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Patabendige M, Chan F, Vayssiere C, Ehlinger V, Van Gemund N, le Cessie S, Prager M, Marions L, Rozenberg P, Chevret S, Young DC, Le Roux PA, Gregson S, Waterstone M, Rolnik DL, Mol BW, Li W. Vaginal misoprostol versus vaginal dinoprostone for cervical ripening and induction of labour: An individual participant data meta-analysis of randomised controlled trials. BJOG 2024. [PMID: 38425020 DOI: 10.1111/1471-0528.17794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles. OBJECTIVES To compare the effectiveness, and maternal and perinatal safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials. SEARCH STRATEGY The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data. DATA COLLECTION AND ANALYSIS An individual participant data meta-analysis was carried out. MAIN RESULTS Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low-dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low-dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low-dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low-dose vaginal misoprostol (aOR 0.80, 95% CI 0.65-0.98, P = 0.03, I2 = 0%). CONCLUSIONS Low-dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low-dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone.
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Affiliation(s)
- Malitha Patabendige
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
- Ministry of Health, Colombo, Sri Lanka
- Monash Health - Casey Hospital, Berwick, Victoria, Australia
| | - Fei Chan
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Christophe Vayssiere
- Centre for Epidemiology and Research in Population Health (CERPOP), UMR1295, Toulouse University, Inserm, Paul Sabatier University, Toulouse, France
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, Toulouse University Hospital, Toulouse, France
| | - Virginie Ehlinger
- Centre for Epidemiology and Research in Population Health (CERPOP), UMR1295, Toulouse University, Inserm, Paul Sabatier University, Toulouse, France
| | - Nicolette Van Gemund
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Saskia le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martina Prager
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Rozenberg
- Department of Gynaecology and Obstetrics, Poissy Hospital, University Paris V, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Hopital Saint-Louis, University Paris VII, INSERM, Paris, France
| | - David C Young
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul A Le Roux
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Sarah Gregson
- Maternity Unit, Queen Mary's Sidcup NHS Trust, Kent, UK
| | | | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health, and School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Podolskyi V, Gemzell-Danielsson K, Marions L, Gomperts R. Preabortion ultrasound - a patient perspective. EUR J CONTRACEP REPR 2023; 28:268-273. [PMID: 37698511 DOI: 10.1080/13625187.2023.2249158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/14/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To explore women's perception of the need for an ultrasound scan before medical abortion provided by telemedicine services. METHODS We have analysed women's requests for medical abortion through the website www.womenonweb.org from the 1st of January 2019 to the 5th of October 2020. Before receiving abortion drugs for self-managed medical abortion, women received online counselling and were asked to complete an online survey on pre-abortion ultrasound scan and the reasons for having or not having one. The initial dataset included 62641 entries from 207 countries. Each entry corresponded to a person's request for medical abortion. Women reported only one or multiple reasons for not having a pre-abortion ultrasound scan. RESULTS Among 59648 women requesting a medical abortion, 45653 (76,54%) did not have any pre-abortion ultrasound scan and specified a reason for that. The countries with the highest rates of women not having a pre-abortion ultrasound scan were Thailand, Poland, Northern Ireland, Mexico, South Korea, Japan, Chile, Indonesia, Germany, and Brazil. The main reasons for not having a pre-abortion ultrasound scan were being confident regarding pregnancy length; and thus, no need for a scan stated by 10910/34390 women (31.7%), lack of resources stated by 10589/34390 women (30.8%), and privacy issues stated by 6472/34390 women (18.8%). CONCLUSION Most women opting for medical abortion through telemedicine did not undergo a pre-abortion ultrasound scan. The main reason stated was that women did not find it necessary, lack of resources and privacy issues.
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Affiliation(s)
- Volodymyr Podolskyi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO-Centre, Karolinska University Hospital Solna, QB:84, Stockholm, Sweden
- Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine, Kyiv, Ukraine
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO-Centre, Karolinska University Hospital Solna, QB:84, Stockholm, Sweden
| | - Lena Marions
- Department Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
- Department Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Söderman L, Böttiger Y, Edlund M, Järnbert-Pettersson H, Marions L. Adjuvant use of melatonin for pain management in endometriosis-associated pelvic pain-A randomized double-blinded, placebo-controlled trial. PLoS One 2023; 18:e0286182. [PMID: 37267394 DOI: 10.1371/journal.pone.0286182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
Considering the pharmacological treatment options for endometriosis-associated pain are confined to hormonal therapy and analgesics, we studied the analgesic effect of 20 mg melatonin as an adjuvant therapy in women with endometriosis-associated pain. This randomized double-blinded, placebo-controlled trial was conducted at the Research Center for Womens' Health at Södersjukhuset, a university hospital in Stockholm, Sweden. Forty women from 18 to 50 years of age with endometriosis and severe dysmenorrhea with or without chronic pelvic pain were given 20 mg Melatonin or placebo orally daily for two consecutive menstrual cycles or months. The level of pain was recorded daily on the 11-point numeric rating scale, a difference of 1.3 units was considered clinically significant. Clincaltrials.gov nr NCT03782740. Sixteen participants completed the study in the placebo group and 18 in the melatonin group. The difference in endometriosis-associated pain between the groups showed to be non-significant statistically as well as clinically, 2.9 (SD 1.9) in the melatonin group and 3.3 (SD 2.0) in the placebo group, p = 0.45. This randomized, double-blinded, placebo-controlled trial could not show that 20 mg of melatonin given orally at bedtime had better analgesic effect on endometriosis-associated pain compared with placebo. No adverse effects were observed.
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Affiliation(s)
- Lisa Söderman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Böttiger
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Måns Edlund
- KBH, Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Podolskyi V, Gemzell-Danielsson K, Maltzman LL, Marions L. Effectiveness and acceptability of home use of misoprostol for medical abortion up to 10 weeks of pregnancy. Acta Obstet Gynecol Scand 2023; 102:541-548. [PMID: 36933004 PMCID: PMC10072251 DOI: 10.1111/aogs.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION The administration of mifepristone, followed by misoprostol, is widely used for medical abortion. Many studies have demonstrated home abortion to be safe in pregnancies up to 63 days of gestation, and recent data support its safety when extended to more advanced pregnancies. We studied the efficacy and acceptability of home use of misoprostol up to 70 days of gestation in a Swedish setting and compared the outcomes between pregnancies with a gestational age of up to 63 days and pregnancies with gestational age 64-70 days. MATERIAL AND METHODS This prospective cohort study was performed between November 2014 and November 2021 at Södersjukhuset and Karolinska University Hospital, Stockholm, and some patients were also recruited from Sahlgrenska University Hospital, Göteborg and Helsingborg Hospital. The primary outcome was the rate of complete abortions and was defined as complete abortion without any need for surgical or medical intervention and assessed by clinical assessment, pregnancy test and/or vaginal ultrasound. Secondary objectives were assessed by daily self-reporting in a diary and included pain, bleeding, side effects and women's satisfaction and perception of home use of misoprostol. A comparison of categorical variables was made with Fisher's exact test. The significance level was set to a p-value ≤0.05. The study was registered at Clinicaltrials.gov on July 14, 2014 (NCT02191774). RESULTS During the study period we enrolled 273 women opting for medical abortion with home use of misoprostol. In the early group, up to 63 days of gestation, 112 women were included with a mean gestational length of 45 days and in the late group, 64-70 days of gestation, 161 women with a mean gestations length of 66.3 days were included. Complete abortion occurred in 95% (95% CI 89-98) of women in the early group and in 96% (95% CI 92-99) in the late group. No differences were found regarding side effects and acceptability was similarly high in both groups. CONCLUSIONS Our results show high efficacy and acceptability of medical abortion when misoprostol is administered at home up to 70 days of gestation. This supports previous findings about maintained safety when misoprostol is administered at home even past a very early pregnancy.
