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  1. 1
    Peer Reviewed

    Preventing Newborn Deaths In Romania And Hungary.

    Kuchna D; Hovsepyan A; Leonard S

    Health Affairs. 2017 Jun 1; 36(6):1160.

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  2. 2
    Peer Reviewed

    Sexual and reproductive health and rights matters: a new age.

    Hussein J; Cottingham J; Mbizvo M; Kismodi E

    Reproductive Health Matters. 2018 Dec; 26(52):1544770.

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  3. 3

    Acute urticaria: an extremely rare adverse effect of levonorgestrel-releasing intrauterine system as a possible manifestation of progestogen hypersensitivity syndrome.

    Emeryk-Maksymiuk J; Grzywa-Celinska A; Wozniak S; Szkodziak P; Szczyrek M

    Postepy Dermatologii I Alergologii. 2018 Oct; 35(5):530-531.

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  4. 4
    Peer Reviewed

    Prolonged retention of the Lippes loop intrauterine device as a cause of vaginal bleeding 10 years after chemoradiotherapy of locally advanced cervical carcinoma: case report and review of the literature.

    Gottwald L; Moszynska-Zielinska M; Zytko L; Tomalczyk A; Loga K; Fijuth J

    Journal of Obstetrics and Gynaecology. 2018 Oct 23; 1-2.

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  5. 5

    The clinical relevance of progestogens in hormonal contraception: Present status and future developments.

    Regidor PA

    Oncotarget. 2018 Oct 2; 9(77):34628-34638.

    The contraceptive pill is an effective and very safe method to control pregnancies. It was developed 60 years ago, and despite, that the composition has been the same since it was first developed (estrogen and progestogen), along the years the concentration of ethinyl estradiol has been reduced to improve tolerability. Nevertheless, progestogens are the basic active agent of hormonal contraception. The mechanism of progestogens is a multimodal one and basically three modes of contraceptive action can be distinguished: (a) A strong antigonadotrophic action leading to the inhibition of ovulation. The necessary dosage of ovulation inhibition per day is a fixed dosage that is inherent to each progestogen and independent of the dosage of estrogen used or the partial activities of the progestogen or the mode of application. (b) Thickening of the cervical mucus to inhibit sperm penetration and (c) Desynchronization of the endometrial changes necessary for implantation. The on the market available progestogens used for contraception are either used in combined hormonal contraceptives (in tablets, patches, or vaginal rings) or as progestogen only contraceptives. Progestogen only contraceptives are available as daily oral preparations, monthly injections, implants (2-3 years), and Intrauterine Systems (IUS). Even the long acting progestogens are highly effective in typical use and have a very low risk profile, with few contraindications. According to their introduction into the market progestogens, in combined hormonal contraceptives, have been described as first, second, third and fourth generation progestogens. Also, progestogens can be derived from testosterone, progesterone, and spironolactone that determine pharmacodynamic and pharmacokinetic differential effects. These effects contribute to the tolerability and additional beneficial or therapeutic effects whether used in combined oral contraceptives COC or as progestogen only drugs enhancing the individual options for different patient profiles. The new development of polymers for vaginal rings allowed on one side the improvement of the estrogen/progestogen combination in these rings especially regarding the comfort of use for women (avoiding of cold chain use or packages with up to six-month rings e.g.) and on the other side the development of progestogen only formulations. Another future development will be the introduction of new progestogen only pills that will provide effective contraceptive protection with more favourable bleeding patterns and a maintenance of ovulation inhibition after scheduled 24-h delays in pill intake than the existing pop with desogestrel.
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  6. 6
    Peer Reviewed

    Impact of EU risk assessment process and administrative regulations for manufacturers of combined hormonal contraceptive prescribing. An analysis of developments in Germany and the implications.

    Selke Krulichova I; Selke GW; Eichler U; Lappe V; Godman B; Schubert I

    Current Medical Research and Opinion. 2018 Oct 26; 1-16.

