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Medicina (Kaunas, Lithuania) May 2024Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing... (Review)
Review
UNLABELLED
Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms.
OBJECTIVES
In this review we present all currently available treatment modalities for uterine fibroids.
METHODS
An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted.
REVIEW
Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient's age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results.
CONCLUSIONS
Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient's desire for definitive treatment or fertility preservation.
Topics: Humans; Leiomyoma; Female; Uterine Neoplasms; Hysterectomy; Uterine Artery Embolization; Uterine Myomectomy
PubMed: 38929485
DOI: 10.3390/medicina60060868 -
Children (Basel, Switzerland) May 2024Evidence has shown that parenting intervention programmes improve parental knowledge, attitudes, and practices, which helps in promoting child development. This study...
Evidence has shown that parenting intervention programmes improve parental knowledge, attitudes, and practices, which helps in promoting child development. This study aims to examine the effectiveness of parenting intervention in improving child behaviours. This is a secondary analysis of data from a cluster-randomised controlled trial with depressed mothers aged 18-44 years with a child aged 0 to 36 months. This paper reports findings from the dataset of participants with a child aged between 24 and 36 months. Villages ( = 120) were randomised into either of two arms: learning through play plus (LTP Plus) or treatment as usual (TAU). LTP Plus is a 10-session, group parenting intervention integrated with cognitive behaviour therapy, delivered over 3 months. This secondary analysis reports findings on the Eyberg Child Behaviour Inventory (ECBI) and the Home Observation for Measurement of the Environment (HOME). Findings show a significant improvement in child behaviour (ECBI) scores ( < 0.011) and HOME scores ( < 0.001) in the intervention group compared to TAU at 3-month follow-up. In a low-resource setting, low-cost group parenting intervention delivered by community health workers has the potential to improve child behaviours and quality of the home environment. Parenting interventions aimed at improving child behavioural problems can have significant implications for the child, family, and broader societal outcomes. Addressing behavioural problems in early years, parenting interventions can potentially reduce long-term consequences and costs associated with untreated child behavioural issues.
PubMed: 38929226
DOI: 10.3390/children11060646 -
World Neurosurgery Jun 2024To investigate the characteristics of the spinal-pelvic sagittal sequence in patients with lumbar vertebral posterior ring apophysis separation (PRAS).
OBJECTIVE
To investigate the characteristics of the spinal-pelvic sagittal sequence in patients with lumbar vertebral posterior ring apophysis separation (PRAS).
METHODS
A retrospective analysis was conducted on 119 hospitalized patients with PRAS, and 119 adults without symptoms of low back and leg pain were selected as the control. General data and spinal-pelvic sagittal parameters were collected and analyzed.
RESULTS
Compared to the control group, the pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) of the PRAS group were significantly lower, while the pelvic tilt (PT), sagittal vertical axis (SVA), and pelvic incidence minus lumbar lordosis (PI-LL) were significantly higher. There was no significant difference in thoracolumbar kyphosis (TLK) between two groups. In patients with PRAS, the LL value of lumbar curvature was moderately correlated with TK and SS, while PI, PT, and SS were pairwise correlated, indicating that the change in one parameter is often accompanied by simultaneous changes in other parameters if PRAS happens. The correlation between different parameters could provide guidance for the diagnosis of PRAS. In terms of lumbar lordosis type, PRAS group was mainly of Roussouly type I, while the control group was mainly of type II, and the difference in the composition ratio was statistically significant.
CONCLUSIONS
As reflected by the spinal-pelvic sagittal parameters, the patients with PRAS exhibited reduced thoracic and lumbar curvature, posterior pelvic tilt, and fewer vertebral bodies involved in lumbar lordosis. These morphological characteristics indicate the changes of the mechanical structure of the spine.
PubMed: 38925246
DOI: 10.1016/j.wneu.2024.06.113 -
Arthritis Care & Research Jun 2024
PubMed: 38924369
DOI: 10.1002/acr.25385 -
Journal of the International AIDS... Jun 2024Habits are a common strategy for successfully countering medication non-adherence, yet existing interventions do not support participants during the long habit formation... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Habits are a common strategy for successfully countering medication non-adherence, yet existing interventions do not support participants during the long habit formation period, resulting in high attrition. We test a novel intervention combining text messages and incentives with anchoring to support antiretroviral therapy (ART) pill-taking habits.
