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Pita-Rodríguez GM, Basabe-Tuero B, Díaz-Sánchez ME, Alfonso-Sagué K, Álvarez AMG, Montero-Díaz M, Valdés-Perdomo S, Chávez-Chong C, Rodríguez-Martinez E, Díaz-Fuentes Y, Llera-Abreu E, Calzadilla-Cámbara A, Ríos-Castillo I. Prevalence of Anemia and Iron Deficiency in Women of Reproductive Age in Cuba and Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5110. [PMID: 36982031 PMCID: PMC10049065 DOI: 10.3390/ijerph20065110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
This study aims to evaluate the prevalence of anemia and iron deficiency in women of reproductive age and the association with inflammation, global overweight, adiposity, and menorrhagia. A sample design of women of reproductive age from the Eastern, Central, and Havana Regions was carried out. Biochemical determinations of hemoglobin, serum ferritin, soluble transferrin receptors, leukocytes, C-reactive protein, alpha-1 acid glycoprotein, and homocysteine were performed. Serum ferritin was also adjusted by inflammation. Nutritional status was assessed, and menstrual characteristics were collected by survey. A total of 742 women were studied. The prevalence of anemia was 21.4%, iron storage deficiency at 16.0%, and erythropoietic dysfunction at 5.4%, with inflammation at 47.0% and elevated homocysteine at 18.6%. Global overweight was 46.2% and increased adiposity at 58.4%. Anemia is associated with iron deposition deficiency (OR = 3.023 (1.816-5.033)) and with erythropoietic deficiency (OR = 5.62 (3.03-10.39)), but not with inflammation, global overweight, and adiposity. Global overweight was found to be associated with inflammation (OR = 2.23 (1.41-3.53)). Anemia was associated with heavy menstrual bleeding (OR = 1.92 (1.34-2.76)). Homocysteine was associated with inflammation (OR = 2.05 (1.08-3.90)), but not with anemia. In conclusion, anemia in Cuba is classified as a moderate public health problem, but not iron deficiency. A high prevalence of overweight and obesity was found, associated with inflammation, but not with anemia or iron deficiency. Heavy menstrual bleeding is a factor associated with anemia.
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Affiliation(s)
| | - Beatriz Basabe-Tuero
- National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana 10300, Cuba
| | | | - Karen Alfonso-Sagué
- National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana 10300, Cuba
| | | | | | - Sonia Valdés-Perdomo
- National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana 10300, Cuba
| | | | | | - Yoandry Díaz-Fuentes
- National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana 10300, Cuba
| | - Elisa Llera-Abreu
- National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana 10300, Cuba
| | | | - Israel Ríos-Castillo
- Food and Agricultural Organization (FAO), Sub Regional Office in Mesoamerica, Panama City 0843-00006, Panama
- Nutrition and Dietetic School, University of Panama, Panama City 3366, Panama
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Hu Y, Zhou K, Shan D, Yang M. Interventions for vaginal bleeding irregularities with contraceptive implant. Hippokratia 2021. [DOI: 10.1002/14651858.cd014649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ying Hu
- Department of Obstetrics and Gynecology; West China Second University Hospital, Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education; Chengdu China
- Reproductive Endocrinology and Regulation Laboratory; West China Second University Hospital, Sichuan University; Chengdu China
| | - Kunyan Zhou
- Department of Obstetrics and Gynecology; West China Second University Hospital, Sichuan University; Chengdu China
- Reproductive Endocrinology and Regulation Laboratory; West China Second University Hospital, Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University); Ministry of Education; Chengdu China
| | - Dan Shan
- Department of Obstetrics and Gynecology; West China Second University Hospital, Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education; Chengdu China
- Reproductive Endocrinology and Regulation Laboratory; West China Second University Hospital, Sichuan University; Chengdu China
| | - Meina Yang
- Department of Obstetrics and Gynecology; West China Second University Hospital, Sichuan University; Chengdu China
- Reproductive Endocrinology and Regulation Laboratory; West China Second University Hospital, Sichuan University; Chengdu China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University); Ministry of Education; Chengdu China
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Mwaliko E, Van Hal G, Bastiaens H, Van Dongen S, Gichangi P, Otsyula B, Naanyu V, Temmerman M. Early detection of cervical cancer in western Kenya: determinants of healthcare providers performing a gynaecological examination for abnormal vaginal discharge or bleeding. BMC FAMILY PRACTICE 2021; 22:52. [PMID: 33706721 PMCID: PMC7953728 DOI: 10.1186/s12875-021-01395-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In western Kenya, women often present with late-stage cervical cancer despite prior contact with the health care system. The aim of this study was to predict primary health care providers' behaviour in examining women who present with abnormal discharge or bleeding. METHODS This was a cross-sectional survey using the theory of planned behaviour (TPB). A sample of primary health care practitioners in western Kenya completed a 59-item questionnaire. Structural equation modelling was used to identify the determinants of providers' intention to perform a gynaecological examination. Bivariate analysis was conducted to investigate the relationship between the external variables and intention. RESULTS Direct measures of subjective norms (DMSN), direct measures of perceived behavioural control (DMPBC), and indirect measures of attitude predicted the intention to examine patients. Negative attitudes toward examining women had a suppressor effect on the prediction of health workers' intentions. However, the predictors of intention with the highest coefficients were the external variables being a nurse (β = 0.32) as opposed to a clinical officer and workload of attending less than 50 patients per day (β = 0.56). In bivariate analysis with intention to perform a gynaecological examination, there was no evidence that working experience, being female, having a lower workload, or being a private practitioner were associated with a higher intention to conduct vaginal examinations. Clinical officers and nurses were equally likely to examine women. CONCLUSIONS The TPB is a suitable theoretical basis to predict the intention to perform a gynaecological examination. Overall, the model predicted 47% of the variation in health care providers' intention to examine women who present with recurrent vaginal bleeding or discharge. Direct subjective norms (health provider's conformity with what their colleagues do or expect them to do), PBC (providers need to feel competent and confident in performing examinations in women), and negative attitudes toward conducting vaginal examination accounted for the most variance. External variables in this study also contributed to the overall variance. As the model in this study could not explain 53% of the variance, investigating other external variables that influence the intention to examine women should be undertaken.