    OBJECTIVE: Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3(rd) generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorisation holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. METHODS: German prescription data for 1.1 million women below 20 were used to analyse the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. RESULTS: Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. CONCLUSION: The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, though very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up.
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  7. 7
    Peer Reviewed

    Situation of Adolescent Contraceptive Use in Germany.

    Oppelt PG; Fahlbusch C; Heusinger K; Lotz L; Dittrich R; Baier F

    Geburtshilfe und Frauenheilkunde. 2018 Oct; 78(10):999-1007.

    Introduction Would adolescent girls in Germany choose a different method of contraception to the combined oral contraceptive if provided with the appropriate information? Is there a need for long-acting contraception among our adolescent girls? How satisfied are female patients with the information they receive at their respective gynaecology practices, and how much do the girls know about different methods of contraception? Materials and Methods In the study "Thinking About Needs in COntraception" (TANCO), not only female patients, but also their respective gynaecologists were surveyed online about current methods of contraception, their satisfaction with these methods, and also their level of knowledge concerning the individual methods of contraception, the situation related to advice about different contraceptive options and their general satisfaction with gynaecological care. This article presents the data from the subset of adolescent girls aged 14 to 19 years (n = 2699) out of the total of 18 521 women surveyed. Results The girls surveyed were familiar with at least the name of more than five different methods of contraception (average 5.3). The doctors assumed that the respondents would know only 4.2 different methods. When asked explicitly about how the individual methods of contraception work, clear deficits became evident. This applies not only to the entire population of respondents, but also the users of the respective contraceptive method. In addition, a strong interest in long-acting contraception emerged from the survey, particularly among young women. Discussion The data from the TANCO study reveal a clear discrepancy between the existing contraception almost exclusively in the form of the contraceptive pill and the contraceptive options considered by adolescent girls if they are thoroughly informed. The need for education into alternatives to the pill is high, as is the willingness to use such alternatives after receiving information - much higher than the figures suggested by the gynaecologists.
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  8. 8

    Contraceptive drugs mitigate experimental stroke-induced brain injury.

    El Amki M; Binder N; Steffen R; Schneider H; Luft AR; Weller M; Imthurn B; Merki-Feld GS; Wegener S

    Cardiovascular Research. 2018 Oct 5;

    Aims: Effective stroke treatments beyond reperfusion remain scant. The natural steroid hormone progesterone has shown protective effects in experimental models of brain injury and cardiovascular disease. However, unfavorable bioavailability limits its clinical use. Desogestrel and drospirenone are new generation progestins with progesterone-like properties, developed as oral contraceptives with excellent bioavailability and safety profile. We investigated the neuroprotective properties of these progestins in vivo using transient middle cerebral artery occlusion (MCAO) and in vitro using an oxygen-glucose deprivation and reoxygenation (OGD/R) model in primary neuronal cells. Methods and Results: MCAO was induced in female, female ovariectomized (modeling postmenopausal females) and male mice. Treatment with the progestins resulted in less severe strokes after MCAO and less neuronal death in OGD/R. Desogestrel and drospirenone induced higher expression levels of GABAAR alpha4 and delta subunits within the brain, suggesting changes in GABAAR configuration favoring tonic inhibition as potential mechanism of action. Treatment with the GABAAR blocker picrotoxin abolished the protection afforded by the progestins in vivo and in vitro. Conclusions: For the first time, here we delineate a potential role of desogestrel and drospirenone, both clinically approved and safe drugs in mitigating the consequences of stroke. Contraception with desogestrel and drospirenone in progestin-only preparations may be particularly beneficial for women at risk of stroke.
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  9. 9

    Sex hormones and venous thromboembolism - from contraception to hormone replacement therapy.

    Beyer-Westendorf J; Bauersachs R; Hach-Wunderle V; Zotz RB; Rott H

    VASA. Zeitschrift Fur Gefasskrankheiten. 2018 Oct; 47(6):441-450.

