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Dupuis M, Weir KR, Vidonscky Lüthold R, Panchaud A, Baggio S. Social determinants of antidepressant continuation during pregnancy in the USA: findings from the ABCD cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01470-0. [PMID: 38740587 DOI: 10.1007/s00737-024-01470-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Patients and healthcare professionals overestimate the risks of using antidepressants during pregnancy. According to current literature, approximately half of people stop taking an anti-depressant medication when they become pregnant. Discontinuing antidepressants during pregnancy increases risks of postnatal relapses. Factors like socioeconomic status, education, and planned pregnancies play a role in the decision to continue antidepressant medication, which can worsen disparities in maternal and child health. Our aim was to identify the sociodemographic factors associated with antidepressant continuation after awareness of pregnancy. METHODS We used representative data from the Adolescent Brain Cognitive Development (ABCD) study that captures maternal medication during pregnancy. We identified women who used antidepressants before awareness of their pregnancy. We calculated crude and adjusted associations between sociodemographic factors and continuation of antidepressant medication during pregnancy. Our model included age, education, ethnicity, first language, household income, living with a partner, having planned the pregnancy, pregnancy duration and smoking during pregnancy. RESULTS In total, 199 women continued antidepressants and 100 discontinued. The logistic regressions resulted in only one significant factor: first language. Native English speakers were more likely to continue medication than other mothers (adjusted OR = 14.94, 95% CI = [2.40; 291.45], p = .015). CONCLUSIONS Language differences were associated with continuation of antidepressants. Non-native English speakers were more likely to discontinue antidepressants, which may lead to health inequities. This finding should be taken into account to reinforce information about the limited risks of antidepressants among people with non-English speaking backgrounds in the USA.
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Affiliation(s)
- Marc Dupuis
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland.
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland.
| | - Kristie Rebecca Weir
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Renata Vidonscky Lüthold
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Manchana T. Long-term continuations rate of ring pessary use for symptomatic pelvic organ prolapse. Arch Gynecol Obstet 2024; 309:2203-2209. [PMID: 38189963 DOI: 10.1007/s00404-023-07299-9] [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: 10/04/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE To evaluate long-term continuation rates, adverse events of ring pessary use at a minimum of 5 years follow-up, and factors associated with discontinuation in symptomatic pelvic organ prolapse (POP). METHODS Women with symptomatic POP who were treated with vaginal ring pessary and had successful fittings were included. Adverse events and reasons for discontinuation of pessary use were recorded. Patients who were lost to follow-up were defined as discontinuation. RESULTS During 12 year-period, 239 of 329 POP patients (72.6%) had successful fittings with ring pessary. The mean age was 67.8 ± 8.9 years (range 27-86) and 70% of patients had advanced stage. The cumulative probability of continued ring pessary use was 84.1%, 64.4%, 49.3%, and 33.5%, at 1, 3, 5, and 10 years, respectively. Most common reason for discontinuation was frequent expulsion (21.6%), followed by vaginal erosion (16.5%), no prolapse improvement (12.4%), and inability or inconvenience to do self-care (9.3%). However, 9 patients (9.3%) had improvement of prolapse and were able to discontinue pessary insertion. Age above 70 years, wide introitus, and incapability of self-care are independent factors associated with long-term discontinuation. Adverse events occurred in 23.4% of patients, 18.8% of them had vaginal erosion, 11.7% vaginal discharge/infection, and 18.4% de novo SUI. However, no statistical significance existed between those who continued and discontinued pessary use due to these adverse events. CONCLUSION Ring pessary is an effective treatment in symptomatic POP, with acceptable long-term continuation rates and minor adverse events. Self-care of pessary is very important aiming to minimize adverse events. Advanced age, wide introitus and incapability of self-care were associated factors for long-term discontinuation.
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Affiliation(s)
- Tarinee Manchana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
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Yokoi K, Watanabe A, Yokota K, Kojima K, Tanaka T, Kojo K, Miura H, Yamanashi T, Sato T, Yamashita K, Kumamoto Y, Hiki N, Naitoh T. Low skeletal muscle radiodensity is a risk factor for adjuvant chemotherapy dis continuation in colorectal cancer. Int J Clin Oncol 2024; 29:276-285. [PMID: 38286874 DOI: 10.1007/s10147-023-02463-2] [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: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Previously, we reported SMR (skeletal muscle radiodensity) as a potential prognostic marker for colorectal cancer. However, there have been limited studies on the association between SMR and the continuation of adjuvant chemotherapy in colorectal cancer. METHODS In this retrospective study, 143 colorectal cancer patients underwent curative surgery and adjuvant chemotherapy using the CAPOX regimen. Patients' SMRs were measured from preoperative CT images and divided into low (bottom quarter) and high (top three quarters) SMR groups. We compared chemotherapy cycles, capecitabine and oxaliplatin doses, and adverse effects in each group. RESULTS The low SMR group had significantly fewer patients completing adjuvant chemotherapy compared to the high SMR group (44% vs. 68%, P < 0.01). Capecitabine and oxaliplatin doses were also lower in the low SMR group. Incidences of Grade 2 or Grade 3 adverse effects did not differ between groups, but treatment discontinuation due to adverse effects was significantly higher in the low SMR group. Logistic regression analysis revealed Stage III disease (odds ratio 18.09, 95% CI 1.41-231.55) and low SMR (odds ratio 3.26, 95% CI 1.11-9.56) as factors associated with unsuccessful treatment completion. Additionally, a higher proportion of low SMR patients received fewer than 2 cycles of chemotherapy (50% vs. 12%). CONCLUSION The low SMR group showed higher treatment incompletion rates and received lower drug doses during adjuvant chemotherapy. Low SMR independently contributed to treatment non-completion in colorectal cancer patients.
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Affiliation(s)
- Keigo Yokoi
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Akiko Watanabe
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Kazuko Yokota
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Keita Kojima
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Toshimichi Tanaka
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Ken Kojo
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Hirohisa Miura
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Takahiro Yamanashi
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Takeo Sato
- Department of Clinical Skills Education, Research and Development Center for Medical Education, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Yusuke Kumamoto
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 252-0374, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, Japan.
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Shim JY, Ryan ME, Milliren CE, Maslyanskaya S, Borzutzky C, Golub S, Pitts S, DiVasta AD. Continuation rates of hormonal intrauterine devices in adolescents and young adults when placed for contraceptive and non-contraceptive indications. Contraception 2024; 129:110304. [PMID: 37806471 DOI: 10.1016/j.contraception.2023.110304] [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: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. STUDY DESIGN We conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least 1-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded. RESULTS A total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p = 0.74). The mean age at insertion was 18.9 years (SD = 2.4 years), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those without follow-up, the overall continuation rates were 77% at 1 year, 66% at 2 years, and 54% at 3 years. While continuation rates did not differ by indication at 1 year, at 3 years, continuation was highest among those who sought the device for menstrual management only (contraception = 53%, menstrual = 57%, both = 53%, p < 0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication. CONCLUSION IUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. IMPLICATIONS Adolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at 1 year regardless of the indication for utilization.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Boston Children's Hospital, Boston, MA, USA.
| | - Morgan E Ryan
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sarah Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Grover S, Kathiravan S, Chakrabarti S. The clinical profile and outcome of patients receiving continuation electroconvulsive therapy (C-ECT): A retrospective study. Indian J Psychiatry 2023; 65:647-654. [PMID: 37485402 PMCID: PMC10358809 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_169_23] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background There is a lack of data on the use of continuation electroconvulsive therapy (C-ECT) from India. Objectives This study aimed to evaluate the clinical profile and outcome of patients receiving C-ECT. Materials and Methods The ECT register was used to identify patients receiving C-ECT (ECT after completion of an acute course, to maintain remission or prevent relapse) from 2011 to July 2022. Socio-demographic, clinical, and treatment outcome details were extracted from their treatment records. Results A total of 72 C-ECT courses were identified that were used in 60 patients. Out of all the patients receiving ECT, only 3.25% of patients receive C-ECT. The majority of the patients were male (60%). The mean age of the patients at the time of starting ECT was around 39 years. The most common diagnosis was schizophrenia (73.3%), followed by recurrent depressive disorder (21.6%). The most common indication was persistent psychotic symptoms poorly responding to multiple antipsychotic trials of 3.09 (SD: 1.39), including clozapine. These patients received a mean of 22.58 (SD: 8.05; range: 10 to 46) ECTs, with 10.0 (SD: 4.83) ECTs for the management of the acute phase of illness and 12.57 (SD: 6.20) ECTs as part of continuation treatment. The majority (61.1%) of the patients received four (once weekly) C-ECTs in the first month, followed by three more in the next month. However, 16 patients received weekly ECTs during the second month too, as symptoms worsened with the lowering of frequencies. Twelve patients received more than one C-ECT course. The majority of the patients maintained the improvement gained during the acute phase or showed further improvement with C-ECT along with ongoing pharmacotherapy as rated on appropriate scales. The Clinical Global Impressions-Severity (CGI-S) difference before and after C-ECTs was 2.94 (SD: 0.88). Conclusions C-ECT is considered in only in a small proportion of patients. However, when used, it is effective in maintaining the benefits gained during the acute course of ECT and preventing relapse.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mao Y, Hu H, Chen D, Fang Y, Liu J, Li M, Zhou W. Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study. Reprod Health 2023; 20:34. [PMID: 36803517 PMCID: PMC9942345 DOI: 10.1186/s12978-023-01564-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 01/05/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Maternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration. METHODS This study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples' characteristics were examined as setting the first subgroup as the base reference. RESULTS Three hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn't supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.47, 95% [Formula: see text]: 1.33-4.61) or antenatal care ([Formula: see text]= 4.05, 95% [Formula: see text]: 1.76-9.34), or who had a lower family socioeconomic status ([Formula: see text]= 4.36, 95% [Formula: see text]: 1.79-10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.94, 95% [Formula: see text]: 1.79-4.82), or to have no previous pregnancy complication ([Formula: see text]=1.80, 95% [Formula: see text]: 0.99-3.28). CONCLUSION Over two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.
