Session 8a IUDs: Special session-clinical aspects

Abstract

Session 8a IUDs: Special session-clinical aspects     

Effectiveness of health-promoting media literacy education: a systematic review

Media literacy education to promote health among youth involves them in a critical examination of media messages that promote risky behaviors and influence their perceptions and practices. Research on its effectiveness is in its infancy. Studies to date have been conducted with more or less rigor and achieved differing results, leaving many questions about effectiveness unanswered. To elucidate some of these questions, we conducted a systematic review of selected health-promoting media literacy education evaluation/research studies, guided by the following research question: What are the context and process elements of an effective health-promoting media literacy education intervention? Based on extensive analysis of 28 interventions, our findings provide a detailed picture of a small, 16- to 17-year (1990 to July 2006) body of important research, including citation information, health issue, target population/N/age, research design, intervention length and setting, concepts/skills taught, who delivered the intervention and ratings of effectiveness. The review provides a framework for organizing research about media literacy education which suggests that researchers should be more explicit about the media literacy core concepts/skills they are including in their interventions, and should more carefully address who delivered the intervention with what fidelity, in what setting, for how long and utilizing what pedagogical approach.     

Advances in contraception: IUDs from a managed care perspective

Contraceptive use in the United States is virtually universal among women of reproductive age. However, unplanned pregnancies continue to occur and can be largely attributed to the nonuse and misuse of contraception. Reducing unintended pregnancies constitutes a critical goal for managed care and the public. This can be achieved in part with intrauterine devices (IUDs), which are an effective method of contraception that require a one-time insertion and stay in place for 5-10 years. Therefore, compliance issues are largely mitigated, and actual use efficacy is the same as perfect use efficacy. The IUD is also reversible, unlike tubal ligation, and could potentially be the contraceptive of choice in today's environment. Unfortunately, safety concerns surrounding the use of older IUDs have precluded many women from recognizing the benefits of their use. Currently, the only approved IUDs in the United States are ParaGard, the copper IUD, and Mirena, the levonorgestrel-releasing intrauterine system (LNG-IUS). These devices offer superior safety profiles compared with those products that were withdrawn from the market in the 1970s. In addition to a favorable safety and tolerability profile, the LNG-IUS offers an advantage over copper IUDs, demonstrating improved efficacy in preventing intrauterine and ectopic pregnancies. Successful communication between patients and providers regarding the improved safety and efficacy of newer IUDs will ensure an appropriate place in therapy. Thus, greater numbers of women will recognize the IUD as a safe, cost-effective means to contraception, thereby reducing the economic and social burdens associated with unplanned pregnancies.     

Effectiveness of physical activity interventions for older adults: a review

OBJECTIVE: This review evaluates the effectiveness of physical activity interventions among older adults. METHODS: Computerized searches were performed to identify randomized controlled trials. Studies were included if: (1) the study population consisted of older adults (average sample population age of > or =50 years and minimum age of 40 years); (2) the intervention consisted of an exercise program or was aimed at promoting physical activity; and (3) reported on participation (i.e., adherence/compliance) or changes in level of physical activity (e.g., pre-post test measures and group comparisons). RESULTS: The 38 studies included 57 physical activity interventions. Three types of interventions were identified: home-based, group-based, and educational. In the short-term, both home-based interventions and group-based interventions achieved high rates of participation (means of 90% and 84%, respectively). Participation declined the longer the duration of the intervention. Participation in education interventions varied widely (range of 35% to 96%). Both group-based interventions and education interventions were effective in increasing physical activity levels in the short-term. Information on long-term effectiveness was either absent or showed no difference of physical activity level between the study groups. CONCLUSIONS: Home-based, group-based, and educational physical activity interventions can result in increased physical activity, but changes are small and short-lived. Participation rates of home-based and group-based interventions were comparable, and both seemed to be unrelated to type or frequency of physical activity. The beneficial effect of behavioral reinforcement strategies was not evident. Comparative studies evaluating the effectiveness of diverse interventions are needed to identify the interventions most likely to succeed in the initiation and maintenance of physical activity.     

