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Veerus P, Nõmm O, Innos K, Allvee K, Karro H. SARS-CoV-2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register-based study. Acta Obstet Gynecol Scand 2024; 103:250-256. [PMID: 37974467 PMCID: PMC10823385 DOI: 10.1111/aogs.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Data from different countries show partly controversial impact of SARS-CoV-2 infection on pregnancy outcomes. A nationwide register-based study was conducted in Estonia to assess the impact of SARS-CoV-2 infection at any time during pregnancy on stillbirth, perinatal mortality, Apgar score at 5 minutes, cesarean section rates, rates of preterm birth and preeclampsia. MATERIAL AND METHODS Data on all newborns and their mothers were obtained from the Estonian Medical Birth Registry, and data on SARS-CoV-2 testing dates, test results and vaccination dates against SARS-CoV-2 from the Estonian Health Information System. Altogether, 26 211 births in 2020 and 2021 in Estonia were included. All analyses were performed per newborn. Odds ratios with 95% confidence intervals (CI) were analyzed for all outcomes, adjusted for mother's place of residence, body mass index, age of mother at delivery and hypertension and for all the aforementioned variables together with mother's vaccination status using data from 2021 when vaccinations against SARS-CoV-2 became available. For studying the effect of a positive SARS-CoV-2 test during pregnancy on preeclampsia, hypertension was omitted from the models to avoid overadjustment. RESULTS SARS-CoV-2 infection during pregnancy was associated with an increased risk of stillbirth (adjusted odds ratio [aOR] 2.81; 95% CI 1.37-5.74) and perinatal mortality (aOR 2.34; 95% CI 1.20-4.56) but not with a lower Apgar score at 5 minutes, higher risk of cesarean section, preeclampsia or preterm birth. Vaccination slightly decreased the impact of SARS-CoV-2 infection during pregnancy on perinatal mortality. CONCLUSIONS A positive SARS-CoV-2 test during pregnancy was associated with higher rates of stillbirth and perinatal mortality in Estonia but was not associated with change in preeclampsia, cesarean section or preterm birth rates.
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Affiliation(s)
- Piret Veerus
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
- West–Tallinn Central Hospital Women's ClinicTallinnEstonia
| | - Oskar Nõmm
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
| | - Kaire Innos
- Department of Epidemiology and BiostatisticsNational Institute for Health DevelopmentTallinnEstonia
| | - Kärt Allvee
- Estonian Medical Birth RegistryNational Institute for Health DevelopmentTallinnEstonia
| | - Helle Karro
- University of TartuTartuEstonia
- Tartu University HospitalTartuEstonia
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Pathare ADS, Saare M, Meltsov A, Lawarde A, Modhukur V, Kalinina A, Sekavin A, Kukushkina V, Karro H, Salumets A, Peters M. The cervical transcriptome changes during the menstrual cycle but does not predict the window of implantation. Front Reprod Health 2023; 5:1224919. [PMID: 37519341 PMCID: PMC10375708 DOI: 10.3389/frph.2023.1224919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The expression of genes in female reproductive organs is influenced by the cyclic changes in hormone levels during the menstrual cycle. While the molecular changes in the endometrium that facilitate embryo implantation have been extensively studied, there is limited knowledge about the impact of the menstrual cycle on cervical cells. Cervical cells can be easily and routinely collected using a cytobrush during gynecological examination, offering a standardized approach for diagnostic testing. In this study we investigated how the transcriptome of cervical cells changes during the menstrual cycle and assessed the utility of these cells to determine endometrial receptivity. Methods Endocervical cells were collected with cytobrushes from 16 healthy women at different menstrual cycle phases in natural cycles and from four women undergoing hormonal replacement cycles. RNA sequencing was applied to gain insight into the transcriptome of cervical cells. Results Transcriptome analysis identified four differentially expressed genes (DEGs) between early- and mid-secretory samples, suggesting that the transcriptome of cervical cells does not change significantly during the opening of the implantation window. The most differences appeared during the transition to the late secretory phase (2136 DEGs) before the onset of menstruation. Cervical cells collected during hormonal replacement cycles showed 1899 DEGs enriched in immune system processes. Conclusions The results of our study suggested that cervical cells undergo moderate transcriptomic changes throughout the menstrual cycle; however, these changes do not reflect the gene expression pattern of endometrial tissue and offer little or no potential for endometrial receptivity diagnostics.
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Affiliation(s)
- Amruta D. S. Pathare
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Merli Saare
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Alvin Meltsov
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ankita Lawarde
- Competence Centre on Health Technologies, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Vijayachitra Modhukur
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | | | - Aire Sekavin
- Women’s Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Women’s Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andres Salumets
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
- Institute of Genomics, University of Tartu, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Maire Peters
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
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Koort K, Sõsa K, Türk S, Lapp E, Talving E, Karits P, Rosenstein K, Jaagura M, Sekavin A, Sõritsa D, Haldre K, Karro H, Korrovits P, Salumets A, Mändar R. Lactobacillus crispatus-dominated vaginal microbiome and Acinetobacter-dominated seminal microbiome support beneficial ART outcome. Acta Obstet Gynecol Scand 2023. [PMID: 37221898 DOI: 10.1111/aogs.14598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Despite the considerable progress made in assisted reproductive technologies (ART), the implantation rate of transferred embryos remains low and in many cases, the reasons for failure remain unclear. We aimed to determine the potential impact of female and male partners' reproductive tract microbiome composition on ART outcome. MATERIAL AND METHODS The ART couples (n = 97) and healthy couples (n = 12) were recruited into the study. The smaller healthy group underwent a careful selection according to their reproductive and general health criteria. Both vaginal and semen samples were subjected to 16S rDNA sequencing to reveal the bacterial diversity and identify distinct microbial community types. Ethics statement The study was approved by the Ethics Review Committee on Human Research of Tartu University, Tartu, Estonia (protocol no. 193/T-16) on 31 May 2010. Participation in the research was voluntary. Written informed consent was obtained from all study participants. RESULTS The men with Acinetobacter-associated community who had children in the past, had the highest ART success rate (P < 0.05). The women with bacterial vaginosis vaginal microbiome community and with L. iners-predominant and L. gasseri-predominant microbiome had a lower ART success rate than women with the L. crispatus-predominant or the mixed lactic-acid-bacteria-predominant type (P < 0.05). The 15 couples where both partners had beneficial microbiome types had a superior ART success rate of 53%, when compared with the rest of the couples (25%; P = 0.023). CONCLUSIONS Microbiome disturbances in the genital tract of both partners tend to be associated with couple's infertility as well as lower ART success levels and may thus need attention before the ART procedure. The incorporation of genitourinary microbial screening as a part of the diagnostic evaluation process may become routine for ART patients if our results are confirmed by other studies.
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Affiliation(s)
- Kairi Koort
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Kristiina Sõsa
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Silver Türk
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Eleri Lapp
- Competence Centre on Health Technologies, Tartu, Estonia
| | | | | | - Karin Rosenstein
- Competence Centre on Health Technologies, Tartu, Estonia
- Nova Vita Clinic, Tallinn, Estonia
| | - Madis Jaagura
- Nova Vita Clinic, Tallinn, Estonia
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Aire Sekavin
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Health Technologies, Tartu, Estonia
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
- Elite Clinic, Tartu, Estonia
| | - Kai Haldre
- West Tallinn Central Hospital, Tallinn, Estonia
- East Tallinn Central Hospital, Tallinn, Estonia
| | - Helle Karro
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Paul Korrovits
- Competence Centre on Health Technologies, Tartu, Estonia
- Andrological Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Reet Mändar
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
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Peters M, Mikeltadze I, Karro H, Saare M, Salumets A, Mägi R, Laisk T. Endometriosis and irritable bowel syndrome: similarities and differences in the spectrum of comorbidities. Hum Reprod 2022; 37:2186-2196. [PMID: 35713579 DOI: 10.1093/humrep/deac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do the spectrum and prevalence of comorbidities of endometriosis and irritable bowel syndrome (IBS) overlap? SUMMARY ANSWER Despite several overlapping symptoms, the most significantly associated comorbidities of endometriosis and IBS are different and are rather related to the organ systems primarily involved in the index diagnosis. WHAT IS KNOWN ALREADY Endometriosis and IBS both have several similar unspecific symptoms, such as recurrent abdominal pain, cramping and anxiety, and both diseases affect young women and are associated with a number of comorbidities causing a poor quality of life. However, a detailed study, revealing the full spectrum of endometriosis and IBS comorbidities in the same study population, is lacking. STUDY DESIGN, SIZE, DURATION This article presents a retrospective in silico analysis of the data from a large nationwide biobank-based cohort consisting of 121 773 women. After excluding all first- and second-degree relatives, the data of up to 65 421 women were analyzed. PARTICIPANTS/MATERIALS, SETTING, METHODS International Classification of Disease-10 diagnosis main codes associated with endometriosis (N80) and IBS (K58) diagnoses were identified from the Estonian Biobank dataset by linking with the Estonian Health Insurance Fund and other relevant registries. The associations between N80 and K58 and other diagnosis codes were tested using logistic regression, adjusting for age at recruitment and 10 genetic principal components to account for potential population stratification. Bonferroni correction was applied to account for multiple testing. MAIN RESULTS AND THE ROLE OF CHANCE Both women with endometriosis and IBS suffered from more conditions compared to the control group, with 226 and 428 diagnosis codes statistically significantly more frequent in women with respective diagnosis compared to controls. Women suffering from both conditions had 275 significantly associated comorbidities. A remarkable proportion of women with IBS or endometriosis suffered also from endometriosis (9.0%) or IBS (13.6%), respectively. In endometriosis, the most prevalent diagnoses were related to diseases of the genitourinary system (33 N-category codes) and in women with IBS, the most associated diagnoses were related to digestive disorders and gastrointestinal tract (52 codes from K-category). Among the most significant diagnoses in endometriosis were uterine leiomyomas (D25), menstrual disorders (N92) and infertility (N97) (P < 1 × 10-315 for all), and in IBS, lactose intolerance (E73), gastritis and duodenitis (K29) and functional dyspepsia (K30) were in the top list of most significant comorbidities (P < 1 × 10-315 for all). LIMITATIONS, REASONS FOR CAUTION The information about the severity stages of endometriosis and subtypes of IBS was not available for analysis. The findings may not be fully extrapolated to all female populations, because all participants were from one geographic area and had good access to health services. WIDER IMPLICATIONS OF THE FINDINGS These findings support previous studies that have found a high prevalence of pre-selected comorbidities in women with endometriosis and IBS. However, taking into account the differences in the full spectrum of comorbidities of endometriosis and IBS may aid in diagnosing these disorders. Women and healthcare providers need to be aware that women with endometriosis are at high risks of complications during pregnancy and should be carefully monitored. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Estonian Research Council (grant PRG1076), Horizon 2020 innovation grant (ERIN, grant no. EU952516), Enterprise Estonia (grant no. EU48695), MSCA-RISE-2020 project TRENDO (grant no. 101008193) and by the European Union through the European Regional Development Fund (Projects no. 2014-2020.4.01.15-0012 and no. 2014-2020.4.01.16-0125). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Peters