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Affiliation(s)
- Yanyan Mao
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Hong Hu
- Community Health Service Center of Jing-An-Si, Jing-an District, Shanghai, 200040 China
| | - Dongyan Chen
- Community Health Service Center of Pengpu Estate, Jing-an District, Shanghai, 200435 China
| | - Yuhang Fang
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Jun Liu
- grid.488200.6NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020 China
| | - Min Li
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Weijin Zhou
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020, China.
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Mannocchi A, Giordano C, Topputo F. A Homotopic Direct Collocation Approach for Operational-Compliant Trajectory Design. J Astronaut Sci 2022; 69:1649-1665. [PMID: 36643333 PMCID: PMC9832099 DOI: 10.1007/s40295-022-00351-x] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
Stand-alone deep-space CubeSats are the future of the space sector. For limited budget reasons, these spacecraft need to follow operational-compliant (OC) trajectories: transfers with thrusting and coasting periods imposed at pre-defined time instants. Traditional trajectory optimisation algorithms exhibit convergence problems when handling discontinuous constraints. In this work, a homotopic direct collocation approach is presented. It employs a continuation algorithm that maps the classical bang-bang trajectory of a fuel-optimal low-thrust problem into an OC solution. M-ARGO CubeSat mission is considered as case study for validation, including a realistic thruster model with variable specific impulse and maximum thrust. The trajectories computed with the developed algorithm are compared with non-operational-compliant solutions. Our algorithm produces transfers similar to the optimal solutions with no operational constraint, both in terms of thrusting profile and propellant mass.
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Affiliation(s)
- Alessandra Mannocchi
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Carmine Giordano
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Francesco Topputo
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
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Zimmerman DR, Kaplan M, Shoob H, Freisthler M, Toledano M, Stein-Zamir C. Breastfeeding challenges and support in a high initiation population. Isr J Health Policy Res 2022; 11:31. [PMID: 36071536 PMCID: PMC9449948 DOI: 10.1186/s13584-022-00538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The breastfeeding initiation rate in Israel is approximately 90%, yet exclusive breastfeeding drops sharply in the early postnatal period. The study objective was to assess early postpartum professional breastfeeding support, its association with breastfeeding success and identification of risk factors for early breastfeeding discontinuation. METHODS As part of a post-discharge newborn follow-up study, a convenience sample of 868 mothers attending Maternal and Child Health Centers (MCHCs) up to three months post-partum were interviewed using a 26-item questionnaire. Breastfeeding-related questions covered demographic variables, pregnancy and birth details; breastfeeding duration, lactation support in hospital and post-discharge; and problems experienced. RESULTS Most mothers, 797 (91.8%), initiated breastfeeding in hospital. All women who initiated breastfeeding in the hospital reported exclusive breastfeeding; by two weeks postpartum, 70 women (13.2%) were supplementing with formula (partial breastfeeding). Kaplan-Meier Survival Analysis revealed an estimated mean duration of exclusive breastfeeding in the sample population of 66.8 ± 1.5 days. This duration was shorter for women with preterm births, low birthweight infants (LBW), cesarean births, and hospitalizations in neonatal intensive care units (NICU). A total of 472 (59.3%) breastfeeding mothers reported receiving in-hospital guidance. Of these, 290 (61.3%) were observed breastfeeding. Of all women who initiated breastfeeding, 280 (35.1%) attended MCHC follow-up within 72 h of hospital discharge. A higher proportion of women experiencing breastfeeding difficulties attended an MCHC within 72 h (131/297, 44.1%) compared to women not experiencing difficulties (148/499, 29.7%). The most frequently reported problems were mechanical (55.2%) or milk supply concerns (18.5%). First-time mothers were more likely to report problems, as were Jewish (vs Arab) mothers. CONCLUSIONS Even in a population with high initiation rates of breastfeeding, breastfeeding duration, both exclusive and partial, is less than recommended. As much of this drop-off occurs during maternity leave, it is likely related to breastfeeding challenges other than employment. Breastfeeding support needs of women are currently not adequately met; staffing and time for both in-hospital and community-based counseling needs to be funded as well as mandated. Counseling hours should be tailored to assure adequate coverage of high-risk groups such as women after cesarean delivery and newborns requiring intensive care.
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Affiliation(s)
- Deena R Zimmerman
- Department of Maternal and Child Health, Public Health Services, Ministry of Health, 39 Yirmyahu St, P.O.B. 1176, 9446724, Jerusalem, Israel.
| | - Michael Kaplan
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Marlaina Freisthler
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Monique Toledano
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University and Hadassah Braun School of Public and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Danna K, Jaworski G, Rahaivondrafahitra B, Rasoanirina F, Nwala A, Nqumayo M, Smith G, Moon P, Jackson A, Thurston S, Kalamar A. Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study. Reprod Health 2022; 19:4. [PMID: 34991651 PMCID: PMC8734281 DOI: 10.1186/s12978-021-01300-x] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. METHODS A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries-Madagascar, Nigeria, and Zambia-where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan-Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion. RESULTS Each country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67-100%) and high rates of continuation at the 12-month mark (82-90%). CONCLUSIONS Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.
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Affiliation(s)
- Kendal Danna
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA
| | - Grace Jaworski
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA
| | - Bakoly Rahaivondrafahitra
- PSI Madagascar: Immeuble Arboretum-ex Village Des Jeux de la Francophonie Ankorondrano, 101, Antananarivo, Madagascar
| | - Francia Rasoanirina
- PSI Madagascar: Immeuble Arboretum-ex Village Des Jeux de la Francophonie Ankorondrano, 101, Antananarivo, Madagascar
| | - Anthony Nwala
- Society for Family Health (SFH) Nigeria, Justice Ifeyinwa Nzeako House, #8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | | | - Gina Smith
- SFH Zambia, Plot No. 549 Ituna Rd, Ridgeway, Lusaka, Zambia
| | - Pierre Moon
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA
| | - Ashley Jackson
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA.,WCG Cares, 12400 High Bluff Drive, Suite 600, San Diego, CA, 92130, USA
| | - Sarah Thurston
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA
| | - Amanda Kalamar
- Population Services International (PSI), 1120 19th St NW #600, Washington, DC, 20036, USA.
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Wilson S, Croarkin PE, Aaronson ST, Carpenter LL, Cochran M, Stultz DJ, Kozel FA. Systematic review of preservation TMS that includes continuation, maintenance, relapse-prevention, and rescue TMS. J Affect Disord 2022; 296:79-88. [PMID: 34592659 DOI: 10.1016/j.jad.2021.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/06/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND A dearth of evidence-based information exists to guide the delivery of transcranial magnetic stimulation (TMS) after a successful acute course of treatment for Major Depressive Disorder. METHODS To provide guidance for clinicians, existing literature focused on "preservation TMS" was systematically reviewed and synthesized. Preservation TMS was defined as TMS used to sustain a clinical response after a successful acute course of treatment and included reports using the terms maintenance, continuation, relapse prevention, or rescue TMS. The review protocol was registered on Open Science Framework and reported following PRISMA guidelines. Data were abstracted by two authors and discrepancies were resolved by a third author. Primary outcome measures focused on clinical efficacy. The evaluated studies were graded using the Levels of Evidence criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS The search included 536 abstracts and 16 additional papers, from which 63 full articles were screened. Data were abstracted from 30 qualifying sources (N=1,494) including 4 randomized controlled trials (one sham controlled), 14 open trials, and 12 case series. Overall, the quality of existing literature was low regarding efficacy but provided clear support for effectiveness and safety across a range of preservation TMS protocols based on mostly uncontrolled studies. CONCLUSIONS Existing literature suggests that preservation TMS protocols significantly vary and are mostly supported by open trials and case series. Due to a lack of effective alternatives, preservation TMS will likely be required for certain patients who respond to acute TMS therapy. More studies of preservation TMS are critically needed.
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Affiliation(s)
- Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Scott T Aaronson
- Sheppard Pratt Health System, Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Linda L Carpenter
- Brown University Department of Psychiatry and Human Behavior, Butler Hospital, Providence, RI, USA
| | - Michelle Cochran
- Department of Psychiatry, Neuroscience and TMS Treatment Centers, Vanderbilt University Medical Center, Brentwood, TN, USA
| | - Debra J Stultz
- Stultz Sleep and Behavioral Health, Barboursville, WV, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, 1115 W. Call Street, Tallahassee, FL 32306, USA.
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11
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Mangenah C, Nhamo D, Gudukeya S, Gwavava E, Gavi C, Chiwawa P, Chidawanyika S, Muleya P, Taruberekera N, Madidi N, Ncube G, Bara H, Napierala S, Dunbar M, Hoke T, Kripke K, Cowan FM, Torjesen K, Terris-Prestholt F. Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe. AIDS Behav 2022; 26:161-170. [PMID: 34453240 PMCID: PMC8786759 DOI: 10.1007/s10461-021-03367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
Although oral PrEP is highly effective at preventing HIV acquisition, optimizing continuation among beneficiaries is challenging in many settings. We estimated the costs of delivering oral PrEP to populations at risk of HIV in seven clinics in Zimbabwe. Full annual economic costs of oral PrEP initiations and continuation visits were estimated from the providers’ perspective for a six-clinic NGO network and one government SGBV clinic in Zimbabwe (January–December 2018). Disaggregating costs of full initiation and incremental follow-up visits enabled modeling of the impact of duration of continuation on the cost per person-year ($pPY) on PrEP. 4677 people initiated oral PrEP, averaging 2.7 follow-up visits per person. Average cost per person initiated was $238 ($183–$302 across the NGO clinics; $86 in the government facility). The full cost per initiation visit, including central and direct costs, was $178, and the incremental cost per follow-up visit, capturing only additional resources used directly in the follow up visits, was $22. The average duration of continuation was 3.0 months, generating an average $pPY of $943, ranging from $839 among adolescent girls and young women to $1219 in men. Oral PrEP delivery costs varied substantially by scale of initiations and by duration of continuation and type of clinic. Extending the average oral PrEP continuation from 2.7 to 5 visits (about 6 months) would greatly improve service efficiency, cutting the $pPY by more than half.