    The use of sex hormones such as combined oral contraceptives (COC) or hormone replacement therapy (HRT) increases the risk for venous thromboembolism (VTE) considerably, especially in patients with an increased intrinsic risk for thromboembolic complications. Despite public and media attention and increasing scientific evidence, prescription patterns seem to be hard to change. It is well recognized that the patient's baseline risk is the most relevant factor in the absolute risk for developing VTE. The relative risk increase associated with sex hormones, depends on the type and dosage of hormones, the route of application (oral, vaginal, transdermal), and for COC, on the specific combination of oestrogen and gestagen components. Consequently, a careful decision for or against any specific type of hormone treatment needs to be based on an assessment of the patient's risk profile (disposition) as well as on the treatment-associated risks and benefits (exposition). This review discusses the most common sex hormone treatments in contraception and HRT, the relevance for VTE risk patients, and strategies to counsel patients with regard to hormone use according to their risk profiles. Keywords: Oral contraceptives, hormonal contraception, hormone replacement therapy, venous thromboembolism.
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  10. 10
    Peer Reviewed

    General practitioners can increase participation in cervical cancer screening - A model program in Hungary.

    Gyulai A; Nagy A; Pataki V; Tonté D; Ádány R; Vokó Z

    BMC Family Practice. 2018; 19(1)

    Background: Cervical cancer is a preventable disease. Unfortunately, its mortality is high in Hungary: 9.2 deaths /100000 women/year in 2015. The Hungarian organized, nationwide cervical screening program was launched in 2003, but it could improve the coverage rate of cervical cancer screening only by a few percentage points. The vast majority of women still uses opportunistic screening and the organized screening program had little impact on participation by women who never or rarely consult their gynecologists. We assessed whether involving general practitioners in the cervical cancer screening process would increase participation. Methods: The study consisted of two parts: 1. A questionnaire-based health survey was conducted using a representative sample of women aged 25 to 65 years from 11 Hungarian counties, in which we studied where women obtained information about cervical cancer screening. 2. Additionally, a model program and its evaluation were implemented in the practices of general practitioners in one of the 11 counties (Zala county). In this program, general practitioners were informed of their patients' participation in the cervical cancer screening program, and they motivated those who refused the invitation. Results: Questionnaire-based health survey: A total of 74% (95% confidence interval (CI): 70-77%) of the target population had a screening examination within the previous 3 years. The majority (58, 95% CI: 54-62%) of the target population did not ask for information about cervical cancer screening at all. Only 21% (95% CI: 17-26%) consulted their general practitioners about cancer screening. Evaluation of the model program: the general practitioners effectively motivated 24 out of 88 women (27, 95% CI: 18-38%) who initially refused to participate in the screening program. Conclusion: The majority of Hungarian women are not informed about cervical cancer screening beyond the invitation letter. General practitioners could play a more important role in mobilizing the population to utilize preventive services. The involvement of general practitioners in the organization of the cervical cancer screening program could increase the participation of those women who generally refuse the services. © 2018 The Author(s).
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  11. 11
    Peer Reviewed

    A multicenter randomized clinical trial of etonogestrel and levonorgestrel contraceptive implants with nonrandomized copper intrauterine device controls: effect on weight variations up to 3 years after placement.

    Bahamondes L; Brache V; Ali M; Habib N

    Contraception. 2018 Sep; 98(3):181-187.

    OBJECTIVES: To evaluate weight changes in women randomized to either the etonogestrel (ENG)- or the levonorgestrel (LNG)-releasing contraceptive implants and to compare with users of the TCu380A intrauterine device (IUD). STUDY DESIGN: A multicenter randomized trial with 1:1 allocation ratio of the ENG and the LNG implants with nonrandomized, age-matched control group of women choosing TCu380A IUD. The primary objective was to assess contraceptive efficacy and method continuation rates and, secondarily, the incidence of common complaints and side effects (including weight changes) associated with use of the three contraceptives. All women were enrolled in nine centers at seven countries. Weight change was evaluated from time at device(s) placement. Confounders were sociodemographic, baseline weight and body mass index, center and time from insertion. We used a linear mixed-effects regression modeling with random intercept and slope. Weight was compared between the two implants groups and between the implants and the IUD groups through linear mixed multivariable regression model. RESULTS: A total of 995, 997 and 971 users in the ENG implant, LNG implant and IUD groups, respectively, were included. At 36months of use, ENG and LNG implant users had similar significant mean weight increase of 3.0 kg [95% confidence interval (CI) 2.5-3.5] and 2.9 kg (95% CI 2.4-3.4), respectively (p<.0001), while IUD users had an increase of 1.1 kg (95% CI 0.5-1.7) (p=.0003). On adding the group-time interaction term to the stratified baseline weight models, implant users gained 0.759 kg (standard error [SE] .11) and 0.787 kg (SE .22) more weight than their IUD-user counterparts per year since placement if their baseline weight was in the category 51-69 kg (p<.0001) or >/=70 kg (p=.0005), respectively. CONCLUSIONS: ENG and LNG implant as well as IUD users had a small but significant weight increase with little clinical significance during the 3 years of follow-up, and it was slightly higher among implant than IUD users weighing >50 kg. IMPLICATIONS: These findings must be useful for clinicians to counsel implant users which could improve method continuation. Copyright (c) 2018 Elsevier Inc. All rights reserved.
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  12. 12