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | - I Mikeltadze
- Department of Oncosurgery, Tartu University Hospital Haematology and Oncology Clinic, Tartu, Estonia
| | - H Karro
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Tartu University Hospital Women's Clinic, Tartu, Estonia
| | - M Saare
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | | | - A Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia.,Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - R Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - T Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
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Lippus H, Laanpere M, Part K, Ringmets I, Karro H. Polyvictimization and the Associations Between Poor Self-Perceived Health, Dissatisfaction With Life, and Sexual Dysfunction Among Women in Estonia. J Interpers Violence 2021; 36:3922-3940. [PMID: 29884111 DOI: 10.1177/0886260518780412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The severe impact of different forms of violence on health has been demonstrated in a substantial number of studies. At the same time, it has been acknowledged that different forms of violence tend to co-occur, such that many survivors of violence have been exposed to more than one violent event and/or more than one form of violence. Despite mounting evidence concerning the associations between polyvictimization and health, there are still important gaps in this knowledge concerning adult female population's sexual health, including both physical and mental aspects associated with it. The aim of this study was to evaluate the exposure to emotional, physical, and sexual violence among women and associations with poor self-perceived health, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The term polyvictimization is used in this article to express the exposure to more than one form of violence. We used data from a cross-sectional study carried out in Estonia in 2014 among women aged 16 to 44 years. Responses of 2,333 women were analyzed for this article. Of all the respondents, 27.9% were polyvictimized. Women who had been exposed to all three forms of violence had, after adjusting for confounding factors, the highest risk of reporting poor self-perceived health, limited daily activities due to chronic health problems, feelings of depression, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The results of this study demonstrate that exposure to violence is associated with poorer health outcomes and that the association is stronger among those who have been polyvictimized.
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Affiliation(s)
- Hedda Lippus
- University of Tartu, Estonia
- Emory University, Atlanta, GA, USA
| | - Made Laanpere
- University of Tartu, Estonia
- Sexual Health Clinic of Tartu, Estonia
- Tartu University Hospital, Estonia
| | - Kai Part
- University of Tartu, Estonia
- Sexual Health Clinic of Tartu, Estonia
- Tartu University Hospital, Estonia
| | | | - Helle Karro
- University of Tartu, Estonia
- Tartu University Hospital, Estonia
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Lippus H, Laanpere M, Part K, Ringmets I, Karro H. What do we know about the impact of sexual violence on health and health behaviour of women in Estonia? BMC Public Health 2020; 20:1897. [PMID: 33302901 PMCID: PMC7727120 DOI: 10.1186/s12889-020-09953-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence against women is a major public health issue and a breach of human rights. Although various consequences of sexual violence on health have been described in a large number of scientific publications, very little is known about this topic in Estonia. The aim of this study was to examine the prevalence of sexual violence and associations between exposure to sexual violence and risky health and sexual behaviours among women in Estonia. METHODS A population-based cross-sectional study was carried out in Estonia in 2014. Self-reported data regarding selected indicators of risky health and sexual behaviours were collected from 1670 women, aged 18-44 years, via a self-administered questionnaire. To measure the prevalence of sexual violence, questions from the NorVold Abuse Questionnaire were included. Chi-square and multivariate logistic regression were used to analyse the data. RESULTS Of the respondents, 22.7% (n = 379) reported being exposed to sexual violence during their lifetime, and over half of these women had had these experiences before the age of 18. Statistically significant associations were found between sexual violence and smoking (adjusted odds ratio (AOR) 1.32, 95% CI 1.03-1.70), alcohol consumption (AOR 1.52, 95% CI 1.18-1.95), illicit drug use (AOR 2.21, 95% CI 1.70-2.89), sexual intercourse for money or other material reward (AOR 3.51, 95% CI 1.62-7.61), concurrent sexual relationships (AOR 2.64; 95% CI 1.80-3.86), and being diagnosed with sexually transmitted infections (AOR 1.48, 95% CI 1.09-2.01). CONCLUSIONS In Estonia, sexual violence against women is widespread and is associated with several risky health and sexual behaviours. Efforts should be made, both among the general public and professionals, to raise awareness regarding the prevalence and negative impact of sexual violence. Women who have been exposed to sexual violence are in need of professional medical, legal and psychological help free from prejudice to help them recover from such traumatic events.
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Affiliation(s)
- Hedda Lippus
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa, 51014 Tartu, Estonia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa, 51014 Tartu, Estonia
- Sexual Health Clinic of Tartu, Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
| | - Kai Part
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa, 51014 Tartu, Estonia
- Sexual Health Clinic of Tartu, Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
| | - Inge Ringmets
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa, 51014 Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
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Saare M, Laisk T, Teder H, Paluoja P, Palta P, Koel M, Kirss F, Karro H, Sõritsa D, Salumets A, Krjutškov K, Peters M. A molecular tool for menstrual cycle phase dating of endometrial samples in endometriosis transcriptome studies†. Biol Reprod 2020; 101:1-3. [PMID: 31004479 DOI: 10.1093/biolre/ioz072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Merli Saare
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia
| | - Triin Laisk
- Competence Centre on Health Technologies; Tartu, Estonia.,Estonian Genome Center Science Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Hindrek Teder
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Priit Paluoja
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Computer Science, University of Tartu, Estonia
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - Mariann Koel
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Fred Kirss
- Tartu University Hospital, Women's Clinic, Tartu, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia.,Tartu University Hospital, Women's Clinic, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Health Technologies; Tartu, Estonia.,Elite Clinic, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaarel Krjutškov
- Competence Centre on Health Technologies; Tartu, Estonia.,Research Program of Molecular Neurology, Research Programs Unit, University of Helsinki, and Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Maire Peters
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia
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Lippus H, Soo K, Laanpere M, Yount KM, Part K, Ringmets I, Ainsaar M, Karro H. The prevalence and patterns of exposure to interpersonal violence among men and women in Estonia. PLoS One 2020; 15:e0237562. [PMID: 32797115 PMCID: PMC7428354 DOI: 10.1371/journal.pone.0237562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background To understand better the total burden of interpersonal violence on society, it is useful to assess the prevalence of interpersonal violence among both, men and women. Exposure to multiple forms of interpersonal violence, referred to as polyvictimization, has been associated with more severe health consequences than exposure to any form separately. The aims of this study were to assess the prevalence of emotional, physical and sexual interpersonal violence in childhood, adulthood and at both childhood and adulthood among men and women in Estonia, analyze the patterns of interpersonal violence and socio-demographic correlates of polyvictimization in adulthood by gender. Methods The analysis was based on two population-based, cross-sectional, self-administered surveys carried out among men and women in Estonia in 2014. In both surveys, the NorVold Abuse questionnaire was used to measure exposure to interpersonal violence. Men and women aged 18–44 were included to the analysis. Results Among men 66.6% and among women 54.2% had been exposed to at least one form of interpersonal violence during lifetime. Men had been more often exposed to isolated physical interpersonal violence, among women the distribution of different forms of interpersonal violence was more even and exposure to sexual violence was more common. The prevalence of polyvictimization in adulthood was two times higher among women compared to men and more socio-demographic correlates, were associated with it. Exposure to violence in childhood was associated with polyvictimization in adulthood across gender. Conclusions The prevalence of interpersonal violence in Estonia is high among men and women. The most prevalent forms and patterns of interpersonal violence, however, differ by gender, as do the socio-demographic correlates. Screening for interpersonal violence, in childhood and adulthood, and gender-specific interventions are needed, especially for high-risk groups identified in this study. Primary prevention of childhood violence should be a priority, as it was associated with higher risk for exposure to violence later in life across gender.
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Affiliation(s)
- Hedda Lippus
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Kadri Soo
- Institute of Social Studies, University of Tartu, Tartu, Estonia
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
- Sexual Health Clinic of Tartu, Tartu, Estonia
| | - Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Sociology, Emory University, Atlanta, Georgia, United States of America
| | - Kai Part
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
- Sexual Health Clinic of Tartu, Tartu, Estonia
| | - Inge Ringmets
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mare Ainsaar
- Institute of Social Studies, University of Tartu, Tartu, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital Women’s Clinic, Tartu, Estonia
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9
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Piltonen TT, Ruokojärvi M, Karro H, Kujanpää L, Morin-Papunen L, Tapanainen JS, Stener-Victorin E, Sundrström-Poromaa I, Hirschberg AL, Ravn P, Glintborg D, Mellembakken JR, Steingrimsdottir T, Gibson-Helm M, Vanky E, Andersen M, Arffman RK, Teede H, Falah-Hassani K. Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe. PLoS One 2019; 14:e0226074. [PMID: 31877155 PMCID: PMC6932801 DOI: 10.1371/journal.pone.0226074] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/18/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia. METHODS This cross-sectional survey was conducted among 382 endocrinologists and obstetrician-gynaecologists in the Nordic countries and Estonia in 2015-2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS. RESULTS Clinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6-8.1) or metformin (OR = 5.0, CI 2.5-10.2), but less frequently OCP (OR = 0.5, CI 0.2-0.9) for non-fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1-4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46-55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2-0.8). CONCLUSION Despite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence-based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.