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Affiliation(s)
- Volodymyr Podolskyi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Lukyanova Institute of Pediatrics, Obstetrics and Gynecology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Lena L Maltzman
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Lena Marions
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Eshraghi B, Hermansson J, Berggren V, Marions L. Risk of obstetric anal sphincter tear among primiparous women with a history of female genital mutilation, giving birth in Sweden. PLoS One 2022; 17:e0279295. [PMID: 36584223 PMCID: PMC9803268 DOI: 10.1371/journal.pone.0279295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/04/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Female genital mutilation (FGM) includes a range of procedures involving partial or total removal of the external female genitalia. It is a harmful procedure that violates human rights of girls and women. FGM has been associated with obstetric anal sphincter injury (OASI), among other adverse obstetric complications. However, the obstetric outcomes in high-income countries are not clear. The aim of this study was to compare the risk of OASI among primiparous women, with and without a history of FGM, giving birth in Sweden. METHOD A population-based cohort-study based on data from the Swedish Medical Birth Register during the period 2014-2018. The study included primiparous women with singleton term pregnancies. We compared the risk, using multivariable logistic regression, of our main outcome OASI between women with a diagnosis of FGM and women without a diagnosis of FGM. Secondary outcomes included episiotomy and instrumental vaginal delivery. RESULT A total of 239,486 primiparous women with a term singleton pregnancy were identified. We included 1,444 women with a diagnosis of FGM and 186,294 women without a diagnosis of FGM in our analysis. The overall rate of OASI was 3% in our study population. By using multivariable logistic regression analysis, we found that women with a diagnosis of FGM had a significantly increased odds ratio (OR) of OASI (OR 2.69, 95%CI: 2.14-3.37) compared to women without a diagnosis of FGM. We also found an association between FGM and instrumental delivery as well as the use of episiotomy. CONCLUSION Women with a history of FGM have an almost tripled risk of OASI in comparison with women without FGM, when giving birth in a Swedish setting. Increased knowledge and awareness regarding FGM, and its potential health implications is crucial in order to minimise the risk of OASI among women with FGM giving birth in high-income countries. A limitation in our study is the lack of information about the specific types of FGM.
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Affiliation(s)
- Bita Eshraghi
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jonas Hermansson
- Department of Research, Angered Hospital, SV-Hospital Group, Gothenburg, Sweden
| | - Vanja Berggren
- Department of Neurobiology, Caring Science and Society and Health (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Jones MN, Palmer KR, Pathirana MM, Cecatti JG, Filho OBM, Marions L, Edlund M, Prager M, Pennell C, Dickinson JE, Sass N, Jozwiak M, Eikelder MT, Rengerink KO, Bloemenkamp KWM, Henry A, Løkkegaard ECL, Christensen IJ, Szychowski JM, Edwards RK, Beckmann M, Diguisto C, Gouge AL, Perrotin F, Symonds I, O'Leary S, Rolnik DL, Mol BW, Li W. Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative): an individual participant data meta-analysis of randomised controlled trials. Lancet 2022; 400:1681-1692. [PMID: 36366885 DOI: 10.1016/s0140-6736(22)01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Induction of labour is one of the most common obstetric interventions globally. Balloon catheters and vaginal prostaglandins are widely used to ripen the cervix in labour induction. We aimed to compare the effectiveness and safety profiles of these two induction methods. METHODS We did an individual participant data meta-analysis comparing balloon catheters and vaginal prostaglandins for cervical ripening before labour induction. We systematically identified published and unpublished randomised controlled trials that completed data collection between March 19, 2019, and May 1, 2021, by searching the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and PubMed. Further trials done before March 19, 2019, were identified through a recent Cochrane review. Data relating to the combined use of the two methods were not included, only data from women with a viable, singleton pregnancy were analysed, and no exclusion was made based on parity or membrane status. We contacted authors of individuals trials and participant-level data were harmonised and recoded according to predefined definitions of variables. Risk of bias was assessed with the ROB2 tool. The primary outcomes were caesarean delivery, indication for caesarean delivery, a composite adverse perinatal outcome, and a composite adverse maternal outcome. We followed the intention-to-treat principle for the main analysis. The primary meta-analysis used two-stage random-effects models and the sensitivity analysis used one-stage mixed models. All models were adjusted for maternal age and parity. This meta-analysis is registered with PROSPERO (CRD42020179924). FINDINGS Individual participant data were available from 12 studies with a total of 5460 participants. Balloon catheters, compared with vaginal prostaglandins, did not lead to a significantly different rate of caesarean delivery (12 trials, 5414 women; crude incidence 27·0%; adjusted OR [aOR] 1·09, 95% CI 0·95-1·24; I2=0%), caesarean delivery for failure to progress (11 trials, 4601 women; aOR 1·20, 95% CI 0·91-1·58; I2=39%), or caesarean delivery for fetal distress (10 trials, 4441 women; aOR 0·86, 95% CI 0·71-1·04; I2=0%). The composite adverse perinatal outcome was lower in women who were allocated to balloon catheters than in those allocated to vaginal prostaglandins (ten trials, 4452 neonates, crude incidence 13·6%; aOR 0·80, 95% CI 0·70-0·92; I2=0%). There was no significant difference in the composite adverse maternal outcome (ten trials, 4326 women, crude incidence 22·7%; aOR 1·02, 95% CI 0·89-1·18; I2=0%). INTERPRETATION In induction of labour, balloon catheters and vaginal prostaglandins have comparable caesarean delivery rates and maternal safety profiles, but balloon catheters lead to fewer adverse perinatal events. FUNDING Australian National Health and Medical Research Council and Monash Health Emerging Researcher Fellowship.
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Affiliation(s)
- Madeleine N Jones
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Maleesa M Pathirana
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Måns Edlund
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Martina Prager
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Craig Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Nelson Sass
- Departamento de Obstetricia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marta Jozwiak
- Gynaecologic Oncology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Mieke Ten Eikelder
- Department of Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Katrien Oude Rengerink
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, Netherlands
| | - Amanda Henry
- Medicine & Health, University of New South Wales, Kensington, NSW, Australia.
| | - Ellen C L Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | | | - Jeff M Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodney K Edwards
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - Michael Beckmann
- Mothers, Babies and Women's Health Services, Mater Health, South Brisbane, QLD, Australia
| | - Caroline Diguisto
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Amélie Le Gouge
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Franck Perrotin
- Department of Obstetrics, Gynaecology and Fetal Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Ian Symonds
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Sean O'Leary
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK.