    Can the evolution of male contraception lead to a revolution? Review of the current state of knowledge.

    Frankiewicz M; Polom W; Matuszewski M

    Central European Journal of Urology. 2018; 71(1):108-113.

    Introduction: Great advances in medical research concerning methods of contraception have been achieved in recent years, however, more than 25% of couples worldwide still rely on condoms - a method with poor efficacy. Even though there is a spectrum of 11 different contraceptive methods for women, there are only 4 commonly used by men (condoms, periodic abstinence, withdrawal and vasectomy). In this review, advances and present, state-of-the-art, both hormonal and non-hormonal male contraceptive methods will be presented and evaluated. Potential novel targets that warrant greater research will be highlighted. Material and methods: A comprehensive literature search without a time limit was performed using the Medline database on May 2017. The terms 'male contraception' in conjunction with 'reversible inhibition of sperm under guidance' (RISUG), 'hormonal', 'non-hormonal', 'vasectomy' or 'testosterone' were used. The articles were limited to those published in English, Polish or French. Results: There are various contraceptives currently available to regulate male fertility. Vasectomy is still the most effective permanent form of male contraceptive with a failure rate lower than 1%. Reversible, non hormonal methods of male contraception, like reversible inhibition of sperm under guidance, are very promising and close to being introduced into the market. In regards to hormonal contraception research, the use of testosterone injections has been widely studied yet they often harbor undesirable side effects and require further development. Conclusions: Despite continuous efforts worldwide, it seems that another several years of research is needed to provide safe, effective and affordable male contraceptives which will allow both men and women to participate fully in family planning.
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  13. 13

    How is the process of setting micronutrients recommendations reflected in nutrition policies in Poland? The case study of folate.

    Sicinska E; Jeruszka-Bielak M; Roszkowski W; Brzozowska A; Jarosz M; Raats MM

    Annals of Agricultural and Environmental Medicine. 2018 Mar 14; 25(1):82-86.

    INTRODUCTION AND OBJECTIVE: Ensuring the adequate intake of micronutrients by populations is an important aspect of public health. This study aims to elucidate the process of setting nutrition recommendations and the development of subsequent policies associated with micronutrients in Poland by using the case study of folate. MATERIAL AND METHODS: The study was based on 13 interviews conducted between October 2010 - February 2011, and desk research comprising a review of the associated scientific literature and relevant documents, such as scientific opinions and reports of the meetings of scientific committees. The interviews were conducted within the EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence in the frame of the European Union's 6th Framework Programme. RESULTS: Since 1997, the Experts Group of the Ministry of Health recommended that all women of childbearing age should consume folic acid as a supplement to prevent neural tube defects in their offspring. The fortification of foodstuffs with folic acid is not obligatory. This study describes the revision of the folate nutrient recommendation and the process by which strategies to increase the intake of this vitamin by the Polish population were identified. The institution responsible for the choice and implementation of folate policy is the Ministry of Health and the National Food and Nutrition Institute is responsible for setting/updating the nutrient recommendations. CONCLUSIONS: The current Polish nutrition recommendations for folate are consistent with the levels set by most other countries. The constant improvement of nutritional knowledge on folate among consumers, especially young women, is necessary.
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  14. 14
    Peer Reviewed

    Hormonal Contraceptive Use Is Associated With Higher Total but Unaltered Free 25-Hydroxyvitamin D Serum Concentrations.

