Contraception for Adolescents Todd, Nicole; Black, Amanda
Journal of clinical research in pediatric endocrinology,
01/2020, Letnik:
12, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of ...the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are “forgettable” and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent.
Background
Dysmenorrhoea (painful menstrual cramps) is common and a major cause of pain in women. Combined oral contraceptives (OCPs) are often used in the management of primary dysmenorrhoea, but ...there is a need for reporting the benefits and harms. Primary dysmenorrhoea is defined as painful menstrual cramps without pelvic pathology.
Objectives
To evaluate the benefits and harms of combined oral contraceptive pills for the management of primary dysmenorrhoea.
Search methods
We used standard, extensive Cochrane search methods. The latest search date 28 March 2023.
Selection criteria
We included randomised controlled trials (RCTs) comparing all combined OCPs with other combined OCPs, placebo, or management with non‐steroidal anti‐inflammatory drugs (NSAIDs). Participants had to have primary dysmenorrhoea, diagnosed by ruling out pelvic pathology through pelvic examination or ultrasound.
Data collection and analysis
We used standard methodological procedures recommended by Cochrane. The primary outcomes were pain score after treatment, improvement in pain, and adverse events.
Main results
We included 21 RCTs (3723 women). Eleven RCTs compared combined OCP with placebo, eight compared different dosages of combined OCP, one compared two OCP regimens with placebo, and one compared OCP with NSAIDs.
OCP versus placebo or no treatment
OCPs reduce pain in women with dysmenorrhoea more effectively than placebo. Six studies reported treatment effects on different scales; the result can be interpreted as a moderate reduction in pain (standardised mean difference (SMD) −0.58, 95% confidence interval (CI) −0.74 to −0.41; I² = 28%; 6 RCTs, 588 women; high‐quality evidence). Six studies also reported pain improvement as a dichotomous outcome (risk ratio (RR) 1.65, 95% CI 1.29 to 2.10; I² = 69%; 6 RCTs, 717 women; low‐quality evidence). The data suggest that in women with a 28% chance of improvement in pain with placebo or no treatment, the improvement in women using combined OCP will be between 37% and 60%.
Compared to placebo or no treatment, OCPs probably increase the risk of any adverse events (RR 1.31, 95% CI 1.20 to 1.43; I² = 79%; 7 RCTs, 1025 women; moderate‐quality evidence), and may also increase the risk of serious adverse events (RR 1.77, 95% CI 0.49 to 6.43; I² = 22%; 4 RCTs, 512 women; low‐quality evidence).
Women who received OCPs had an increased risk of irregular bleeding compared to women who received placebo or no treatment (RR 2.63, 95% CI 2.11 to 3.28; I² = 29%; 7 RCTs, 1025 women; high‐quality evidence). In women with a risk of irregular bleeding of 18% if using placebo or no treatment, the risk would be between 39% and 60% if using combined OCP. OCPs probably increase the risk of headaches (RR 1.51, 95% CI 1.11 to 2.04; I² = 44%; 5 RCTs, 656 women; moderate‐quality evidence), and nausea (RR 1.64, 95% CI 1.17 to 2.30; I² = 39%; 8 RCTs, 948 women; moderate‐quality evidence). We are uncertain of the effect of OCP on weight gain (RR 1.83, 95% CI 0.75 to 4.45; 1 RCT, 76 women; low‐quality evidence). OCPs may slightly reduce requirements for additional medication (RR 0.63, 95% CI 0.40 to 0.98; I² = 0%; 2 RCTs, 163 women; low‐quality evidence), and absence from work (RR 0.63, 95% CI 0.41 to 0.97; I² = 0%; 2 RCTs, 148 women; low‐quality evidence).
One OCP versus another OCP
Continuous use of OCPs (no pause or inactive tablets after the usual 21 days of hormone pills) may reduce pain in women with dysmenorrhoea more effectively than the standard regimen (SMD −0.73, 95% CI −1.13 to 0.34; 2 RCTs, 106 women; low‐quality evidence). There was insufficient evidence to determine if there was a difference in pain improvement between ethinylestradiol 20 μg and ethinylestradiol 30 μg OCPs (RR 1.06, 95% CI 0.65 to 1.74; 1 RCT, 326 women; moderate‐quality evidence). There is probably little or no difference between third‐ and fourth‐generation and first‐ and second‐generation OCPs (RR 0.99, 95% CI 0.93 to 1.05; 1 RCT, 178 women; moderate‐quality evidence). The standard regimen of OCPs may slightly increase the risk of any adverse events over the continuous regimen (RR 1.11, 95% CI 1.01 to 1.22; I² = 76%; 3 RCTs, 602 women; low‐quality evidence), and probably increases the risk of irregular bleeding (RR 1.38, 95% CI 1.14 to 1.69; 2 RCTs, 379 women; moderate‐quality evidence). Due to lack of studies, it is uncertain if there is a difference between continuous and standard regimen OCPs in serious adverse events (RR 0.34, 95% CI 0.01 to 8.24; 1 RCT, 212 women), headaches (RR 0.94, 95% CI 0.50 to 1.76; I² = 0%; 2 RCTs, 435 women), or nausea (RR 1.08, 95% CI 0.51 to 2.30; I² = 23%; 2 RCTs, 435 women) (all very low‐quality evidence).