Effectiveness of community health workers in Brazil: a systematic review

The objective of this study is to assess the effectiveness of community health workers (CHWs) in Brazil. This systematic review included all studies that sought to assess interventions involving CHWs. Despite the low quality of evidence for most outcomes, analysis of the 23 publications included often found benefit for CHW intervention, best documented for frequency of child weighing, prevalence of breast-feeding, and delayed introduction of bottle-feeding. These findings and the current major role CHWs play in Brazil suggest that clarifying the benefit of CHW actions across a broad range of health care interventions should be a major research priority.     

Effectiveness of continuing education for health professionals: a literature review

The 1970s saw the development of a mandatory continuing education system as a result of actions by state legislatures and professional organizations. Although the actions of these bodies imply a relationship between participation in continuing education activities and the maintenance of professional competency, such a relationship has never been clearly and consistently demonstrated. This article reviews studies of the effectiveness of continuing education in the health professions, notes weaknesses in the continuing education system, and suggests strategies for improving it.     

IUDs in Korea: latest studies

In 1968 data was presented on the use-effectiveness of the IUD in Korea. 5 years' experience in 3 clinics, from January 1963-December 1967 was analyzed. Up to August 1965, 4564 Lippes loops had been inserted. Of these, 2020 of 44.3% were terminated because of pregnancy, expulsion, or removal, and a further 11.4% of women were lost to follow-up. Only 44.3% were active users at the cut-off date. The total cumulative termination rates per 100 first insertions were calculated at the end of Year 1, 2, 3, and 4. These were respectively 23.6, 37.3, 45.9, and 52.6. The results of the 3 clinics were compared with those in the larger national program. By the end of the second year of the program, 56% of the cases were terminated, and by the thirtieth month 62.9%. There were more expulsions and removals in the national program than in the clinic trials. Despite more insertions every year, the number of IUD users has levelled off and has failed to increase. The level is at about 800,000. It has been shown that with 250,000 users a year and 17% of reinsertions among drop-outs, the number of IUD users will stabilize at 815,000. A plateau of IUD users emerges which cannot be raised by present methods.     

Notes on IUDs

Rare breaking up in utero: Many plastic intra-uterine devices are manufactured from polyethylene and contain barium sulphate to make them radio-opaque. IUDs are usually moulded under high pressure. When properly made and, if they are not boiled or left in the inserter for too long before insertion, they should retain their shape and survive for many years when placed in the uterus. In the past two years there have been isolated reports from clinics in various parts of the world about IUDs fragmenting or breaking up inside the uterus. These reports have been exceptionally rare, and it is now becoming clear that most of them can be traced to a single batch of defective IUDs. This source of possible breakage has now been eliminated, but we wish to establish for certain that no other cases have escaped attention, although no women with fragmented IUDs have suffered any clinical symptoms. The IPPF is therefore asking all readers of the IPPF Medical Bulletin to send any additional information on this subject to the IPPF Medical Secretary (18-20 Lower Regent Street, London, S.W. 1, England) giving, if possible, the source from which the IUD was obtained, the type of device, the date on which it was inserted, the date when the breaking up was noted and any other clinical details which might be useful. The "M" device: The Pathfinder Fund has requested us to remind those who are using M devices that these IUDs are intended exclusively for clinical testing. The Pathfinder Fund does not endorse or officially recommend any use beyond their present clinical analysis. Pathfinder continues to have reservations about widening the use of the device until analysis of this IUD can be brought to a conclusion late in 1970. When this analysis is complete a definitive report will be issued.     

缬沙坦氨氯地平片治疗高血压有效性和安全性的系统评价

目的 系统评价缬沙坦氨氯地平片(倍博特)治疗高血压的有效性和安全性.方法 采用循证医学的方法,将国内外符合纳入标准的12项(共计2 796例患者)关于倍博特治疗高血压的随机对照试验进行Meta分析.采用收缩压、舒张压、24 h平均血压、临床疗效以及不良反应率作为结局指标判定治疗效果.运用RevMan 5.0软件进行Meta分析.结果 Meta分析结果显示倍博特的临床疗效优于氨氯地平组(OR=3.36,95％ CI:2.17～5.19,P＜0.001)、缬沙坦80 mg组(OR =3.19,95％ CI:2.40 ～4.24,P＜0.001)和缬沙坦160 mg组(OR=1.61,95％ CI:1.12 ～2.32,P=0.010);倍博特组患者不良反应的发生率低于氨氯地平组(OR=0.45,95％ CI:0.27～0.74,P＜0.001),而倍博特组与缬沙坦80 mg组及160 mg组不良反应的发生率差异无统计学意义.结论 倍博特治疗高血压的效果优于对照组,且具有较好的安全性.     