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12
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Lee S, Schwartz S. Adherence and persistence to long-acting injectable dopamine receptor blocking agent therapy in the United States: A systematic review and meta-analysis of cohort studies. Psychiatry Res 2021; 306:114277. [PMID: 34808495 DOI: 10.1016/j.psychres.2021.114277] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/25/2021] [Accepted: 11/06/2021] [Indexed: 01/24/2023]
Abstract
The purpose of this systematic review and meta-analysis was to assess adherence and persistence to long-acting injectable dopamine receptor blocking agents (LAI DRBAs) in published observational cohort studies conducted in the United States. Adherence rate (proportion of days covered ≥80%) and persistence rate (no gap in therapy ≥60 days) to LAI DRBAs were examined in 26 articles for qualitative review and 8 articles for quantitative review. There was significant variability in adherence and persistence rates to LAI DRBAs in the reported observational cohort studies. The mean adherence and persistence rates to LAI DRBAs in the included studies were 36% (8-66%) and 56% (32-80%), respectively. The use of LAI DRBAs showed cumulative benefit of achieving adherence 1.40 times higher compared to oral agents. The persistence rate was measured by number of patients having no more than 60 days gap in therapy at follow-up, and the cumulative benefit of being persistently on the therapy was 1.65 times higher among the LAI agents-exposed group compared to the oral agents-exposed group. The use of LAI DRBAs confers benefit in adherence and persistence compared to oral DRBA formulations.
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Affiliation(s)
- Sun Lee
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, NC, USA
| | - Shaina Schwartz
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, NC, USA.
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Shitie A, Azene ZN. Factors affecting the initiation and continuation of maternal health service utilization among women who delivered in the past one year in Enemay district, East Gojjam, Ethiopia. Arch Public Health 2021; 79:171. [PMID: 34583748 PMCID: PMC8477485 DOI: 10.1186/s13690-021-00689-y] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skilled birth attendant (SBA), and postnatal care (PNC) within 48 h of delivery. It is one of the essential strategies for reducing maternal and newborn morbidity and mortality. Therefore, this study aimed to assess the prevalence and factors affecting the initiation and continuation of maternal health service utilization among women who delivered in the past one year in Enemay district, East Gojjam zone, Ethiopia. Methods A community-based cross-sectional study was conducted among six hundred twenty-one (621) women who gave birth in the last one year in Enemay district from February 25 to March 10, 2019. A simple random sampling technique was used to select the study participants. Data were collected by face-to-face interviewer-administered, pretested, and semi-structured questionnaire. Binary logistic regressions (bi-variable and multivariable) were fitted to identify statistically significant variables. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare statistically significant variables on the basis of p-value < 0.05 in the multivariable binary logistic regression. Results In this study, around 61% of women had antenatal care follow-up. Out of those women having ante natal care follow-up, about 77.5% (95% CI 73, 81.7%) had continued to receiving skilled birth delivery service. Age (AOR = 1.7 95% CI: (1.0, 2.88)), marital status (AOR = 1.6, 95% CI: (1.01, 2.76)), women’s educational status (AOR = 2.9, 95% CI: (1.30, 6.72)), autonomy for health care decision-making (AOR = 3.71, 95%CI: (2.36, 6.02)), exposure to media (AOR = 2.8, 95% CI: (1.78, 4.6)), wanted pregnancy (AOR = 3.6 95% CI: (2.2, 5.95)), and parity (AOR = 0.34, 95%CI: (0.16, 0.71)) were statistically significant variables associated with initiation of antenatal care, whereas educational status of women (AOR = 4.65, 95% CI: (1.37, 15.7)), autonomy for health care decision making (AOR = 2.62, 95% CI:(1.0, 6.82)), and had counseled during antenatal care (AOR = 2.88 95% CI: (1.21, 6.83)) were statistically significant variables associated with the continuation of maternal health care services. Conclusions This study demonstrated that the initiation and continuity of maternal health care services are low in the study area. Age, marital status, residence, women’s educational status, health care decision-making autonomy, exposure to media, wanted pregnancy, and parity were factors significantly affecting the initiation of antenatal care. Whereas, women’s educational status, health care decision-making autonomy, and counseling during antenatal care were predictors influencing the continuation of maternal health care services (antenatal care to skilled birth delivery).
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Affiliation(s)
- Anguach Shitie
- Department of Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women's and family health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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14
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Burke HM, Chen M, Packer C, Fuchs R, Ngwira B. Young Women's Experiences With Subcutaneous Depot Medroxyprogesterone Acetate: A Secondary Analysis of a One-Year Randomized Trial in Malawi. J Adolesc Health 2020; 67:700-707. [PMID: 32389457 DOI: 10.1016/j.jadohealth.2020.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/28/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness, safety, and experiences with side effects of self-injected and provider-administered injectable contraception between young (18-24 years) versus older (≥25 years) women. METHODS We conducted secondary analysis of data from a 12-month randomized controlled trial in Malawi, where a total of 731 women were randomized to receive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) administered by a provider or be trained to self-inject subcutaneous depot medroxyprogesterone acetate. Data collectors contacted women after the reinjection window at 3, 6, and 9 months to collect data on discontinuation and women's experiences, including adverse events. Twelve months after enrollment or at early discontinuation, women had their final interview, including pregnancy testing. We compared continuation, pregnancy, safety, and side effects among young women versus older women. RESULTS Among self-injectors, there were no significant differences found in continuation by age (p = .345) with continuation rates at 12 months of 79% for young women and 69% for older women. Continuation rates were lower for both age groups with provider-administered injections. In the provider-administered group, continuation rates among young women (39%) were lower than among older women (49%) (p = .047). The distribution of reasons for discontinuation did not differ significantly by age for those receiving provider injections (p = .698). However, younger self-injectors were less likely to miss the reinjection window than older self-injectors (p = .011). Age did not significantly influence pregnancy or safety. CONCLUSIONS With evidence of potential higher impact on continuation and no safety concerns, we recommend self-injection be added to the contraception options available to young women in low-resource settings.
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Affiliation(s)
- Holly M Burke
- FHI 360, Reproductive, Maternal, Newborn, and Child Health, Durham, North Carolina.
| | - Mario Chen
- FHI 360, Biostatistics, Durham, North Carolina
| | - Catherine Packer
- FHI 360, Reproductive, Maternal, Newborn, and Child Health, Durham, North Carolina
| | | | - Bagrey Ngwira
- College of Medicine, University of Malawi, Blantyre, Malawi
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15
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McAnulla SJ, Ball SE, Knapp KM. Understanding student radiographer attrition: Risk factors and strategies. Radiography (Lond) 2020; 26:198-204. [PMID: 32052762 DOI: 10.1016/j.radi.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/20/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Diagnostic student radiographer attrition is reported at 14%, 6% higher than the average for higher education, however, little research has been undertaken on this subject. This study explored risk factors for attrition and strategies that enabled these to be overcome. METHODS A two-phase study was undertaken. Phase one: data for 579 former student diagnostic radiographers (468 completers and 111 non-completers) from 3 English universities were analysed. Logistic regression was used to estimate odds ratios and 95% confidence intervals for completion based on individual characteristics. Phase two: content analysis of data from an online survey of 186 current UK student diagnostic radiographers exploring their experiences was undertaken. RESULTS Phase one: Attrition was 19%. Increased age, non A-level entry qualifications and poor academic performance were predictors of attrition (p < 0.005). Phase two: Challenges reported by groups identified as 'at risk' showed that for mature students and those with non-traditional entry qualifications, external responsibilities/pressures and financial pressures were likely to be the greatest cause of attrition and for younger students with traditional qualifications, academic difficulty and excessive workload were most significant. Scientific learning and academic writing were identified as the most common academic difficulties by all groups. Poor mental health may also be a risk factor. CONCLUSION Although characteristics were identified that increased the chance of attrition, the study concluded that attrition is most likely to be multi-factorial. Academic and personal support were identified as key in students continuing their studies when they considered leaving. Clinical placement experience is likely to influence continuation decisions. IMPLICATIONS FOR PRACTICE Transparency around course expectations and academic requirements together with ensuring high quality clinical placements may assist in reducing attrition.
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Affiliation(s)
- S J McAnulla
- Medical Imaging, College of Medicine and Health, University of Exeter, Exeter, UK.
| | - S E Ball
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC), South West Peninsula, UK
| | - K M Knapp
- Medical Imaging, College of Medicine and Health, University of Exeter, Exeter, UK
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Blakeley C, Smith DM, Johnstone ED, Wittkowski A. Parental decision-making following a prenatal diagnosis that is lethal, life-limiting, or has long term implications for the future child and family: a meta-synthesis of qualitative literature. BMC Med Ethics 2019; 20:56. [PMID: 31395047 PMCID: PMC6688313 DOI: 10.1186/s12910-019-0393-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Information on the factors influencing parents' decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. METHODS Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden's (2008) thematic synthesis method was used to synthesise data from identified studies. RESULTS Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled 'all life is precious', described parents' perception of the importance of the fetus' life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 ('hope for a positive outcome') contained two sub-themes which considered the parent's own imagined future and the influence of other people's experiences. Finally, Theme 3 ('a life worth living') presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. CONCLUSION The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents' decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other's quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices.