    Pilz S; Obeid R; Schwetz V; Trummer C; Pandis M; Lerchbaum E; Pieber TR; Obermayer-Pietsch B; Wilhelm M; Hahn A; Schon C

    Journal of Clinical Endocrinology and Metabolism. 2018 Jun 1; 103(6):2385-2391.

    Context: Intake of hormonal contraceptives (HC) is associated with higher total 25-hydroxyvitamin D [25(OH)D] concentrations, but the effect of HC on free 25(OH)D is unclear. Objective: We investigated whether free 25(OH)D concentrations differ according to use of HC. Design: This is a post hoc analysis of a randomized open trial. Setting: This study was conducted from 13 January to 9 May, 2016, at a clinical research organization in Esslingen, Germany. Participants: We included 201 apparently healthy women of childbearing age. Intervention: Participants were randomly assigned to receive a daily multimicronutrient supplement for 8 weeks; the supplement contained 200 IU (n =100) or 800 IU (n = 101) of vitamin D3. Main Outcome Measures: Primary outcome was the difference in free 25(OH)D between users and nonusers of HC. Results: Overall, 176 participants [median (25th to 75th percentiles) age: 25 (22 to 29) years] with available free 25(OH)D were included in the present analysis. At baseline, total 25(OH)D was significantly higher in users (n = 110) than in nonusers (n = 66) of HC [49.2 (33.4 to 63.4) vs 39.1 (23.8 to 52.5) nmol/L; P < 0.001], whereas there was no difference in free 25(OH)D [7.87 (6.50 to 10.11) vs 7.88 (6.35 to 10.12) pmol/L; P = 0.923]. These results were confirmed after multimicronutrient supplementation and in subgroups according to treatment allocation. Conclusions: Use of HC was associated with, on average, 26% higher total 25(OH)D, whereas free 25(OH)D values did not differ according to use of HC. These findings are relevant for epidemiological studies, but the physiological implications remain to be clarified.
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  15. 15
    Peer Reviewed

    Factors that Predict Parental Willingness to Have Their Children Vaccinated against HPV in a Country with Low HPV Vaccination Coverage.

    Ganczak M; Owsianka B; Korzen M

    International Journal of Environmental Research and Public Health. 2018 Mar 31; 15(4)

    Background: Adolescent HPV (Human Papilloma Virus) vaccination is yet to be introduced as a mandatory program in Poland. Polish literature on factors associated with adolescent HPV vaccination is scant, despite the fact that uptake is one of the poorest in the European Union. Objectives: To assess HPV awareness and identify independent predictors for parental willingness to have their children vaccinated against HPV. Methods: All parents of first grade students from three selected high schools in Zgorzelec, Poland, who participated in parent-teacher meetings at the time the study was conducted, had their children unvaccinated regarding HPV, and who gave informed consent to participate were included. There were 600 first grade students; 9 were vaccinated against HPV. This left 591 parents who met the eligibility criteria; the response rate was 76.1%. Results: Awareness of HPV was reported by 55.3% of 450 parents (mean age 42 years, 70.9% females); 85.1% expressed their willingness to vaccinate their children against HPV; 31.3% identified HPV as a sexually transmitted pathogen, and 36.2% identified it as a risk factor of cervical cancer. Multivariable logistic regression analyses indicated that being employed (OR 2.09; 95% CI: 1.10-3.86), having positive attitudes toward vaccines (OR 3.02; 95% CI: 1.34-6.49), previous information about HPV (OR 2.02; 95% CI: 1.17-3.51), and concerns about the side effects of the HPV vaccine (OR 0.60; 95% CI: 0.35-0.99) were independent predictors of parents' willingness to vaccinate. Conclusions: Attitudes regarding their child being vaccinated against HPV were positive among Polish parents, even though awareness and knowledge of HPV in this group were low. Most of the significant factors that influenced their willingness were modifiable, such as being informed about HPV and having positive attitudes toward vaccines. Future interventions should focus specifically on vulnerable subgroups, such as unemployed parents.
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  16. 16
    Peer Reviewed

    The Political Economy of Family Planning: Population Dynamics and Contraceptive Markets.