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Affiliation(s)
- Terhi T. Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- * E-mail:
| | - Maria Ruokojärvi
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Helle Karro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Linda Kujanpää
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Angelica L. Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernille Ravn
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jan Roar Mellembakken
- Department of Reproductive Medicine, Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Thora Steingrimsdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Marianne Andersen
- Department of Language and Culture, UiT—The Arctic University of Norway, Tromsø, Norway
| | - Riikka K. Arffman
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kobra Falah-Hassani
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
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10
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Saare M, Laisk T, Teder H, Paluoja P, Palta P, Koel M, Kirss F, Karro H, Sõritsa D, Salumets A, Krjutškov K, Peters M. A molecular tool for menstrual cycle phase dating of endometrial samples in endometriosis transcriptome studies†. Biol Reprod 2019; 101:868. [PMID: 31687746 DOI: 10.1093/biolre/ioz092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Merli Saare
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia
| | - Triin Laisk
- Competence Centre on Health Technologies; Tartu, Estonia.,Estonian Genome Center Science Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Hindrek Teder
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Priit Paluoja
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Computer Science, University of Tartu, Estonia
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - Mariann Koel
- Competence Centre on Health Technologies; Tartu, Estonia.,Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Fred Kirss
- Tartu University Hospital, Women's Clinic, Tartu, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia.,Tartu University Hospital, Women's Clinic, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Health Technologies; Tartu, Estonia.,Elite Clinic, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaarel Krjutškov
- Competence Centre on Health Technologies; Tartu, Estonia.,Research Program of Molecular Neurology, Research Programs Unit, University of Helsinki, and Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Maire Peters
- Competence Centre on Health Technologies; Tartu, Estonia.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu; Tartu, Estonia
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Veerus P, Karro H. The role of professional society in quality of perinatal care: Experience from Estonia. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Rahu K, Allvee K, Karro H, Rahu M. Singleton pregnancies after in vitro fertilization in Estonia: a register-based study of complications and adverse outcomes in relation to the maternal socio-demographic background. BMC Pregnancy Childbirth 2019; 19:51. [PMID: 30696425 PMCID: PMC6352442 DOI: 10.1186/s12884-019-2194-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background An increased risk of adverse conditions related to in vitro fertilization (IVF) pregnancies has been repeatedly reported. Our study aimed to summarize outcome differences between pregnancies after IVF and after spontaneous conception (SC) in Estonia. Methods Data on all liveborn singletons to primiparas women aged 25–40 years during the period 2005–2014 were obtained from the Estonian Medical Birth Registry. There were 1778 and 33,555 newborns in the IVF and SC cohort, respectively. The relative risk of pregnancy-related complications and adverse pregnancy outcomes in the IVF cohort in comparison with the SC cohort was quantified by prevalence proportion ratios (RR) with 95% confidence intervals (CI) using modified Poisson regression models adjusted for maternal age, education, ethnicity, marital status and study period. Results The cohort of IVF singletons experienced a higher risk of preterm birth (RR 1.51; 95% CI 1.28–1.78), iatrogenic preterm birth (RR 1.62; 95% CI 1.32–1.98), very preterm birth (RR 1.49; 95% CI 1.00–2.23), low birthweight (RR 1.47; 95% CI 1.20–1.80), congenital anomalies (RR 1.51; 95% CI 1.08–2.11), and admission to a neonatal intensive care unit (RR 1.13; 95% CI 1.01–1.26). Somewhat elevated risk of spontaneous preterm birth did not reach statistical significance (RR 1.32; 95% CI 0.97–1.80). IVF mothers were at increased risk of placenta previa (RR 7.15; 95% CI 4.04–12.66), placental abruption (RR 2.12; 1.43–3.14) and cesarean section (RR 1.28; 95% CI 1.20–1.37). The risk of pre-eclampsia was borderline (RR 1.25; 95% CI 0.98–1.59). Adjustment for maternal age attenuated the associations between IVF and adverse outcomes. Maternal education, ethnicity and marital status had no effect on the magnitude of the risk estimates. Conclusions The increased risk of pregnancy-related complications and adverse pregnancy outcomes was observed in the Estonian cohort of IVF singletons in comparison with the cohort of SC singletons. The relative risk estimates grew with maternal age but were not influenced by the maternal education, ethnicity and marital status. To monitor the efficacy and safety of the used assisted reproductive technology, a specialized country-wide register should be created in Estonia.
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Affiliation(s)
- Kaja Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Kärt Allvee
- Estonian Medical Birth Registry, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.,Tartu University Hospitals Womens Clinic, L. Puusepa 8, 51014, Tartu, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
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13
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Gibson-Helm M, Dokras A, Karro H, Piltonen T, Teede HJ. Knowledge and Practices Regarding Polycystic Ovary Syndrome among Physicians in Europe, North America, and Internationally: An Online Questionnaire-Based Study. Semin Reprod Med 2018; 36:19-27. [PMID: 30189447 DOI: 10.1055/s-0038-1667155] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND To inform knowledge translation by identifying evidence-practice gaps in polycystic ovary syndrome (PCOS) care and variations between disciplines and across world regions via an online, anonymous, devised questionnaire distributed via professional societies and completed by 1,495 physicians (2015-2016). METHODS Multivariable logistic regression analyses generated adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations between outcome measures and world region, specialty, annual patients with PCOS, age, and sex. RESULTS Features corresponding to Rotterdam diagnostic criteria were well recognized (e.g., irregular menstrual cycles by 99% of physicians), but psychological implications were recognized only by 29 to 64%. Reproductive endocrinologists were more likely to use Rotterdam diagnostic criteria (OR: 3.1; 95% CI: 2.3-4.3; p < 0.007) than obstetrician-gynecologists. Reproductive (OR: 2.0; 95% CI: 1.5-2.8; p < 0.007) and medical endocrinologists (OR: 3.1; 95% CI: 1.7-5.7; p < 0.007) were more likely to recommend lifestyle management than obstetrician-gynecologists. Physicians in Europe (OR: 4.7; 95% CI: 3.5-6.1; p < 0.007) and other regions (OR: 4.0; 95% CI: 2.8-5.9; p < 0.007) were more likely to use Rotterdam diagnostic criteria than physicians in North America. CONCLUSION Knowledge gaps in PCOS care to be addressed internationally include physician awareness of the breadth of PCOS features, application of diagnostic criteria, and recommending lifestyle management effectively.
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Affiliation(s)
- Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helle Karro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Diabetes and Endocrinology Units, Monash Health, Melbourne, Australia
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14
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Allvee K, Rahu M, Haldre K, Karro H, Rahu K. Quality of IVF status registration in the Estonian Medical Birth Registry: a national record linkage study. Reprod Health 2018; 15:133. [PMID: 30089492 PMCID: PMC6083506 DOI: 10.1186/s12978-018-0575-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Information regarding in vitro fertilization (IVF) as a pregnancy risk factor (yes/ no) is stored in each birth record of the Estonian Medical Birth Registry (EMBR). This study aimed to assess the validity of registration of newborns’ IVF status in the EMBR. Methods To identify the newborns conceived by IVF, the birth records in the EMBR were compared to individual records on the embryo transfer procedures in the Estonian Health Insurance Fund (EHIF) database as a reference. Maternal age was restricted to 40 years, the age limit for IVF treatment covered by the EHIF. The embryo transfer procedures, that dated up to eight weeks before pregnancy, were additionally checked in the infertility treatment clinics. The validity of IVF status was measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV). Relative risk (RR) of unrecorded IVF status among IVF mothers by socio-demographic characteristics and birth plurality was estimated using modified Poisson regression models. Results There were 3198 newborns identified as conceived by IVF in the EMBR in 2005–2014. Eight of them were incorrectly entered as born after IVF. The record linkage with the EHIF database revealed 1014 newborns with unrecorded IVF status in the EMBR. A total of 4204 newborns were verified as conceived by IVF, 24.1% of them were not categorized as born after IVF. The sensitivity of the IVF status registration was poor (75.9%), specificity (100.0%), PPV (99.8%) and NPV (99.3%) were high. The misclassifications were significantly more common among mothers of younger age or non-Estonians or with singleton birth. Conclusion Information based on mother’s self-report or her antenatal chart does not accurately identify the newborn’s IVF status. The lack of a specialized country-wide assisted reproductive technology register in Estonia requires routine record linkage of the EMBR, EHIF and the infertility treatment clinics’ databases to obtain adequate information regarding IVF status in the EMBR. Electronic record linkages between databases would help considerably to improve the validity of data to be used in medical decision making, in research and for statistical purposes.