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
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Jones M, Palmer K, Pathirana MM, Cecatti JG, Moraes Filho OB, Marions L, Prager M, Edlund M, Jozwiak M, Eikelder MT, Rengerink KO, Bloemenkamp KW, Henry A, Beckmann M, Kumar S, Diguisto C, Le Gouge A, Perrotin F, Symonds I, O'Leary S, Rolnik DL, Mol BW, Li W. A comparison of balloon catheters and vaginal prostaglandins for cervical ripening prior to labour induction. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Becker K, Heinemann K, Imthurn B, Marions L, Moehner S, Gerlinger C, Serrani M, Faustmann T. Real world data on symptomology and diagnostic approaches of 27,840 women living with endometriosis. Sci Rep 2021; 11:20404. [PMID: 34650132 PMCID: PMC8516876 DOI: 10.1038/s41598-021-99681-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/29/2021] [Indexed: 12/18/2022] Open
Abstract
Endometriosis is a chronic disease that requires a suitable, lifelong treatment. To our knowledge, the Visanne Post-approval Observational Study (VIPOS) is to date the largest real-world, non-interventional study investigating hormonal management of endometriosis. We describe women’s experiences of endometriosis in the real world by considering their symptoms and the diagnostic process in their healthcare setting. Overall, 27,840 women were enrolled from six European countries via networks of gynecologists or specialized centers. Of these, 87.8% of women were diagnosed based on clinical symptoms; the greatest and lowest proportions of women were in Russia (94.1%) and Germany (61.9%), respectively. Most women (82.8%) experienced at least one of the triad of endometriosis-associated pain symptoms: pelvic pain, pain after/during sexual intercourse, and painful menstrual periods. The most frequently reported endometriosis-associated symptoms were painful periods (61.8%), heavy/irregular bleeding (50.8%), and pelvic pain (37.2%). Women reported that endometriosis impacted their mood; 55.6% reported feeling “down”, depressed, or hopeless, and 53.2% reported feeling like a failure or having let down family/friends. VIPOS broadens our understanding of endometriosis based on real-world data by exploring the heterogeneity of symptoms women with endometriosis experience and the differences in diagnostic approaches between European countries. Trial registration: ClinicalTrials.gov, NCT01266421; registered 24 December 2010. Registered in the European Union electronic Register of Post-Authorisation Studies as number 1613.
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Affiliation(s)
| | | | - Bruno Imthurn
- Department of Reproductive Endocrinology, University of Zurich, 8001, Zurich, Switzerland
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 118 83, Stockholm, Sweden
| | | | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, 13553, Berlin, Germany.,Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421, Homburg, Saar, Germany
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Becker K, Heinemann K, Imthurn B, Marions L, Moehner S, von Stockum S, Gerlinger C, Serrani M, Faustmann T. Patient-reported utilization patterns of endometriosis medications in Europe: Real-world results from the non-interventional VIPOS study. Journal of Endometriosis and Pelvic Pain Disorders 2021. [DOI: 10.1177/22840265211035993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Women with endometriosis require individualized, long-term treatment. Analyzing prescription choices, medication switches, discontinuations, and breaks can describe real-world treatment patterns and optimize pathways for women. To our knowledge, the Visanne Post-approval Observational Study (VIPOS) is the largest real-world, non-interventional study examining the safety of hormonal treatments for the routine clinical management of endometriosis. We present data from VIPOS on endometriosis drug utilization patterns, including treatment discontinuation due to treatment failure. Methods: VIPOS was a prospective, long-term, controlled, non-interventional cohort study in six European countries (Germany, Switzerland, Russia, Poland, Ukraine, and Hungary) conducted between 2010 and 2018. Women self-reported medical and gynecological history and symptoms and treatment information via comprehensive questionnaires. Results: Overall, 27,840 women were enrolled via gynecologists or specialized centers. Inter-country variance in treatment prescription patterns suggests the influence of differential management strategies and guidelines on prescribing behavior and diagnostic methods. Most enrolled women were receiving combined hormonal contraceptives. Women receiving dienogest 2 mg or gonadotropin-releasing hormone agonists more often had a surgical diagnosis of endometriosis compared to other treatments, while most women receiving combined hormonal contraceptives, other progestins or danazol had a symptom-based diagnosis. Although treatment changes during follow-up were common, only 4733 discontinuations out of 42,342 treatment starts were reported due to side effects or treatment ineffectiveness. Conclusion: VIPOS provides valuable insights into the considerable inter-country variance in endometriosis treatment prescription and potential role of differing management guidelines and practices strategies. Findings presented here suggest the need greater alignment of clinical practice to optimize patient management.
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Affiliation(s)
| | | | - Bruno Imthurn
- Formerly of Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Lena Marions
- Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | | | | | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, Berlin, Germany
- Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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Veličko I, Ploner A, Sparén P, Herrmann B, Marions L, Kühlmann-Berenzon S. Changes in the Trend of Sexually Acquired Chlamydia Infections in Sweden and the Role of Testing: A Time Series Analysis. Sex Transm Dis 2021; 48:329-334. [PMID: 33122597 PMCID: PMC8048723 DOI: 10.1097/olq.0000000000001318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the notification trends of sexually acquired chlamydia (chlamydia) and its association with testing in Sweden before (1992-2004) and after (2009-2018) the discovery of a new variant of Chlamydia trachomatis (nvCT). METHODS We applied monthly time series analysis to study chlamydia trends and annual time series to study chlamydia rates adjusted for testing. We analyzed incidence nationally and by county group (based on able and unable to detect nvCT at time of discovery). RESULTS We present data on 606,000 cases of chlamydia and 9.9 million persons tested. We found a U-shaped chlamydia trend during the period 1992-2004, with an overall increase of 83.7% from 1996 onward. The period 2009-2018 began with a stable trend at a high incidence level followed by a decrease of 19.7% during the period 2015-2018. Peaks were seen in autumn and through during winter and summer. Similar results were observed by groups of county, although with varying levels of increase and decrease in both periods. Furthermore, increased testing volume was associated with increased chlamydia rates during the first period (P = 0.019) but not the second period. CONCLUSIONS Our results showed that chlamydia trends during the period 2009-2018 were not driven by testing, as they were during the period 1992-2004. This suggests less biased notified chlamydia rates and thus possibly a true decrease in chlamydia incidence rates. It is important to adjust case rates for testing intensity, and future research should target other potential factors influencing chlamydia rates.
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Affiliation(s)
- Inga Veličko
- From the Department of Medical Epidemiology and Biostatistics, Karolinska Institute
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm
| | - Alexander Ploner
- From the Department of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Pär Sparén
- From the Department of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Björn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institute
- Section of Obstetrics and Gynaecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Sharon Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm
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Asiki G, Newton R, Marions L, Kamali A, Smedman L. The effect of childhood stunting and wasting on adolescent cardiovascular diseases risk and educational achievement in rural Uganda: a retrospective cohort study. Glob Health Action 2019; 12:1626184. [PMID: 31232215 PMCID: PMC6598535 DOI: 10.1080/16549716.2019.1626184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Little is known about the long-term effects of early childhood undernutrition on adolescent cardiovascular disease risk and educational performance in low-income countries. We examined this in a rural Ugandan population. Objective: To investigate if stunting or wasting among children aged 2–5 years is associated with cardiovascular disease risk or educational achievement during adolescence. Methods: We conducted analyses using data from a cohort of children followed from early childhood to adolescence. Weight and height were measured in 1999–2000 when the children were 2–5 years of age and repeated in 2004/2005 and 2011. We compared cardiovascular disease risk parameters (mean blood pressure, lipids, HbA1c) and schooling years achieved in 2011 among 1054 adolescents categorised into four groups: those who experienced stunting or wasting throughout follow-up; those who recovered from stunting or wasting; those who were normal but later became stunted or wasted; and those who never experienced stunting or wasting from childhood up to adolescence. We controlled for possible confounding using multiple generalised linear regression models along with Generalised Estimating Equations to account for clustering of children within households. Results: Wasting was negatively associated with systolic blood pressure (−7.90 95%CI [−14.52,-1.28], p = 0.02) and diastolic blood pressure (−3.92, 95%CI [−7.42, −0.38], p = 0.03). Stunting had borderline negative association with systolic blood pressure (−2.90, 95%CI [−6.41, 0.61] p = 0.10). Recovery from wasting was positively associated with diastolic blood pressure (1.93, 95%CI [0.11, 3.74] p = 0.04). Stunting or wasting was associated with fewer schooling years. Conclusion: Recovery from wasting rather than just an episode in early childhood is associated with a rise in blood pressure while educational achievement is compromised regardless of whether recovery from undernutrition happens. These findings are relevant to children exposed to undernutrition in low-income settings.