    Bendix D; Schultz S

    Development and Change. 2018; 49(2):259-285.

    This article explores recent changes in international development policy with regard to population and reproductive health and connects these to contemporary dynamics in contraceptive markets, taking the German government and the pharmaceutical company Bayer HealthCare as an example. While the vocabulary of individual reproductive rights remains ever-present, governments in the global South — and in Africa in particular — are currently encouraged to manage their ‘human capital’ in the light of population age composition and available resources. More than 20 years after the Cairo Conference on population and development, key documents and budgets evidence a discursive and financial shift once again towards more explicitly neo-Malthusian approaches and stand-alone family planning. At the same time, a return to formerly discredited long-acting reversible contraception is evident in major public–private partnerships of governments, companies and NGOs. Drawing on policy papers, interviews and statistical data, this article finds considerable interplay between a reoriented development policy under the name of ‘population dynamics’ and the interests of pharmaceutical companies in contraceptive markets. © 2017 International Institute of Social Studies
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  17. 17

    [Intrauterine device and pelvic inflammatory disease: Myth or reality?] Dispositif intra-uterin et infections genitales hautes : mythe ou realite ?

    Straub T; Reynaud M; Yaron M

    Gynecologie, Obstetrique, Fertilite and Senologie. 2018 Apr; 46(4):414-418.

    INTRODUCTION: Intrauterine device (IUD) is a reliable contraceptive method that is long term reversible, and well tolerated. Numerous studies prove its efficiency and report rare complications that are attributed to it. However, its use is limited due to fear that it can cause a pelvic inflammatory disease (PID). This is based on historical data on infections related to the "Dalkon Shield", which was removed from the market in 1974. METHOD: The analyzed articles were extracted from PUBMED database between 2000 and 2016. In total, 22 studies were retained. A meta-analysis was not possible due to the methodological diversity among the selected articles contributing to this narrative review of the literature. RESULTS: After analysis, the following factors influence the risk of PID linked to IUDs: an advanced age and sexually transmitted infections. CONCLUSION: The risk of PID linked to IUDs is lower than 1%. This is explained by new models of IUD, better screening tests, more frequent follow-up of the patients and the improvement of care PID patients. In the light of our results, the threat of pelvic inflammatory disease should not hinder the use of IUDs. Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.
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  18. 18

    Seizure Freedom in Patients with Dravet Syndrome with Contraceptives: A Case Report with Two Patients.

    Lotte J; Grothe S; Kluger GJ

    Neuropediatrics. 2018 Aug; 49(4):276-278.

    Dravet syndrome is a rare and malignant epileptic syndrome that is typically resistant to antiepileptic drugs. There is a growing interest in the antiepileptic properties of neurosteroids. Especially progesterone is known to act as an anticonvulsive agent. However, contraceptives that act as orally given neurosteroids often lead to increased seizures in women with epilepsy.We report on two girls with Dravet syndrome, who gained seizure freedom under therapy with contraceptives. The first patient received an oral contraceptive, a combination of an estrogen, and a gestagen, due to hypermenorrhea. The second received a pure gestagen implant for contraception.The antiepileptic effect of progesterone is mainly attributed to its conversion into allopregnanolone and related neurosteroids, which are positive modulators of gamma-aminobutyric acid A receptors. It is unclear whether the observed effect of these contraceptives containing synthetic progesterone derivatives may be specific for the Dravet syndrome, and it is unclear whether and how this observation can be used therapeutically. Georg Thieme Verlag KG Stuttgart . New York.
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  19. 19
    Peer Reviewed

    Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: The role of the progestogen type and estrogen dose.

    Oedingen C; Scholz S; Razum O

    Thrombosis Research. 2018 Mar 15; 165:68-78.

