaPar
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
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Martín Mañero C, Medina Durán P, Morales Delgado N, Martín Rioboó E. [Patent foramen ovale. An update for primary care]. Semergen 2021; 47:189-196. [PMID: 33509725 DOI: 10.1016/j.semerg.2020.12.003] [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: 06/05/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Patent foramen ovale (FOP) is the most prevalent cause of cryptogenic strokes in people under 60 years old. Although it is usually asymptomatic, it has a high risk of producing paradoxical embolism and, therefore, stroke with indeterminate outcomes. The study should be started based on clinical suspicion, and includes a multidisciplinary assessment and a determination of the type of treatment to be performed. The therapeutic possibilities range from conservative treatment (indefinite antithrombotic treatment), to its percutaneous closure (currently the most widely used). The first objective is to decrease the number of stroke recurrences. Conservative treatment should be reserved for those cases of low embolic risk. The risk assessment must be individualised, fundamentally based on the anatomical characteristics of the FOP and the patient clinic picture. The use of the RoPE risk scale (The Risk of Paradoxical Embolism) should be a tool to consider.
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Affiliation(s)
- C Martín Mañero
- Medicina Familiar y Comunitaria, Centro de Salud Ribera del Muelle, Distrito Sanitario Bahía de Cádiz-La Janda, Puerto Real, Cádiz, España
| | - P Medina Durán
- Servicio de Urgencias, Hospital Alta Resolución Montilla, Montilla, Córdoba, España
| | - N Morales Delgado
- Medicina Familiar y Comunitaria, Unidad de Gestión Clínica Poniente, Distrito Sanitario Córdoba Guadalquivir, Córdoba, España
| | - E Martín Rioboó
- Unidad de Gestión Clínica Poniente, Distrito Sanitario Córdoba Guadalquivir, Grupo de Investigación clínico-epidemiológica (GICEAP), IMIBIC, Hospital Reina Sofía Córdoba, Córdoba, España.
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Association between subjective olfactory dysfunction and female hormone-related factors in South Korea. Sci Rep 2019; 9:20007. [PMID: 31882785 PMCID: PMC6934502 DOI: 10.1038/s41598-019-56565-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/30/2019] [Indexed: 12/27/2022] Open
Abstract
An association between olfactory dysfunction and female hormone level has been reported; however, no previous studies have investigated the correlation with life-long female hormone exposure. The aim of this study was to estimate the association between subjective olfactory dysfunction and various endogenous and exogenous female hormone-related factors including age at menarche and menopause, number of pregnancies and deliveries, age at first and last delivery, duration of breastfeeding, use of oral contraceptives, and use of hormone therapy. The study analysed a total of 3863 female participants using data from the Korean National Health and Nutrition Examination Survey V (2010-2012). The prevalence of olfactory dysfunction was 3.5% for premenopausal participants and 6.2% for postmenopausal women. Among premenopausal women (compared to women breastfed less than 12 months), the 12-24-month group (OR = 4.690, 95% CI = 1.431-15.369) and the 25-48-month group (OR = 6.548, 95% CI = 1.758-24.394) had higher rates of olfactory dysfunction. In postmenopausal women, starting menopause at a younger age was positively associated with olfactory dysfunction (OR = 0.939, 95% CI = 0.887-0.993). These data suggest that a longer duration of endogenous oestrogen deprivation is associated with subjective olfactory dysfunction.