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Affiliation(s)
- Kärt Allvee
- Estonian Medical Birth Registry, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Kai Haldre
- Centre for Reproductive Medicine, West Tallinn Central Hospital Women's Clinic, Sõle 23, 10614, Tallinn, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.,Tartu University Hospital's Women's Clinic, L. Puusepa 8, 51014, Tartu, Estonia
| | - Kaja Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
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15
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Rekker K, Saare M, Eriste E, Tasa T, Kukuškina V, Roost AM, Anderson K, Samuel K, Karro H, Salumets A, Peters M. High-throughput mRNA sequencing of stromal cells from endometriomas and endometrium. Reproduction 2017; 154:93-100. [PMID: 28495852 DOI: 10.1530/rep-17-0092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/07/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
The aetiology of endometriosis is still unclear and to find mechanisms behind the disease development, it is important to study each cell type from endometrium and ectopic lesions independently. The objective of this study was to uncover complete mRNA profiles in uncultured stromal cells from paired samples of endometriomas and eutopic endometrium. High-throughput mRNA sequencing revealed over 1300 dysregulated genes in stromal cells from ectopic lesions, including several novel genes in the context of endometriosis. Functional annotation analysis of differentially expressed genes highlighted pathways related to cell adhesion, extracellular matrix-receptor interaction and complement and coagulation cascade. Most importantly, we found a simultaneous upregulation of complement system components and inhibitors, indicating major imbalances in complement regulation in ectopic stromal cells. We also performed in vitro experiments to evaluate the effect of endometriosis patients' peritoneal fluid (PF) on complement system gene expression levels, but no significant impact of PF on C3, CD55 and CFH levels was observed. In conclusion, the use of isolated stromal cells enables to determine gene expression levels without the background interference of other cell types. In the future, a new standard design studying all cell types from endometriotic lesions separately should be applied to reveal novel mechanisms behind endometriosis pathogenesis.
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Affiliation(s)
- Kadri Rekker
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia .,Competence Centre on Health TechnologiesTartu, Estonia
| | - Merli Saare
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia
| | - Elo Eriste
- Competence Centre on Health TechnologiesTartu, Estonia
| | - Tõnis Tasa
- Institute of Computer ScienceUniversity of Tartu, Tartu, Estonia.,Estonian Genome CenterUniversity of Tartu, Tartu, Estonia
| | - Viktorija Kukuškina
- Estonian Genome CenterUniversity of Tartu, Tartu, Estonia.,Institute of Molecular and Cell BiologyUniversity of Tartu, Tartu, Estonia
| | | | | | - Külli Samuel
- Competence Centre on Health TechnologiesTartu, Estonia
| | - Helle Karro
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Tartu University Hospital's Women's ClinicTartu, Estonia
| | - Andres Salumets
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia.,Department of BiomedicineInstitute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maire Peters
- Department of Obstetrics and GynecologyInstitute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Competence Centre on Health TechnologiesTartu, Estonia
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16
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Lippus H, Laanpere M, Part K, Ringmets I, Karro H. Sexual violence – are there associations with self-perceived and mental health? Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Saare M, Modhukur V, Suhorutshenko M, Rajashekar B, Rekker K, Sõritsa D, Karro H, Soplepmann P, Sõritsa A, Lindgren CM, Rahmioglu N, Drong A, Becker CM, Zondervan KT, Salumets A, Peters M. The influence of menstrual cycle and endometriosis on endometrial methylome. Clin Epigenetics 2016; 8:2. [PMID: 26759613 PMCID: PMC4710036 DOI: 10.1186/s13148-015-0168-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/30/2015] [Indexed: 12/29/2022] Open
Abstract
Background Alterations in endometrial DNA methylation profile have been proposed as one potential mechanism initiating the development of endometriosis. However, the normal endometrial methylome is influenced by the cyclic hormonal changes, and the menstrual cycle phase-dependent epigenetic signature should be considered when studying endometrial disorders. So far, no studies have been performed to evaluate the menstrual cycle influences and endometriosis-specific endometrial methylation pattern at the same time. Results Infinium HumanMethylation 450K BeadChip arrays were used to explore DNA methylation profiles of endometrial tissues from various menstrual cycle phases from 31 patients with endometriosis and 24 healthy women. The DNA methylation profile of patients and controls was highly similar and only 28 differentially methylated regions (DMRs) between patients and controls were found. However, the overall magnitude of the methylation differences between patients and controls was rather small (Δβ ranging from –0.01 to –0.16 and from 0.01 to 0.08, respectively, for hypo- and hypermethylated CpGs). Unsupervised hierarchical clustering of the methylation data divided endometrial samples based on the menstrual cycle phase rather than diseased/non-diseased status. Further analysis revealed a number of menstrual cycle phase-specific epigenetic changes with largest changes occurring during the late-secretory and menstrual phases when substantial rearrangements of endometrial tissue take place. Comparison of cycle phase- and endometriosis-specific methylation profile changes revealed that 13 out of 28 endometriosis-specific DMRs were present in both datasets. Conclusions The results of our study accentuate the importance of considering normal cyclic epigenetic changes in studies investigating endometrium-related disease-specific methylation patterns. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0168-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merli Saare
- Competence Centre on Health Technologies Tartu, Tartu, Estonia.,Tartu University Women's Clinic, Tartu, Estonia.,Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
| | | | | | | | - Kadri Rekker
- Competence Centre on Health Technologies Tartu, Tartu, Estonia.,Tartu University Women's Clinic, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Health Technologies Tartu, Tartu, Estonia.,Tartu University Women's Clinic, Tartu, Estonia.,Elite Clinic, Tartu, Estonia.,Women's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Helle Karro
- Tartu University Women's Clinic, Tartu, Estonia.,Women's Clinic, Tartu University Hospital, Tartu, Estonia
| | | | | | - Cecilia M Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Nilufer Rahmioglu
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Alexander Drong
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Christian M Becker
- Endometriosis CaRe Centre, Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - Krina T Zondervan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,Endometriosis CaRe Centre, Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - Andres Salumets
- Competence Centre on Health Technologies Tartu, Tartu, Estonia.,Tartu University Women's Clinic, Tartu, Estonia.,Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Health Technologies Tartu, Tartu, Estonia.,Tartu University Women's Clinic, Tartu, Estonia
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Abstract
OBJECTIVES Our study aimed to explore the association between the use of effective contraceptive methods and access to different contraceptive services, as well as to describe accessibility-related obstacles when using contraceptive services and satisfaction with those services. METHODS From a population-based cross-sectional study carried out in 2004 (response rate 53.8%), the data of 16- to 24-year-old women requiring contraception (N = 868) were analysed. Factors associated with the use of effective contraceptive methods and, specifically, hormonal methods, were explored using multiple logistic regression analysis. RESULTS Effective contraception was used by 75.1% of the respondents. The use of effective contraceptive methods was associated with school-based sexuality education (adjusted prevalence odds ratio 2.69; 95% confidence interval 1.32 - 5.50), visiting a youth-friendly clinic (YFC) (1.82; 1.03-3.23) or a private gynaecologist (2.08; 1.11-3.92). The use of hormonal methods was additionally associated with being a native Estonian speaker and visiting a family doctor. More than half of the respondents reported some obstacle in accessing contraceptive services. The highest satisfaction ratings were given to YFCs. CONCLUSIONS Steps to promote the use of services that are youth-friendly and associated with better uptake of effective contraceptive methods are needed among all 16- to 24-year-old women.
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Affiliation(s)
- Kai Part
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia.,c Tartu Sexual Health Clinic , Tartu , Estonia
| | - Inge Ringmets
- d Department of Public Health , University of Tartu , Tartu , Estonia
| | - Made Laanpere
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia.,c Tartu Sexual Health Clinic , Tartu , Estonia
| | - Mati Rahu
- e Department of Epidemiology and Biostatistics , National Institute for Health Development , Tallinn , Estonia
| | - Helle Karro
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia
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Lukasse M, Laanpere M, Karro H, Kristjansdottir H, Schroll AM, Van Parys AS, Wangel AM, Schei B. Pregnancy intendedness and the association with physical, sexual and emotional abuse - a European multi-country cross-sectional study. BMC Pregnancy Childbirth 2015; 15:120. [PMID: 26008119 PMCID: PMC4494794 DOI: 10.1186/s12884-015-0558-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancies are common and when not resulting in a termination of pregnancy may lead to unintended childbirth. Unintended pregnancies are associated with increased health risks, also for women for whom pregnancy continues to childbirth. Our objective was to present the prevalence of unintended pregnancy in six European countries among pregnant women attending routine antenatal care, and to investigate the association with a history of physical, sexual and emotional abuse. METHODS A prospective cross-sectional study, of 7102 pregnant women who filled out a questionnaire during pregnancy as part of a multi-country cohort study (Bidens) with the participating countries: Belgium, Iceland, Denmark, Estonia, Norway and Sweden. A validated instrument, the Norvold Abuse Questionnaire (NorAq) consisting of 10 descriptive questions measured abuse. Pregnancy intendedness was assessed using a single question asking women if this pregnancy was planned. Cross-tabulation, Chi-square tests and binary logistic regression analysis were used. RESULTS Approximately one-fifth (19.2 %) of all women reported their current pregnancy to be unintended. Women with an unintended pregnancy were significantly younger, had less education, suffered economic hardship, had a different ethnic background from the regional majority and more frequently were not living with their partner. The prevalence of an unintended pregnancy among women reporting any lifetime abuse was 24.5 %, and 38.5 % among women reporting recent abuse. Women with a history of any lifetime abuse had significantly higher odds of unintended pregnancy, also after adjusting for confounding factors, AOR for any lifetime abuse 1.41 (95 % CI 1.23-1.60) and for recent abuse AOR 2.03 (95 % CI 1.54-2.68). CONCLUSION Women who have experienced any lifetime abuse are significantly more likely to have an unintended pregnancy. This is particularly true for women reporting recent abuse, suggesting that women living in a violent relationship have less control over their fertility.
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Affiliation(s)
- Mirjam Lukasse
- Institutt for Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
| | - Made Laanpere
- Department of Obstetrics and Gynaecology,, University of Tartu, Tartu, Estonia. .,Tartu University Hospital Women's Clinic, Tartu, Estonia.
| | - Helle Karro
- Department of Obstetrics and Gynaecology,, University of Tartu, Tartu, Estonia. .,Tartu University Hospital Women's Clinic, Tartu, Estonia.
| | | | | | - An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
| | | | - Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Obstetrics and Gynaecology, St. Olav's University Hospital, Trondheim, Norway.