    INTRODUCTION: Currently available combined oral contraceptives (COC) reportedly increase the risk of venous thromboembolism (VTE). We aimed to quantify this risk considering both progestogen type and estrogen dose. MATERIALS AND METHODS: PubMed, Embase and LIVIVO were searched for relevant publications until April 2017. Case-control and cohort studies including healthy women taking COC and assessing incident VTE as outcome were selected. Adjusted relative risks (RR) with 95% confidence intervals (CI) derived from random effects model using a generic inverse-variance approach are reported. RESULTS: Overall, 1,359 references were identified and 17 studies were included in the meta-analysis. The pooled RR of VTE was associated with various COC, with the association depending on their respective estrogen dose and progestogen type. Compared to the reference, levonorgestrel with 30-40mug ethinylestradiol, the overall risk of VTE was higher for all other COC. Preparations with desogestrel with 30-40mug estrogen showed the highest relative risk (RR: 1.46; 95% CI: 1.33-1.59), while RRs for drospirenone (30-40mug ethinylestradiol) and desogestrel (30-40/20mug ethinylestradiol) were lower. COC containing gestodene and cyproterone with 30-40mug estrogen showed the lowest risk (RR: 1.27; 95% CI: 1.15-1.41 and RR: 1.29; 95% CI: 1.12-1.49, respectively). CONCLUSIONS: Compared to levonorgestrel with 30-40mug ethinylestradiol, all COC showed a significantly increased VTE risk. The association varied depending on the progestogen type and the dose of estrogen. Our results suggest that the prescription of COC with the lowest possible dose of ethinylestradiol may help to avoid VTE cases among young, healthy women. Copyright (c) 2018 Elsevier Ltd. All rights reserved.
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  20. 20
    Peer Reviewed

    Trends in cervical cancer incidence and mortality in Poland: is there an impact of the introduction of the organised screening?

    Nowakowski A; Wojciechowska U; Wieszczy P; Cybulski M; Kaminski MF; Didkowska J

    European Journal of Epidemiology. 2017 Jun; 32(6):529-532.

    Aside from existing opportunistic screening, an organised screening programme (OSP) for cervical cancer (CC) was implemented in 2006/2007 in Poland. We applied joinpoint regression and age-period-cohort model to look for the impact of the OSP on CC incidence/mortality trends. Decline of age-standardised incidence rates (ASIRs) in the screening-age group (25-59 years) accelerated from -2.2% (95% CI -2.7 to -1.7%) between 1993 and 2008 to -6.1% (95% CI -7.7 to -4.4%) annually after 2008. In women aged 60+ years, ASIRs declined from 1986 until 2005 [annual percent change (APC) = -2.6%, 95% CI -2.9 to -2.4%] and stabilised thereafter. Decline of age-standardised mortality rates (ASMRs) in the screening-age group accelerated from -1.3% (95% CI -1.5 to -1.1%) between 1980 and 2005 to -4.7% (95% CI -5.6 to -3.8%) annually after 2005. In women aged 60+ ASMR declined between 1991 and 2004 (APC = -2.9%, 95% CI -3.5 to -2.3%) and stabilised thereafter. Relative risks of CC diagnosis and death were 0.63 (95% CI 0.62-0.65) and 0.61 (95% CI 0.59-0.63), respectively, for the most recent period compared to the reference around 1982. Implementation of the OSP possibly accelerated downward trends in the burden of CC in Polish women under the age of 60, but recent stabilisation of trends in older women requires actions.
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  21. 21
    Peer Reviewed

    Clinical and health policy experiences with HPV prevalence within the Hungarian organized cervical cancer screening program.

    Vajda R; Juhasz K; Endrei D

    Journal of Gynecologic Oncology. 2018 May; 29(3):e45.

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  22. 22

    Needs and preferences of women users of oral contraceptives in selected countries in Central and Eastern Europe.

    Fait T; Buryak D; Cirstoiu MM; Luczai E; Janczura R

    Drugs In Context. 2018; 7:212510.

