RESUMEN

INTRODUCTION: Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. MATERIAL AND METHODS: We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway, and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term, and no previous cesarean section. Confounders comprised country, time-period, and gestational age. RESULTS: In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared with women aged 25-29 years, the corresponding relative risks were 0.60 (95% confidence interval [95% CI] 0.57 to 0.64) and 1.72 (95% CI 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared with women aged 25-29 years, the relative risks were 0.86 (95% CI 0.54 to 1.37) and 1.98 (95% CI 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period, and gestational age on risk for cesarean section. CONCLUSIONS: Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.

Asunto(s)

Cesárea/estadística & datos numéricos , Trabajo de Parto Inducido , Edad Materna , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Países Escandinavos y Nórdicos

RESUMEN

INTRODUCTION: The retropubic tension-free vaginal tape has been the preferred method for primary surgical treatment of stress urinary incontinence and stress-dominated mixed urinary incontinence in women for more than 20 years. This study presents long-term safety and efficacy data and assesses risk factors for long-term recurrence. MATERIAL AND METHODS: In a case-series design we assessed a historical cohort of primary surgeries performed with the tension-free vaginal tape procedure in 596 women from 1998 to 2012 with follow up through 2015. Information from the medical records was transferred to a case report form comprising data on early and late complications and recurrence of urinary incontinence defined as bothersome stress urinary incontinence symptoms. All analyses were performed with SPSS using Pearson chi-square, survival and Cox regression analyses. RESULTS: After a 10-year follow up, mixed urinary incontinent women (hazard ratio 2.1, 95% confidence interval [CI] 1.4-3.0) had a significantly increased risk of recurrence of stress urinary incontinence symptoms compared with women with pure stress urinary incontinence as the indication for surgery. Overall cumulative cure rates after 1, 5 and 10 years were 92% (95% CI; 90%-94%), 79% (95% CI; 75%-83%) and 69% (95% CI; 63%-75%), respectively. Recurrent surgery (0.3%) and serious tape complications needing major surgical treatment (0.3%) were rare. Six patients (1.0%) had the tape cut due to urinary retention, and nine patients (1.5%) reported urinary retention more than 3 months after surgery. CONCLUSIONS: The tension-free vaginal tape procedure has a high long-term durability. Mixed urinary incontinence as an indication for surgery predicted long-term recurrence. Long-term complications were rare.

Asunto(s)

Procedimientos Quirúrgicos Ginecológicos , Efectos Adversos a Largo Plazo , Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos , Adulto , Anciano , Estudios de Cohortes , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Efectos Adversos a Largo Plazo/epidemiología , Efectos Adversos a Largo Plazo/cirugía , Registros Médicos Orientados a Problemas/estadística & datos numéricos , Persona de Mediana Edad , Noruega/epidemiología , Falla de Prótesis , Recurrencia , Factores de Riesgo , Cabestrillo Suburetral/efectos adversos , Cabestrillo Suburetral/estadística & datos numéricos , Incontinencia Urinaria de Esfuerzo/epidemiología , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos

RESUMEN

INTRODUCTION: Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. MATERIAL AND METHODS: In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. RESULTS: The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. CONCLUSIONS: Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset.

Asunto(s)

Analgesia Epidural , Cesárea/estadística & datos numéricos , Edad Materna , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Adulto , Peso al Nacer , Estudios de Casos y Controles , Dinamarca , Femenino , Humanos , Noruega , Embarazo , Factores de Riesgo

RESUMEN

INTRODUCTION: In this study, we examined changes in depot medroxyprogesterone acetate (DMPA) prescriptions over a time-period when new professions started prescribing, and when the method gained some negative media attention. MATERIAL AND METHODS: The Norwegian Prescription Database provided data on hormonal contraception from 2006 through 2012. We estimated the annual number of DMPA users by calculating doses sold per day/1000 women and calculated, for each contraceptive method on annual basis, a proportion of defined daily doses of all hormonal contraceptives in five-year age groups at reproductive age. All analyses were done in SPSS, version 22, with Chi-square test, t-test, and survival analysis with p < 0.05 as significance level. RESULTS: There were minor differences in overall DMPA use during the study years. The take-out rate was equivalent to 11-12/1000 women aged 15-49 years. DMPA sales amounted to nearly 4% of all daily doses of hormonal contraceptives sold. General practitioners and physicians without a specialty were the major prescribers. The number of starters decreased by nearly 40% during the study years and was consistent across age groups. The average use duration among starters was 17.7 (95% CI 17.5-17.9) months (range 0-90). There were minor changes in the relative proportion of long-term users beyond 24 months during the study years. CONCLUSIONS: DMPA plays a minor role in the overall use of hormonal contraception in Norway, even among teenagers. The number of starters is decreasing, indicating a more restrictive attitude toward first use, especially among general practitioners.