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Lukasse M, Schroll AM, Karro H, Schei B, Steingrimsdottir T, Van Parys AS, Ryding EL, Tabor A. Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries. Acta Obstet Gynecol Scand 2015; 94:508-17. [DOI: 10.1111/aogs.12593] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Mirjam Lukasse
- Department of Health, Nutrition and Management; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Anne-Mette Schroll
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Helle Karro
- Department of Obstetrics and Gynecology; University of Tartu; Tartu Estonia
| | - Berit Schei
- Department of Public Health and General Practice at the Faculty of Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Obstetrics and Gynecology; St. Olav's University Hospital; Trondheim Norway
| | - Thora Steingrimsdottir
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | | | - Elsa Lena Ryding
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Solna Sweden
| | - Ann Tabor
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; Copenhagen University; Copenhagen Denmark
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Ryding EL, Lukasse M, Parys ASV, Wangel AM, Karro H, Kristjansdottir H, Schroll AM, Schei B. Fear of childbirth and risk of cesarean delivery: a cohort study in six European countries. Birth 2015; 42:48-55. [PMID: 25676793 DOI: 10.1111/birt.12147] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few studies have examined the mode of birth among women with fear of childbirth, and the results are conflicting. The objective of this study was to assess the association between fear of childbirth and cesarean delivery in North European women. METHODS A longitudinal cohort study was conducted among 6,422 pregnant women from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records. RESULTS Among 3,189 primiparous women, those reporting severe fear of childbirth were more likely to give birth by elective cesarean, (OR, 1.66 [95% CI 1.05-2.61]). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean (OR 1.87 [95% CI 1.30-2.69]). Reporting lack of positive anticipation, one of six dimensions of fear of childbirth, was most strongly associated with elective cesarean (OR 2.02 [95% CI 1.52-2.68]). A dose-effect pattern was observed between level of fear and risk of emergency cesarean in both primiparous and multiparous women. Indications for cesarean were more likely to be reported as "nonmedical" among those with severe fear of childbirth; 16.7 versus 4.6 percent in primiparous women, and 31.7 versus 17.5 percent in multiparous women. CONCLUSION Having severe fear of childbirth increases the risk of elective cesarean, especially among multiparous women. Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean delivery. Counseling for women who do not look forward to vaginal birth should be further evaluated.
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Affiliation(s)
- Elsa Lena Ryding
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Saare M, Rekker K, Laisk-Podar T, Sõritsa D, Roost AM, Simm J, Velthut-Meikas A, Samuel K, Metsalu T, Karro H, Sõritsa A, Salumets A, Peters M. High-throughput sequencing approach uncovers the miRNome of peritoneal endometriotic lesions and adjacent healthy tissues. PLoS One 2014; 9:e112630. [PMID: 25386850 PMCID: PMC4227690 DOI: 10.1371/journal.pone.0112630] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/09/2014] [Indexed: 12/20/2022] Open
Abstract
Accumulating data have shown the involvement of microRNAs (miRNAs) in endometriosis pathogenesis. In this study, we used a novel approach to determine the endometriotic lesion-specific miRNAs by high-throughput small RNA sequencing of paired samples of peritoneal endometriotic lesions and matched healthy surrounding tissues together with eutopic endometria of the same patients. We found five miRNAs specific to epithelial cells – miR-34c, miR-449a, miR-200a, miR-200b and miR-141 showing significantly higher expression in peritoneal endometriotic lesions compared to healthy peritoneal tissues. We also determined the expression levels of miR-200 family target genes E-cadherin, ZEB1 and ZEB2 and found that the expression level of E-cadherin was significantly higher in endometriotic lesions compared to healthy tissues. Further evaluation verified that studied miRNAs could be used as diagnostic markers for confirming the presence of endometrial cells in endometriotic lesion biopsy samples. Furthermore, we demonstrated that the miRNA profile of peritoneal endometriotic lesion biopsies is largely masked by the surrounding peritoneal tissue, challenging the discovery of an accurate lesion-specific miRNA profile. Taken together, our findings indicate that only particular miRNAs with a significantly higher expression in endometriotic cells can be detected from lesion biopsies, and can serve as diagnostic markers for endometriosis.
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Affiliation(s)
- Merli Saare
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
- Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Kadri Rekker
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
| | - Triin Laisk-Podar
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Tartu University Hospital's Women's Clinic, Tartu, Estonia
- Elite Clinic, Sangla 63, Tartu, Estonia
| | - Anne Mari Roost
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
| | - Jaak Simm
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
- Centre for Biology of Integrated Systems, Tallinn University of Technology, Tallinn, Estonia
| | - Agne Velthut-Meikas
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Centre for Biology of Integrated Systems, Tallinn University of Technology, Tallinn, Estonia
| | - Külli Samuel
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
| | - Tauno Metsalu
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
- Tartu University Hospital's Women's Clinic, Tartu, Estonia
| | | | - Andres Salumets
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
- Institute of Bio- and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia
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Sõritsa D, Saare M, Laisk-Podar T, Peters M, Sõritsa A, Matt K, Karro H, Salumets A. Pregnancy rate in endometriosis patients according to the severity of the disease after using a combined approach of laparoscopy, GnRH agonist treatment and in vitro fertilization. Gynecol Obstet Invest 2014; 79:34-9. [PMID: 25277802 DOI: 10.1159/000365329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the effects of combined treatment approaches on endometriosis-associated infertility in different stages of endometriosis using laparoscopy, gonadotropin-releasing hormone (GnRH) agonist (GnRHa) therapy and in vitro fertilization (IVF). METHODS This retrospective study was carried out on 179 women with surgically confirmed endometriosis. Patients were divided into subgroups: group 1 (stage I-II, n = 121) and group 2 (stage III-IV, n = 58). Patients eligible for IVF, who were found to have adenomyosis or moderate to severe endometriosis, were also given postoperative GnRHa. Pregnancy and delivery rates were cumulatively calculated during 5 years according to the severity of the disease. RESULTS The overall pregnancy, delivery and miscarriage rates were 66.5, 56.4 and 15.1%, respectively, for all patients following spontaneous and assisted conception. There were no significant differences in reproductive outcomes between the study groups. The pregnancy and delivery rates were also comparable within group 1 between the patients with and without GnRHa treatment. CONCLUSION Pregnancy and delivery rates at different stages of endometriosis were not affected by the different approaches used for infertility treatment, with >60 and >50% of patients having conceived and delivered a baby, respectively, in both groups. The usefulness of GnRHa treatment for endometriosis patients with minimal to mild forms is questionable and deserves further studies.
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Affiliation(s)
- Deniss Sõritsa
- Women's Clinic of Tartu University Hospital, Tartu, Estonia
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Laanpere M, Ringmets I, Part K, Allvee K, Veerus P, Karro H. Abortion trends from 1996 to 2011 in Estonia: special emphasis on repeat abortion. BMC Womens Health 2014; 14:81. [PMID: 25005363 PMCID: PMC4099403 DOI: 10.1186/1472-6874-14-81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/04/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The study aimed to describe the overall and age-specific trends of induced abortions from 1996 to 2011 with an emphasis on socio-demographic characteristics and contraceptive use of women having had repeat abortions in Estonia. METHODS Data were retrieved from the Estonian Medical Birth and Abortion Registry and Statistics Estonia. Total induced abortion numbers, rates, ratios and age-specific rates are presented for 1996-2011. The percentage change in the number of repeat abortions within selected socio-demographic subgroups, contraception use and distribution of induced abortions among Estonians and non-Estonians for the first, second, third, fourth and subsequent abortions were calculated for the periods 1996-2003 and 2004-2011. RESULTS Observed trends over the 16-year study period indicated a considerable decline in induced abortions with a reduction in abortion rate of 57.1%, which was mainly attributed to younger cohorts. The percentage of women undergoing repeat abortions fell steadily from 63.8% during 1996-2003 to 58.0% during 2004-2011. The percentage of women undergoing repeat abortions significantly decreased over the 16 years within all selected socio-demographic subgroups except among women with low educational attainment and students. Within each time period, a greater percentage of non-Estonians than Estonians underwent repeat abortions and obtained third and subsequent abortions. Most women did not use any contraceptive method prior to their first or subsequent abortion. CONCLUSION A high percentage of women obtaining repeat abortions reflects a high historical abortion rate. If current trends continue, a rapid decline in repeat abortions may be predicted. To decrease the burden of sexual ill health, routine contraceptive counselling, as standard care in the abortion process, should be seriously addressed with an emphasis on those groups--non-Estonians, women with lower educational attainment, students and women with children--vulnerable with respect to repeat abortion.
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Affiliation(s)
- Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, L, Puusepa 8, Tartu 51014, Estonia.
