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Archives of Gynecology and Obstetrics. 2007 Dec; 276(6):583-589.The objective was to evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 plus or minus 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL. (author's)
Contraception Report. 1999 Jan; 9(6): p..A recent WHO-sponsored study has demonstrated that the progestin levonorgestrel, used alone, is a highly effective and well-tolerated form of emergency contraception. With the proportion of pregnancies prevented up to 95% - depending on the timeliness of administration - the levonorgestrel regimen proved more effective than the most commonly used regimen, the Yuzpe method. The Yuzpe method employs a dual-hormone (ethinyl estradiol plus levonorgestrel) approach to preventing pregnancy. Despite the Yuzpe regimen's 75% efficacy rate (a weighted average from 10 studies) the method has been associated with drawbacks. About 50% of users experience nausea and 20% report vomiting, which can reduce patient compliance. (excerpt)
Progress in Reproductive Health Research. 2005; (68):6-7.The preferred regimen for emergency contraceptive pills (ECPs) is 1.5 mg of levonorgestrel in a single dose. Alternatively, the levonorgestrel can be taken as two doses of 0.75 mg, at an interval of 12 hours. A third option is 2 doses of 100 µg of ethinylestradiol plus 0.5 mg of levonorgestrel, at an interval of 12 hours. 1. When should ECPs be taken? Ideally, the ECPs should be taken as early as possible after unprotected intercourse, within 72 hours. If this is not possible, the ECPs may be taken up to 120 hours after unprotected intercourse. However, the woman should be advised that the longer the delay, the lower the effectiveness of the pills; To ensure that women have ECPs available when they need them, they may be given an advance supply or an advance prescription. (excerpt)
Reduced osmolarity ORS more effective than standard WHO solution for treating acute diarrhea in children.
Global HealthLink. 2001 Nov-Dec; (112):16.According to UNICEF, diarrhea kills 8,000 children a day and remains one of the major killers of children under five globally. As dehydration is the main complication of diarrhea, treatment focuses upon rehydration through fluid replacement. Intravenous fluids were commonly used until the 1960s when ORS was developed as an alternative treatment. Today, ORS provides an inexpensive way to treat dehydration. The simple combination of sugar and salt effectively enhances fluid absorption in the small intestine. Currently, the World Health Organization (WHO) recommends a standard formulation of glucose-based ORS solution (90 mmol/l of sodium and 11 1 mmol/l of glucose with a total osmolarity of 31 1 mmol/l) for children with diarrhea. However, recent studies suggest that this formula may not be optimal, as increased glucose and sodium concentrations reduce fluid absorption due to higher osmotic loads. Based on these findings, controlled trials were conducted to evaluate the clinical effects of reduced osmolarity ORS (total osmolarity <250 mmol/l with reduced sodium) compared with standard WHO ORS. (excerpt)
Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception.
Lancet. 1998 Aug 8; 352(9126):428-33.A previous study suggested that provision of two 0.75 mg doses of levonorgestrel for emergency contraception caused less nausea and vomiting and was more effective than the Yuzpe regimen of combined oral contraceptives (two doses of 100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel). These two regimens were evaluated further in a double-blind, randomized World Health Organization study of 1998 women recruited from 21 centers worldwide who requested emergency contraception within 72 hours of unprotected intercourse. Among the 1955 women for whom the outcome was known, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group and 3.2% (31/979) in the Yuzpe group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% confidence interval, 0.18-0.70). The proportion of pregnancies prevented was 85% in the former group and 57% in the latter group. Nausea and vomiting occurred significantly less frequently in the levonorgestrel group (23.1% and 5.6%, respectively) than in the Yuzpe regimen group (50.5% and 18.8%, respectively). The efficacy of both treatments declined significantly (p = 0.01) with increasing time since unprotected intercourse. These findings confirm that the levonorgestrel regimen may be more effective and is better tolerated than the current standard in emergency contraception.
Contraception. 1982 Mar; 25(3):231-41.A randomized, controlled, clinical trial comparing 6 combined oral contraceptives (OCs) with 50 mcg or less of ethinyl estradiol was undertaken in 10 WHO Collaborating Centers for Clinical Research in Human Reproduction. A total of 2430 women entered the trial and were observed for 28,077 woman-cycles. All low-dose combined OCs demonstrated equivalent efficacy with 1-year pregnancy rates of 1-6%. However, discontinuation rates for medical reasons differed significantly between the treatment groups with the preparation containing 20 mcg ethinyl estradiol and that containing 400 mcg norethisterone acetate being associated with higher discontinuation rates due to bleeding disturbances. Even among the preparations which did not differ in discontinuation rates, the reasons for discontinuation did differ. Women receiving norethisterone preparations tended to discontinue because of bleeding disturbances while those receiving the levonorgestrel-containing preparations tended to discontinue because of complaints of nausea and vomiting. (author's)