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Affiliation(s)
- Gershim Asiki
- a Department of women's and children's Health , Karolinska Institutet , Stockholm , Sweden.,b Medical Research Council/Uganda Virus Research Council , Uganda Research Unit on AIDS , Entebbe , Uganda.,c African Population and Health Research Center , Health and systems for Health Unit , Nairobi , Kenya
| | - Robert Newton
- b Medical Research Council/Uganda Virus Research Council , Uganda Research Unit on AIDS , Entebbe , Uganda.,d Department of Health Sciences , University of York , York , UK
| | - Lena Marions
- e Department of Clinical Science and Education , Karolinska Institutet , Stockholm , Sweden
| | - Anatoli Kamali
- b Medical Research Council/Uganda Virus Research Council , Uganda Research Unit on AIDS , Entebbe , Uganda.,f Africa Program , International AIDS Vaccine Initiative , Nairobi , Kenya
| | - Lars Smedman
- a Department of women's and children's Health , Karolinska Institutet , Stockholm , Sweden
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12
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Marions L, Gustafson P. [Not Available]. Lakartidningen 2019; 116:FP9W. [PMID: 31573671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Söderman L, Edlund M, Marions L. Prevalence and impact of dysmenorrhea in Swedish adolescents. Acta Obstet Gynecol Scand 2018; 98:215-221. [PMID: 30312470 DOI: 10.1111/aogs.13480] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objective of this study was to estimate the prevalence of dysmenorrhea among adolescents and its effect on daily life. MATERIAL AND METHODS A web-based questionnaire with questions regarding menstrual symptoms was distributed to all girls born in 2000 and residing in Stockholm City (n = 3998). Questions regarding pain severity, other menstrual-related symptoms, medical treatment, healthcare visits, and social and academic absenteeism were included in the questionnaire. RESULTS A total of 1785 (45%) young women responded to the questionnaire. Of these, 1580 (89%, 95% CI 87-90) stated that they had dysmenorrhea. Severe dysmenorrhea, scores 8-10 on the numeric rating scale for pain, was reported by 574 of 1580 women (36%, 95% CI 34-39). Fatigue was reported by 1314 of 1580 women (83%, 95% CI 81-85), headache by 1296 (82%, 95% CI; 80-84), dyschezia by 578 (37%, 95% CI 34-39) and dysuria by 560 (35%, 95% CI 33-38). A suboptimal use of analgesics was reported. Hormonal therapy as pain treatment was used by 10% (157/1580, 95% CI 9-12). Healthcare facilities, including school nurses, had been visited by 525 of 1580 women (33%, 95% CI; 31-36). Doctors had been consulted by 7% (116/1580, 95% CI 6-9). Fifty-nine percent (930/1580, 95% CI 56-61) reported refraining from social activities due to dysmenorrhea. Absenteeism from school was reported to occur monthly by 228 of 1580 women (14%, 95% CI 13-16), and several times per year by 716 (45%, 95% CI 43-48). CONCLUSIONS Our findings demonstrate that menstrual pain is prevalent among teenagers in Stockholm. The results indicate that many women are disabled in their daily life and that only a small number of women seek medical attention, although possible selection bias might have affected the results. Information and education are needed to optimize the use of existing treatment options and more awareness is needed to reduce normalization of disabling dysmenorrhea.
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Affiliation(s)
- Lisa Söderman
- Division of Obstetrics and Gynecology, Department of Clinical Science and Education, Södersjukhuset University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Lena Marions
- Division of Obstetrics and Gynecology, Department of Clinical Science and Education, Södersjukhuset University Hospital, Karolinska Institutet, Stockholm, Sweden
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Podolskyi V, Gemzell-Danielsson K, Marions L. Contraceptive experience and perception, a survey among Ukrainian women. BMC Womens Health 2018; 18:159. [PMID: 30268130 PMCID: PMC6162952 DOI: 10.1186/s12905-018-0651-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 09/18/2018] [Indexed: 11/18/2022]
Abstract
Background Abortion rate in Ukraine is high and the use of effective contraceptive methods is low. Aiming to explore women’s knowledge and attitudes towards modern contraceptive methods, we performed a survey among women with a recent pregnancy. Methods A convenience sample of 500 women who had an abortion or a delivery (250 women post abortion and 250 women post partum) in Kiev, Ukraine was chosen to participate in the study. A self-administered questionnaire which included questions regarding demographics, plans for future pregnancy, and contraceptive usage, knowledge and the main barriers to contraceptive uptake was distributed. Results Most women in our study expressed a wish to postpone or refrain from future pregnancies after the current abortion or delivery. The experience of and the knowledge regarding long acting contraception (LARC) such as intrauterine contraception (IUC) and implants were however low. Barrier methods and oral contraceptives were the most commonly used methods while only a few women had used IUC. Conclusion Since most of the respondents did not want a pregnancy in the near future, the findings from this study thus indicate a low uptake for effective and acceptable contraceptive methods and especially LARC methods. Increasing the availability of LARC methods as well as adequate and updated information from providers are essential to reduce the rate of unplanned pregnancy and abortion among Ukrainian women.
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Affiliation(s)
- Volodymyr Podolskyi
- Institute of Pediatrics, Obstetrics and Gynecology of Ukraine, Kiev, Ukraine. .,Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Lena Marions
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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15
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Lundin C, Malmborg A, Slezak J, Danielsson KG, Bixo M, Bengtsdotter H, Marions L, Lindh I, Theodorsson E, Hammar M, Sundström-Poromaa I. Sexual function and combined oral contraceptives - a randomised, placebo-controlled trial. Endocr Connect 2018; 7:/journals/ec/aop/ec-18-0384.xml. [PMID: 30352399 PMCID: PMC6215801 DOI: 10.1530/ec-18-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The effect of combined oral contraceptives (COC) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an estradiol-containing COC influences sexual function. DESIGN Investigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomized to a combined oral contraceptive (1.5 mg estradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles. METHODS Sexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points. RESULTS Compared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: -2.0; interquartile range (IQR): -5.0-0.5 vs. placebo: -1.0; IQR: -3.0-2.0, p = 0.019), which remained following adjustment for change in self-rated depressive symptoms B = -0.80 ± 0.30, Wald = 7.08, p = 0.008. However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs. placebo 16 (17.8%), p = 0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments. CONCLUSIONS This study suggests that use of estradiol-based combined oral contraceptives is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.