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Affiliation(s)
- Claire Blakeley
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK
| | - Debbie M Smith
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Leeds Trinity University, Brownberrie Lane, Horsforth, LS18 5HD, Leeds, UK
| | - Edward D Johnstone
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Central Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Anja Wittkowski
- The University of Manchester, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK.
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Lazenby G, Francis E, Brzozowski N, Rucker L, Dempsey A. Postpartum LARC dis continuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina. Contraception 2019; 100:279-282. [PMID: 31226321 DOI: 10.1016/j.contraception.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/14/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate rates of discontinuation and short interval pregnancy among women with HIV who received a postpartum IUD or implant. METHODS We conducted a retrospective cohort study of women who had an IUD or implant placed within 3 months postpartum during a 9-year period (1/1/09 to 2/14/18). We assessed the prevalence of discontinuation within 12 months and rates of subsequent delivery within 18 months. We examined differences in these outcomes between women with and without HIV. RESULTS Of the 794 women who received a long-acting reversible contraception (LARC) within 3 months postpartum, most chose an IUD (85%). Twenty-one percent (165) elected for immediate postpartum placement: 119 IUDs and 46 implants. Women with HIV were more likely to receive an implant (48% vs 13%, p<.0001) and were more likely to have immediate postpartum placement (76% vs 17%, p<.0001). Women with HIV (n=50) were not more likely to remove LARC devices within 12 months of placement (38% vs 36%, p=.9), and they did not experience any short interval pregnancies. CONCLUSIONS Women with HIV in South Carolina were more likely than HIV-negative women to receive immediate postpartum LARC and to receive an implant. They were not more likely to discontinue LARC within 12 months nor experience short interval pregnancies. IMPLICATIONS Further study is needed to evaluate preferences for implants and immediate postpartum insertion among women with HIV.
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Affiliation(s)
- Gweneth Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425.
| | - Elizabeth Francis
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Nicole Brzozowski
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Lindsay Rucker
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Angela Dempsey
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
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Mansour D, Fraser IS, Edelman A, Vieira CS, Kaunitz AM, Korver T, Pong A, Lin J, Shah AK, Fox M, Rekers H, Creinin MD. Can initial vaginal bleeding patterns in etonogestrel implant users predict subsequent bleeding in the first 2 years of use? Contraception 2019; 100:264-268. [PMID: 31176688 DOI: 10.1016/j.contraception.2019.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/01/2019] [Revised: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate if a simple method for characterizing vaginal bleeding patterns in etonogestrel contraceptive implant users can predict subsequent patterns and bleeding-related discontinuation over the first 2 years of use. STUDY DESIGN We reanalyzed phase 3 study bleeding data for non-breastfeeding participants from the United States, Europe, Russia and Chile during the first 2 years of implant use to characterize and correlate bleeding patterns. We used 90-day reference periods with period 1.1 starting at Day 29 and ending at Day 118. We dichotomized bleeding patterns as "favorable" (amenorrhea, infrequent bleeding and normal frequency bleeding without prolonged bleeding) or "unfavorable' (prolonged and/or frequent bleeding) and tracked user groups based on these bleeding patterns in reference period 1.1 through Year 1 and from Year 1 through Year 2, respectively. RESULTS We evaluated data from 537 and 428 women with up to 1 and 2 years use, respectively. Of the 325 (60.5%) women with favorable bleeding in reference period 1.1, 275 (84.6%) reported favorable bleeding also in reference period 2, 197 (60.6%) reported favorable bleeding throughout Year 1, and favorable bleeding in 75-85% of reference periods in Year 2. Among 212 (39.5%) women with unfavorable bleeding in reference period 1.1, 118 (55.7%) continued with unfavorable bleeding in reference period 2, while about 40%-50% reported favorable patterns in RP 2, 3 and/or 4. Initial favorable bleeding resulted in lower discontinuation rates than initial unfavorable bleeding in years 1 (3.7% vs 12.7%, p≪.0001) and 2 (2.5% vs 16.5%, p≪.0001). CONCLUSION Implant users with favorable bleeding in the first reference period are likely to continue with favorable bleeding over the next 2 years. Initial bleeding patterns predict overall continuation rates in years 1 and 2. Implications Statement When evaluating vaginal bleeding in any 90-day reference period over 2 years of etonogestrel implant use, approximately 80% of women with favorable and 40% with unfavorable bleeding patterns will have favorable bleeding in the next reference periods. These findings can facilitate counseling regarding bleeding for women using the etonogestrel implant.
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Affiliation(s)
- Diana Mansour
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Ian S Fraser
- School of Women's and Children's Health, University of New South Wales and the Royal Hospital for Women, Sydney, Australia
| | | | - Carolina S Vieira
- Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Andrew M Kaunitz
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Tjeerd Korver
- Reprovision Clinical Consultancy, Oss, The Netherlands
| | - Annpey Pong
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Jianxin Lin
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Arvind K Shah
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Michelle Fox
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Hans Rekers
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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Blakeley C, Smith DM, Johnstone ED, Wittkowski A. Women's lived experiences of a prenatal diagnosis of fetal growth restriction at the limits of viability: An interpretative phenomenological study. Midwifery 2019; 76:110-117. [PMID: 31195219 DOI: 10.1016/j.midw.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). METHODS Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FINDINGS Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.
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Affiliation(s)
- Claire Blakeley
- University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, United Kingdom
| | - Debbie M Smith
- University of Manchester, Manchester, United Kingdom; Leeds Trinity University, Leeds, United Kingdom
| | - Edward D Johnstone
- University of Manchester, Manchester, United Kingdom; Central Manchester NHS Foundation Trust, United Kingdom
| | - Anja Wittkowski
- University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
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20
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Vieira CS, de Nadai MN, de Melo Pereira do Carmo LS, Braga GC, Infante BF, Stifani BM, Ferriani RA, Quintana SM. Timing of postpartum etonogestrel-releasing implant insertion and bleeding patterns, weight change, 12-month continuation and satisfaction rates: a randomized controlled trial. Contraception 2019; 100:258-263. [PMID: 31145885 DOI: 10.1016/j.contraception.2019.05.007] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate whether timing of etonogestrel (ENG) implant insertion during the postpartum period affects maternal bleeding patterns, body mass index (BMI) and 12-month satisfaction and continuation rates. STUDY DESIGN This is a secondary analysis of an open, randomized, controlled trial. Postpartum women were block-randomized to early (up to 48 h postpartum) or delayed (6 weeks postpartum) insertion of an ENG implant. Bleeding patterns and BMI were evaluated every 90 days for 12 months. At 12 months, we measured implant continuation rates and used Likert and face scales to measure users' satisfaction. The level of significance was 0.4% (adjusted by Bonferroni test for multiplicity). RESULTS We enrolled 100 postpartum women; we randomized 50 to early and 50 to delayed postpartum ENG implant insertion. Bleeding patterns were similar between groups. Amenorrhea rates were high in both groups during the follow-up (52%-56% and 46%-62% in the early and delayed insertion group, respectively). Prolonged bleeding episodes were unusual in both groups during the follow-up (0-2%). Maternal BMI was similar between groups and decreased over time. Twelve-month continuation rates were similar between groups (early insertion: 98% vs. delayed insertion: 100%, p=.99). Most participants were either very satisfied or satisfied with the ENG implant in both groups (p=.9). CONCLUSION Women who underwent immediate postpartum insertion of the ENG implant have similar bleeding patterns, BMI changes, and 12-month satisfaction and continuation rates compared to those who underwent delayed insertion. IMPLICATIONS Our results from a secondary analysis of a clinical trial support that satisfaction, continuation and bleeding patterns do not differ when women received contraceptive implants immediately postpartum or at 6 weeks. However, the emphasis on infant growth in the trial and easy access to delayed placement may have influenced results.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
| | - Mariane Nunes de Nadai
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Lilian Sheila de Melo Pereira do Carmo
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Bruna Fregonesi Infante
- Women' s Health Reference Center of Ribeirão Preto. Avenida Wanderley Taffo, 330 Quintino Facci II, CEP: 14070-000, Ribeirão Preto, SP, Brazil
| | - Bianca M Stifani
- Department of Obstetrics, Gynecology and Women's Health of Albert Einstein College of Medicine / Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; Women' s Health Reference Center of Ribeirão Preto. Avenida Wanderley Taffo, 330 Quintino Facci II, CEP: 14070-000, Ribeirão Preto, SP, Brazil
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21
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Thapa K, Dhital R, Rajbhandari S, Acharya S, Mishra S, Pokhrel SM, Pande S, Tunnacliffe EA, Makins A. Factors affecting the behavior outcomes on post-partum intrauterine contraceptive device uptake and continuation in Nepal: a qualitative study. BMC Pregnancy Childbirth 2019; 19:148. [PMID: 31046715 PMCID: PMC6498647 DOI: 10.1186/s12884-019-2310-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background The use of post-partum family planning (PPFP) methods such as post-partum intrauterine device (PPIUD) in general remains low despite its benefits for the women. The reasons or factors affecting the uptake and continuation of such PPFP methods in developing countries such as Nepal remains unclear. This qualitative research aims to explore the factors affecting PPIUD uptake and continuation related behaviors among post-partum mothers within 6 weeks of childbirth in Nepal. Methods This qualitative study was conducted through 43 in-depth interviews among post-partum mothers who delivered in 3 selected hospitals in Nepal. Data were analyzed through content analysis using the theory of planned behavior (TPB) as the theoretical framework. Results The themes and categories were structured around the three major components of the TPB on attitude, subjective norms, and behavioral control. Majority of the women in this study, irrespective of their behavioral outcome expressed a positive attitude towards PPIUD use. However, the women who expressed an unfavorable attitude towards PPIUD influenced their behavior to not choose or discontinue PPIUD. Subjective norms such as the family, peer, and societal influences against PPIUD negatively affected the women’s intention and behavior related to PPIUD. Whereas, the positive influence of the health providers positively affected their behavior. Regarding the behavior control, women who had their own control over decisions tended to use PPIUD. However, external factors such as their husband’s preference or medical conditions also played a prominent role in preventing many to use PPIUD despite their positive intentions. Conclusion As suggested in TPB, this study shows that multiple factors that are interlinked affected the behaviors related to uptake and continuation of PPIUD. The attitude helped in s`haping intention but did not always lead to the behavioral outcome of PPIUD uptake and continuation. Subjective norms had a strong influence on both intention and behavior. Behavior control belief also had an important role in the outcome with respect to PPIUD uptake and continuation. Thus, a more layered, multidimensional and interlinked intervention is necessary to bring positive behavior changes related to PPIUD. Electronic supplementary material The online version of this article (10.1186/s12884-019-2310-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kusum Thapa
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.