METHODS
In a randomized, parallel controlled trial, a sample of 155 participants 18 years and older who initiated ART within 3 months were recruited at Mildmay Uganda between October 2021 and April 2022. All participants were educated on the anchoring strategy and chose an anchor, that is existing routines, to pair with pill-taking. Participants were randomized to either usual care (C = 49), daily text message reminders to follow their anchoring plan (Messages group; T1 = 49) or messages and incentives conditional on pill-taking in line with their anchor (Incentives group; T2 = 57). Assessments occurred at baseline, month 3 (end of intervention) and month 9 (end of observation period). The primary outcomes are electronically measured mean adherence and pill-taking consistent with participants' anchor time.
RESULTS
The primary outcome of pill-taking in line with the anchoring plan was higher in the Incentives group during the 3-month intervention (12.2 p.p. [95% CI: 2.2 22.2; p = .02]), and remained significantly higher after the incentives were withdrawn (months 4-6 (14.2 p.p. [95% CI 1.1 27.2; p = .03]); months 7-9 (14.1 p.p. [95% CI -0.2 28.5; p = .05])). Mean adherence was higher in both treatment groups relative to the control group during the intervention (T1 vs. C, p = .06; T2 vs. C, p = .06) but not post-intervention.
CONCLUSIONS
The promising approach of using incentives to support habit formation among ART treatment initiators needs to be evaluated in a fully powered study to further our understanding of the habit formation process and to evaluate its cost-effectiveness.
Topics: Humans; Uganda; Medication Adherence; Male; Female; HIV Infections; Adult; Motivation; Reminder Systems; Pilot Projects; Text Messaging; Middle Aged; Anti-HIV Agents; Young Adult; Anti-Retroviral Agents
PubMed: 38923298
DOI: 10.1002/jia2.26306 -
The Journal of Clinical Endocrinology... Jun 2024
PubMed: 38922827
DOI: 10.1210/clinem/dgae406 -
JAMA Network Open Jun 2024The US Supreme Court Dobbs v Jackson Women's Health Organization decision allowed states to strengthen restrictions on abortion access, triggering the closure of family...
IMPORTANCE
The US Supreme Court Dobbs v Jackson Women's Health Organization decision allowed states to strengthen restrictions on abortion access, triggering the closure of family planning clinics and leading to confusion about the legality of emergency contraceptives (ECs).
OBJECTIVES
To evaluate the association between the Dobbs decision and fills for oral and emergency contraceptives in states that enacted the most restrictive abortion policies after Dobbs.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data on contraceptive fills for women of reproductive age (15-49 years) in the US from IQVIA's National Prescription Audit PayerTrak and data from the Guttmacher Institute were used to categorize changes in abortion restrictions in each state. A difference-in-differences analysis compared changes in monthly fill rates for daily oral contraceptive pills (OCPs) and ECs in states that became most restrictive (implemented a full abortion ban after Dobbs) and comparison states (kept a medium level of abortion restrictions after Dobbs) before (March 2021 to November 2021) and after (July 2022 to October 2023) the Dobbs decision.
EXPOSURE
State-level abortion restrictions.
MAIN OUTCOMES AND MEASURES
Monthly fills of OCPs and ECs per 100 000 women of reproductive age.
RESULTS
Between March 2021 and October 2023, 142.8 million prescriptions for OCPs and 904 269 prescriptions for ECs were dispensed at US retail pharmacies. Before Dobbs, trends in monthly fill rates were similar for OCPs and ECs between the most restrictive and comparison states. After the Dobbs decision, states that became the most restrictive experienced an additional 4.1% decline in OCP fills with 285.9 fewer fills per 100 000 (95% CI, -495.8 to -6.8; P = .04). In contrast to OCPs, fills for ECs increased during the first year after Dobbs (July 2022 to June 2023) in both groups of states. However, 1 year after Dobbs (July 2023 to October 2023), the most restrictive states experienced an additional 65% decrease in emergency contraceptive fills with 13.2 fewer fills per 100 000 (95% CI, -27.2 to -4.1; P = .01).
CONCLUSIONS AND RELEVANCE
In this cohort study of prescriptions filled at US pharmacies, the Dobbs decision was associated with declines in oral contraceptives, particularly ECs, in states enacting the most restrictive abortion policies. Given the important role of OCPs and ECs in preventing pregnancy and the need for abortion, efforts to improve access may be needed, especially in states where legal abortion is no longer an option.