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Affiliation(s)
- Cecilia Lundin
- Department of Women’s and Children’s HealthUppsala University, Uppsala, Sweden
| | - Agota Malmborg
- Obstetrics and GynaecologyDepartment of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Julia Slezak
- Clinical ChemistryDepartment of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women’s and Children’s HealthKarolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Bixo
- Department of Clinical ScienceObstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Hanna Bengtsdotter
- Department of Obstetrics and GynaecologyÖrebro University, Örebro, Sweden
| | - Lena Marions
- Department of Clinical Science and EducationKarolinska Institutet Södersjukhuset, Stockholm, Sweden
| | - Ingela Lindh
- Department of Obstetrics and GynaecologySahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elvar Theodorsson
- Clinical ChemistryDepartment of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Obstetrics and GynaecologyDepartment of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Bruno I, Marions L, Moehner S, Becker K, Faustmann T, Heinemann K. Baseline characteristics from >27,000 women with endometriosis enrolled in the VIPOS study. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Joneborg U, Folkvaljon Y, Papadogiannakis N, Lambe M, Marions L. Temporal trends in incidence and outcome of hydatidiform mole: a retrospective cohort study. Acta Oncol 2018; 57:1094-1099. [PMID: 29451409 DOI: 10.1080/0284186x.2018.1438653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reported incidence rates of hydatidiform mole (HM) show wide geographic and temporal variations, making reliable international comparisons difficult. The aim of the current study was to examine temporal trends in the incidence of HM and post-molar gestational trophoblastic neoplasia (GTN) in Stockholm County. MATERIAL AND METHODS Data of all women with a diagnosis of HM in Stockholm County 1991-2010 was collected. The incidence of HM was assessed both in relation to number of births and viable conceptions (births and pregnancy terminations). The risk of post-molar GTN was analysed for all HM, as well as for the subtypes complete (CHM) and partial hydatidiform mole (PHM). Temporal trends were analysed by stratifying the study period into five-year intervals. RESULTS The overall incidence rate of HM was 2.08/1000 deliveries and 1.48/1000 viable conceptions. A significant temporal increase in the incidence rate of HM, as well as in the total number and proportion of PHM, was seen. Among 956 women with HM, 77 (8%) progressed into post-molar GTN. There was evidence of a slight, but non-significant increase in the risk of malignancy in the two last five-year periods under study. CONCLUSIONS We found evidence of a significant temporal increase in the incidence rate of HM, which could not fully be explained by an increase in maternal age over time. Changes in diagnostic methods probably contributed to the increased incidence rate of PHM. The risk of post-molar GTN remained constant over time.
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Affiliation(s)
- Urika Joneborg
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital/Institutet, Stockholm, Sweden
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital/Institutet, Stockholm, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Division of Obstetrics and Gynaecology, Karolinska Institutet Södersjukhuset, Stockholm, Sweden
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18
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Marions L, Brodda-Jansen G. [Not Available]. Lakartidningen 2018; 115:E96A. [PMID: 29989655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Gunilla Brodda-Jansen
- Karolinska Institutet Department of Clinical Sciences Danderyd Hospital - Danderyd, Sweden Karolinska Institutet Department of Clinical Sciences Danderyd Hospital - Danderyd, Sweden
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19
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Asiki G, Newton R, Kibirige L, Kamali A, Marions L, Smedman L. Feasibility of using smartphones by village health workers for pregnancy registration and effectiveness of mobile phone text messages on reduction of homebirths in rural Uganda. PLoS One 2018; 13:e0198653. [PMID: 29949593 PMCID: PMC6021061 DOI: 10.1371/journal.pone.0198653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/12/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Homebirths are common in low and middle income countries and are associated with poor child survival. We assessed the feasibility of using smartphones by village health workers for pregnancy registration and the effectiveness of health text messages (SMS) sent to pregnant women through village health workers in reducing homebirths in rural Uganda. Methods A non-randomised intervention study was undertaken in 26 villages. In the intervention arm, village health workers registered pregnant women (n = 262) in 13 villages using a smartphone app (doForm) and paper forms and gestation age-timed SMS were sent through village health workers to the pregnant women. In 13 control villages, (n = 263) pregnant women were registered on paper forms only and no SMS was sent. The main outcome was place of birth measured through a self-report. Logistic regression with generalised estimating equations was used to explore the effect of the intervention. Results Comparing 795 corresponding data fields on phone and paper revealed that numeric variable fields were 86%-95% similar while text fields were 38%-48% similar. Of the 525 pregnant women followed, 83 (15.8%) delivered at home. In the adjusted analysis, the intervention was associated with lower odds of homebirths [AOR = 0.38, 95%CI (0.15–0.97)]. Muslim religion [AOR = 4.0, 95%CI (1.72–9.34)], primary or no maternal education [AOR = 2.51, 95%CI (1.00–6.35)] and health facility distance ≥ 2 km [AOR = 2.26, 95%CI (0.95–5.40)] were independently associated with homebirths. Conclusion Village health workers can register pregnant women at home using phones and relay gestation age specific SMS to them to effectively reduce homebirths.
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Affiliation(s)
- Gershim Asiki
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.,African Population and Health Research Center, Nairobi, Kenya
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.,Department of Health Sciences, University of York, York, United Kingdom
| | - Leonard Kibirige
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Anatoli Kamali
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Lars Smedman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Islam JY, Khatun F, Alam A, Sultana F, Bhuiyan A, Alam N, Reichenbach L, Marions L, Rahman M, Nahar Q. Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: a population based, cross-sectional study. BMC Womens Health 2018; 18:15. [PMID: 29325530 PMCID: PMC5765714 DOI: 10.1186/s12905-018-0510-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/03/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine. METHODS A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine. RESULTS The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35-44 years (aOR: 2.92 (1.34-6.33) and rural women aged 25-34 years (aOR: 2.90 (1.24-6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67-7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61-5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28-3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high. CONCLUSIONS Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on cervical cancer must include information on symptoms, risk factors, and preventive methods. Despite poor knowledge, the study population was willing to receive the HPV vaccine.