    Background: The availability of various oral contraceptive (OC) pill formulations with different hormone compositions suggests that there is potential to align a particular product with an individual user's needs and preferences. To explore this concept further, a survey was conducted of current users of OCs to define and confirm areas of specific needs, and to gain insight into their views and preferences for OC formulations. Methods: During November and December 2015, women users (n=615) of OCs in five Central and Eastern European countries were surveyed in face-to-face interviews conducted by experienced interviewers. The survey questionnaire comprised 34 questions about the use of and specific needs for OCs. Results: Four basic needs of women taking OCs were identified: reliable contraception, reversibility of contraception, no effect on body weight and safety. Overall, 85% of surveyed women indicated that prevention of pregnancy was the main reason for taking OCs. Weight gain was the side effect of greatest concern with OC use (46% spontaneous answer; 65% aided answer). Independent behavioural segmentation analysis identified four groups - Solved Cycle Problems (46% of participants), Low Hormone Content (22%), Lifestyle (17%) and Beauty (14%) - which characterised the women according to needs and preferences beyond the basic needs of OCs. Each group had unique features and distinct preferences for different formulations of OCs. Conclusions: Aligning product advantages with specific individual needs may enhance users' overall experience with OCs as a contraceptive option.
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  23. 23

    [The use of free-of-charge prescription contraceptives among women : Results of a pilot project in the German federal state of Mecklenburg-Western Pomerania] Inanspruchnahme kostenfreier verschreibungspflichtiger Verhutungsmittel durch Frauen : Ergebnisse eines Modellprojekts in Mecklenburg-Vorpommern.

    Ulbricht S; Beyer A; John U

    Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2018 Apr; 61(4):412-419.

    BACKGROUND: There is a connection between the receipt of unemployment benefits and the failure to use contraceptives in Germany. This study aims to understand the use of contraceptives among women entitled to unemployment benefits under the Sozialgesetzbuch II or XII (SGB II or SGB XII), prior and during an offer of contraceptives free of charge (CFOC). METHODS: The criteria for the use of CFOC (pill, intrauterine device, or ring) over a 12-month period were: age between 20 and 35 years, resident in predefined urban or rural postal codes in the German federal state of Mecklenburg-Western Pomerania, and participation in a self-administered survey. Data about participants' age, education, number of children, relationship status, period of payment according to SGB II or SGB XII, the use and barriers to use of contraceptives during every occurrence of sexual intercourse, as well as the kind of contraceptives used. RESULTS: From a total of 418 women: 40.9% were single-mothers, 39.0% did not graduate school, 21.1% were childless, and 57.9% had received unemployment benefits for at least three years. Further, 21.1% rated their type of contraceptive as "less safe" or "unsafe." The most commonly cited reasons for nonregular use of contraceptives were: they are too expensive or their use is forgotten. A change in contraceptives was made by 30.9% due to the offer of CFOC. The change was associated with the number of children and the exclusive use of less safe contraceptives. DISCUSSION: CFOC seems to be attractive, especially for women with children and those who receive long-term unemployment benefits. Changing demands concerning the safety of birth control during the lives of women should be considered in the discussion about common rules for the access to CFOC.
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  24. 24
    Peer Reviewed

    Oral contraception in adolescents with type 1 diabetes and its association with cardiovascular risk factors. A multicenter DPV study on 24 011 patients from Germany, Austria or Luxembourg.

    Bohn B; Monkemoller K; Hilgard D; Dost A; Schwab KO; Lilienthal E; Hammer E; Hake K; Fritsch M; Gohlke B; de Beaufort C; Holl RW

    Pediatric Diabetes. 2018 Aug; 19(5):937-944.

    OBJECTIVE: To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry. METHODS: Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background. STATISTICAL ANALYSIS: SAS 9.4. RESULTS: In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%). CONCLUSIONS: OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education. (c) 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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  25. 25
    Peer Reviewed

    Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary.

    Vanya M; Devosa I; Barabas K; Bartfai G; Kozinszky Z

    European Journal of Contraception and Reproductive Health Care. 2018 Feb; 23(1):52-57.

    OBJECTIVES: The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS: A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS: In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS: Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.
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