Asunto(s)

Conducta Anticonceptiva/tendencias , Acetato de Medroxiprogesterona/uso terapéutico , Pautas de la Práctica en Medicina/tendencias , Programas de Monitoreo de Medicamentos Recetados/tendencias , Medicamentos bajo Prescripción/uso terapéutico , Adulto , Estudios Transversales , Femenino , Humanos , Noruega , Mal Uso de Medicamentos de Venta con Receta/prevención & control , Adulto Joven

RESUMEN

INTRODUCTION: The aim of this study was to describe and compare contraceptive use, fertility, birth, and abortion rates in the Nordic countries. MATERIAL AND METHODS: National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analyzed. RESULTS: Use of hormonal contraceptives and copper intrauterine devices varied between 31 and 44%. The highest use was in Denmark (39-44%) and Sweden (40-42%). Combined hormonal contraception followed by the levonorgestrel-releasing intrauterine system were the most common methods. During 1975-2013 abortion rates decreased in Denmark (from 27/1000 women to 15/1000 women aged 15-44/1000 women) and Finland (from 20 to 10/1000 women), remained stable in Norway (≈16) and Sweden (≈20) and increased in Iceland (from 6 to 15/1000 women). Birth rates remained stable around 60/1000 women aged 15-44 in all countries except for Iceland where the birth rate decreased from 95 to 65/1000 women. Abortion rates were highest in the age group 20-24 years. In the same age group, Sweden had a lower contraceptive use (51%) compared with Denmark (59%) and Norway (56%) and a higher abortion rate 33/1000 compared with Denmark (25/1000) and Norway (27/1000). CONCLUSIONS: In contrast to the declining average fertility and birth rates in Europe, rates in the Nordic countries remain high and stable despite high contraceptive use and liberal access to abortion on women's request.

Asunto(s)

Aborto Inducido/estadística & datos numéricos , Tasa de Natalidad , Conducta Anticonceptiva/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Dinamarca , Femenino , Finlandia , Humanos , Persona de Mediana Edad , Embarazo , Suecia

RESUMEN

INTRODUCTION: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. MATERIAL AND METHODS: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. RESULTS: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. CONCLUSIONS: The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.

Asunto(s)

Cesárea/tendencias , Bases de Datos Factuales , Cesárea/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Servicios de Salud Materna/estadística & datos numéricos , Servicios de Salud Materna/tendencias , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Países Escandinavos y Nórdicos/epidemiología

RESUMEN

INTRODUCTION: The aim was to compare contraceptive use in the Nordic countries and to assess compliance with recommendations from the European Medicines Agency regarding the use of combined oral contraception containing low-dose estrogen and levonorgestrel, norethisterone or norgestimate. MATERIAL AND METHODS: Data on hormonal contraceptive prescriptions and sales figures for copper intrauterine devices were obtained from national databases and manufacturers in Denmark, Finland, Iceland, Norway and Sweden in 2010-2013. RESULTS: Contraceptive use was highest in Denmark (42%) and Sweden (41%), followed by Finland (40%). Combined oral contraception was the most used method in all countries, with the highest use in Denmark (26%). The second most used method was the levonorgestrel-releasing intrauterine system, with the highest use in Finland (15%) and ≈10% in the other countries. Copper intrauterine devices (7%) and the progestin-only pill (7%) were most often used in Sweden. Combined oral contraception use decreased with increasing age and levonorgestrel-releasing intrauterine system and progestin-only pills use increased. The use of long-acting reversible methods of contraception (=levonorgestrel-releasing intrauterine system, copper intrauterine devices, and implants) increased with time and was highest in Sweden (20%) and Finland (18%). The highest use of European Medicines Agency recommended combined oral contraception was in Denmark, increasing from 13 to 50% between 2010 and 2013. In Finland, recommended combined oral contraception remained below 1%. CONCLUSIONS: Contraceptive use was highest in Denmark and Sweden, levonorgestrel-releasing intrauterine system use was highest in Finland and all long-acting methods were most common in Sweden. The use of combined oral contraception recommended by the European Medicines Agency was highest in Denmark.

