Fam Plann Reprod Health Care Research Articles

Every ED Visit is an Opportunity to Talk about Contraception

Every ED Visit is an Opportunity to Talk about Contraception

Investigating the relationship between community pharmacy and GP Emergency Hormonal Contraception (EHC) provision: a linear regression analysis

Abstract Introduction Emergency Hormonal Contraception (EHC) is contracted by Local Authorities to be provided free-of-charge from 46% of community pharmacies in England. (1) There is no difference in EHC consultation outcomes between community pharmacy and GP surgeries. A study in a rural area demonstrated that introduction of a community pharmacy EHC service can reduce GP EHC prescribing rates by approximately 41%, without influencing Family Planning Clinics or Accident and Emergency departments. (2) However, it is not known whether this relationship is universally present, and this relationship has not previously been quantified. Aim To describe the relationship between rates of GP EHC prescribing and commissioned community pharmacy EHC provision. Methods Freedom of Information (FOI) requests were submitted to all Local Authorities in England for numbers of EHC provisions through commissioned services between March 2019 and April 2020. The data were matched to Clinical Commissioning Group (CCG) GP prescribing data, obtained from openprescribing.net. Using population estimates from the Office of National Statistics, rates of supply per 10,000 female population (aged 12-55) were determined. The data indicated small numbers of outliers, which can distort linear regression; boxplots allowed the removal of data points outside 1.5 times the Inter Quartile Range from the 1st or 3rd quarter. Using SPSS v24, linear regressions were calculated between GP prescribing rates and community pharmacy EHC provision rates. This was repeated for community pharmacy EHC provision rates and the proportion of commissioned pharmacies. Results There were 147 Local Authority commissioners identified across England, 113 (76.9%) responded to the FOI request. Of these, 5 did not commission EHC services from community pharmacy. Local Authority and CCG boundaries were compared, 86 areas were identified as ‘co-terminus’ (i.e., greater than 95% overlap). These 86 areas included 82,822 GP prescriptions and 207,731 community pharmacy provisions. The data reflected an estimated female population aged 12-55 of 9,380,153 (Local Authority mean 109,072, SD 83,899), 60% of the total English female (12-55) population. Removing outliers left 92.5% of the data for analysis. The mean GP prescribing rate was 79.3/10,000 (SD 26.3) and the mean community pharmacy provision rate was 200.2/10,000 (SD 154.9). Linear regression indicated a negative correlation between GP prescribing rates and community pharmacy provision rates (R2=0.21) and a positive correlation between community pharmacy provision rates and the proportion of commissioned pharmacies (R2=0.21). Conclusion This study shows that increasing the community pharmacy provision rate by 100/10,000 decreases the GP prescribing rate by 8/10,000. Increasing the proportion of commissioned pharmacies to 100%, through a national service may change GP prescribing rates. This regression analysis predicts this would decrease the GP EHC prescribing rate by 15% to 66.3/10,000. Whilst this data is not fully representative of commissioning in England, this single commissioning change could move 20,706 GP consultations to community pharmacy annually across England. Comparisons with Wales and Scotland (who have national services) suggest this impact could potentially even be doubled. The strength of this study is it’s use of routine data facilitating replication, however local commissioning arrangements mean the conclusions are not necessarily applicable beyond England. References (1) Mackridge AJ, Gray NJ, Krska J. A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England. BMJ Open. 2017;7(7):e015511 (2) Lloyd K, Gale E. Provision of emergency hormonal contraception through community pharmacies in a rural area. J Fam Plann Reprod Health Care. 2005;31(4):297-300.

Abstract P1-10-03: Estrogen and breast cancer benefits: Emerging hormone replacement therapy breast cancer paradigms