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Affiliation(s)
- Emily Mwaliko
- Department of Reproductive Health, School of Medicine, Moi University, Box 4606, Eldoret, 30100 Kenya
| | - Guido Van Hal
- Epidemiology and Social Medicine, Social Epidemiology and Health Policy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331 - 2610 Wilrijk, Antwerp, Belgium
| | - Stefan Van Dongen
- Department of Biology, Evolutionary Ecology Group, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Peter Gichangi
- DVC Academic Research & Extension, Technical University of Mombasa, Mumbasa, Kenya
- Ghent University, Ghent, Belgium
| | - Barasa Otsyula
- Department of Surgery, School of Medicine, Moi University, P.O. Box 4606, Eldoret, 30100 Kenya
| | - Violet Naanyu
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, P.O. Box 3900, Eldoret, 30100 Kenya
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University, P O. Box 00100, Nairobi, Kenya
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Jewson M, Purohit P, Lumsden MA. Progesterone and abnormal uterine bleeding/menstrual disorders. Best Pract Res Clin Obstet Gynaecol 2020; 69:62-73. [PMID: 32698992 DOI: 10.1016/j.bpobgyn.2020.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/30/2022]
Abstract
This chapter explores the role of progesterone and progestogens in the management of abnormal uterine bleeding (AUB). Progestogens are used to regulate intermenstrual bleeding and decrease heavy menstrual bleeding (HMB) in women of reproductive age or who are perimenopausal. In menopausal women, progesterones and progestogens prevent endometrial hyperplasia and aim to reduce the development of endometrial cancer. We hope to make clear current best practice including preparation, specific benefits and risks. Progesterone also acts in concert with other hormones to affect breast, cardiovascular system, lipid profile and bone. We hope to explain how its unintended side effects may be used beneficially or may cause intended side effects.
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Affiliation(s)
- Michaela Jewson
- Obstetrics and Gynaecology, Greater Glasgow and Clyde, Glasgow, UK.
| | - Prashant Purohit
- Obstetrics & Gynaecology, Kings College Hospital NHS Foundation Trust, London, UK
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Paoletti E, Rezkallah S, El Harake S, Castelli M, Benresdouane Y, Brunet D, Suchon P, Morange P, Sarlon-Bartoli G. Descriptive study of the general practitioners' perception of direct oral anticoagulants and the risk of genital bleeding in women of childbearing age. JOURNAL DE MEDECINE VASCULAIRE 2020; 45:198-209. [PMID: 32571560 DOI: 10.1016/j.jdmv.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
AIM OF THE STUDY AND PATIENTS Direct oral anticoagulants (DOA) tend to replace antivitamins K (VKA). The incidence of major and minor hemorrhages is higher in women, a difference potentially linked to genital hemorrhages. The objective is to assess the practices and perception of general practitioners of the use of oral anticoagulant therapy in women of childbearing age. MATERIALS AND METHODS Descriptive, observational, transversal and monocentric study. An 11-items questionnaire was sent to 900 randomized general practitioners, assessing the type of patient, the type of anticoagulant prescribed, the management of genital bleeding, and the assessment of the quality of life of anticoagulated patients. RESULTS DOA were the most prescribed anticoagulants. Genital hemorrhage was the second leading cause of minor hemorrhage. Most doctors (60.6%) believed they were due to VKAs. 25% reported an alteration in the quality of life of patients following these genital hemorrhages and 47.5% addressed this subject in consultation. CONCLUSION Our study suggests that, according to the general practitioners interviewed, genital hemorrhage is more frequent on VKA than on DOA in women of reproductive age, which is contradictory with the data in the literature. The probably taboo subject is rarely mentioned in consultation and is responsible for a deterioration in the quality of life in these young patients. No recommendation exists on the management of this type of genital hemorrhage in these women. An algorithm is proposed for their management.