Asunto(s)

Conducta Anticonceptiva/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Condones/estadística & datos numéricos , Anticonceptivos Hormonales Orales/uso terapéutico , Anticonceptivos Sintéticos Orales/uso terapéutico , Anticonceptivos Poscoito/uso terapéutico , Bases de Datos Factuales , Femenino , Humanos , Dispositivos Intrauterinos/estadística & datos numéricos , Levonorgestrel/uso terapéutico , Persona de Mediana Edad , Países Escandinavos y Nórdicos/epidemiología , Adulto Joven

Asunto(s)

Síndrome Postrombótico/diagnóstico , Síndrome Postrombótico/epidemiología , Trombosis de la Vena/complicaciones , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Calidad de Vida , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

INTRODUCTION: The objective of this study was to examine the association between planned mode of delivery and neonatal outcomes in breech deliveries. MATERIAL AND METHODS: In this retrospective cohort study we studied singleton term breech deliveries in Norway from 1991 to 2011 (n = 30 861) using the Medical Birth Registry of Norway. We compared planned vaginal delivery with planned cesarean delivery across two time periods: from 1 January 1991 to 31 October 2000 (first period) and from 1 November 2000 to 31 December 2011 (second period). Intrapartum and neonatal deaths were validated against source data in medical records, autopsy reports, and other relevant documents. The main outcome measures were intrapartum and neonatal mortality within the first 28 days of life, 5-min Apgar-scores <7 and <4, neonatal intensive care unit stays ≥4 days, respiratory morbidity, and intracranial bleeding disorders. RESULTS: Rate of planned cesarean delivery increased from 34.4 to 51.3% over the period. Simultaneously, early neonatal mortality rate (0-6 days) declined (from 0.10% to 0.04%, p = 0.04). During the second period, 30.7% of term breech presentations were delivered vaginally. Eight deaths in the planned vaginal vs. four in the planned cesarean groups were observed (OR 2.11 95% CI 0.64-7.01). Neonatal morbidity outcomes were significantly worse in planned vaginal deliveries compared with planned cesarean deliveries in both periods. CONCLUSION: Overall intrapartum and neonatal mortality decreased during the entire period. Higher mortality in planned vaginal delivery relative to planned cesarean delivery in the second period was not statistically significant. However, neonatal morbidity was significantly higher in planned vaginal than planned cesarean deliveries in both periods. This warrants continuous surveillance of breech deliveries.

Asunto(s)

Presentación de Nalgas/mortalidad , Parto Obstétrico , Enfermedades del Recién Nacido/epidemiología , Adulto , Puntaje de Apgar , Presentación de Nalgas/terapia , Cuidados Críticos , Femenino , Edad Gestacional , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/terapia , Tiempo de Internación , Masculino , Noruega/epidemiología , Embarazo , Resultado del Embarazo , Sistema de Registros , Estudios Retrospectivos , Adulto Joven

RESUMEN

UNLABELLED: Whether the high incidence of venous thromboembolism (VTE) in the elderly can be attributed to cancer is not well studied. We assessed the impact of cancer on risk of VTE in young, middle-aged and elderly. 26,094 subjects without a history of cancer or VTE were recruited from the Tromsø study. Incident cancer (n = 2,290) and VTE (n = 531) were recorded from baseline (1994-1995) through December 31st, 2009. Cox regression with cancer as time-varying exposure was used to calculate hazard ratios with 95 % confidence intervals (CI). Overt cancer was associated with a fivefold (95 %CI 4.3, 6.7) increased risk of VTE, with an age-dependent gradient from 26-fold (95 %CI 12.1, 56.5) increased in the young, ninefold (95 % CI 6.6, 12.7) increased in the middle-aged, and threefold (95 % CI 2.5, 4.5) increased risk in the elderly. The population attributable risks were 14, 27 and 18 %, respectively. CONCLUSION: The relative risk of VTE by cancer were higher in young compared to elderly subjects, but the proportion of VTEs in the population due to cancer did not differ much across age groups. Our findings indicate that the increased risk of VTE by advancing age cannot be attributed to higher incidence of cancer in the elderly.