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Affiliation(s)
- Jessica Yasmine Islam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Anadil Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Farhana Sultana
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, VIC, 3010, Australia.,Registries and Research, Victorian Cytology Service Registries, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia
| | | | - Nazmul Alam
- University of Montreal Hospital Research Centre (CR-CHUM), Montreal, QC, Canada
| | | | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
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Bengtsdotter H, Lundin C, Gemzell Danielsson K, Bixo M, Baumgart J, Marions L, Brynhildsen J, Malmborg A, Lindh I, Sundström Poromaa I. Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use. EUR J CONTRACEP REPR 2018; 23:45-51. [DOI: 10.1080/13625187.2017.1422239] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hanna Bengtsdotter
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - Cecilia Lundin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Bixo
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Juliane Baumgart
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Agota Malmborg
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
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Saha R, Kuja-Halkola R, Tornvall P, Marions L. Reproductive and Lifestyle Factors Associated with Endometriosis in a Large Cross-Sectional Population Sample. J Womens Health (Larchmt) 2017; 26:152-158. [DOI: 10.1089/jwh.2016.5795] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Rama Saha
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet
| | - Lena Marions
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet
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Lundin C, Danielsson KG, Bixo M, Moby L, Bengtsdotter H, Jawad I, Marions L, Brynhildsen J, Malmborg A, Lindh I, Sundström Poromaa I. Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology 2017; 76:135-143. [PMID: 27923181 DOI: 10.1016/j.psyneuen.2016.11.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Ever since the introduction of combined oral contraception (COC), one of the major reasons for discontinuing the pill use has been mood-related side effects. Moreover, women who discontinue the pill turn to less effective methods whereby the probability of an unintended conception increases. Approximately 4-10% of COC users complain of depressed mood, irritability or increased anxiety, but drug-related causality has been difficult to prove. Given the lack of randomized controlled trials in this area, we aimed to prospectively estimate the severity of adverse mood in COC users that would be as representative of general users as possible. METHODS This investigator-initiated, multi-center, randomized, double-blinded, placebo-controlled study included 202 healthy women. Women were randomized to a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo for three treatment cycles. Main outcome measure was the Daily Record of Severity of Problems (DRSP), which was filled out daily during one baseline cycle and the final treatment cycle. RESULTS Results from 84 women in the COC group and 94 women in the placebo group were analysed. COC use was associated with small, but statistically significant, increases in mean anxiety (0.22; 95% CI: 0.07-0.37, p=0.003), irritability (0.23; 95% CI: 0.07-0.38, p=0.012), and mood swings scores (0.15; 95% CI: 0.00-0.31, p=0.047) during the intermenstrual phase, but a significant premenstrual improvement in depression (-0.33; 95% CI: -0.62 to -0.05, p=0.049). Secondary analyses showed that women with previous adverse hormonal contraceptive experience reported significantly greater mood worsening in the intermenstrual phase in comparison with healthy women, p<0.05. The proportion of women who reported a clinically relevant mood deterioration did not differ between those allocated to COC (24.1%) or placebo (17.0%), p=0.262. CONCLUSION COC use is associated with small but statistically significant mood side effects in the intermenstrual phase. These findings are driven by a subgroup of women who clearly suffer from COC-related side effects. However, positive mood effects are noted in the premenstrual phase and the proportion of women with clinically relevant mood worsening did not differ between treatment groups.
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Affiliation(s)
- Cecilia Lundin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Marie Bixo
- Department of Clinical Health, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Lena Moby
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Bengtsdotter
- Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Izabella Jawad
- Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Agota Malmborg
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
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Marions L. [Not Available]. Lakartidningen 2017; 114:EAW4. [PMID: 28117866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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25
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Marions L. [Not Available]. Lakartidningen 2016; 113:D76A. [PMID: 27727422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Veličko I, Ploner A, Sparén P, Marions L, Herrmann B, Kühlmann-Berenzon S. Sexual and testing behaviour associated with Chlamydia trachomatis infection: a cohort study in an STI clinic in Sweden. BMJ Open 2016; 6:e011312. [PMID: 27566631 PMCID: PMC5013445 DOI: 10.1136/bmjopen-2016-011312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Genital chlamydia infection (chlamydia) is the most commonly reported sexually transmitted infection (STI) in Sweden. To guide prevention needs, we aimed to investigate factors associated with chlamydia. METHODS A cohort of visitors aged 20-40 years at an urban STI clinic in Sweden was recruited. Behavioural data were collected using a self-administered questionnaire. Self-sampled specimens were tested for chlamydia by a DNA amplification assay. Statistically significant (p<0.05) and epidemiologically relevant covariates were entered in a multivariate Poisson model adjusted for potential confounders (age and gender). Backward stepwise elimination produced a final model. Multiple imputation was used to account for missing values. RESULTS Out of 2814 respondents, 1436 were men with a chlamydia positivity rate of 12.6% vs 8.9% in women. Lifetime testing for chlamydia and HIV was high (82% and 60%, respectively). Factors significantly associated with chlamydia were: 20-24 years old (adjusted risk ratio (ARR)=2.10, 95% CI 1.21 to 3.65); testing reason: contact with a chlamydia case (ARR=6.55, 95% CI 4.77 to 8.98) and having symptoms (ARR=2.19, 95% CI 1.48 to 3.24); 6-10 sexual partners (ARR=1.53, 95% CI 1.06 to 2.21); last sexual activity 'vaginal sex and oral sex and anal sex and petting' (ARR=1.84, 95% CI 1.09 to 3.10); alcohol use before sex (ARR=1.98, 95% CI 1.10 to 3.57); men with symptoms (ARR=2.09, 95% CI 1.38 to 3.18); tested for chlamydia (ARR=0.72, 95% CI 0.55 to 0.94). CONCLUSIONS Risk factors associated with chlamydia were consistent with previous reports in similar settings and suggest no major changes over time. Increased risk for chlamydia infection associated with high-risk behaviour (eg, alcohol use, increased number of sexual partners) supports the need for behavioural interventions in this population such as promotion of safer sex behaviour (condom use) and testing.
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Affiliation(s)
- Inga Veličko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Unit of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Section of Obstetrics and Gynaecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Björn Herrmann
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Vyth R, Leval A, Eriksson B, Ericson EL, Marions L, Hergens MP. Gonorrhoea Diagnostic and Treatment Uncertainties: Risk Factors for Culture Negative Confirmation after Positive Nucleic Acid Amplification Tests. PLoS One 2016; 11:e0155017. [PMID: 27152704 PMCID: PMC4859506 DOI: 10.1371/journal.pone.0155017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
Gonorrhoea incidence has increased substantially in Stockholm during the past years. These increases have coincided with changes in testing practice from solely culture-based to nucleic acid amplification tests (NAAT). Gonorrhoea NAAT is integrated with Chlamydia trachomatis testing and due to opportunistic screening for chlamydia, testing prevalence for gonorrhoea has increased substantially in the Stockholm population. The aim of this study was to examine epidemiological risk-factors for discordant case which are NAAT positive but culture negative. These discordant cases are especially problematic as they give rise to diagnostic and treatment uncertainties with risk for subsequent sequelae. All gonorrhoea cases from Stockholm county during 2011-2012 with at least one positive N. gonorrhoea NAAT test and follow-up cultures were included (N = 874). Data were analysed using multivariate and stratified logistic regression models. Results showed that women were 4-times more likely (OR 4.9; 95% CI 2.4-6.7) than men to have discordant cultures. Individuals tested for gonorrhoea without symptoms were 2.3 times more likely (95% CI 1.5-3.5) than those with symptoms to be discordant. NAAT method and having one week or more between NAAT and culture testing were also indicative of an increased likelihood for discordance. Using NAAT should be based on proper clinical or epidemiological indications and, when positive, followed-up with a culture-based test within one week if possible. Routine gonorrhoea testing is not recommended in low prevalence populations.
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Affiliation(s)
- Rebecka Vyth
- Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden
- * E-mail:
| | - Amy Leval
- Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden
- Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden
| | - Björn Eriksson
- Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden
- Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden
| | - Eva-Lena Ericson
- Division of Clinical Microbiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden
- Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden
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Marions L. [Not Available]. Lakartidningen 2016; 113:DWRL. [PMID: 26928688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Asiki G, Newton R, Marions L, Seeley J, Kamali A, Smedman L. The impact of maternal factors on mortality rates among children under the age of five years in a rural Ugandan population between 2002 and 2012. Acta Paediatr 2016; 105:191-9. [PMID: 26503711 DOI: 10.1111/apa.13252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/23/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
AIM Accurately estimating child mortality in rural communities in Africa with poor vital registration is a challenge. We aimed to estimate mortality rates and risk factors for children under five years old in rural Uganda. METHODS Age-specific mortality rates were estimated using the synthetic cohort life-table technique for 10 118 children under the age of five years, between 2002 and 2012. Calendar year-specific hazard rates were calculated using five-year moving averages, and risk factors were explored by Cox regression. RESULTS The mortality rate was 92 per 1000 newborn infants from birth to five years, based on a total of 256 deaths. It was 40 for boys and 23 for girls in the neonatal period and 68 for boys and 42 for girls up to the age of one year. A substantial decline in mortality from 2002 to 2012 was observed between the ages of 28 days and 11 months. Multivariate analysis demonstrated that mortality increased with decreasing child age, home delivery, human immuno-deficiency virus in the child, a birth interval of less than one year, having an unmarried mother and a maternal parity of more than four. CONCLUSION Under-five mortality rates in rural Uganda are driven by maternal factors.
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Affiliation(s)
- Gershim Asiki
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Medical Research Council/Uganda Virus Research Council; Uganda Research Unit on AIDS; Entebbe Uganda
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Council; Uganda Research Unit on AIDS; Entebbe Uganda
- Department of Health Sciences; University of York; York UK
| | - Lena Marions
- Department of Clinical Science and Education; Karolinska Institutet; Stockholm Sweden
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Council; Uganda Research Unit on AIDS; Entebbe Uganda
- London School of Hygiene and Tropical Medicine; London UK
| | - Anatoli Kamali
- Medical Research Council/Uganda Virus Research Council; Uganda Research Unit on AIDS; Entebbe Uganda
| | - Lars Smedman
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Asiki G, Baisley K, Newton R, Marions L, Seeley J, Kamali A, Smedman L. Adverse pregnancy outcomes in rural Uganda (1996-2013): trends and associated factors from serial cross sectional surveys. BMC Pregnancy Childbirth 2015; 15:279. [PMID: 26515763 PMCID: PMC4627380 DOI: 10.1186/s12884-015-0708-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022] Open
Abstract
Objective Community based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods. Methods Within a general population cohort, between 1996 and 2013, women aged 15–49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012–13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome. Results One third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity. Discussion Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates. Conclusion Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0708-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gershim Asiki
- Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden. .,Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.
| | - Kathy Baisley
- Technical Epidemiological Group, London School Hygiene and Tropical Medicine, London, UK
| | - Rob Newton
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.,Department of Health Sciences, University of York, York, UK
| | - Lena Marions
- Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.,London School Hygiene and Tropical Medicine, London, UK
| | - Anatoli Kamali
- Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda.,London School Hygiene and Tropical Medicine, London, UK
| | - Lars Smedman
- Department of women's and children's Health, Karolinska Institute, Stockholm, Sweden
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Marions L. [Not Available]. Lakartidningen 2015; 112:DRZZ. [PMID: 26661267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Grün N, Ährlund-Richter A, Franzén J, Mirzaie L, Marions L, Ramqvist T, Dalianis T. Follow-up on oral and cervical human papillomavirus prevalence 2013-2015 in youth at a youth clinic in Stockholm, Sweden. Infect Dis (Lond) 2015; 48:169-70. [PMID: 26536907 DOI: 10.3109/23744235.2015.1094573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nathalie Grün
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | | | - Joar Franzén
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Leila Mirzaie
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Lena Marions
- b From the Department of Clinical Science and Education , Södersjukhuset , Stockholm , Sweden
| | - Torbjörn Ramqvist
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
| | - Tina Dalianis
- a From the Department of Oncology-Pathology , Södersjukhuset , Stockholm , Sweden
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Asplin N, Wessel H, Marions L, Georgsson Öhman S. Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected. Sexual & Reproductive Healthcare 2015; 6:191-5. [DOI: 10.1016/j.srhc.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/19/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
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Marions L. [Not Available]. Lakartidningen 2015; 112:DHF7. [PMID: 25965654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Marions L, Johansson S. [Transparent teamwork necessary for safe obstetric care. Territorial thinking and low competence resulted in healthcare scandal in the UK]. Lakartidningen 2015; 112:DFHP. [PMID: 25849518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Buhling KJ, Hauck B, Dermout S, Ardaens K, Marions L. Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: results of a survey of European/Canadian healthcare providers. Eur J Obstet Gynecol Reprod Biol 2014; 183:146-54. [DOI: 10.1016/j.ejogrb.2014.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/16/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
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Joneborg U, Eloranta S, Johansson AL, Marions L, Weibull CE, Lambe M. Hydatidiform mole and subsequent pregnancy outcome: a population-based cohort study. Am J Obstet Gynecol 2014; 211:681.e1-7. [PMID: 24949537 DOI: 10.1016/j.ajog.2014.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/10/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of the study was to investigate whether a history of hydatidiform mole (HM) is associated with an increased risk of adverse outcomes in subsequent pregnancies. STUDY DESIGN This was a nationwide cohort study with data from population-based registers. The study population consisted of all children registered in the Swedish Medical Birth Register 1973-2009 (n = 3,730,825). Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for adverse maternal and offspring pregnancy outcomes by maternal history of HM prior to the delivery, with children to women with no maternal history of HM as the reference. Risk estimates were adjusted for maternal age at delivery and maternal country of birth. RESULTS A history of HM was not associated with an increased risk of adverse maternal outcomes in subsequent pregnancies (n = 5186). Women exposed to a molar pregnancy prior to the index birth were at an almost 25% increased risk of preterm birth (OR, 1.23; 95% CI, 1.06-1.43), whereas women with at least 1 birth between the HM and the index birth were at an increased risk of a large-for-gestational-age birth and stillbirth (OR, 1.35; 95% CI, 1.10-1.67 and OR, 1.81; 95% CI, 1.11-2.96, respectively). The risk of repeat mole was 0.4%. CONCLUSION Women with a history of HM are at no increased risk of adverse maternal outcomes in subsequent pregnancies but have an increased risk of large-for-gestational-age birth, stillbirth, and preterm birth. However, in absolute terms, the risk of subsequent adverse offspring outcomes is very low.
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Grün N, Ährlund-Richter A, Franzén J, Mirzaie L, Marions L, Ramqvist T, Dalianis T. Oral human papillomavirus (HPV) prevalence in youth and cervical HPV prevalence in women attending a youth clinic in Sweden, a follow up-study 2013-2014 after gradual introduction of public HPV vaccination. Infect Dis (Lond) 2014; 47:57-61. [PMID: 25378085 DOI: 10.3109/00365548.2014.964764] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During 2009-2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15-23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007-2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009-2011 (p < 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine.
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Affiliation(s)
- Nathalie Grün
- From the Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
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Kopp Kallner H, Gomperts R, Salomonsson E, Johansson M, Marions L, Gemzell-Danielsson K. The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by doctors or by nurse-midwives: a randomised controlled equivalence trial. BJOG 2014; 122:510-7. [DOI: 10.1111/1471-0528.12982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H Kopp Kallner
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Department of Obstetrics and Gynaecology; Department of Clinical Sciences at Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - R Gomperts
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Women on Waves; Amsterdam the Netherlands
| | - E Salomonsson
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - M Johansson
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - L Marions
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - K Gemzell-Danielsson
- Division of Obstetrics and Gynaecology; Department of Women's and Children's Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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Joneborg U, Marions L. Current clinical features of complete and partial hydatidiform mole in Sweden. J Reprod Med 2014; 59:51-55. [PMID: 24597287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe the current clinical presentation of complete (CHM) and partial (PHM) hydatidiform mole in a Swedish setting. STUDY DESIGN A retrospective analysis of medical charts from 331 women with hydatidiform mole (HM) between 1991 and 2010 was performed. Demographics and clinical features were analyzed, and symptoms in women with CHM were compared to those from a historic group (1988 to 1993) from the New England Trophoblastic Disease Center. RESULTS In women with CHM, bleeding was more common than in women with PHM (57% vs. 41%, p < 0.001) but significantly less common as compared to the historic group (84%). Women with CHM and PHM were diagnosed before the onset of symptoms in 32% and 53%, respectively, compared to the previously reported 10% (p < 0.001). There was a significantly higher proportion of women 240 years of age with CHM than with PHM (23% vs. 7%). Ultrasound predicted the molar diagnosis in 73% of CHMs and 35% of PHMs (p < 0.001). CONCLUSION In our study a large proportion of molar pregnancies were asymptomatic at the time of diagnosis. This confirms earlier reports of the changing clinical presentation of HM and shows that this trend continues. Age, ultrasound findings and hCG levels can add valuable information.