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Guardo FD, Currò JM, Valenti G, Rossetti P, Di Gregorio LM, Conway F, Chiofalo B, Garzon S, Bruni S, Rizzo G. Non-pharmacological management of gestational diabetes: The role of myo-inositol. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0111/jcim-2019-0111.xml. [PMID: 31527297 DOI: 10.1515/jcim-2019-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder occurring in pregnancy. GDM plays an important role in the current diabetes epidemic: exposure to a high glycemic environment during the early stages of development increases the risk of the fetus to develop type two diabetes mellitus (T2DM) in adult life. Various cardiometabolic risk factors are linked to GDM. A thorough knowledge of the risk factors and genes involved in the development of GDM, along with an understanding of the underlying pathophysiological mechanisms are crucial to properly identify patients at risk of developing this condition. There is growing evidence showing that myo-inositol, combined with an appropriate therapeutic regimen for GDM, can provide additional benefits to the patient. The aim of this review is to analyze the role of inositol isomers - especially myo-inositol (MYO-INS) - in the treatment of patients with GDM.
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Affiliation(s)
- Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | | | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Catania, Italy
| | - Luisa Maria Di Gregorio
- Department of General Surgery and Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Bruni
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Altıntas Y, Bayrak M. Evaluation of 1294 Female Patients with Breast Pain: A Retrospective Study. Adv Ther 2018; 35:1411-1419. [PMID: 30094702 DOI: 10.1007/s12325-018-0769-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mastalgia, or breast pain, is one of the most important complaints referred to outpatient clinics. The objective of this study was to evaluate the factors causing mastalgia. All patients who presented to our clinic with complaints of mastalgia were assessed along with their type of mastalgia symptoms, menopausal status, and radiology results. METHODS A total of 3157 patients with mastalgia complaints visited our clinic between January 2015 and February 2018. Only 1294 of them were retrospectively screened. Age, sex, menopausal (premenopausal, postmenopausal) status, mastalgia type (cyclic, non-cyclic), and imaging findings of the patients were examined. RESULTS The mean age was 43.8 ± 11.8 (13-86) years, with 453 (35%) patients younger than 40 years and 841 (65%) older than 40. Cyclic mastalgia was found in 207 (16%) patients, and non-cyclic mastalgia was seen in 1087 (84%) patients. A total of 786 (60.7%) patients were premenopausal, and 508 (39.3%) were postmenopausal. Mammography was used in 545 (42.1%) patients; 1190 (92.0%) women had breast ultrasonography. CONCLUSION Although breast pain is a common symptom in women who are referred to breast outpatient clinics, we concluded that patients who complain of mastalgia should not be afraid of cancer. Despite this and for reassurance, clinical imaging may be necessary to alleviate these patients' suspicions.
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Neri M, Piras B, Paoletti AM, Vallerino V, Corda V, Ronchetti C, Taccori V, Pilloni M, Zedda P, Capobianco G, Dessole S, Melis GB, Mais V. Long-acting reversible contraception (LARC) with the intrauterine system with levonorgestrel (6 mcg/d): observational study on the acceptability, quality of life, and sexuality in Italian women. Gynecol Endocrinol 2018; 34:532-535. [PMID: 29254390 DOI: 10.1080/09513590.2017.1416465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This observational study was conducted in healthy premenopausal women, who presented themselves for contraception with an intrauterine system (IUS) releasing LNG (6 mcg/d) (Jaydess®, Bayer, Germany) at the outpatient Family Planning Clinics of the Departments of Obstetrics and Gynaecology of the Universities of Cagliari and Sassari (CA/SS), University-Hospitals of CA/SS (Italy). After a screening visit, 31 women without contraindications to Jaydess® were included in the study. No difficulty in Jaydess® insertion (Ji) was found in 87% of subjects, with pelvic pain (PP) (visual analogic scale, VAS:5.33 ± 2.54) reported by 27/31 subjects at the Ji. Pelvic pain was reported by 17/31 subjects on the first day (VAS: 3.07 ± 3.1), 16/31 subjects on the second day (VAS:2.37 ± 2.71), and 11/31 subjects on the third day (VAS:1.18 ± 2.02) from Ji, with a significant (p < .001) decrease in the intensity. The primary purposes of the study were to evaluate whether a 12-month-treatment (12-M-T) with Jaydess® interferes on either the quality of life (QoL) or sexuality. Jaydess® did not modify either QoL or sexuality in the 25 subjects who completed the 12-M-T. Throughout the 12-M-T, PP, or pregnancies were not found; the menstrual blood loss was significantly (p < .0001) reduced, and the intensity VAS of dysmenorrhea (#14 subjects) significantly (p < .001) improved.