Asunto(s)

Envejecimiento/fisiología , Neoplasias/epidemiología , Tromboembolia Venosa/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Vigilancia de la Población , Estudios Prospectivos , Análisis de Regresión , Riesgo , Factores de Riesgo , Factores de Tiempo

RESUMEN

OBJECTIVE: Pain is associated with cancer, cancer treatment, co-morbidity and socioeconomic conditions. The aim of this cross-sectional study was to explore the relationship between co-morbidity and number of pain sites (NPS) in long-term survivors of gynecological cancer and a representative sample of women from the general population. Study population comprised recurrence-free long-term gynecological cancer survivors (n=160) and women selected at random from the general population (n=493) in Mid-Norway. Mean age was 58 and 57 (range 32-75), respectively. Mean follow-up time after treatment for gynecological cancer was 12 years (SD 2.6; range 8-17). METHODS: Co-morbidity was assessed as conditions/diseases over the past 12 months. NPS was recorded using a body outline diagram indicating where the respondents had experienced pain during the past week. Socioeconomic conditions were measured by Socioeconomic Condition Index (SCI). All assessments were self-reported. We tested three models of covariates with NPS as outcome: 1-2/0 (A), 3/0 (B) and 4-7/0 (C) pain sites in forward stepwise logistic regression. Outcome measure was adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS: There were no differences in co-morbidity and NPS between gynecological cancer survivors and women from the general population. After adjustment for SCI, age and BMI, musculoskeletal disorders were the strongest predictor of NPS in all models, whereas migraine/headache, sleeping and psychiatric disorders were significantly associated with NPS in model A/B/C, B/C, and C, respectively. CONCLUSIONS: Gynecological cancer survivors are as healthy, and carry as much co-morbid conditions as women from the general population assessed through associations with NPS.

Asunto(s)

Neoplasias de los Genitales Femeninos/epidemiología , Dolor/epidemiología , Sobrevivientes/estadística & datos numéricos , Adulto , Anciano , Estudios de Casos y Controles , Comorbilidad , Femenino , Neoplasias de los Genitales Femeninos/complicaciones , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Noruega/epidemiología , Dolor/etiología , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

Inherited thrombophilias are probably associated with placenta-mediated pregnancy complications, but the strength of the association between inherited thrombophilias and intrauterine fetal death after 22 gestational weeks varies due to small sample size and different methodologies used across studies. The objective of the present study was to investigate the association of inherited thrombophilia and intrauterine fetal death in a case-control design. We studied 105 women with a history of intrauterine fetal death after 22 gestational weeks and 262 controls with live births. We investigated the prevalence of the factor V Leiden (F5 rs6025) and prothrombin gene G20210A (F2 rs1799963) polymorphisms, and antithrombin, protein C and protein S deficiencies, and their association with intrauterine fetal death. Results were presented as percentages and odds ratios (ORs) with 95% confidence intervals (CIs). A total of 18.4% of cases and 11.8% of controls were positive for at least one inherited thrombophilia (OR 1.7; 95% CI 0.9-3.1). The prothrombin gene G20210A polymorphism (OR 4.0; 95% CI 1.1-14.4), but not the factor V Leiden polymorphism, or antithrombin, protein C or protein S deficiencies, was associated with intrauterine fetal death after 22 weeks of gestation. Compared with women with live births only, women with a history of intrauterine fetal death after 22 gestational weeks were significantly more often carriers of the prothrombin gene G20210A polymorphism.