| | - Rolina Dhital
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal
| | - Sameena Rajbhandari
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal
| | - Shreedhar Acharya
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.,Department of Obstetrics and Gynecology, Lumbini Zonal Hospital, Butwal, Nepal
| | - Sangeeta Mishra
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.,Department of Obstetrics and Gynecology, Koshi Zonal Hospital, Biratnagar, Nepal
| | - Sunil Mani Pokhrel
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.,Department of Obstetrics and Gynecology, Bharatpur Hospital, Bharatpur, Nepal
| | - Saroja Pande
- Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal
| | | | - Anita Makins
- International Federation of Obstetrics and Gynaecology, London, UK
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22
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McGovern AP, Dennis JM, Shields BM, Hattersley AT, Pearson ER, Jones AG. What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study. BMC Med 2019; 17:79. [PMID: 30979373 PMCID: PMC6460517 DOI: 10.1186/s12916-019-1307-8] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/13/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND It is unclear what to do when people with type 2 diabetes have had no or a limited glycemic response to a recently introduced medication. Intra-individual HbA1c variability can obscure true response. Some guidelines suggest stopping apparently ineffective therapy, but no studies have addressed this issue. METHODS In a retrospective cohort analysis using the UK Clinical Practice Research Datalink (CPRD), we assessed the outcome of 55,530 patients with type 2 diabetes starting their second or third non-insulin glucose-lowering medication, with a baseline HbA1c > 58 mmol/mol (7.5%). For those with no HbA1c improvement or a limited response at 6 months (HbA1c fall < 5.5 mmol/mol [0.5%]), we compared HbA1c 12 months later in those who continued their treatment unchanged, switched to new treatment, or added new treatment. RESULTS An increase or a limited reduction in HbA1c was common, occurring in 21.9% (12,168/55,230), who had a mean HbA1c increase of 2.5 mmol/mol (0.2%). After this limited response, continuing therapy was more frequent (n = 9308; 74%) than switching (n = 1177; 9%) or adding (n = 2163; 17%). Twelve months later, in those who switched medication, HbA1c fell (- 6.8 mmol/mol [- 0.6%], 95%CI - 7.7, - 6.0) only slightly more than those who continued unchanged (- 5.1 mmol/mol [- 0.5%], 95%CI - 5.5, - 4.8). Adding another new therapy was associated with a substantially better reduction (- 12.4 mmol/mol [- 1.1%], 95%CI - 13.1, - 11.7). Propensity score-matched subgroups demonstrated similar results. CONCLUSIONS Where glucose-lowering therapy does not appear effective on initial HbA1c testing, changing agents does not improve glycemic control. The initial agent should be continued with another therapy added.
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Affiliation(s)
- Andrew P McGovern
- University of Exeter Medical School, The Institute of Clinical and Biological Sciences, University of Exeter, Exeter, UK.
| | - John M Dennis
- Health Statistics Group, Institute of Health Research, University of Exeter, Exeter, UK
| | - Beverley M Shields
- University of Exeter Medical School, The Institute of Clinical and Biological Sciences, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- University of Exeter Medical School, The Institute of Clinical and Biological Sciences, University of Exeter, Exeter, UK
| | - Ewan R Pearson
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Angus G Jones
- University of Exeter Medical School, The Institute of Clinical and Biological Sciences, University of Exeter, Exeter, UK.
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Rodriguez MI, Darney BG, Edelman AB, Yee K, Anderson LB, McConnell KJ. Pharmacists expand access to reproductive heaLthcare: PEARL study protocol. BMC Health Serv Res 2019; 19:207. [PMID: 30935394 PMCID: PMC6444429 DOI: 10.1186/s12913-019-4038-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 02/19/2019] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2016, Oregon became the first of eight states to allow pharmacists to directly prescribe hormonal contraception (HC), including the pill, patch, or ring, without a clinic visit. In the two years following this policy change, the majority of ZIP codes across the state of Oregon had a pharmacist certified to prescribe HC. METHODS We will utilize complementary methodologies to evaluate the effect of this policy change on convenient access to contraception (cost, supply dispensed), safety, contraceptive continuation and unintended pregnancy rates. We will conduct a prospective clinical cohort study to directly measure the impact of provider type on contraceptive continuation and to understand who is accessing hormonal contraception directly from pharmacists. We will concurrently conduct a retrospective analysis using medical claims data to evaluate the state-level effect of the policy. We will examine contraceptive continuation rates, incident pregnancy, and safety measures. The combination of these methodologies allows us to examine key woman-level factors, such as pregnancy intention and usual place of care, while also estimating the impact of the pharmacist prescription policy at the state level. DISCUSSION Pharmacist prescription of HC is emerging nationally as a strategy to reduce unintended pregnancy. This study will provide data on the effect of this practice on convenient access to care, contraceptive safety and continuation rates.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA.
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA
| | - Alison B Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR, 97239, USA
| | - Kimberly Yee
- Center for Health Systems Effectiveness, Oregon Health &Science University, Portland, USA
| | | | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health &Science University, Portland, USA
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Adelman S, Free C, Smith C. Predictors of postabortion contraception use in Cambodia. Contraception 2018; 99:155-159. [PMID: 30471264 DOI: 10.1016/j.contraception.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/16/2018] [Revised: 10/17/2018] [Accepted: 11/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate which characteristics collected at the point of abortion are associated with contraceptive use over the extended postabortion period for women in Cambodia. METHODS The study includes a cohort of 500 women who attended a Marie Stopes International Cambodia clinic for an induced abortion. The primary outcomes are use of effective contraception ≥80% of the time over the 4- and 12-month period postabortion. We conducted a bivariate analysis to assess the association between each characteristic and the outcome, followed by multivariable modeling to identify the strongest predictors of the outcomes. RESULTS Nearly 44% of the women used contraception for more than 80% of the time during both follow-up periods. Several sociodemographic and reproductive factors were crudely associated with the outcomes. In the multivariable model, prior use of contraception, intention to use postabortion contraception, increased number of children and medical abortion were associated with increased contraceptive use over the year postabortion. Occupation was a predictor at 4 months only, and abortion method was a predictor at 12 months only. CONCLUSIONS The models were satisfactory in predicting the outcome of contraceptive continuation both at 4 and 12 months. The paper sets out a methodology for modeling these predictors that can help inform more client-centered counseling and services for women. IMPLICATIONS Factors known when attending a clinic for induced abortion can help inform more targeted and client-centered postabortion family planning counseling and services for women in Cambodia.
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Affiliation(s)
| | | | - Chris Smith
- London School of Hygiene and Tropical Medicine; School of Tropical Medicine and Global Health, Nagasaki University
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25
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Mair C, Rezgui D, Titurus B. Nonlinear stability analysis of whirl flutter in a rotor-nacelle system. Nonlinear Dyn 2018; 94:2013-2032. [PMID: 30956393 PMCID: PMC6413826 DOI: 10.1007/s11071-018-4472-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/09/2018] [Indexed: 06/09/2023]
Abstract
Whirl flutter is an aeroelastic instability that affects propellers/rotors and the surrounding airframe structure on which they are mounted. Whirl flutter analysis gets progressively more complicated with the addition of nonlinear effects. This paper investigates the impact of nonlinear pylon stiffness on the whirl flutter stability of a basic rotor-nacelle model, compared to a baseline linear stiffness version. The use of suitable nonlinear analysis techniques to address such a nonlinear model is also demonstrated. Three types of nonlinearity were investigated in this paper: cubic softening, cubic hardening and a combined cubic softening-quintic hardening case. The investigation was conducted through a combination of eigenvalue and bifurcation analyses, supplemented by time simulations, in order to fully capture the effects of nonlinear stiffness on the dynamic behaviour of the rotor-nacelle system. The results illustrate the coexistence of stable and unstable limit cycles and equilibria for a range of parameter values in the nonlinear cases, which are not found in the linear baseline model. These branches are connected by a number of different bifurcation types: fold, pitchfork, Hopf, homoclinic and heteroclinic. The results also demonstrate the importance of nonlinear whirl flutter models and analysis methods. Of particular interest are cases where the dynamics of the nacelle are unstable despite linear analysis predicting stable behaviour. A more complete stability envelope for the combined model was generated to take account of this phenomenon.