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Lukasse M, Schroll AM, Ryding EL, Campbell J, Karro H, Kristjansdottir H, Laanpere M, Steingrimsdottir T, Tabor A, Temmerman M, Van Parys AS, Wangel AM, Schei B. Prevalence of emotional, physical and sexual abuse among pregnant women in six European countries. Acta Obstet Gynecol Scand 2014; 93:669-77. [DOI: 10.1111/aogs.12392] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mirjam Lukasse
- Department of Public Health and General Practice; Norwegian University of Science and Technology; Trondheim Norway
- Department of Health, Nutrition and Management; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Anne-Mette Schroll
- Center for Fetal Medicine and Pregnancy; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Elsa Lena Ryding
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
| | | | - Helle Karro
- Department of Obstetrics and Gynecology; University of Tartu; Tartu University Hospital Women's Clinic; Tartu Estonia
| | - Hildur Kristjansdottir
- Health Directorate; Reykjavik Iceland
- Faculty of Nursing; Department of Midwifery; University of Iceland; Reykjavik Iceland
| | - Made Laanpere
- Department of Obstetrics and Gynecology; University of Tartu; Tartu Sexual Health Clinic; Tartu Estonia
| | | | - Ann Tabor
- Center for Fetal Medicine and Pregnancy; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; Copenhagen University; Copenhagen Denmark
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences Ghent University; International Centre for Reproductive Health; Ghent Belgium
| | - An-Sofie Van Parys
- Faculty of Medicine and Health Sciences Ghent University; International Centre for Reproductive Health; Ghent Belgium
| | | | - Berit Schei
- Department of Public Health and General Practice; Norwegian University of Science and Technology; Trondheim Norway
- Department of Obstetrics and Gynecology; St Olav's University Hospital; Trondheim Norway
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Schei B, Lukasse M, Ryding EL, Campbell J, Karro H, Kristjansdottir H, Laanpere M, Schroll AM, Tabor A, Temmerman M, Van Parys AS, Wangel AM, Steingrimsdottir T. A history of abuse and operative delivery--results from a European multi-country cohort study. PLoS One 2014; 9:e87579. [PMID: 24498142 PMCID: PMC3909197 DOI: 10.1371/journal.pone.0087579] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. DESIGN The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. RESULTS Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19). CONCLUSION Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.
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Affiliation(s)
- Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St.Olav's University Hospital, Trondheim, Norway
| | - Mirjam Lukasse
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elsa Lena Ryding
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden
| | - Jacquelyn Campbell
- John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Helle Karro
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Hildur Kristjansdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Directorate of Health, Reykjavik, Iceland
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Anne-Mette Schroll
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Tabor
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | | - Thora Steingrimsdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland
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Part K, Moreau C, Donati S, Gissler M, Fronteira I, Karro H. Teenage pregnancies in the European Union in the context of legislation and youth sexual and reproductive health services. Acta Obstet Gynecol Scand 2013; 92:1395-406. [PMID: 24004102 DOI: 10.1111/aogs.12253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study cross-country and regional variations and trends in reported teenage pregnancies in the context of legislation and youth sexual and reproductive health (SRH) services in Europe. DESIGN Data were collected on teenage live births and induced abortions, abortion legislation and youth SRH services. SETTING Population-based statistics from the European Union (EU) member states. POPULATION Fifteen- to nineteen-year-old female teenagers. METHODS Detailed statistical information for each member state about teenage live births, induced abortions, abortion legislation and youth SRH services were compiled relying on national and international data sources. MAIN OUTCOME MEASURES The annual reported pregnancies per 1000 women aged 15-19 years. RESULTS Teenage pregnancy rates have declined since 2001, although progress has been uneven across regions and countries. Eastern Europe has a higher average teenage pregnancy rate (41.7/1000) than Northern (30.7/1000), Western (18.2/1000) and Southern Europe (17.6/1000). While data on teenage live births are available across Europe, data on teenage abortions are unavailable or incomplete in more than one-third of EU countries. Reported teenage pregnancy rates are generally lower for countries where parental consent for abortion is not required, youth SRH services are available in all areas and contraceptives are subsidized for all minors, compared with countries where these conditions are not met. CONCLUSIONS The collection of standardized teenage pregnancy statistics is critically needed in the EU. The remarkable variability in teenage pregnancy rates across the EU is likely to be explained, among other factors, by varying access to abortion and youth SRH services.
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Affiliation(s)
- Kai Part
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia; Doctoral School of Clinical Medicine, University of Tartu, Tartu University Hospital, Tartu, Estonia
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Velthut A, Zilmer M, Zilmer K, Kaart T, Karro H, Salumets A. Elevated blood plasma antioxidant status is favourable for achieving IVF/ICSI pregnancy. Reprod Biomed Online 2013; 26:345-52. [PMID: 23415995 DOI: 10.1016/j.rbmo.2012.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/22/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022]
Abstract
The aim of the study was to determine the roles of intrafollicular and systemic oxidative stress and antioxidant response in ovarian stimulation and intracytoplasmic sperm injection (ICSI) outcomes. For this purpose, 102 ICSI patients undergoing controlled ovarian stimulation were enrolled and samples were collected on the day of follicle puncture. Total peroxide (TPX) concentrations and total antioxidant response (TAR) were measured in follicular fluid and blood plasma, and an oxidative stress index (OSI) was calculated based on these two parameters. Urinary concentrations of 8-iso-prostaglandin F2a (F2IsoP) were measured. Elevated intrafollicular oxidative stress was positively correlated with ovarian stimulation outcome: less FSH per retrieved oocyte was used, more oocytes were collected and higher serum oestradiol concentrations were measured in patients with higher follicular OSI. However, high urinary F2IsoP related to lower embryo quality and F2IsoP was also elevated in smoking patients. Patients with endometriosis had lower follicular antioxidant status. Most importantly, higher systemic blood TAR was significantly favourable for achieving clinical pregnancy (P=0.03). In conclusion, the findings suggest clear associations between oxidative stress, antioxidant status and several aspects of ovarian stimulation and IVF/ICSI outcome, including pregnancy rate. Several oxygen-dependent biochemical reactions produce reactive oxygen species as by-products that may eventually lead to oxidative stress, which is detrimental to cells and tissues. Total antioxidant status, on the other hand, comprises several agents that balance the excess of these reactive oxygen species and reduce potential damage to the body. The aim of the current work was to study this balance in 102 patients participating in an ICSI programme and to examine the degree to which total peroxide content and antioxidant status influence infertility and pregnancy outcome. During the study, several tests were performed to characterize oxidative stress levels in ovarian follicular fluid, blood plasma and urine. We found a significantly higher oxidative stress environment in the ovary when compared with blood plasma. This suggests a prominent role of oxidative stress in the ovaries of these patients. The elevated oxidative stress levels were correlated to a higher number of oocytes that could be obtained via the procedure and to a lower amount of FSH needed to mature the oocytes, suggesting that oxidative stress, to some degree, is favourable for hormone stimulation outcome. A high level of lipid peroxidation products in the urine, another marker of oxidative stress, was observed in smokers and this marker was elevated in patients with embryos that had lower developmental potential. A higher overall antioxidant status in blood plasma was advantageous for achieving pregnancy.
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Affiliation(s)
- Agne Velthut
- Centre for Biology of Integrated Systems, Tallinn University of Technology, Tallinn, Estonia.
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Laanpere M, Ringmets I, Part K, Karro H. Intimate partner violence and sexual health outcomes: a population-based study among 16-44-year-old women in Estonia. Eur J Public Health 2012; 23:688-93. [PMID: 23093715 DOI: 10.1093/eurpub/cks144] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Violence against women as a public issue and health burden has only recently been acknowledged in Estonia. The aim of this study was to outline the prevalence and to explore the associations of intimate partner violence (IPV) and selected sexual health outcomes. METHODS Data from the population based cross-sectional survey among representative sample of 16-44-year-old non-pregnant women (n = 1966) were analysed using multivariate logistic regression. RESULTS Of 1966 respondents, 362 (18.4%) reported IPV during 12 months preceding the survey. Physical IPV was reported by 339 (17.2%), sexual by 80 (4.1%) and both physical and sexual by 35 (1.8%) of respondents. After controlling for significant confounding socio-demographic factors, exposure to IPV was found to be associated with contraception non-use [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI) 1.44-2.82] or the use of unreliable contraceptive methods (AOR = 1.54, CI 1.16-2.04) during the most recent sexual intercourse, having never used a condom (AOR = 1.53, CI 1.12-2.10), repeat induced abortion (AOR = 1.72, CI 1.24-2.37), lifetime sexually transmitted infections (AOR = 2.05, CI 1.56-2.68) and dyspareunia (AOR = 2.14, CI 1.65-2.77). CONCLUSION The exposure of IPV was an important contributor to sexual risk behaviour and adverse sexual health outcomes among women of reproductive age in Estonia. Any strategy to promote sexual health should include prevention of IPV and other forms of violence against women with the strengthening of women's sexual and reproductive rights.
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Affiliation(s)
- Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.
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Schei B, Lukasse M, Ryding E, Schroll AM, Steingrimsdottir T, Karro H. O407 EMOTIONAL, PHYSICAL AND SEXUAL ABUSE IN PREGNANT WOMEN AND MODE OF DELIVERY IN SIX EUROPEAN COUNTRIES - RESULTS FROM THE BIDENS* STUDY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Laanpere M, Rahu K, Part K, Dubikaytis T, Karro H. Ethnic differences in factors associated with the use of contraception among 20- to 44-year-old women in Estonia and St. Petersburg, Russia. Contraception 2012; 86:132-40. [DOI: 10.1016/j.contraception.2011.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 11/27/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022]
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Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, da Siva MO, Olsen J, Savona-Ventura C, Temmerman M, Hemminki E. Terminations of pregnancy in Europe: the East-West divide. BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03354.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saare M, Soritsa D, Vaidla K, Palta P, Remm M, Laan M, Karro H, Soritsa A, Salumets A, D'Hooghe T, Peters M. No evidence of somatic DNA copy number alterations in eutopic and ectopic endometrial tissue in endometriosis. Hum Reprod 2012; 27:1857-64. [DOI: 10.1093/humrep/des125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, Oliveira da Silva M, Olsen J, Savona-Ventura C, Temmerman M, Hemminki E. Terminations of pregnancy in the European Union. BJOG 2011; 119:324-32. [PMID: 22129480 DOI: 10.1111/j.1471-0528.2011.03189.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the current legislation and trends in terminations of pregnancy in the European Union (EU). DESIGN Data were collected on legislation and statistics for terminations of pregnancy. SETTING Population-based statistics from the EU member states. POPULATION Women in reproductive age in the 27 EU member states. METHODS Information on legislation was collected for all 27 EU member states. Statistical information until 2008 was compiled from international (n = 24) and national sources (n = 17). Statistical data were not available for Austria, Cyprus and Luxembourg. MAIN OUTCOMES MEASURES Terminations of pregnancy per 1000 women aged 15-49 years. RESULTS Ireland, Malta and Poland have restrictive legislation. Luxembourg permits termination of pregnancy on physical and mental health indications; Cyprus, Finland, and the UK further include socio-economic indications. In all other EU member states termination of pregnancy can be performed in early pregnancy on a women's request. In general, the rates of termination of pregnancy have declined in recent years. In total, 10.3 terminations were reported per 1000 women aged 15-49 years in the EU in 2008. The rate was 12.3/1000 for countries requiring a legal indication for termination, and 11.0/1000 for countries allowing termination on request. Northern Europe (10.9/1000) and Central and Eastern Europe (10.8/1000) had higher rates than Southern Europe (8.9/1000). Northern Europe, however, had substantially higher rates of termination of pregnancy among teenagers. CONCLUSION A more consistent and coherent reporting of terminations of pregnancy is needed in the EU. The large variation of termination rates between countries suggests that termination of pregnancy rates may be reduced in some countries without restricting women's access to termination. Sexual education and provision of access to reliable and affordable contraception are essential to achieve low rates of termination of pregnancy.