Asunto(s)

Trastornos de la Coagulación Sanguínea Heredados/genética , Muerte Fetal/genética , Polimorfismo de Nucleótido Simple , Complicaciones Hematológicas del Embarazo/genética , Protrombina , Trombofilia/genética , Adulto , Antitrombinas/sangre , Trastornos de la Coagulación Sanguínea Heredados/sangre , Trastornos de la Coagulación Sanguínea Heredados/diagnóstico , Trastornos de la Coagulación Sanguínea Heredados/epidemiología , Estudios de Casos y Controles , Factor V/análisis , Femenino , Muerte Fetal/sangre , Muerte Fetal/diagnóstico , Muerte Fetal/epidemiología , Feto , Humanos , Noruega/epidemiología , Oportunidad Relativa , Embarazo , Complicaciones Hematológicas del Embarazo/sangre , Complicaciones Hematológicas del Embarazo/diagnóstico , Complicaciones Hematológicas del Embarazo/epidemiología , Diagnóstico Prenatal , Prevalencia , Proteína C/análisis , Proteína S/análisis , Protrombina/genética , Protrombina/metabolismo , Trombofilia/sangre , Trombofilia/diagnóstico , Trombofilia/epidemiología , Útero/metabolismo , Útero/patología

RESUMEN

BACKGROUND: The population of gynaecological cancer survivors is growing. However, there is little knowledge of the long-term quality of life among these former patients. The aim of this study was to investigate the long-term quality of life in women treated successfully for gynaecological cancer and a control group of representative women selected from the general population. MATERIAL AND METHODS: The study comprised women aged 30-75 years residing in the central part of Norway. Cases were 319 gynaecological cancer survivors treated at St Olav's Hospital Trondheim, Norway, between 1987 and 1996, whereas 1276 age-matched women selected at random from the general population served as controls. The study population was identified and the respondents were invited to answer a postal questionnaire. After one reminder, the response rate was 55% (176/319) and 41% (521/1276) for cases and controls, respectively. Sixteen cases and 28 controls had incomplete responses to most questions and were excluded from the analyses. Eligible for the final analyses were 160 cases and 493 controls. Ferrans & Powers' Quality of Life Index (QLI) was used. All analyses were performed in SPSS version 13.0 with chi-square (categorical variables) and Mann-Whitney (continuous variables) tests. p

Asunto(s)

Neoplasias de los Genitales Femeninos/fisiopatología , Calidad de Vida , Sobrevivientes , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Neoplasias de los Genitales Femeninos/psicología , Neoplasias de los Genitales Femeninos/terapia , Humanos , Persona de Mediana Edad , Noruega

RESUMEN

PURPOSE OF REVIEW: To investigate the impact of intrauterine devices on subsequent fertility. RECENT FINDINGS: Intrauterine devices are safe, well tolerated and used by millions of women worldwide. Subsequent fertility is studied among women who remove the intrauterine contraceptive device for planning pregnancy or among women who have removed the intrauterine contraceptive device because of intrauterine contraceptive device-related complications and later on have become pregnant. Study participants are recruited from randomized clinical trials on intrauterine contraceptive device performance or in case series among women who remove the intrauterine contraceptive device. Pregnancy rates after removal are high and are similar to time-to-pregnancy rates in the general population. The birth rates are high with a normal distribution of preterm deliveries, normal birth weight and sex ratio of newborns. The ratio of extra-intrauterine pregnancies and the need for infertility work up are low, and the distribution of infertility causes among fully investigated couples is as seen in the general population. SUMMARY: Despite small sample size of studies investigating impact of intrauterine contraceptive devices on subsequent fertility, the results are consistent and reassuring on high pregnancy rates, and a normal distribution of pregnancy outcomes. There are limited data on return of fertility after usage of medicated intrauterine contraceptive devices--more studies are warranted among women who have used hormone-releasing intrauterine contraceptive devices.

Asunto(s)

Infertilidad Femenina/etiología , Dispositivos Intrauterinos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Enfermedad Inflamatoria Pélvica/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

BACKGROUND: January 1, 2002, copayment for outpatient female sterilization in Norwegian public hospitals increased from 33 euro to 750 euro after a revision of the health care system. The aim of the present study was to investigate the effect of the new copayment system on female sterilization epidemiology. METHODS: We retrieved data on all female sterilizations 1999-2005 (N = 23 1333) from the Norwegian Patient Register, an administrative register to which it is mandatory for all hospitals to report. Sterilizations with diagnostic codes indicative of vaginal delivery, caesarean section, spontaneous abortion, ectopic pregnancy, and termination of pregnancy were analyzed separately. All other sterilizations were defined as "interval sterilization". RESULTS: An abrupt fall in female sterilization was observed after the raise in copayment. Age-adjusted incidence rates dropped from 6.3-6.8 per 1000 women in 1999-2001 to 2.2-2.3 per 1000 women during 2002-2005. Interval sterilizations dropped to 25% of the previous level after the rise in copayment while sterilizations in conjunction with caesarean section and postpartum sterilization remained constant. CONCLUSION: For many Norwegian women seeking contraception, sterilization is no longer an available alternative.