Abstract BACKGROUND. Large scale clinical hormone replacement therapy [HRT] studies have yielded conflicting breast cancer [BrCa] outcomes. The studies reviewed include:. Two Non-Randomized Studies [Non-RS], based on either estrogen+progestin Provera [E+P HRT]; or estrogen-alone [E-HRT]:. 1. Collaborative Group Meta-analysis of 58 HRT studies [CG-M] [1]. 2. Million Women Study [MWS] [2]. Two Randomized Studies [RS] - the Women’s Health Initiative [WHI] Trials 1 and 2:. 1. WHI HRT Trial 1 - based on E+P HRT [3] 2. WHI HRT Trial 2 - based on E-HRT [3]. Of all the above HRT studies, only the WHI HRT Trial 2 showed long-term reductions in Breast Cancer Incidence [BrCa-I] and Mortality [BrCa-M], while all others showed varying degrees of BrCa harms. OBJECTIVES. To evaluate differences between the representative HRT studies, their results and conclusions. METHODOLOGY. Compared were BrCa outcomes:. i. Between the two the RS - WHI HRT Trial 2 vs. 1 (Analysis 1) ii. E-HRT impact from a RS [i.e., the WHI HRT Trial 2] vs. Non-RS [the CG-M/MWS] (Analysis 2). For both analyses, risk ratios (RR) for BrCa-I & BrCa-M, and the corresponding 95% confidence intervals (CI), were obtained from the studies [RR1 and RR2, respectively]. Subsequently, the ratio of “risk ratios” (R-RRs), were estimated, in each analysis, separately for BrCa-I and BrCa-M. The 95% confidence intervals and p-values for the R-RRs were derived through logarithmic transformation of the risk ratios and 95% CI originally reported. RESULTS. CONCLUSIONS.. Based on these outcomes, the following emerging HRT paradigms can be considered:. PARADIGM 1: The addition of Progestin Provera abrogates the benefits of E-alone HRT [4]. PARADIGM 2: Considering the presence of many confounding factors in non-randomized HRT studies [e.g., selection bias, with more high-risk women receiving HRT (5)], the reduction of BrCa-I and BrCa-M rates observed in the WHI Trial 2 has to be accepted as the least biased conclusion of the E-HRT impact on breast cancer. PARADIGM 3: The mechanism of the E-alone based HRT breast cancer benefit could be explained by the Estrogen Duality [endogenous estrogen remaining breast carcinogenic, while the exogenous estrogen emerging breast cancer suppressive] - a concept articulated already in 2010 [6], now confirmed in the WHI HRT Trial 2 final outcomes, and in these analyses. REFERENCES. 1. Collaborative Group on Hormonal Factors in Breast Cancer. The Lancet, 2019; vol. 394(1024). 2. Beral V et al. The Lancet, 2019; vol. 394. 3. Chlebowski R et al. JAMA, 2020; vol. 324(4). 4. Ragaz J et al. AACR, 2019; vol. 79(4) Supplement. 5. Shapiro S et al. J Fam Plann Reprod Health Care, 2013; vol. 39(2). 6. Ragaz J et al. Ca Res, 2010; vol. 70(24) Supplement. Analysis 1: RS WHI Trial 2 vs. 1 [ 3]RS - RRs: E-HRT vs. Placebo. RR1 [95% C.I.]RS - RRs: E+P HRT vs. Placebo. RR2 [95% C.I.]Ratio of “Risk Ratios” [R-RRs]PBrCa Incidence0.78 [0.65-0.93]1.28 [1.13-1.45]0.61 [0.49-0.76]<0.001BrCa Mortality0.60 [0.37-0.97]1.35 [0.94-1.95]0.44 [0.25-0.81]0.008Analysis 2: [E-HRT] of RS vs. Non-RS - [WHI Trial 2 vs. CG-M/MWS 1,2]RS: E-HRT vs. Placebo- RRs. RR1 [95% C.I.]Non-RS E-HRT “users” vs. “Non-users” - RRs. RR2 [95% C.I.]R-RRs. RR1/RR2 [95% C.I.]PBrCa Incidence0.78 [0.65-0.93]1.33 [1.28-1.38]0.59 [0.49-0.70]<0.001BrCa Mortality0.60 [0.37-0.97]1.35 [1.24-1.47]0.44 [0.27-0.72]0.001 Citation Format: Joseph Ragaz, John J Spinelli, Hong Qian, Hubert Wong, Shayan Shakeraneh, Joel Fox, Kenneth S Wilson. Estrogen and breast cancer benefits: Emerging hormone replacement therapy breast cancer paradigms [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-10-03.