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Affiliation(s)
- M Gissler
- Information Department, THL National Institute for Health and Welfare, Helsinki, Finland.
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lamp M, Peters M, Reinmaa E, Haller-Kikkatalo K, Kaart T, Kadastik U, Karro H, Metspalu A, Salumets A. Polymorphisms in ESR1, ESR2 and HSD17B1 genes are associated with fertility status in endometriosis. Gynecol Endocrinol 2011; 27:425-33. [PMID: 20586553 DOI: 10.3109/09513590.2010.495434] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate whether polymorphisms in genes involved in biosynthesis and signalling of sex steroids influence susceptibility to endometriosis and to infertility associated with it. MATERIALS AND METHODS Patients with endometriosis (n = 150) and fertile controls (n = 199) were genotyped for polymorphisms in oestrogen receptor genes ESR1 (rs2234693 - T/C single nucleotide polymorphism (SNP), dinucleotide (TA)(n) repeat) and ESR2 (dinucleotide (CA)(n) repeat), progesterone receptor gene PGR (rs10895068 - G/A SNP, 306-bp Alu-insertion), 17β-hydroxysteroid dehydrogenase type 1 gene HSD17B1 (rs605059 - A/G SNP), and aromatase gene CYP19A1 (rs10046 - C/T SNP, (TTTA)(n) tetranucleotide repeat, 3-bp TCT insertion/deletion polymorphism). RESULTS The HSD17B1 A/G SNP A allele increased overall endometriosis risk and the risk of stage I-II disease, while ESR1 longer (TA)(n) repeats only correlated with susceptibility to stage I-II endometriosis. When considering patients' fertility status, HSD17B1 A/G SNP A allele and ESR1 longer (TA)(n) repeats were associated with endometriosis accompanied by infertility, while ESR2 shorter (CA)(n) repeats were linked with endometriosis without infertility. Other polymorphisms were distributed similarly among patients and controls. CONCLUSIONS Genetic variants in ESR1, ESR2, and HSD17B1 genes could modify susceptibility to endometriosis and might influence the fertility status in endometriosis patients.
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Affiliation(s)
- Merit Lamp
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.
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Abstract
AIMS To examine factors associated with early sexual intercourse among 15 to 16-year-old adolescents by gender. METHODS The data were collected from a random sample of Estonian basic schools' ninth grade pupils in 1999 using self-completed questionnaires. A multivariate logistic regression analysis for boys and girls was used to test for associations between sexual intercourse, and personal gender role-related attitudes, attitudes towards sexual intercourse, pubertal timing, smoking status and experience of drunkenness. RESULTS Of the respondents, 14.6% of boys and 13.1% of girls had experienced sexual intercourse. Traditional gender role-related attitudes were associated with sexual intercourse among girls, but not among boys. Smoking and experience of drunkenness was strongly associated with sexual intercourse for both genders. CONCLUSIONS Gender differences in the association between gender role-related attitudes and early sexual intercourse were observed among 15 to 16-year-olds in Estonia. Smoking and experience of drunkenness were strongly related to sexual intercourse for both genders.
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Affiliation(s)
- Kai Part
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia, Tartu Youth Counselling Centre, Tartu, Estonia.
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Palial KK, Drury J, Heathcote L, Valentijin A, Farquharson RG, Gazvani R, Rudland PS, Hapangama DK, Celik N, Celik O, Aktan E, Ozerol E, Celik E, Bozkurt K, Paran H, Hascalik S, Ozerol I, Arase T, Maruyama T, Uchida H, Miyazaki K, Oda H, Uchida-Nishikawa S, Kagami M, Yamazaki A, Tamaki K, Yoshimura Y, De Vos M, Ortega C, Smitz J, Van Vaerenbergh I, Bourgain C, Devroey P, Luciano D, Exacoustos C, Zupi E, Luciano AA, Arduini D, Palomino WA, Argandona F, Kohen P, Azua R, Scarella A, Devoto L, McKinnon B, Bersinger NA, Mueller MD, Bonavita M, Mattila M, Ferreira FP, Maia-Filho V, Rocha AM, Serafini P, Motta ELA, Kim H, Kim CH, You RM, Nah HY, Lee JW, Kang HJ, Kang BM, Letur - Koenirsch H, Haouzi D, Olivennes F, Rouleau C, Cohen-Bacri P, Dechaud H, Hamamah S, D'Hooghe T, Hummelshoj L, Dunselman GAJ, Dirksen CD, EndoCost Consortium WERF, Simoens S, Novembri R, Luisi S, Carrarelli P, Rocha ALL, Toti P, Reis FM, Florio P, Petraglia F, Bruce KD, Sadek KH, Macklon N, Cagampang FR, Cheong Y, Goudakou M, Kalogeraki A, Matalliotakis I, Papatheodorou A, Pasadaki T, Karkanaki A, Prapas I, Prapas I, Kalogeraki A, Matalliotakis I, Panagiotidis I, Kasapi E, Karkanaki A, Goudakou M, Barlow D, Oliver J, Loumaye E, Khanmohammadi M, kazemnejad S, darzi S, Khanjani S, Zarnani A, Akhondi M, Tan CW, Ng CP, Loh SF, Tan HH, Choolani M, Griffith L, Chan J, Andersson KL, Sundqvist J, Scarselli G, Gemzell-Danielsson K, Lalitkumar PG, Jana S, Chattopadhyay R, Datta Ray C, Chaudhury K, Chakravarty BN, Hannan N, Evans J, Hincks C, Rombauts LJF, Salamonsen LA, Choi D, Lee J, Park J, Chang H, Kim M, Hwang K, Takeuchi K, Kurematsu T, Fukumoto Y, Yuki Y, Kuroki Y, Homan Y, Sata Y, Takeuchi M, Munoz Munoz E, Ortiz Olivera G, Fernandez Lopez I, Martinez Martinez B, Aguilar Prieto J, Portela Perez S, Pellicer Martinez A, Keltz M, Sauerbrun M, Breborowicz A, Gonzales E, Vicente-Munoz S, Puchades-Carrasco L, Morcillo I, Hidalgo JJ, Gilabert-Estelles J, Novella-Maestre E, Pellicer A, Pineda-Lucena A, Yavorovskaya KA, Okhtyrskaya TA, Demura TA, Faizulina NM, Ezhova LS, Kogan EA, Bilibio JP, Souza CAB, Rodini GP, Genro V, Andreoli CG, de Conto E, Cunha-Filho JSL, Saare M, Soritsa D, Jarva L, Vaidla K, Palta P, Laan M, Karro H, Soritsa A, Salumets A, Peters M, Miskova A, Pilmane M, Rezeberga D, Haouzi D, Dechaud H, Assou S, Letur H, Olivennes F, Hamamah S, Piomboni P, Stendardi A, Gambera L, De Leo V, Petraglia F, Focarelli R, Tamm K, Simm J, Salumets A, Metsis M, Vodolazkaia A, Fassbender A, Kyama CM, Bokor A, Schols D, Huskens D, Meuleman C, Peeraer K, Tomassetti C, D'Hooghe TM, Machens K, Afhuppe W, Schulz A, Diefenbach K, Schutt B, Faustmann T, Reischl J, Peters M, Altmae S, Reimand J, Laisk T, Saare M, Hovatta O, Kolde R, Vilo J, Stavreus-Evers A, Salumets A, Lee JH, Kim SG, Kim YY, Park IH, Sun HG, Lee KH, Ezoe K, Kawano H, Yabuuchi A, Ochiai K, Nagashima H, Osada H, Kagawa N, Kato O, Tamura I, Asada H, Taketani T, Tamura H, Sugino N, Garcia Velasco J, Prieto L, Quesada JF, Cambero O, Toribio M, Pellicer A, Hur CY, Lim KS, Lee WD, Lim JH, Germeyer A, Nelson L, Graham A, Jauckus J, Strowitzki T, Lessey B, Gyulmamedova I, Illina O, Illin I, Mogilevkina I, Chaika A, Nosenko O, Boykova I, Gulmamedova E, Isik H, Moraloglu O, Seven ALI, Kilic S, Erkayiran U, Caydere M, Batioglu S, Alhalabi M, Samawi S, Taha A, Kafri N, Modi S, Khatib A, Sharif J, Othman A, Lancuba S, Branzini C, Lopez M, Baricalla A, Cristina C, Chen J, Jiang Y, Zhen X, Hu Y, Yan G, Sun H, Mizumoto J, Ueno J, Carvalho FM, Casals G, Ordi J, Guimera M, Creus M, Fabregues F, Casamitjana R, Carmona F, Balasch J, Choi YS, Kim KC, Lee WD, Kim KH, Lee BS, Kim SH, Fassbender A, Overbergh L, Verdrengh E, Kyama C, Vodolazkaia A, Bokor A, Meuleman C, Peeraer K, Tomassetti C, Waelkens E, Mathieu C, D'Hooghe T, Iwasa T, Hatano K, Hasegawa E, Ito H, Isaka K, L. Rocha AL, Luisi S, Carrarelli P, Novembri R, Florio P, Reis F, Petraglia F, Lee KS, Joo JK, Son JB, Choi JR, Vidali A, Barad DH, Gleicher N, Jiang Y, Chen J, Zhen X, Hu Y, Sun H, Yan G, Sayyah-Melli M, Kazemi-Shishvan M. POSTER VIEWING SESSION - ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laisk T, Peters M, Saare M, Haller-Kikkatalo K, Karro H, Salumets A. Association of CCR5, TLR2, TLR4 and MBL genetic variations with genital tract infections and tubal factor infertility. J Reprod Immunol 2010; 87:74-81. [DOI: 10.1016/j.jri.2010.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/01/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Laisk T, Haller-Kikkatalo K, Laanpere M, Jakovlev U, Peters M, Karro H, Salumets A. Androgen receptor epigenetic variations influence early follicular phase gonadotropin levels. Acta Obstet Gynecol Scand 2010; 89:1557-63. [PMID: 21050150 DOI: 10.3109/00016349.2010.526182] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE we examined the influence of the androgen receptor gene (AR) CAG microsatellite (AR-CAG) repeat polymorphism and X-chromosome inactivation (XCI) pattern on ovarian reserve markers (follicle stimulating hormone (FSH) and antral follicle count on menstrual cycle day 3-5) and disease etiology in patients with polycystic ovarian syndrome (PCOS) or premature ovarian failure (POF). DESIGN case-control study. Population. In all, 32 women with PCOS, 26 women with POF and 79 controls were investigated. METHODS AR-CAG and XCI were analyzed using polymerase chain reaction-based assays following DNA digestion with the methylation-sensitive restrictase HpaII. MAIN OUTCOME MEASURES distribution of AR-CAG alleles and XCI patterns. RESULTS POF patients had shorter AR-CAG microsatellites than controls. AR-CAG microsatellite length was negatively associated with serum dehydroepiandrosterone sulfate level. The magnitude of XCI skewing was negatively and positively correlated with luteinizing hormone (LH) and FSH serum levels, respectively, during the early follicular phase, but showed no correlation with the number of early antral follicles. CONCLUSIONS our results suggest that AR-CAG variations and XCI pattern exert an effect on FSH and LH values, and also have the potential to influence the etiopathogenesis of POF.