癌症患者益处发现干预措施及其效果的系统评价

目的 系统评价癌症患者益处发现干预措施及其效果。方法 计算机检索中国知网(CNKI)、万方、维普、中国生物医学数据库(CBM)、PubMed、Cochrane library、Wiley Online Library、Elsevier ScienceDirect、Springer Link、EBSCO,检索时限为建库至2017年7月,研究类型为随机对照试验。两名研究者独立进行文献筛选、质量评价和资料提取,采用定性方法分析纳入文献的干预措施及其效果。结果 最终纳入9篇RCT研究,采取团体认知行为压力管理疗法共6篇,瑜伽干预共2篇,1篇是中医五行音乐配合肌肉放松训练,均可改善癌症患者的益处发现。结论 纳入的研究均能提高患者益处发现水平,但研究较少,措施复杂,干预者多是心理学专家,国内实施困难,未来需结合我国临床实际情况,构建简单有效,在临床实施可行的益处发现的干预措施。     

Early insertion of IUDs

A study of 340 women in Yugoslavia who were followed for 15 months after postabortion insertion of an IUD found that 91% were still active users. In Singapore a study of 8935 women who had postpartum IUD insertions showed that expulsions were greatest in the group who had IUDs inserted immediately after delivery, 22.7%, compared to 8.1% for those with the insertion 4 to 6 weeks postpartum, and 5.3% for those 8 weeks postpartum. Of the total, 3.3% became pregnant and 18.5% had the IUD removed. In 61 of the women the IUD migrated outside the uterus. This was attributed to the small size of the Asian uteri, making the Lippes Loop size D, unsuitable.     

Actinomycosis and IUDs

The continuing presence of an IUD, which is a foreign body, is frequently associated with increasing colonization of the cervix with aerobic and anaerobic organisms, among which growth or actinomycetes have been identified. Actinomyces israelii is the principal pathogen of the actinomycete family or organisms. A delicate slow growing anaerobe of low pathogenicity, it has been cultured from the gut and recently has been identified in vaginal smears of women without an IUD. Yet, thus far, microscopically recognizable growths in direct cervical smears and positive cultures have been obtained only in the presence of an IUD or other foreign body. 2 mechanisms have been described by which organisms from the vaginal pool and lower endocervical canal can spread throughout the genital tract. There is increasing evidence that the presence of the tail of the IUD helps the ascent of organisms from the vagina into the body of the uterus. Also, calcium encrustation and disintegration of the IUD, which at times occur after prolonged use, results in migration of fragments of calcium encrusted plastic throughout the genital tract. These form niduses for colonization of actinomycetes and other organisms. In the presence of an IUD, actinomycetes have been reported with increasing frequency in routine cervical smears of women who have been almost or totally symptom free. Histologically and bacteriologically verified cases of pelvic actinomycosis are rare. Prior to the introduction of the plastic IUD, documented cases were mainly associated with large bowel disease. Now an increasing number of cases (to date over 100) have been recorded in association with IUD use. Clinically, pelvic actinomycosis usually presents as a low grade smoldering infection. The initial symptoms are mild: often general ill health and slight fever, with chills and sweats. Offensive discharge, pelvic tenderness, or a mass may develop late, and occasionally the patient is hospitalized with a ruptured pelvic abscess. Culture identification is a problem unless measures are taken to inhibit the growth of more robust and fast growing anaerobes by metronidazole and a dilution technique. When actinomyces like organisms are found in cervical smears and the finding is confirmed by Gram stain or by culture and/or immunofluorescence, the patient should be informed in general terms. The IUD should always be removed, if necessary under antibiotic cover, and if the patient so desires, a new IUD may be inserted after the infection has cleared.     