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Affiliation(s)
- Ulrika Joneborg
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.
| | - Lena Marions
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
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Marions L. [Zero vision for abortions is not a goal. The goal is to avoid unwanted pregnancies]. Lakartidningen 2013; 110:1652. [PMID: 24199439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Asplin N, Wessel H, Marions L, Ohman SG. Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination. Sex Reprod Healthc 2013; 4:79-84. [PMID: 23663926 DOI: 10.1016/j.srhc.2013.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/10/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made. DESIGN Descriptive study. SETTING Four fetal care referral centres in Stockholm, Sweden. POPULATION Pregnant women with a detected fetal malformation. METHODS Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed. RESULTS Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p < or = 0.004) of previous abortions than those in the continuing group (23.2%). CONCLUSION The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.
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Affiliation(s)
- Nina Asplin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Björck E, Juth N, Marions L. [Integrated teaching of ethics of value in the medical education]. Lakartidningen 2012; 109:1167-1169. [PMID: 22834210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Erik Björck
- Karolinska universitetssjukhuset, Karolinska institutet
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Asplin N, Wessel H, Marions L, Georgsson Öhman S. Pregnant women’s experiences, needs, and preferences regarding information about malformations detected by ultrasound scan. Sexual & Reproductive Healthcare 2012; 3:73-8. [DOI: 10.1016/j.srhc.2011.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/15/2011] [Accepted: 12/06/2011] [Indexed: 11/27/2022]
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Marions L. [HIV testing should be offered generously. Important both for the individual and the society]. Lakartidningen 2012; 109:616. [PMID: 22624342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Joneborg U, Papadogiannakis N, Lindell G, Marions L. Choriocarcinoma following ovarian hydatidiform mole: a case report. J Reprod Med 2011; 56:511-514. [PMID: 22195336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ovarian ectopic pregnancies are uncommon, and a hydatidiform mole in this location is extremely rare but may later develop into a choriocarcinoma. CASE A 49-year-old woman with a history of an ectopic pregnancy, lost to follow-up in spite of rising human chorionic gonadotropin (hCG) levels, presented three years later at the emergency ward with hemoptysis, vaginal bleeding and elevated serum hCG. Pulmonary and vaginal metastasis was found, and the diagnosis of a choriocarcinoma was confirmed. She received chemotherapy during a 6-month period and recovered successfully. Seven years later she is free of disease. Reevaluation of the histological specimen from the previous ectopic pregnancy confirmed an ovarian hydatidiform mole and the later development of choriocarcinoma which probably originated from this mole. CONCLUSION The diagnosis of hydatidiform mole can be difficult, however, it may be crucial to the patient. Whenever a histopathologic examination of products of conception is performed, it is important that a hydatidiform mole can be ruled out, and that may require additional analysis such as immunohistochemistry and DNA ploidy. In cases in which a gestational trophoblastic disease is suspected, it is necessary to monitor serum hCG until values are negative.
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Affiliation(s)
- Ulrika Joneborg
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
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Phongsavan K, Phengsavanh A, Wahlström R, Marions L. Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos. Int J Gynaecol Obstet 2011; 114:268-72. [DOI: 10.1016/j.ijgo.2011.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/15/2011] [Accepted: 05/13/2011] [Indexed: 01/23/2023]
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Marions L, Lövkvist L, Taube A, Johansson M, Dalvik H, Øverlie I. Use of the levonorgestrel releasing-intrauterine system in nulliparous women – a non-interventional study in Sweden. EUR J CONTRACEP REPR 2011; 16:126-34. [DOI: 10.3109/13625187.2011.558222] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Cervical cancer is the second most common cancer of women in the world, and it becomes a major cause of cancer mortality in low-income countries. Currently, little is known regarding cervical cancer incidence in Laos, although it is anticipated to be high like in neighboring countries. To be able to develop a screening program in the country, it is essential to explore women's perception of the disease. The purpose of this study was therefore to describe knowledge, awareness, and attitudes regarding cervical cancer among rural women of Laos. METHODS In a descriptive cross-sectional study, women were interviewed using a structured questionnaire covering sociodemographic factors, knowledge of the disease and its risk factors, awareness, and attitudes toward cervical cancer and its prevention. RESULTS Eight hundred women were included in the study, and 58% claimed to know about cervical cancer. Approximately one third (38%) considered themselves to be at risk, but less than 5% had ever had a Papanicolau test. Sixty-two percent believed it was possible to prevent cervical cancer and that vaccination may be a suitable method, but only 14% know about risk factors. Another method for prevention was frequent vaginal douching, which was suggested by 70% of the women. Symptoms like bleeding and discharge were correctly identified as possible indicators of cervical cancer, but only 57 women (7%) knew that an early stage of the disease could be symptom-free. Lack of subjective symptoms was the main reason for women to refrain from gynecological examinations. CONCLUSIONS This study indicates that rural women in Laos have limited knowledge about cervical cancer and even less about screening and prevention. There is a need to educate the general community about the disease and its prevention.
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Ramqvist T, Du J, Lundén M, Ahrlund-Richter S, Ferreira J, Marions L, Sparén P, Andersson S, Dalianis T. Pre-vaccination prevalence of human papillomavirus types in the genital tract of 15-23-year-old women attending a youth health clinic in Stockholm, Sweden. ACTA ACUST UNITED AC 2010; 43:115-21. [PMID: 20964488 DOI: 10.3109/00365548.2010.526957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Knowledge of the prevalence of different human papillomavirus (HPV) types in young girls is important for the early detection of changes in HPV prevalence, e.g. due to HPV vaccines. The purpose of this study was to obtain information on the prevalence of 24 different genital HPV types in a group of sexually active young women (aged 15-23 y) attending a major youth healthcare centre in Stockholm, before the introduction of public HPV vaccination of young women in the autumn of 2010. A total of 615 women were analyzed for 24 different, mainly high-risk HPV (HR-HPV) types using multiplex polymerase chain reaction and Luminex technology. A high HPV prevalence in this cohort was demonstrated, particularly with regard to HPV16, but also to all included HR-HPV types. Of the 544 successfully analyzed samples from non-vaccinated individuals, 70% were positive for the HPV types assayed for, and 62% were positive for HR-HPV types. Over a third (34.7%) of the women were infected with HPV16, and a high frequency of infections with HR-HPV types 51 (10.7%), 18 (10.1%), 52 (9.9%) and 73 (9.4%) was also observed. At least 9 different non-vaccine HR-HPV types were present with a prevalence of >6% in this selected group of young women.
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Affiliation(s)
- Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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