Topics: Humans; Female; United States; Adult; Adolescent; Young Adult; Contraceptives, Postcoital; Middle Aged; Supreme Court Decisions; Contraceptives, Oral; Abortion, Induced; Cohort Studies; Pregnancy; Contraception, Postcoital
PubMed: 38922616
DOI: 10.1001/jamanetworkopen.2024.18620 -
Clinics and Practice Jun 2024Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception... (Review)
Review
BACKGROUND
Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development.
OBJECTIVES
This study aims to analyze the literature on the safety of progestogen hormonal contraceptive methods during lactation.
METHODS
We conducted a thorough search across various databases, including the National Library of Medicine (PubMed), and the Cochrane Database, Drugs and Lactation Database (LactMed). Our search utilized specific phrases such as: "lactation" and "breastfeeding" and "oral contraception" with "drospirenone" or "desogestrel", with "subcutaneous etonogestrel implant" or "etonogestrel implant", with "levonorgestrel-releasing intrauterine system", and "emergency contraception", with "levonorgestrel" or "ulipristal acetate".
CONCLUSIONS
Based on published scientific reports, progestogen hormonal contraceptives can be considered a relatively safe solution for women desiring to continue feeding their infant with their milk while using hormonal contraception. It is important to seek guidance on selecting the best contraception method based on the latest medical knowledge, tailored to the individual needs and clinical circumstances of each woman and place of residence. A woman should always be informed of the potential risks of such a treatment and then allowed to make her own decision based on the knowledge received from a specialist.
PubMed: 38921261
DOI: 10.3390/clinpract14030083 -
Behavioral Sciences (Basel, Switzerland) May 2024It has been posited that ingesting a pill constitutes a pivotal action that facilitates the effects of open-label placebos (OLPs: placebos honestly prescribed). In the...
It has been posited that ingesting a pill constitutes a pivotal action that facilitates the effects of open-label placebos (OLPs: placebos honestly prescribed). In the present OLP experiment, the motor components of a placebo treatment were systematically varied. The participants ( = 183) were randomly allocated to one of four groups that all viewed aversive pictures. The 'active OLP' group took a placebo pill with specific instructions concerning the sequence of motor actions for the intake. The 'usual OLP' group swallowed the pill (without specific motor instructions), while the third group received an 'imaginary OLP' (no pill intake). The fourth group applied cognitive reappraisal (CR; active control group) to reduce emotional distress. The participants rated their affective state as well as the efficacy and plausibility of the treatment approach. Moreover, blood pressure and pulse were recorded as indicators of bodily arousal. The four groups did not differ in their valence ratings and physiological measures. The 'imaginary OLP' received higher ratings for both effectiveness and plausibility than the 'usual OLP'. CR was rated as superior relative to all OLP conditions. In conclusion, reducing emotional distress with OLPs does not necessitate the consumption of a placebo pill. In terms of acceptability and ease of implementation, CR stands as a well-established alternative.
PubMed: 38920788
DOI: 10.3390/bs14060455 -
The Journal of Clinical Endocrinology... Jun 2024To describe the natural history of inhibin B throughout life according to sex, age, and pubertal development.
OBJECTIVE
To describe the natural history of inhibin B throughout life according to sex, age, and pubertal development.
METHODS
Based on serum samples from 2707 healthy controls aged 0 to 80 years, sex- and age-specific reference ranges of inhibin B concentrations were constructed. Concentrations were evaluated according to pubertal development and use of oral contraceptives (OCs). Also, measurements from 42 patients with Klinefelter syndrome were included.
RESULTS
In both sexes, inhibin B concentrations were high during minipuberty, decreased in childhood, and increased significantly from Tanner stages B1 to B3 (peak: B4) in females and from G1 to G3 (peak: G3) in males. Despite variations in menstruating females, inhibin B concentrations remained relatively constant after puberty, until becoming unmeasurable at menopause. Despite a modest decrease, the inhibin B concentration in males remained relatively high from puberty onwards. At any age, males had highest concentrations. Inhibin B standard deviation (SD) scores were lower in OC-users (median SD score = -0.88) than in non-users (SD score = 0.35), p < 0.001. In patients with Klinefelter syndrome, inhibin B concentrations spanned the reference range until around 15 years of age, where they decreased to subnormal or unmeasurable levels.
CONCLUSION
Valuable sex- and age-specific reference data for inhibin B concentrations were provided. In OC-users, decreased concentrations of inhibin B underlined the ovaries as the only place of inhibin B production. In patients with Klinefelter syndrome, the decline in inhibin B concentrations at puberty underlined the shift in regulation of inhibin B production at pubertal onset.
PubMed: 38920271
DOI: 10.1210/clinem/dgae439