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| 3. |
- Ahrendt, Hans-Joachim, et al.
(författare)
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Efficacy, acceptability and tolerability of the combined contraceptive ring, NuvaRing, compared with an oral contraceptive containing 30 mug of ethinyl estradiol and 3 mg of drospirenone
- 2006
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Ingår i: Contraception. - : Elsevier BV. - 0010-7824. ; 74:6, s. 451-457
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This randomized multicenter, open-label, trial compared efficacy, acceptability, tolerability and compliance of NuvaRing with a combined oral contraceptive (COC), containing 30 mug of ethinyl estradiol (EE) and 3 mg of drospirenone. METHOD: In this 13-cycle study, 983 women were randomized and treated (intent-to-treat population) with NuvaRing or COC. RESULTS: One in-treatment pregnancy occurred with NuvaRing (Pearl Index=0.25) (95% confidence interval [CI]: 0.006, 1.363) and four with the COC (Pearl Index=0.99) (95% CI: 0.269, 2.530). For both groups, compliance (89.2% NuvaRing, 85.5% COC) and satisfaction (84% NuvaRing; 87% COC) were high; the vast majority of women found NuvaRing easy to insert (96%) and remove (97%). Tolerability was similar; the most frequent adverse events with NuvaRing were related to ring use, whereas estrogen-related events were more common with the COC. CONCLUSION: NuvaRing has comparable efficacy and tolerability to a COC containing 30 mug of EE and 3 mg drospirenone. User acceptability of both methods was high.
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| 4. |
- Al-Mukhtar Othman, Jwan, 1980, et al.
(författare)
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Fecal incontinence in nonpregnant nulliparous women aged 25-64 years - a randomly selected national cohort prevalence study.
- 2021
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Ingår i: American journal of obstetrics and gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 226:5
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Tidskriftsartikel (refereegranskat)abstract
- The extent to which fecal incontinence is associated with obstetric history or pelvic floor injuries is still a controversial and unresolved issue. One crucial first step towards answering this question is the need to study fecal incontinence in non-pregnant nulliparous women.Therefore, the aim of this study was to present detailed, descriptive measures of accidental leakage of liquid or solid stool and gas in a randomly selected, large national cohort of non-pregnant nulliparous women aged 25 to 64 years.The Swedish Total Population Register identified the source population. Four independent, age-stratified, simple random samples in a total of 20,000 nulliparous women aged 25-64 years were drawn from 625,810 eligible women. Information was collected in 2014 using postal and web-based questionnaires. The 40-item questionnaire included questions about the presence and frequency of leakage of solid and liquid stool and gas, which provided the basis for the generic terms fecal and anal incontinence. Statistical analyses of differences between groups were performed using Fisher's exact test for dichotomous variables and the Mann-Whitney U-test for continuous variables. The trend between >2 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics. When analyzing the trend between multiple ordered versus non-ordered categorical variables, the Kruskal-Wallis test was used. The age-related probability and risk increase per 10 years for incontinence parameters was calculated from logistic regression models adjusted for body mass index (BMI).The study population was 9197 women, and the response rate was 52.2%, ranging from 44.7% in women aged 25-34 years to 62.4% among those 55-64 years. All types of incontinence, except severe isolated gas incontinence, increased with age up to 64 years. The estimated probability of fecal incontinence was 8.8% at age 25 years and 17.6% at age 64. Leakage of liquid stool was dominant, occurring in 93.1% (95%CI 91.4-94.5) of the women with fecal incontinence, whereas leakage of solid stool occurred in 33.9% (95%CI, 31.1-36.7), of which ∼80% also had concomitant leakage of liquid stool. Leakage of liquid stool increased markedly up to age 65, whereas the increase in isolated leakage of solid stool was negligible across all ages (overall <0.4%). Liquid and solid stool, separate or in combination, co-occurred with gas in ∼80%. The distribution pattern of the different types of leakage, single or combined, was similar in all age groups. Both age and BMI (kg/m2) were risk factors for fecal incontinence (P<0.0001) with an interaction effect of P=0.16.Abnormal stool consistency has been identified as the strongest risk factor for accidental bowel leakage. The same pattern characterized by a dominance of liquid stool and gas leakage, prevalent concomitant leakage of solid and liquid stool, and a negligible rate of isolated leakage of solid feces, was observed across all ages. The low rates of isolated leakage of solid stool support the impression that dysfunction of the continence mechanism of the pelvic floor had a negligible role for bowel incontinence, which is essential information for the comparison with women with birth-related injuries.
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- Al-Mukhtar Othman, Jwan, 1980, et al.
(författare)
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Urinary incontinence in nulliparous women aged 25-64 years: a national survey.
- 2017
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Ingår i: American journal of obstetrics and gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 2016:2
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Tidskriftsartikel (refereegranskat)abstract
- A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously.The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women.This postal and World Wide Web-based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n = 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index-adjusted prevalence and its 95% confidence limits were calculated for each 10-year category.The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m(2) to 48.4% among the oldest women with a body mass index ≥35 kg/m(2). The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand.Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.
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- Alfonzo, Emilia, et al.
(författare)
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Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study.
- 2022
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 129:8, s. 1261-1267
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the effectiveness and performance of Swedescore in the Swedish screening programme.Cross-sectional register study.All Swedish women aged over 18 years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015-20.Colposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models.CIN2+.A total of 11 317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0-1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0-1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88.Swedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See-and-treat at Swedescore 8-10 is feasible only if referral cytology showed high-grade squamous intraepithelial lesion.No safe cutoff level for refraining from biopsy nor for see-and-treat with Swedescore.
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| 7. |
- Alfonzo, Emilia, et al.
(författare)
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Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population-based national cohort study.