We are uncertain if one type of OCP reduces absence from work more than the other (RR 1.12, 95% CI 0.64 to 1.99; 1 RCT, 445 women; very low‐quality evidence).
OCPs versus NSAIDs
There were insufficient data to determine whether OCPs were more effective than NSAIDs for pain (mean difference −0.30, 95% CI −5.43 to 4.83; 1 RCT, 91 women; low‐quality evidence). The study did not report on adverse events.
Authors' conclusions
OCPs are effective for treating dysmenorrhoea, but they cause irregular bleeding, and probably headache and nausea. Long‐term effects were not covered in this review. Continuous use of OCPs was probably more effective than the standard regimen but safety should be ensured with long‐term data. Due to lack of data, we are uncertain whether NSAIDs are better than OCPs for treating dysmenorrhoea.
To examine the effectiveness of concussion prevention strategies in reducing concussion risk in sport.
Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and ...Meta-Analysis) guidelines.
Eleven electronic databases searched and hand-search of references from selected studies.
The following were the study inclusion criteria: (1) contained original human research data; (2) investigated an outcome of concussion or head impact; (3) evaluated a concussion prevention intervention; (4) included sport participants; (5) analytical study designand (6) peer-reviewed. The following were the exclusion criteria: (1) review articles, case series or case studies and (2) not in English.
The studies selected (n=48) provided evidence related to protective gear (helmets, headgear, mouthguards) (n=25), policy and rule changes (n=13) and other interventions (training, education, facilities) (n=10). Meta-analyses demonstrate a combined effect of a 70% reduction (incidence rate ratio (IRR)=0.3 (95% CI: 0.22 to 0.41)) in concussion risk in youth ice hockey leagues where policy disallows body checking, and the point estimate (IRR=0.8 (95% CI: 0.6 to 1.1)) suggests a protective effect of mouthguards in contact and collision sport (basketball, ice hockey, rugby).
Highlights include a protective effect of helmets in skiing/snowboarding and the effectiveness of policy eliminating body checking in youth ice hockey. Future research should examine mouthguards in contact sport, football helmet padding, helmet fit in collision sport, policy limiting contact practice in youth football, rule enforcement to reduce head contact in ice hockey and soccer, ice surface size and board/glass flexibility in ice hockey and training strategies targeting intrinsic risk factors (eg, visual training).
PROSPERO 2016:CRD42016039162.
Background
Endometriosis is a common gynaecological condition affecting 10% to 15% of reproductive‐age women and may cause dyspareunia, dysmenorrhoea, and infertility. One treatment strategy is ...combining surgery and medical therapy to reduce the recurrence of endometriosis. Though the combination of surgery and medical therapy appears to be beneficial, there is a lack of clarity about the appropriate timing of when medical therapy should be used in relation with surgery, that is, before, after, or both before and after surgery, to maximize treatment response.
Objectives
To determine the effectiveness of medical therapies for hormonal suppression before, after, or both before and after surgery for endometriosis for improving painful symptoms, reducing disease recurrence, and increasing pregnancy rates.
Search methods
We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in November 2019 together with reference checking and contact with study authors and experts in the field to identify additional studies.
Selection criteria
We included randomized controlled trials (RCTs) which compared medical therapies for hormonal suppression before, after, or before and after, therapeutic surgery for endometriosis.
Data collection and analysis
Two review authors independently extracted data and assessed risk of bias. Where possible, we combined data using risk ratio (RR), standardized mean difference or mean difference (MD) and 95% confidence intervals (CI). Primary outcomes were: painful symptoms of endometriosis as measured by a visual analogue scale (VAS) of pain, other validated scales or dichotomous outcomes; and recurrence of disease as evidenced by EEC (Endoscopic Endometriosis Classification), rAFS (revised American Fertility Society), or rASRM (revised American Society for Reproductive Medicine) scores at second‐look laparoscopy.
Main results
We included 25 trials with 3378 women with endometriosis. We used the term "surgery alone" to refer to placebo or no medical therapy.
Presurgical medical therapy compared with placebo or no medical therapy
Compared to surgery alone, we are uncertain if presurgical medical hormonal suppression reduces pain recurrence at 12 months or less (dichotomous) (RR 1.10, 95% CI 0.72 to 1.66; 1 RCT, n = 262; very low‐quality evidence) or whether it reduces disease recurrence at 12 months – total (AFS score) (MD –9.6, 95% CI –11.42 to –7.78; 1 RCT, n = 80; very low‐quality evidence).
We are uncertain if presurgical medical hormonal suppression decreases disease recurrence at 12 months or less (EEC stage) compared to surgery alone (RR 1.11, 95% CI 0.86 to 1.43; 1 RCT, n = 262; very low‐quality evidence). We are uncertain if presurgical medical hormonal suppression improves pregnancy rates compared to surgery alone (RR 1.18, 95% CI 0.97 to 1.45; 1 RCT, n = 262; very low‐quality evidence). No trials reported pelvic pain at 12 months or less (continuous) or disease recurrence at 12 months or less.
Postsurgical medical therapy compared with placebo or no medical therapy
We are uncertain about the improvement observed in pelvic pain at 12 months or less (continuous) between postsurgical medical hormonal suppression and surgery alone (SMD ‐0.79, 95% CI ‐1.02 to ‐0.56; 3 RCTs, n = 340; I2 = 91%; very low‐quality evidence).
Compared to surgery alone, postsurgical medical therapy may decrease pain recurrence at 12 months or less (dichotomous) (RR 0.70, 95% CI 0.52 to 0.94; 5 RCTs, n = 657; I2 = 0%; low‐quality evidence).
We are uncertain if postsurgical medical hormonal suppression improves disease recurrence at 12 months – total (AFS score) compared to surgery alone (MD –2.29, 95% CI –4.01 to –0.57; 1 RCT, n = 51; very low‐quality evidence).
Disease recurrence at 12 months or less may be reduced with postsurgical medical hormonal suppression compared to surgery alone (RR 0.30, 95% CI 0.17 to 0.54; 4 RCTs, n = 433; I2 = 58%; low‐quality evidence).
We are uncertain if postsurgical medical hormonal suppression improves disease recurrence at 12 months or less (EEC stage) (RR 0.88, 95% CI 0.67 to 1.15; 1 RCT, n = 285; very low‐quality evidence).
Pregnancy rate is probably increased with postsurgical medical hormonal suppression compared to surgery alone (RR 1.19, 95% CI 1.02 to 1.38; 11 RCTs, n = 955; I2 = 27%; moderate‐quality evidence).
Pre‐ and postsurgical medical therapy compared with surgery alone or surgery and placebo
There were no trials identified in the search for this comparison.
Presurgical medical therapy compared with postsurgical medical therapy
We are uncertain about the difference in pain recurrence at 12 months or less (dichotomous) between postsurgical and presurgical medical hormonal suppression therapy (RR 1.40, 95% CI 0.95 to 2.07; 2 RCTs, n = 326; I2 = 2%; low‐quality evidence).
We are uncertain about the difference in disease recurrence at 12 months or less (EEC stage) between postsurgical and presurgical medical hormonal suppression therapy (RR 1.26, 95% CI 0.97 to 1.65; 1 RCT, n = 273; very low‐quality evidence).
We are uncertain about the difference in pregnancy rate between postsurgical and presurgical medical hormonal suppression therapy (RR 1.08, 95% CI 0.90 to 1.30; 1 RCT, n = 273; very low‐quality evidence).
No trials reported pelvic pain at 12 months or less (continuous), disease recurrence at 12 months – total (AFS score) or disease recurrence at 12 months or less (dichotomous).
Postsurgical medical therapy compared with pre‐ and postsurgical medical therapy
There were no trials identified in the search for this comparison.
Serious adverse effects for medical therapies reviewed
There was insufficient evidence to reach a conclusion regarding serious adverse effects, as no studies reported data suitable for analysis.
Authors' conclusions
Our results indicate that the data about the efficacy of medical therapy for endometriosis are inconclusive, related to the timing of hormonal suppression therapy relative to surgery for endometriosis. In our various comparisons of the timing of hormonal suppression therapy, women who receive postsurgical medical therapy compared with no medical therapy or placebo may experience benefit in terms of pain recurrence, disease recurrence, and pregnancy. There is insufficient evidence regarding hormonal suppression therapy at other time points in relation to surgery for women with endometriosis.
Although there is increased understanding of language barriers in cross-language studies, the point at which language transformation processes are applied in research is inconsistently reported, or ...treated as a minor issue. Differences in translation timeframes raise methodological issues related to the material to be translated, as well as for the process of data analysis and interpretation. In this article we address methodological issues related to the timing of translation from Portuguese to English in two international cross-language collaborative research studies involving researchers from Brazil, Canada, and the United States. One study entailed late-phase translation of a research report, whereas the other study involved early phase translation of interview data. The timing of translation in interaction with the object of translation should be considered, in addition to the language, cultural, subject matter, and methodological competencies of research team members.
Assessments of climate forecast skill depend on choices made by the assessor. In this perspective, we use forecasts of the El Niño-Southern-Oscillation to outline the impact of bias-correction on ...skill. Many assessments of skill from hindcasts (past forecasts) are probably overestimates of attainable forecast skill because the hindcasts are informed by observations over the period assessed that would not be available to real forecasts. Differences between hindcast and forecast skill result from changes in model biases from the period used to form forecast anomalies to the period over which the forecast is made. The relative skill rankings of models can change between hindcast and forecast systems because different models have different changes in bias across periods.
Abstract
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OBJECTIVE:To provide incidence rates and days to symptom resolution and cognitive recovery stratified by sex and sport at a Canadian institution.
STUDY DESIGN:A retrospective chart analysis.
...SUBJECTS:Seven hundred fifty-nine varsity level athletes competing in menʼs football, menʼs and womenʼs soccer, menʼs and womenʼs volleyball, menʼs and womenʼs basketball, menʼs and womenʼs ice hockey, womenʼs field hockey, womenʼs rugby, menʼs and womenʼs tennis, menʼs and womenʼs water polo, menʼs and womenʼs swimming, badminton, cross-country, and track and field in the 2008 to 2009 season through the 2010 to 2011 season.
MAIN OUTCOME MEASURES:Incidence of concussion, days to symptom recovery, and days to cognitive recovery as measured by clinical interpretation using the sports concussion assessment tool (SCAT)/SCAT2 and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) with baseline and follow-up data.
RESULTS:A total of 81 concussions were reported and diagnosed among 759 athletes. Significantly, more female athletes were concussed than male athletes (13.08%–7.53%, respectively; P = 0.014) with the highest rates in womenʼs rugby incidence density (ID) = 20.00 concussions per athlete-season, womenʼs ice hockey (ID = 18.67 per athlete-season), and menʼs basketball (ID = 20.00 per athlete-season). Sex differences in symptom recovery and cognitive recovery were not significant.
CONCLUSIONS:The incidence of concussion across multiple sports in a Canadian varsity athlete population is of concern. There are inconsistencies found between the time an athlete claims to have no symptoms and the time of neurocognitive recovery as measured by computerized neurocognitive testing. Therefore, objective computerized testing is recommended to ensure that athletes are functionally recovered before return to play.
In 2013, Hockey Canada introduced an evidence-informed policy change delaying the earliest age of introduction to body checking in ice hockey until Bantam (ages 13-14) nationwide.
To determine if the ...risk of injury, including concussions, changes for Pee Wee (11-12 years) ice hockey players in the season following a national policy change disallowing body checking.
In a historical cohort study, Pee Wee players were recruited from teams in all divisions of play in 2011-2012 prior to the rule change and in 2013-2014 following the change. Baseline information, injury and exposure data for both cohorts were collected using validated injury surveillance.
Pee Wee players were recruited from 59 teams in Calgary, Alberta (n=883) in 2011-2012 and from 73 teams in 2013-2014 (n=618). There were 163 game-related injuries (incidence rate (IR)=4.37/1000 game-hours) and 104 concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change, and 48 injuries (IR=2.16/1000 game-hours) and 25 concussions (IR=1.12/1000 game-hours) after the rule change. Based on multivariable Poisson regression with exposure hours as an offset, the adjusted incidence rate ratio associated with the national policy change disallowing body checking was 0.50 for all game-related injuries (95% CI 0.33 to 0.75) and 0.36 for concussion specifically (95% CI 0.22 to 0.58).
Introduction of the 2013 national body checking policy change disallowing body checking in Pee Wee resulted in a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old hockey players in Alberta.
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