Asunto(s)

Procedimientos Quirúrgicos Ambulatorios/economía , Seguro de Costos Compartidos/legislación & jurisprudencia , Reforma de la Atención de Salud , Hospitales Públicos/economía , Programas Nacionales de Salud/economía , Servicio Ambulatorio en Hospital/economía , Esterilización Reproductiva/estadística & datos numéricos , Adulto , Bases de Datos Factuales , Femenino , Accesibilidad a los Servicios de Salud/economía , Precios de Hospital , Humanos , Incidencia , Persona de Mediana Edad , Programas Nacionales de Salud/legislación & jurisprudencia , Noruega , Sistema de Registros , Esterilización Reproductiva/clasificación , Esterilización Reproductiva/economía

RESUMEN

OBJECTIVE: To document prescribing patterns of lipid-modifying therapies in hypercholesterolemic patients, cholesterol goal attainment, and factors associated with cholesterol goal attainment in Norway. METHOD: This was a retrospective, observational study using existing computerized patient records at 11 primary healthcare centers in Norway and the Norwegian Patient Register of hospital data. The study population was 3111 patients identified in the primary care database who were prescribed a lipid-modifying therapy between the dates of July 1987 and May 2003 and who were > or = 18 years of age at the time of the first prescription. Of these patients, 1337 patients had uncontrolled lipid measures at baseline. In the analysis of goal attainment, data were available for 877 (28% of the total study population) and 1144 (37%) patients with baseline and follow-up total cholesterol (TC) and/or low-density lipoprotein-cholesterol (LDL-C) levels after 4 and 12 months' treatment, respectively. OUTCOME MEASURES: Initial lipid-modifying therapy (drug and dosage), changes in initial lipid-modifying therapy, cholesterol goal attainment, and factors related to cholesterol goal attainment. Cholesterol treatment goals were defined as LDL-C <3.0 mmol/L and/or TC <5.0 mmol/L (as per the Second Joint Task Force of European Societies on the Prevention of Cardiovascular Disease). RESULTS: The initial lipid-modifying therapy was a HMG-CoA reductase inhibitor (statin) in 98% of patients, most often simvastatin (42%; mean initial dosage = 18.4 mg/day) or atorvastatin (34%; 12.7 mg/day). The median year of treatment initiation was 1999 and the mean duration of follow-up was 39 months. The initial prescription remained unchanged at year 1 for most patients (69%), whereas 17% discontinued drug treatment. Mean TC levels decreased from 7.36 mmol/L at baseline (n = 1337) to 5.31 mmol/L at 12 months (n = 1144; p < 0.05), whereas mean LDL-C levels decreased from 4.98 (n = 847) to 3.08 mmol/L at 12 months (n = 713; p < 0.05). These mean reductions occurred within 3 months of the initial prescription and did not change subsequently. A total of 32.9% of patients who were not at goal at baseline achieved cholesterol goal 12 months after initiating treatment. The factors related to cholesterol goal attainment at 12 months were: baseline TC level (odds ratio [OR] 0.64; 95% CI 0.58, 0.71), treatment with a statin (OR 8.60; 95% CI 1.13, 65.4), diagnosis of diabetes mellitus (OR 2.91; 95% CI 2.01, 4.21), and age (OR 1.02; 95% CI 1.01, 1.03). CONCLUSIONS: Lipid-modifying therapy in Norway is dominated by statin monotherapy. In this analysis of primary-care patients, maximal reductions in cholesterol levels were seen within the first 3-4 months after therapy initiation. After 12 months of treatment, 67% of patients remained above recommended cholesterol levels. More effective and well tolerated treatment strategies are needed to improve the probability of patients achieving cholesterol treatment goals.

Asunto(s)

Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Anciano , Colesterol/sangre , LDL-Colesterol/sangre , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/clasificación , Hipercolesterolemia/sangre , Masculino , Persona de Mediana Edad , Noruega , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento