The public health implications of the 1995 'pill scare'

The warning issued by the UK Committee on Safety Medicines in October 1995, followed by their 'Dear Doctor' letter of October 18, 1995, that oral contraceptive pills containing gestodene or desogestrel were associated with a higher risk of venous thromboembolism has had a negative impact on public heath. A significant number of women either switched brands or ceased contraception altogether following the announcement. National data suggest a strong association between the pill scare and a substantial increase in the number of unintended pregnancies, particularly significant among younger women, with use of oral contraception falling from 40 to 27% of under 16s between 1995-1996 and 1996-1997. The resulting cost of the increase in births and abortions to the National Health Service has been estimated at about Pound Sterling 21 million for maternity care and from Pound Sterling 46 million for abortion provision. The level of risk should, in future, be more carefully assessed and advice more carefully presented in the interests of public health.     

Safety of modern oral contraception: the options for women: lessons to be learned

The relatively short history of hormonal contraception has been marked by a series of 'pill scares', all of which--after creating panic among users--were proven to be unfounded in terms of public health impact. The latest pill scare, provoked by regulatory action in the United Kingdom and the Federal Republic of Germany in response to the publication of a series of articles indicating a doubling of risk of deep venous thrombosis in users of oral contraceptives containing third-generation progestins, seems finally settled: both the British and the German Drug Regulatory Authorities have now reverted their verdict. The damage unfortunately stays: hundreds of thousands of women have been compelled to abandon the pill of their choice, often deciding to drop contraception altogether, thereby exposing themselves to unwanted pregnancy and--in a number of cases--to pregnancy termination. This latest episode should be turned into something positive: we need to learn that, in the case of drugs in widespread use, before restrictive action is taken--and except for very rare and specific instances--the scientific community must carry out an exhaustive debate on the reality and importance of the observed effects. Although the public should, in each instance, be properly informed, it is only after this process has been completed that restrictive action should be taken. It is hoped that, after this last episode, all concerned have learned this simple principle and will accept being guided by it from now on.     

The effect of etonogestrel on VEGF, oestrogen and progesterone receptor immunoreactivity and endothelial cell number in human endometrium

Contraceptive use often leads to disrupted endometrial bleeding patterns in women. In this study, two different contraceptive regimes (Mircette, a monophasic oral contraceptive and Implanon, a long-acting gestagen) were used and their effects on the immunoreactivity of vascular endothelial growth factor (VEGF), oestrogen receptor (ER), progesterone receptor (PR) and endothelial cell number were determined. During the untreated normal cycle, there was a significant increase (P = 0.005) in glandular VEGF immunoreactivity and a significant decrease (P < 0.05) in PR immunoreactivity in the mid- and late secretory phases compared with the proliferative phase. There was a significant positive correlation (gamma = 0.38, P = 0.046) between stromal VEGF immunoreactivity and endothelial cell number. This correlation was also apparent during treatment with Implanon, but not with Mircette. Disrupted bleeding patterns were associated with Implanon and, to a lesser extent, with Mircette. Both contraceptives significantly reduced glandular VEGF immunoreactivity. Implanon significantly increased (P = 0.016) glandular PR staining, but Mircette significantly reduced (P = 0.027) stromal PR staining when compared with secretory before-treatment biopsies. There were no changes in endothelial cell number or glandular or stromal ER during the normal cycle, or with use of either contraceptive. There was no association between the parameters measured with bleeding patterns and histological category.     

A randomized double-blind placebo-controlled study to assess the effect of oral contraceptive pills on the outcome of medical abortion with mifepristone and misoprostol

This was a randomized double-blind placebo-controlled trial to determine the effect of oral contraceptive (OC) pills taken immediately after medical abortion on the duration of bleeding and complete abortion rate. Two hundred women in the first 49 days of pregnancy were given 200 mg mifepristone orally followed by 400 microg misoprostol vaginally 48 h later. One day later, they were randomized to receive either OC pills (30 microg of ethinyl oestradiol and 0.15 mg of levonorgestrel per tablet) or placebo for 21 days. The complete abortion rates were 98% in the OC group and 99% in the placebo group. The median duration of bleeding was similar: 17 (range: 5-57) days in the OC group and 16 (range: 6-55) days in the placebo group. In the OC group there was a small but significant fall in the haemoglobin concentration by 14 days (5.3 g/dl) after administration of mifepristone. The incidence of side-effects was similar in the two groups. We conclude that the use of OC pills does not decrease the duration of bleeding after medical abortion nor does it affect the abortion rate.     