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Affiliation(s)
- Christopher Mair
- Department of Aerospace Engineering, University of Bristol, Queens Building, Bristol, UK
| | - Djamel Rezgui
- Department of Aerospace Engineering, University of Bristol, Queens Building, Bristol, UK
| | - Branislav Titurus
- Department of Aerospace Engineering, University of Bristol, Queens Building, Bristol, UK
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Sapkota S, Rajbhandary R, Lohani S. The Impact of Balanced Counseling on Contraceptive Method Choice and Determinants of Long Acting and Reversible Contraceptive Continuation in Nepal. Matern Child Health J 2018; 21:1713-1723. [PMID: 26955996 DOI: 10.1007/s10995-016-1920-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Long-acting reversible contraceptives (LARCs) reduce rates of unintended pregnancies and repeat abortion. Uptake and continuation rates of LARCs are very low in Nepal, despite free provision from most health facilities. We sought to establish the effectiveness of a new approach to LARC promotion in Nepal. Methods We examined change in contraceptive method mix in Nepal using service data resulting from introduction of a balanced counseling (BC) approach to family planning (FP). All staff located at nine randomly selected FP sites were trained and began applying BC in April and May 2014. Women who accepted LARCs from a participating facility were re-contacted at 1, 3, 6 and 12 months. We estimated the LARC continuation rate and assessed determinants of continuation using descriptive analysis, Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazard analysis. Results A total of 5744 women received BC between April and July 2014. 1580 women (27.5 %) took up LARCs, raising its contribution to contraceptive method mix at [organization] to 40 %, significantly higher than the 15 % recorded in 2013. 913 women were followed-up, and the LARC continuation rate at 12 months was 82 %. Women's reported satisfaction with LARC [AHR 0.23; 95 % CI 0.14-0.39, p = 0.000] was the single strongest determinant of LARC continuation after adjusting for all background characteristics. Discussion The findings suggest BC is an effective approach for increasing LARC uptake in Nepal. The rate of LARC continuation and its determinants are important inputs to strategies for improved delivery of FP services.
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Affiliation(s)
- Sabitri Sapkota
- Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP, UK.
| | | | - Shilpa Lohani
- Sunaulo Parivar Nepal, GPO Box 11254, Kathmandu, Nepal
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Tang JH, Lemani C, Nkambule J, Talama G, Banda C, Zgambo W, Chagomerana M. Two-year contraceptive continuation rates among immediate postpartum implant users at a district hospital in Malawi: a prospective cohort study. Contraception 2018; 98:220-2. [PMID: 29750925 DOI: 10.1016/j.contraception.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare 2-year continuation rates in Malawian women undergoing immediate postpartum insertion of the levonorgestrel implant or etonorgestrel implant. STUDY DESIGN We followed 159 women who underwent immediate postpartum levonorgestrel implant or etonorgestrel implant insertion at Kasungu District Hospital for up to 2 years. RESULTS We analyzed continuation data on 145 (92.4%) implant users. The 2-year continuation rates were 93.4 (95% CI 86.5-96.8) for levonorgestrel implant and 96.3 (95% CI: 76.5-99.5) for etonorgestrel implant (p=.268). CONCLUSIONS Immediate postpartum implant insertion of both the levonorgestrel and etonorgestrel implant had high continuation rates at 2 years in Malawian women. IMPLICATIONS Immediate postpartum implant insertion of both the levonorgestrel and etonorgestrel implant had continuation rates of over 90% at 2 years among our population of Malawian women. Both implants should be offered routinely to eligible and interested women prior to hospital discharge after delivery.
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Ali M, Azmat SK, Hamza HB. Assessment of modern contraceptives continuation, switching and discontinuation among clients in Pakistan: study protocol of 24-months post family planning voucher intervention follow up. BMC Health Serv Res 2018; 18:359. [PMID: 29751807 PMCID: PMC5948711 DOI: 10.1186/s12913-018-3156-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 05/15/2017] [Accepted: 04/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pakistan has the second highest fertility rate in South Asia and its increasing population growth presents a significant challenge for country's path to progress and development. Modern contraceptive methods only account for a slow-rising 26% of use in Pakistan which is further lowest in the underserved areas (< 20%), with a high unmet need for family planning (20%). The David and Lucile Packard Foundation USA and Pakistan funded two operational research projects from 2012 to 2015, that employed a Demand-side Financing (DSF) approach testing the effectiveness of single and multi-purpose voucher schemes in increasing access and uptake of FP services and products among the women of two-lowest income quintiles in the Punjab province of Pakistan. The present paper presents a study protocol which intends to assess the longer term impact of these two voucher intervention programs among married women of reproductive age (MWRA) who received contraceptive services through vouchers. METHODS This will be a mixed methods study using qualitative and quantitative approaches. A quantitative cross sectional survey will measure the contraceptive uptake among voucher users, included in the endline survey and to examine the attitudes and behaviour of women with respect to contraceptive continuation, switching and discontinuation 24 months post intervention in two districts of Chakwal and Faisalabad in Punjab province of Pakistan. Qualitative in-depth interviews will be conducted with FP service providers operating in intervention areas and with key policy makers in the public sector to examine and document the service provider perspective on sustainability on contraceptive practices and behaviour in the post project closure period within the intervention areas. DISCUSSION Globally, there is almost negligible direct evidence on the assessment of longer-term impact of a demand-side financing programs using free or subsidized vouchers for family planning services especially during post-intervention period or when donor money runs out. The findings of this study will help fill the knowledge gap in the context of sustainability issues post-intervention and will provide information to policy makers to develop and plan contraceptive services in the target area to sustain the positive behaviour change in the population.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Syed Khurram Azmat
- Department of Uro-Gynaecology, University of Ghent, 9000, Ghent, East Flanders, Belgium.,Department of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Liu J, Shen J, Diamond-Smith N. Predictors of DMPA-SC continuation among urban Nigerian women: the influence of counseling quality and side effects. Contraception 2018; 98:430-437. [PMID: 29733817 PMCID: PMC6197834 DOI: 10.1016/j.contraception.2018.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
Objectives In 2015, private healthcare providers in Nigeria introduced DMPA-SC (depot medroxyprogesterone acetate administered subcutaneously) into the method mix. We aimed to [1] examine the sociodemographic predictors of continued DMPA-SC use after 3 months, and [2] characterize the additional influences of contraceptive counseling quality and experiences of side effects on continuation. Study design From March to August, 2016, we conducted phone interviews with a convenience sample of women obtaining DMPA-SC from selected providers to survey them about their experience obtaining an initial dose of DMPA-SC. Study coordinators contacted women again about 3 months later after when they were due for reinjection. We used logistic regressions to examine the likelihood of having obtained a subsequent dose of DMPA-SC at follow-up as predicted by sociodemographic characteristics, a quality of counseling indicator based on responses to a 14-item scale, and reports of side effects experienced. Results Of the 541 DMPA-SC users who completed the first survey, 311 were reached again via phone after 3 months to conduct a second survey. Multivariate results for sociodemographic predictors of continued DMPA-SC use show that those with some college education or more (OR=2.79; 95% CI: 1.09–7.14), and those with four or more children (OR=2.89; 95% CI: 1.09 0 7.67) were more likely to obtain another dose. Our summary quality measure showed that women overall rated the quality of their initial counseling session high. Logistic regressions indicated that higher quality during the initial counseling session is related to the likelihood of getting another dose of DMPA-SC (OR=2.04; 95% CI: 1.12–3.47) whereas experiencing more bleeding reduced the likelihood of continuation after 3 months (OR=0.15; 95% CI: 0.07–0.34). Conclusions Among urban Nigerian women, both counseling quality and experiencing side effects were important factors in predicting continued use of DMPA-SC after 3 months. These findings are consistent with previous studies of DMPA and injectable contraception continuation. Implications New contraceptive methods that are designed for increased access and ease of use, combined with high quality provision, have potential to increase contraceptive use in settings with low levels of contraceptive prevalence. Higher quality counseling can help encourage women's continuation of a new injectable contraceptive method at 3 months.
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Affiliation(s)
- Jenny Liu
- Institute for Health and Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, USA.
| | - Jennifer Shen
- Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 3333 California Street, Suite 266D, San Francisco, CA 94101, USA.
| | - Nadia Diamond-Smith
- Global Health Sciences, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street Mission Hall, San Francisco, CA 94158, USA.
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Yun X, Hazenberg SJ, van Lier R. Temporal properties of amodal completion: Influences of knowledge. Vision Res 2018; 145:21-30. [PMID: 29621493 DOI: 10.1016/j.visres.2018.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/20/2017] [Revised: 02/16/2018] [Accepted: 02/18/2018] [Indexed: 10/17/2022]
Abstract
We studied the influence of knowledge in the interpretation of partly occluded objects. In the past decades, amodal completion has often been studied by using abstract, meaningless outlines of rather stylistic, geometric shapes. It has been recognized that smooth continuation of partly occluded contours behind an occluding surface is a strong completion tendency. In the current study we contrast this structurally driven completion tendency with knowledge driven tendencies. We used a set of partly occluded well-known objects for which structure-based completions and knowledge-based completions resulted in either the same or different interpretations. We adopted the behavioural primed matching paradigm to measure differential priming effects due to these completion tendencies. Our results implied differential temporal properties for structure-based and knowledge-based effects during perception of partly occluded objects. Interestingly, knowledge has an influence as early as 150 ms after the onset of the prime.
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Affiliation(s)
- Xuyan Yun
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, The Netherlands.
| | - Simon J Hazenberg
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | - Rob van Lier
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
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Gunsoy NB, Cockle SM, Yancey SW, Keene ON, Bradford ES, Albers FC, Pavord ID. Evaluation of Potential Continuation Rules for Mepolizumab Treatment of Severe Eosinophilic Asthma. J Allergy Clin Immunol Pract 2017; 6:874-882.e4. [PMID: 29258789 DOI: 10.1016/j.jaip.2017.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mepolizumab significantly reduces exacerbations in patients with severe eosinophilic asthma. The early identification of patients likely to receive long-term benefit from treatment could ensure effective resource allocation. OBJECTIVE To assess potential continuation rules for mepolizumab in addition to initiation criteria defined as 2 or more exacerbations in the previous year and blood eosinophil counts of 150 cells/μL or more at initiation or 300 cells/μL or more in the previous year. METHODS This post hoc analysis included data from 2 randomized, double-blind, placebo-controlled studies (NCT01000506 and NCT01691521) of mepolizumab in patients with severe eosinophilic asthma (N = 1,192). Rules based on blood eosinophils, physician-rated response to treatment, FEV1, Asthma Control Questionnaire (ACQ-5) score, and exacerbation reduction were assessed at week 16. To assess these rules, 2 key metrics accounting for the effects observed in the placebo arm were developed. RESULTS Patients not meeting continuation rules based on physician-rated response, FEV1, and the ACQ-5 score still derived long-term benefit from mepolizumab. Nearly all patients failing to reduce blood eosinophils had counts of 150 cells/μL or less at baseline. For exacerbations, assessment after 16 weeks was potentially premature for predicting future exacerbations. CONCLUSION There was no evidence of a reliable physician-rated response, ACQ-5 score, or lung function-based continuation rule. The added value of changes in blood eosinophils at week 16 over baseline was marginal. Initiation criteria for mepolizumab treatment provide the best method for assessing patient benefit from mepolizumab treatment, and treatment continuation should be reviewed on the basis of a predefined reduction in long-term exacerbation frequency and/or oral corticosteroid dose.
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Affiliation(s)
- Necdet B Gunsoy
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, United Kingdom.
| | - Sarah M Cockle
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC
| | - Oliver N Keene
- Clinical Statistics, GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, United Kingdom
| | - Eric S Bradford
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC
| | - Frank C Albers
- Respiratory Medical Franchise, GlaxoSmithKline, Research Triangle Park, NC
| | - Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Goes R, Muskens IS, Smith TR, Mekary RA, Broekman MLD, Moojen WA. Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis. Spine J 2017; 17:1939-1946. [PMID: 28823937 DOI: 10.1016/j.spinee.2017.08.238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/04/2017] [Revised: 07/25/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Aspirin is typically discontinued in spinal surgery because of increased risk of hemorrhagic complications. The risk of perioperative continuation of aspirin in neurosurgery needed to be evaluated. PURPOSE This study aimed to evaluate all available evidence about continuation of aspirin and to compare peri- and postoperative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin perioperatively in spinal surgery. STUDY SETTING Systematic review and meta-analysis were carried out. METHOD A meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or non-spinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection [SSI]), stroke, myocardial infarction within 30 days postoperatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I-squared [I2]) and effect modification (P-interaction) assessment. RESULTS Out of 1,339 studies, three case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean=201.8 minutes, 95% confidence interval [CI]=193.3; 210.3; I2=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95% CI=119.1; 237.6; I2=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean perioperative blood loss were seen between the aspirin-continuing group (mean=553.9 milliliters, 95% CI=468.0; 639.9; I2=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 milliliters, 95% CI=427.6; 649.8; I2=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the two groups were found for cardiac events, stroke, and surgical site infections. CONCLUSIONS This meta-analysis showed an absence of significant differences in perioperative complications between aspirin continuation and discontinuation. Because of the paucity of included studies, further well-designed prospective trials are imperative to demonstrate potential benefit and safety.
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Affiliation(s)
- Rik Goes
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands.
| | - Ivo S Muskens
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands; Cushing Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, 60 Fenwood Road, 1st Floor, Boston, MA, USA
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, 60 Fenwood Road, 1st Floor, Boston, MA, USA
| | - Rania A Mekary
- Cushing Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, 60 Fenwood Road, 1st Floor, Boston, MA, USA; Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, 179 Longwood Ave, Boston, MA, 02115, USA
| | - Marike L D Broekman
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands; Cushing Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, 60 Fenwood Road, 1st Floor, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, 15 Parkman Street 835, Boston, MA, 02114, USA
| | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands; Department of Neurosurgery, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545AA, The Hague, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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Sanders JN, Turok DK, Royer PA, Thompson IS, Gawron LM, Storck KE. One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception. Contraception 2017; 96:99-105. [PMID: 28596121 PMCID: PMC6040824 DOI: 10.1016/j.contraception.2017.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE(S) This study compares 1-year intrauterine device (IUD) continuation among women presenting for emergency contraception (EC) and initiating the copper (Cu T380A) IUD or the levonorgestrel (LNG) 52 mg IUD plus 1.5 mg oral LNG. STUDY DESIGN This cohort study enrolled 188 women who presented at a single family planning clinic in Utah between June 2013 and September 2014 and selected either the Cu T380A IUD or LNG 52 mg IUD plus oral LNG for EC. Trained personnel followed participants by phone, text or e-mail for 12 months or until discontinuation occurred. We assessed reasons for discontinuation and used Cox proportional hazard models, Kaplan-Meier estimates and log-rank tests to assess differences in continuation rates between IUDs. RESULTS One hundred seventy-six women received IUDs; 66 (37%) chose the Cu T380A IUD and 110 (63%) chose the LNG 52 mg IUD plus oral LNG. At 1 year, we accounted for 147 (84%) participants, 33 (22%) had requested removals, 13 (9%) had an expulsion and declined reinsertion, 3 (2%) had a pregnancy with their IUD in place and 98 (67%) were still using their device. Continuation rates did not differ by IUD type; 60% of Cu T380A IUD users and 70% of LNG 52 mg IUD plus oral LNG users were still using their device at 12 months (adjusted hazard ratio 0.72, 95% confidence interval 0.40-1.3). CONCLUSION(S) Two-thirds of women who chose IUD placement at the EC clinical encounter continued use at 1 year. Women initiating Cu T380A IUD and LNG 52 mg IUD had similar 1-year continuation rates. These findings support same-day insertion of IUDs for women who are seeking EC and would like to use a highly effective reversible method going forward. IMPLICATIONS Providing IUD options for EC users presents an opportunity to increase availability of highly effective contraception.
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Affiliation(s)
- J N Sanders
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA.
| | - D K Turok
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - P A Royer
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - I S Thompson
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - L M Gawron
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
| | - K E Storck
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209, USA
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Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29:659-667. [PMID: 27386754 DOI: 10.1016/j.jpag.2016.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 01/20/2016] [Revised: 04/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type. RESULTS Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474). CONCLUSION Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
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Affiliation(s)
- K M Usinger
- Columbia University School of Nursing, New York, New York
| | - S B Gola
- Columbia University School of Nursing, New York, New York
| | - M Weis
- Columbia University School of Nursing, New York, New York
| | - A Smaldone
- Columbia University School of Nursing, New York, New York.
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Vande Voort JL, Morgan RJ, Kung S, Rasmussen KG, Rico J, Palmer BA, Schak KM, Tye SJ, Ritter MJ, Frye MA, Bobo WV. Continuation phase intravenous ketamine in adults with treatment-resistant depression. J Affect Disord 2016; 206:300-304. [PMID: 27656788 DOI: 10.1016/j.jad.2016.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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] [Received: 08/05/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the antidepressive effects of repeated intravenous ketamine infusions beyond the acute phase of treatment in patients with refractory depression. METHODS Twelve subjects with treatment-resistant non-psychotic unipolar or bipolar major depression and suicidal ideation were given repeated (up to 6) thrice-weekly acute-phase intravenous infusions of ketamine (0.5mg/kg, administered over 100min). Those who remitted during acute-phase treatment received continuation-phase treatment that consisted of 4 weekly ketamine infusions, followed by 4 weeks of post-continuation phase follow-up (during which no further ketamine infusions were administered). Clinical measures were assessed at baseline, at 24h following each infusion, at the last acute-phase observation, and during continuation and post-continuation follow-up (acute phase remitters only). RESULTS Of the 12 enrollees, 5 (41.7%) remitted and 7 (58.3%) responded to ketamine treatment during the acute-phase. All five subjects who remitted during the acute-phase experienced further depressive symptom improvement during continuation-phase treatment. Four subjects lost remission status during the post-continuation phase, but all were still classified as positive treatment responders at the end of the post-continuation phase. Adverse effects were generally mild and transient during acute- and continuation-phase treatment; however, one subject developed behavioral outbursts and suicide threats during follow-up while hospitalized, and one subject died by suicide several weeks after the end of follow-up. LIMITATIONS This was an uncontrolled feasibility study with a small sample size. CONCLUSIONS The continuation-phase administration of ketamine at weekly intervals to patients with treatment-resistant depression who remitted during acute-phase ketamine treatment can extend the duration of depressive symptom remission. The antidepressive effect of ketamine persisted for several weeks after the end of continuation-phase treatment. Our results highlight the need for close monitoring of subjects who are at high baseline risk for suicide but do not respond clinically to ketamine. CLINICALTRIALS. GOV IDENTIFIER NCT02094898.
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Affiliation(s)
- Jennifer L Vande Voort
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Robert J Morgan
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Simon Kung
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Keith G Rasmussen
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Jose Rico
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Brian A Palmer
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M Schak
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Susannah J Tye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA.