Effectiveness of seasonal influenza vaccination in healthcare workers: a systematic review

Vaccination is considered a key measure to protect vulnerable groups against influenza infection. The objectives of this review are to determine the effect of influenza vaccinations in reducing laboratory-confirmed influenza infections, influenza-like illnesses (ILIs), working days lost among vaccinated HCWs, and associated adverse effects after vaccination. Twenty-two healthcare-related databases and internet resources, as well as reference lists, and the bibliographies of all of the retrieved articles were examined. All randomized controlled trials (RCTs) comparing the effectiveness of any kind of influenza vaccine among all groups of HCWs with a placebo/vaccine other than the influenza vaccine/no intervention were included in the review. Only three RCTs matched the inclusion criteria. There is a limited amount of evidence suggesting that receiving influenza vaccination reduces laboratory-confirmed influenza infections in HCWs. No evidence can be found of influenza vaccinations significantly reducing the incidence of influenza, number of ILI episodes, days with ILI symptoms, or amount of sick leave taken among vaccinated HCWs. There is insufficient data to assess the adverse effects after vaccination. There is no definitive conclusion on the effectiveness of influenza vaccinations in HCWs because of the limited number of related trials. Further research is necessary to evaluate whether annual vaccination is a key measure to protect HCWs against influenza infection and thus increase their confidence in the vaccine. In the mean time, the direction of promoting influenza vaccination to HCWs can be shifted from staff protection to patient protection, with accurate information to address concerns and misconceptions.     

Effectiveness of email-based reminders to increase vaccine uptake: a systematic review

BackgroundIn times of vaccine hesitancy and decreasing immunization coverage, it is crucial to exploit the potential of digital solutions to support immunization programmes and ultimately increase vaccine uptake. Scant evidence exists on the impact of email-based immunization reminders. In particular, while email communication is exponentially increasing at the global level, its use for health communication is still sporadic and limited data exists on its application to immunization programmes. The objective of this study is to systematically retrieve and critically appraise the available literature on the effectiveness of email-based reminders to increase vaccine uptake, with the ultimate aim to inform and encourage its integration in the implementation of immunization programmes.MethodsWe conducted a systematic review of literature following the PRISMA. We included studies providing quantitative comparative data on any measure of vaccine uptake. We extracted data on study design, study population, vaccine type and details of email-based interventions; data were pooled by type of comparison (no reminders, traditional reminders, other digital reminders).ResultsEleven studies were included, 90% with experimental study designs. While email communication succeeds in increasing vaccine uptake when compared with no intervention, weak and heterogeneous data exist supporting the superiority of email reminders, as compared to traditional methods or other digital reminders. Encouraging evidence report the effectiveness of reminder methods combining different strategies and tailored to target populations’ preferences.ConclusionsTheoretically, email communication offers many advantages: it is cheaper and faster, it can be automated and linked to electronic immunization registries, and reach people on the move. As we urge the need for further research to prove email communication impact on vaccine uptake in different settings, we underline the importance of identifying how to best integrate email communication in vaccine delivery equipping immunization programmes with technical infrastructures and normative frameworks suitable to embrace innovation.     

Effectiveness of workplace health promotion and primary prevention interventions: a review

Background

Workplace health promotion and primary prevention interventions are highly prevalent. However, their effectiveness remains mostly unclear.

Aim

This article compiles and summarizes the results of current reviews concerning the effectiveness of health promotion and primary prevention interventions in the workplace.

Subjects and methods

Studies were selected from four electronic databases on the basis of the following criteria: (1) Meta-analysis or systematic reviews, (2) published in international peer-reviewed journals (3) between 1 January 2004 and 30 June 2008 (4) in English or German (5) that examined the effectiveness of workplace health promotion and primary prevention interventions.

Results

Seventeen reviews met the inclusion criteria and were subsequently categorized into the following areas of intervention: stress, physical activity and nutrition, organizational development, smoking, and ergonomics and back pain. Singular interventions showed limited effectiveness. Workplace interventions aimed at helping individuals reported substantially greater effects than workplace interventions aimed at the workforce as a whole; here, methodological influences play an important role.

Conclusions

The greatest results are achievable through comprehensive multimodal (or systemic) programs including relational and behavioral elements. Future research is needed in the conception of methodologically sound and setting-appropriate study designs.