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Affiliation(s)
- E Paoletti
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - S Rezkallah
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - S El Harake
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - M Castelli
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France
| | - Y Benresdouane
- Laboratory of Haematology, La Timone Hospital, Marseille, France
| | - D Brunet
- Laboratory of Haematology, La Timone Hospital, Marseille, France
| | - P Suchon
- Laboratory of Haematology, La Timone Hospital, Marseille, France; C2VN, Aix Marseille University, Marseille, France
| | - P Morange
- Laboratory of Haematology, La Timone Hospital, Marseille, France; C2VN, Aix Marseille University, Marseille, France
| | - G Sarlon-Bartoli
- Medicine Vascular Department, La Timone Hospital, CHU Timone, 264, rue Saint-Pierre, Marseille, France; C2VN, Aix Marseille University, Marseille, France.
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Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC FAMILY PRACTICE 2018; 19:135. [PMID: 30060741 PMCID: PMC6066914 DOI: 10.1186/s12875-018-0817-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients. METHODS We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES. RESULTS Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy. CONCLUSIONS The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required.
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Affiliation(s)
- Brenda F. Narice
- Clinical Research Fellow in Obstetrics & Gynaecology; Academic Unit of Reproductive and Developmental Unit, University of Sheffield, Sheffield, S10 2SF UK
| | - Brigitte Delaney
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
| | - Jon M. Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
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Dickson JM, Delaney B, Connor ME. Primary care endometrial sampling for abnormal uterine bleeding: a pilot study. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:296-301. [PMID: 28823998 DOI: 10.1136/jfprhc-2017-101735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 11/04/2022]
Abstract
AIM To design and evaluate a pilot service for primary care endometrial sampling (PCES). DESIGN Retrospective analysis of data from two service evaluations. SETTING General practices and the gynaecology department in a large city in the UK. METHODS These were two-fold: (1) To design the new service we identified all the endometrial samples taken in the city's gynaecology department in 2012/2013 and estimated the proportion of these with abnormal uterine bleeding (AUB) that would be suitable for PCES. (2) To evaluate the new PCES service we analysed data from the first year of activity. RESULTS (1) A total of 1894 endometrial samples were taken in hospital in 2012/2013. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. (2) In the first year of the PCES service 108 samples were taken by general practitioners (GPs). Initial management of these patients was exclusively in primary care in 97.2% (104/108) of cases; most patients were treated with the Mirena intrauterine system (79/109; 73.1%) and there were no cases of hyperplasia or cancer. CONCLUSIONS Most premenopausal patients with AUB could potentially be managed in primary care without referral to hospital if endometrial sampling (ES) was made available to appropriately trained and supported GPs. However, this study was limited by its retrospective, non-interventional design, and more research is required to demonstrate safety and cost-effectiveness.
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Affiliation(s)
- Jon M Dickson
- The University of Sheffield, The Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield, UK
| | - Brigitte Delaney
- The University of Sheffield, The Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield, UK
| | - Mary E Connor
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Burness CB. Extended-Cycle Levonorgestrel/Ethinylestradiol and Low-Dose Ethinylestradiol (Seasonique(®)): A Review of Its Use as an Oral Contraceptive. Drugs 2015; 75:1019-26. [PMID: 26017303 DOI: 10.1007/s40265-015-0407-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 91-day extended-cycle oral contraceptive (OC) consisting of levonorgestrel/ethinylestradiol 150/30 µg for 84 days and ethinylestradiol 10 µg for 7 days (Seasonique(®)) has recently been approved for the prevention of pregnancy in adult women in the EU. This regimen allows for a reduction in the number of withdrawal bleeding episodes to four per year, compared with 13 episodes per year with conventional 28-day regimens. Seasonique(®) was effective in preventing pregnancy in a large (n = 1006), noncomparative trial of healthy, sexually active women. In this trial, the overall Pearl index (pregnancies per 100 woman-years of use) in women aged 18-35 years (n = 621) was 0.76 and the Pearl index for method-failure (compliant use) was 0.26. Scheduled (withdrawal) bleeding and/or spotting remained fairly constant over time, with a mean of 2 days of bleeding and 1 day of spotting per each 91-day cycle. Unscheduled bleeding and unscheduled spotting was highest during the first few cycles of use and decreased thereafter. Seasonique(®) was generally well tolerated, with a tolerability profile in line with that expected for OCs. Seasonique(®) extends the contraceptive options currently available to women, particularly in those who desire fewer withdrawal bleeding episodes.
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Affiliation(s)
- Celeste B Burness
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
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Hardman SM, Gebbie AE. The contraception needs of the perimenopausal woman. Best Pract Res Clin Obstet Gynaecol 2014; 28:903-15. [DOI: 10.1016/j.bpobgyn.2014.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/25/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023]
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