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Affiliation(s)
- Manuela Neri
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Bruno Piras
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Anna Maria Paoletti
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Valerio Vallerino
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Valentina Corda
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Camilla Ronchetti
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Valeria Taccori
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Monica Pilloni
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Pierina Zedda
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Giampiero Capobianco
- c Department of Surgical, Microsurgical and Medical Sciences , University of Sassari , Sassari , Italy
- d Department of Obstetrics and Gynecology , University Hospital of Sassari (AOUSS) , Sassari , Italy
| | - Salvatore Dessole
- c Department of Surgical, Microsurgical and Medical Sciences , University of Sassari , Sassari , Italy
- d Department of Obstetrics and Gynecology , University Hospital of Sassari (AOUSS) , Sassari , Italy
| | - Gian Benedetto Melis
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
| | - Valerio Mais
- a Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
- b Department of Obstetrics and Gynecology , University Hospital of Cagliari (AOUCA) , Cagliari , Italy
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Momoeda M, Kondo M, Elliesen J, Yasuda M, Yamamoto S, Harada T. Efficacy and safety of a flexible extended regimen of ethinylestradiol/drospirenone for the treatment of dysmenorrhea: a multicenter, randomized, open-label, active-controlled study. Int J Womens Health 2017; 9:295-305. [PMID: 28496369 PMCID: PMC5422539 DOI: 10.2147/ijwh.s134576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dysmenorrhea is a common condition in women, which is characterized by menstrual pain. Low-dose estrogen/progestin combined oral contraceptives have been shown to reduce the severity of dysmenorrhea symptoms, and a 28-day cyclic regimen of ethinylestradiol/drospirenone (28d regimen) is approved for this indication in Japan. AIM The aim of this study was to assess the safety and efficacy of a flexible extended regimen of ethinylestradiol/drospirenone (flexible regimen) in Japanese women with dysmenorrhea. METHODS This multicenter, open-label study was performed in Japanese women with dysmenorrhea who, after a baseline observational phase, were randomized to receive ethinylestradiol 20 μg/drospirenone 3 mg in a flexible regimen (one tablet each day for 24-120 days followed by a 4-day tablet-free interval) or in the standard 28d regimen (one tablet each day for 24 days, followed by 4 days of placebo tablets for six cycles). The primary endpoint was the number of days with dysmenorrhea of at least mild intensity over a 140-day evaluation period. Dysmenorrhea scores, bleeding patterns, and other pain-related parameters were also assessed. RESULTS A total of 216 women (mean age 29.7 years) were randomized to the flexible regimen (n=108) or 28d regimen (n=108) and 212 were included in the full analysis sets (flexible regimen, n=105; 28d regimen, n=107). Women in the flexible-regimen group reported a mean of 3.4 fewer days with dysmenorrheic pain than women in the 28d-regimen group, with similar decreases in disease severity reported in both treatment groups. According to the investigators, 64.8% and 59.4% of women in the flexible-regimen and 28d-regimen treatment groups had "very much improved" or "much improved" disease, while 54.3% and 50.9% of patients reported being "very much satisfied" or "much satisfied" with their treatment, respectively. CONCLUSION In Japanese women with dysmenorrhea, a flexible extended regimen of ethinylestradiol/drospirenone decreased the number of days with dysmenorrheic pain versus the traditional 28d regimen.
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Affiliation(s)
- Mikio Momoeda
- Department of Integrated Women's Health, St Luke's International Hospital, Tokyo
| | - Masami Kondo
- Product Development, Bayer Yakuhin Ltd, Osaka, Japan
| | | | | | | | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Tottori, Japan
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