复方软伤伸筋丸治疗膝关节骨性关节炎临床研究

目的 :探讨复方软伤伸筋丸治疗膝关节骨性关节炎的疗效机理。方法 :采用单盲法将膝关节骨性关节炎患者 2 2 0例 ,随机分为软伤伸筋丸组 (治疗组 ) 1 60例 ,壮骨关节丸组 (对照组 ) 60例 ,对比分析两组临床疗效。结果 :1治疗组临床治愈率为 88.75 % ,总有效率为 99.3 5 % ;对照组临床治愈率为 2 3 .3 3 % ,总有效率为 91 .68% ,治疗组优于对照组 ,具有显著性差异 (P<0 .0 1 )。2复方软伤伸筋丸无毒副作用。3复方软伤伸筋丸的应用可使增生骨刺吸收 ,损伤半月板修复。结论 :复方软伤伸筋丸是一种治疗膝关节骨性关节炎安全有效药物。     

降脂保肝丸治疗脂肪肝的研究

目的　观察降脂保肝丸对脂肪肝的治疗作用。方法　将 1 2 8例脂肪肝患者随机分为 2组 ,治疗组服用降脂保肝丸 ;对照组服用多烯康胶囊。对两组进行临床观察 1个疗程后比较疗效。结果　治疗组总有效率为 1 0 0 % ,治愈率为 80 % ;对照组总有效率为 40 % ,治愈率为6 .7%。治疗组疗效明显优于对照组 ,有非常显著性差异 (P <0 .0 1 )。结论　降脂保肝丸是目前治疗脂肪肝的有效药物     

避孕药物醋酸烯诺孕酮的研究进展

哺乳期妇女出于对婴儿安全的考虑 ,对于避孕药物的选择十分谨慎。醋酸烯诺孕酮的激素特性和药代动力学特点使其在临床试验中避孕率高 ,副作用小 ,尤其对婴儿无影响 ,其皮下埋植剂有希望成为哺乳期妇女避孕的首选药物。本文就醋酸烯诺孕酮的化学结构、激素活性、药代动力学特性、临床有效率、副作用、药物作用机制以及阴道环剂型等方面作一综述。     

Quality of care in institutionalized deliveries: the paradox of the Dominican Republic.

OBJECTIVES: To better understand the paradox in the Dominican Republic of a relatively high maternal mortality ratio despite nearly universal institutionalized deliveries with trained attendants, a rapid assessment using an adaptation of the strategic assessment method was conducted. METHODS: A multi-disciplinary team reviewed national statistics and hospital records, inventoried facilities, and observed peripartum client-provider interactions at 14 facilities. RESULTS: The major referral hospitals, where more than 40% of births in the country occur, were overcrowded and understaffed, with inexperienced residents overseeing care provided by medical students, interns and nurses. Uncomplicated labor and deliveries were overmedicalized, while complicated ones were not managed appropriately; emergencies were not dealt with in a timely fashion. In the peripheral hospitals physicians were seldom present and clients were either turned away or delivered by unprepared nursing staff. Providers in the busiest facilities suffered from compassion fatigue, and were demoralized and overworked. In all facilities, quality of care was lacking and the delivery and birthing process was dehumanized. CONCLUSIONS: Access and availability of institutional delivery alone is not enough to decrease MMR, it is also the quality of emergency obstetric care that saves lives.     

左归丸现代临床应用和实验研究进展

综合近10年公开发表的中西医药学术期刊，发现左归丸至少可治疗西医50种以上的疾病，尽管其适用于临床的病证复杂多变，但总以神经一内分泌一免疫网络功能的衰退和失调密切相关，辨证要点为“形衰精亏”。实验研究初步提示，左归丸对神经一内分泌一免疫网络具有多组分、多途径、多环节和多靶点的整合调节作用。