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Affiliation(s)
- Triin Laisk
- Department of Obstetrics and Gynecology, University of Tartu, Tartu, Estonia. mail:
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Lamp M, Saare M, Laisk T, Karro H, Kadastik Ü, Metspalu A, Peters M, Salumets A. Genetic variations in vascular endothelial growth factor but not in angiotensin I-converting enzyme genes are associated with endometriosis in Estonian women. Eur J Obstet Gynecol Reprod Biol 2010; 153:85-9. [DOI: 10.1016/j.ejogrb.2010.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 06/04/2010] [Accepted: 07/07/2010] [Indexed: 12/14/2022]
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Fronteira I, Oliveira da Silva M, Unzeitig V, Karro H, Temmerman M. Sexual and reproductive health of adolescents in Belgium, the Czech Republic, Estonia and Portugal. EUR J CONTRACEP REPR 2009; 14:215-20. [PMID: 19565419 DOI: 10.1080/13625180902894524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This pilot study, within the REPROSTAT 2 Project, aimed at investigating the sexual and reproductive health (SRH) of school-based youths in four countries of the European Union. METHODS Students of either sex, aged between 16 and 19 years and entering grade 10, 11 or 12 during the 2005-2006 school year participated in a cross sectional survey. A structured questionnaire was administered to a convenience sample of students from selected schools in Belgium, the Czech Republic, Estonia and Portugal. RESULTS In each country, more than three quarters of respondents had previously had a boyfriend or girlfriend and almost half had heterosexual intercourse. More than 85% of sexually experienced youths in each country had used contraception at coital debut. Mean age at coital debut varied between 15.2 (Belgium) and 16.4 years (Czech Republic). While 51% of respondents in Estonia knew of Chlamydia trachomatis infection, the corresponding figure in Portugal was only 12%. CONCLUSIONS Sexual activity is common among school-going youths in all four countries. This highlights the need for Member States to systematically collect indicators of SRH in this population. Use of a common measurement framework can inform the establishment of common targets for joint initiatives such as reducing teenage pregnancy and STIs in adolescents.
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Affiliation(s)
- Inês Fronteira
- Health Systems Unit, Instituto de Higiene e Medicina Tropical, Rua da Junqueira, 96, Lisboa 1349-008, Portugal.
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Schei B, Lukasse M, Temmerman M, Steingrimsdottir T, Tabor A, Karro H, Wangel A, Ryding E. O830 Women's preference for caesarean section and history of sexual abuse - preliminary results from a multi-country study; the BIDENS study. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Laanpere M, Rahu K, Part K, Haldre K, Rahu M, Karro H. P777 Contraceptive counselling in primary health care - what do young women prefer? Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Altmäe S, Haller K, Peters M, Saare M, Hovatta O, Stavreus-Evers A, Velthut A, Karro H, Metspalu A, Salumets A. Aromatase gene (CYP19A1) variants, female infertility and ovarian stimulation outcome: a preliminary report. Reprod Biomed Online 2009; 18:651-7. [PMID: 19549443 DOI: 10.1016/s1472-6483(10)60009-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Progress has been made towards ascertaining the genetic predictors of ovarian stimulation in IVF. Aromatase cytochrome P450, encoded by the CYP19A1 gene, catalyses a key step in ovarian oestrogen biosynthesis. Hence, the aromatase gene is an attractive candidate for genetic studies. This study aimed to examine the genetic influences of CYP19A1 TCT trinucleotide insertion/deletion (Ins/Del) and (TTTA)(n) microsatellite intronic polymorphisms on ovarian stimulation outcome and aetiology of female infertility. IVF patients (n = 152) underwent ovarian stimulation according to recombinant FSH and gonadotrophin releasing hormone antagonist protocol. Del/Del homozygous patients with shorter TTTA repeats exhibited decreased ovarian FSH sensitivity in ovarian stimulation, which may reflect variations in aromatase gene expression during early antral follicle development. Accordingly, this study demonstrates correlations between Del allele and shorter (TTTA)(n) repeat sizes with smaller ovaries (r = -0.70, P = 0.047) and fewer antral follicles (r = 0.21, P = 0.018) on days 3-5 of spontaneous menstrual cycle, respectively. Furthermore, Del variation linked with low-repeat-number (TTTA)(n) alleles are involved in enhanced genetic susceptibility to unexplained infertility (adjusted OR = 4.33, P = 0.039) and endometriosis (r = -0.88, P = 0.026), which corroborates evidence on the overlapping patient profiles of ovarian dysfunction in both types of female infertility.
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Affiliation(s)
- Signe Altmäe
- Department of Biotechnology, Institute of Molecular and Cell Biology, Estonian Genome Foundation, University of Tartu, Estonia
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Haldre K, Rahu K, Karro H, Rahu M. Previous history of surgically induced abortion and complications of the third stage of labour in subsequent normal vaginal deliveries. J Matern Fetal Neonatal Med 2009; 21:884-8. [DOI: 10.1080/14767050802320324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Part K, Rahu K, Rahu M, Karro H. Factors associated with Estonian adolescents' sexuality-related knowledge: Findings from the 1994 and 1999 KISS studies. EUR J CONTRACEP REPR 2009; 13:173-81. [DOI: 10.1080/13625180701800631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hemminki E, Veerus P, Pisarev H, Hovi SL, Topo P, Karro H. The effects of postmenopausal hormone therapy on social activity, partner relationship, and sexual life - experience from the EPHT trial. BMC Womens Health 2009; 9:16. [PMID: 19505307 PMCID: PMC2702282 DOI: 10.1186/1472-6874-9-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 06/08/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND With the exception of sexual functioning and weight, social and behavioural effects of postmenopausal hormone therapy (HT) have not been reported from trials. This paper reports such results from the EPHT-trial in Estonia. METHODS A randomized trial, with a blind and non-blind sub-trial in Estonia. From 1999-2001, 1778 women were recruited. The mean follow-up was 3.6 years. Women's experiences were asked in the first and final study year by mailed questionnaires (74 and 81% response rates). Comparisons of the groups were made by cross-tabulation and logistic regression, adjusting for age. RESULTS There were no differences between the HT and non-HT groups in regard to being employed, the extent of social involvement or marital status or opinions on aging. There was no difference in the frequency of free-time exercise, or overweight. Some of the indicators suggested less sexual inactivity, but the differences were small. CONCLUSION In a trial setting, postmenopausal hormone therapy did not influence work or social involvement or health behaviour.
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Affiliation(s)
- Elina Hemminki
- Health Services and Policy Research, National Institute for Health and Welfare (THL), PO Box 30, Helsinki 00271, Finland.
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Haldre K, Rahu K, Rahu M, Karro H. Individual and familial factors associated with teenage pregnancy: an interview study. Eur J Public Health 2009; 19:266-70. [DOI: 10.1093/eurpub/ckn143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haller K, Sikut A, Karro H, Uibo R, Salumets A. Circulating anti-follicle-stimulating hormone immunoglobulin A in women: a sperm-prone reaction of mucosal tolerance? Fertil Steril 2008; 90:1253-5. [DOI: 10.1016/j.fertnstert.2007.08.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 08/23/2007] [Accepted: 08/31/2007] [Indexed: 11/28/2022]
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