- 2020
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 127:4, s. 448-454
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Tidskriftsartikel (refereegranskat)abstract
- To study the risk of vaginal cancer among hysterectomised women with and without CIN.Population-based national cohort study.All Swedish women, five million in total, aged 20 and up, 1987-2011 using national registries.The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non-hysterectomised.Vaginal cancer.We identified 898 incident cases of vaginal cancer. Women with prevalent CIN at hysterectomy and those with CIN3/AIS history had incidence rates (IR) of vaginal cancer: 51.3 (34.3-76.5) and 17.1 (12.5-23-4) per 100 000, respectively. Age-adjusted IR-ratios (IRRs) compared to hysterectomised with benign cervical history, were 21.0 (13.4-32.9) and 5.81(4.00-8.43), respectively. IR for non-hysterectomised women was 0.87 (0.81-0.93) and IRR 0.37 (0.30-0.46). In hysterectomised with prevalent CIN, the IR remained high after 15 years of follow-up: 65.7 (21.2-203.6).Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non-hysterectomised women in the general population. Still, the incidence rate does not justify screening.
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| 8. |
- Ali, Z, et al.
(författare)
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Efficacy of a paracetamol and caffeine combination in the treatment of the key symptoms of primary dysmenorrhoea
- 2007
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Ingår i: Curr Med Res Opin. ; 23:4, s. 841-51
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Primary dysmenorrhoea is characterised by pain, cramping and backache at the time of menses. Despite the high prevalence of dysmenorrhoea, few sufficiently powered, placebo-controlled studies have examined the efficacy of over the counter analgesics in this condition. Furthermore, even fewer studies have directly examined the efficacy of analgesics on specific dysmenorrhoea symptoms. Research design and main outcome measures: This was a single-dose, placebo-controlled, double blind, crossover study carried out in 320 women with moderate-to-severe dysmenorrhoea pain. At 2 h following dosing, 1 g paracetamol plus 130 mg caffeine led to significantly greater pain relief compared to 1 g paracetamol alone (p < 0.05), 130 mg caffeine alone (p < 0.01) or placebo (p < 0.01). The combination was also significantly more effective in relieving abdominal cramping and backache compared to the other treatment arms. No major treatment related adverse events were reported during this study. CONCLUSIONS: When taken at recommended doses, both paracetamol and the combination of paracetamol and caffeine are safe and effective treatments for primary dysmenorrhoea. Consistent with results from other acute pain states, caffeine acts as an analgesic adjuvant and enhances the efficacy of paracetamol.
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| 9. |
- Altman, D., et al.
(författare)
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Somatic Comorbidity in Women with Overactive Bladder Syndrome
- 2016
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 196:2, s. 473-477
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We explore the influence of co-occurring somatic illnesses on prevalent overactive bladder in women of premenopausal age. Materials and Methods: Data for the present study were derived from a nationwide survey on complex diseases among all twins in the Swedish Twin Registry born 1959 to 1985. The present study was limited to female twins participating in the survey (12,850). Generalized estimating equations were used to estimate odds ratios with 95% CIs. Environmental and genetic influences were assessed in co-twin control analysis. Results: Generalized estimating equations analysis showed a significant association between overactive bladder and migraine (OR 1.34, 95% CI 1.15-1.57), fibromyalgia (1.83, 1.54-2.18), chronic fatigue (1.81, 1.49-2.19) and eating disorders (1.56, 1.24-1.96). There was also a significant association with allergic disorders including asthma (1.24, 1.01-1.52) and eczema (1.22, 1.04-1.43). Among reproductive disorders, urinary tract infections (1.60, 1.40-1.84), dysmenorrhea (1.53, 1.33-1.76) and pelvic pain (1.60, 1.31-1.94) showed the strongest association with overactive bladder. Results from co-twin control analysis indicated that the significant associations observed in generalized estimating equations analysis were influenced by environmental and genetic factors without a common pathway model. Conclusions: Our results suggest a multifactorial and complex pathogenesis of overactive bladder in which associations between various somatic illnesses and overactive bladder may be affected by environmental and genetic factors.
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| 10. |
- Altman, Daniel, et al.
(författare)
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The genetic and environmental contribution to the occurrence of bladder pain syndrome: an empirical approach in a nationwide population sample.
- 2011
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Ingår i: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 59:2, s. 280-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aetiology of bladder pain syndrome (BPS) remains poorly understood, and a number of pathogenic mechanisms have been proposed. The importance of genetic factors for BPS is receiving growing attention, but data so far are of a preliminary nature. OBJECTIVE: To empirically assess the genetic and environmental contribution to BPS in a population-based sample of twins. DESIGN, SETTING, AND PARTICIPANTS: The study included >25 000 twins born between 1959 and 1985. Individuals with BPS were identified using latent class cluster analysis (LCCA) based on self-reported symptoms from a nationwide screening for complex diseases in the Swedish Twin Registry. By comparing monozygotic and dizygotic twins, we estimated twin similarity and the relative proportions of phenotypic variance resulting from genetic and environmental factors. MEASUREMENTS: Twin similarity was measured. RESULTS AND LIMITATIONS: The LCCA yielded an overall BPS prevalence of 1.1% and 2.4% for males and females, respectively. In males, the contribution of genetic effects to BPS could not be assessed because of the small number of concordant twin pairs. In women, twin similarity estimates indicated a genetic component for the aetiology of BPS, but genetic factors contributed less than one-third of the total variation in susceptibility to BPS. Nonshared environmental factors accounted for more than two-thirds of the variance, whereas early nongenetic factors shared within the family were of little or no consequence to the risk of developing BPS later in life. Use of self-reported symptoms to define the disease phenotype is a limitation of the study. CONCLUSIONS: The influence of environmental factors in the development of BPS in women is substantial, whereas genetic influences are of only modest importance for the possibility of developing the disease.
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