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Jameson K, D'Oca K, Leigh P, Murray-Thomas T. Adherence to NICE guidance on glucagon-like peptide-1 receptor agonists among patients with type 2 diabetes mellitus: an evaluation using the Clinical Practice Research Datalink. Curr Med Res Opin 2016; 32:49-60. [PMID: 26428701 DOI: 10.1185/03007995.2015.1101372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 11/23/2022]
Abstract
AIMS To assess adherence to the UK's National Institute for Health and Care Excellence (NICE) guidelines for initiating and continuing glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS A retrospective cohort study of 7133 primary care patients ≥40 years with a first prescription for a GLP-1 receptor agonist following publication of NICE guideline/guidance. Patient characteristics and levels of clinical monitoring were assessed using descriptive analyses. MAIN OUTCOME MEASURES Main outcomes were the proportion of patients initiating GLP-1 receptor agonists as part of NICE-recommended dual- or triple-therapy regimens; the proportions meeting NICE triple therapy initiation criteria (glycosylated hemoglobin [HbA1c] ≥7.5% and body mass index [BMI] ≥35 kg/m(2)) and the proportions continuing GLP-1 receptor agonist at 6 months according to NICE recommendations. RESULTS Mean age at initiating GLP-1 receptor agonists was 58.2 years (SD 9.4), BMI 38.4 kg/m(2) (SD 6.8) and HbA1c 9.2% (SD 3.2%). Overall, only 25% of patients initiated GLP-1 receptor agonists as part of a NICE-recommended regimen. Of patients initiated on a recommended triple-therapy regimen, 50% (646/1284) fulfilled both NICE HbA1c and BMI initiation criteria. Approximately 18% (32/174) of patients continuing NICE-recommended dual therapy at 6 months achieved a 1% reduction in HbA1c and 6.4% (33/515) continuing with NICE-recommended triple therapy achieved NICE's target reductions for both HbA1c and body weight. About 8% of patients continuing exenatide as triple therapy (N = 243) achieved both targets. CONCLUSIONS Adherence to NICE guidance for initiating and continuing GLP-1 receptor agonists is low. However, lack of data on ethnicity (for assessing NICE's BMI criteria) and on contraindications and/or hypersensitivity to other diabetes medication in the treatment pathway have limited our ability to fully assess adherence to GLP-1 prescribing. Further research is warranted to better understand general practitioners' prescribing decisions given the cost of prescribing GLP-1 receptor agonists.
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Affiliation(s)
| | | | - Paul Leigh
- a a Merck Sharp & Dohme Ltd , Hertfordshire , UK
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Schmidt EO, James A, Curran KM, Peipert J, Madden T. Adolescent Experiences With Intrauterine Devices: A Qualitative Study. J Adolesc Health 2015; 57:381-6. [PMID: 26126950 PMCID: PMC4583802 DOI: 10.1016/j.jadohealth.2015.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 06/18/2014] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD). METHODS We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach. RESULTS Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening. CONCLUSIONS Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.
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Affiliation(s)
- Elizabeth O. Schmidt
- Department of Obstetrics and Gynecology, North Shore-LIJ Hofstra School of Medicine
| | - Aimee James
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine
| | - K. Michele Curran
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
| | - Jeffrey Peipert
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
| | - Tessa Madden
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
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Puri M, Henderson JT, Harper CC, Blum M, Joshi D, Rocca CH. Contraceptive dis continuation and pregnancy postabortion in Nepal: a longitudinal cohort study. Contraception 2014; 91:301-7. [PMID: 25553872 DOI: 10.1016/j.contraception.2014.12.011] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine postabortion contraceptive discontinuation and pregnancy in Nepal, where abortion was decriminalized in 2002. STUDY DESIGN We conducted an observational cohort study of 654 women obtaining abortions from four public and nongovernmental facilities in 2011. Patients completed questionnaires at their abortion visit and 6 and 12 months later. We used Cox proportional hazards models to assess contraceptive discontinuation and pregnancy by method initiated postabortion and other sociodemographic and reproductive factors. RESULTS Among the 78% (508/654) of women who initiated a modern contraceptive method within 3 months postabortion, the 1-year contraceptive discontinuation rate was 62 per 100 person-years. Discontinuation was far lower among the 5% of women using long-acting reversible methods (21/100 person-years) than among those using condoms (74/100 person-years), pills (61/100 person-years) and the injectable [64/100 person-years; adjusted hazard ratio (aHR)=0.32 (0.15-0.68)]. Unmarried women and those not living with their husband experienced higher contraceptive discontinuation [aHR=2.16 (1.47-3.17)]. The 1-year pregnancy rate for all women was 9/100 person-years. Pregnancy was highest among those who initiated no modern method postabortion (13/100 person-years) and condoms (12/100 person-years), and pregnancy was lowest among users of long-acting reversible methods (3/100 person-years). The poorest women were at increased pregnancy risk [aHR=2.31 (1.32-4.10)]. CONCLUSION Women using intrauterine devices and implants experienced greatly reduced contraceptive discontinuation and pregnancy within a year postabortion, although initiation of these long-acting methods was low. Increased availability of long-acting methods in Nepal and similar settings may help to prevent unwanted pregnancy and attendant maternal mortality and morbidities. IMPLICATIONS Initiation of modern contraception was high postabortion; however, 1-year discontinuation was high for the condom, pill and injectable, the methods most commonly used. Rates for intrauterine devices and implants were low. Results support efforts to facilitate patient knowledge and access to the full range of contraceptives, including long-acting reversible methods.
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Affiliation(s)
- Mahesh Puri
- Center for Research on Environment Health & Population Activities (CREHPA), Kusunti, Lalitpur, PO Box 9626, Kathmandu, Nepal
| | - Jillian T Henderson
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA; Kaiser Permanente Center for Health Research, Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA
| | - Maya Blum
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA
| | - Deepak Joshi
- Center for Research on Environment Health & Population Activities (CREHPA), Kusunti, Lalitpur, PO Box 9626, Kathmandu, Nepal
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA.
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Abstract
Numerical bifurcation theory involves finding and then following certain types of solutions of differential equations as parameters are varied, and determining whether they undergo any bifurcations (qualitative changes in behaviour). The primary technique for doing this is numerical continuation, where the solution of interest satisfies a parametrised set of algebraic equations, and branches of solutions are followed as the parameter is varied. An effective way to do this is with pseudo-arclength continuation. We give an introduction to pseudo-arclength continuation and then demonstrate its use in investigating the behaviour of a number of models from the field of computational neuroscience. The models we consider are high dimensional, as they result from the discretisation of neural field models-nonlocal differential equations used to model macroscopic pattern formation in the cortex. We consider both stationary and moving patterns in one spatial dimension, and then translating patterns in two spatial dimensions. A variety of results from the literature are discussed, and a number of extensions of the technique are given.
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Affiliation(s)
- Carlo R Laing
- Institute of Natural and Mathematical Sciences, Massey University, Private Bag 102-904 NSMC, Auckland, New Zealand.
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O'Neill E, Tang J, Garrett J, Hubacher D. Characteristics of Kenyan women in a prospective cohort study who continue using subdermal contraceptive implants at 12 months. Contraception 2013; 89:204-8. [PMID: 24360643 DOI: 10.1016/j.contraception.2013.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/07/2013] [Revised: 11/09/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Subdermal contraceptive implant continuation has not been well studied in Africa. We conducted a secondary data analysis to compare baseline characteristics of Kenyan women who continued to use the subdermal implant at 12 months to those who did not. STUDY DESIGN Kenyan women aged 18-24 years who presented to a family planning clinic for short-acting hormonal contraception were offered a two-rod subdermal implant instead. Participants were followed for 12 months after initiation of their contraceptive method. Statistical analysis included Pearson's chi-square or Fisher's exact tests for comparisons of proportions. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to determine factors associated with continuation. RESULTS Eighty-six (89%) of the 97 women who chose the implant were followed for 12 months. Of these women, 68 (79%) continued to use the implant. None of the factors we examined had a statistically significant association with continued use of the implant. Duration of intended use was the only strong factor; 83% of women with 3+ years of need continued using the implant, compared to 56% of those with shorter needs (Risk ratio = 1.48, 95% CI = 0.94-2.31). No substantive continuation differences were found when comparing other participant characteristics including months with their current partner, personal desire and partner preference for future children, previous use of modern birth control and other factors. CONCLUSION High implant continuation rates were noted regardless of previous use of modern birth control, partner preference for children or baseline concern for menstrual change. IMPLICATIONS Contraceptive use in Africa continues to focus on short-acting contraceptives despite the proven superior efficacy of long-acting reversible contraceptives in other settings. The high subdermal implant continuation among Kenyan women in this prospective study, regardless of baseline characteristics, supports the need for increasing access and future research in this population.
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Affiliation(s)
- Erica O'Neill
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Jennifer Tang
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Joanne Garrett
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Grass D. Numerical computation of the optimal vector field: Exemplified by a fishery model. J Econ Dyn Control 2012; 36:1626-1658. [PMID: 25505805 PMCID: PMC4259180 DOI: 10.1016/j.jedc.2012.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/07/2012] [Accepted: 04/10/2012] [Indexed: 05/19/2023]
Abstract
Numerous optimal control models analyzed in economics are formulated as discounted infinite time horizon problems, where the defining functions are nonlinear as well in the states as in the controls. As a consequence solutions can often only be found numerically. Moreover, the long run optimal solutions are mostly limit sets like equilibria or limit cycles. Using these specific solutions a BVP approach together with a continuation technique is used to calculate the parameter dependent dynamic structure of the optimal vector field. We use a one dimensional optimal control model of a fishery to exemplify the numerical techniques. But these methods are applicable to a much wider class of optimal control problems with a moderate number of state and control variables.
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Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is almost exclusively effective in patients with activating EGFR mutations, and median time to progression in such patients is generally up to 12 months. Usually, treatment with EGFR-TKI is terminated when disease progression is confirmed; however, acute exacerbation after the withdrawal of EGFR-TKI has been reported. In this paper, we report a case of a 35-year-old patient whose disease rapidly progressed after discontinuation of gefitinib and then rapidly regressed after reintroduction of gefitinib. In addition, we summarize the cases of 3 other patients who could be safely treated with continued erlotinib in combination with pemetrexed after disease progression. Currently, the mechanism of acquired resistance is intensively investigated and a number of new agents, such as irreversible EGFR inhibitors or MET inhibitors, are under development; however, they are still unavailable in clinical setting. We believe that continuing EGFR-TKI treatment after disease progression should be an option in patients who previously responded to EGFR-TKI under the present circumstances.
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Affiliation(s)
- Young Hak Kim
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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