Hold my Hand

Hold my Hand

Функциональное состояние сосудистой стенки и плазменного звена гемостаза у женщин раннего постменопаузального периода на фоне длительной менопаузальной гормональной терапии

Цель исследования: оценка изменений функциональной активности сосудистой стенки и плазменного звена гемостаза у женщин раннего постменопаузального периода на фоне длительной низкодозовой менопаузальной гормональной терапии (МГТ). Материалы и методы: Обследовано 162 женщины в ранней постменопаузе. В основную группу вошли 84 пациентки, которым была назначена низкодозовая МГТ: 1 мг 17β-эстрадиола (E2) и 2 мг дроспиренона (ДРСП) — препарат Анжелик® (Байер Фарма, Германия). Контрольную группу составили 78 женщин, не получавших МГТ. Длительность наблюдения составила 5,2 [4,8; 5,7] лет. Исследовали антитромбогенную активность сосудистой стенки, лабораторные маркеры эндотелиальной дисфункции. Результаты: Несмотря на увеличение агрегационной активности тромбоцитов и более низкие значения активности антитромбина III у женщин на фоне МГТ, не было отмечено увеличения риска развития венозного тромбоза и эмболий, ишемического инсульта и случаев острого коронарного синдрома. К окончанию наблюдения установлено снижение антиагрегационного потенциала сосудистой стенки, более выраженное у женщин группы кон-троля. У женщин, принимавших МГТ, выявлено снижение концентрации фибриногена крови к окончанию исследования. На фоне МГТ отмечено значимое возрастание уровня метаболитов оксида азота, снижение уровней эндотелина-1 и асимметричного диметиларгинина к 12 мес наблюдения, но в дальнейшем отмечено повышение их уровней, не достигшее исходных значений. Заключение: Изменения функциональной активности эндотелия свидетельствуют об отсутствии негативного влияния на эндотелий сосудов длительной низкодозовой МГТ (1 мг E2/2 мг ДРСП). Objectives: to assess changes in the functional activity of the vascular wall and plasma hemostasis in women of early postmenopausal period under long-term low-dose menopausal hormone therapy (MHT). Patients/Methods: We examined 162 women in early postmenopause. The main group included 84 patients; they were prescribed a low-dose MHT: 1 mg of 17β-estradiol (E2) and 2 mg of drospirenone (DRSP) — Angelique® (Bayer Pharma, Germany). The control group consisted of 78 women did not taking MHT. The duration of observation was 5.2 [4.8; 5.7] years. Antithrombogenic activity of the vascular wall and laboratory markers of endothelial dysfunction were examined. Results: In women taking MHT we found increasing of platelet aggregation activity and lower antithrombin III activity, but did not reveal increased risk of venous thrombosis and embolism, ischemic stroke, and cases of acute coronary syndrome. By the end of observation decreasing of antiplatelet potential of the vascular wall, more expressed in women of the control group, was noted. In women taking MHT, blood fi brinogen concentration decreased by the end of the study. After 12 months of observation in women taking MHT we revealed significant increasing of nitric oxide metabolites, decreasing of endothelin-1 and asymmetric dimethylarginine; later their levels increased but did not reach the initial values. Conclusions: Changes in endothelial functional activity showed no adverse effect of long-term low-dose MHT (1 mg E2/DRSP 2 mg) on the vascular endothelium.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract

'How shall we survive': a qualitative study of women's experiences following denial of menstrual regulation (MR) services in Bangladesh.

BackgroundAbout one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation [J Fam Plann Reprod Health Care 41(3):161-163, 2015, Issues Brief (Alan Guttmacher Inst) (3):1-8, 2012]. Little is known about barriers to MR services, and whether women denied MR seek abortion elsewhere, self-induce, or continue the pregnancy.MethodsAfter obtaining authorization from four health facilities in Bangladesh, we recruited eligible and interested women in to the study and requested informed consent for study participation. We conducted in-depth interviews with 20 women denied MR from four facilities in four districts in Bangladesh. Interviews were translated and transcribed, and the transcripts were analyzed by two researchers through an iterative process using a qualitative content analysis approach.ResultsOf those interviewed, 12 women sought abortion elsewhere and eight of these women were successful; four women who sought subsequent services were denied again. Two of the eight women who subsequently terminated their pregnancies suffered from complications. None of the participants were aware of the legal gestational limit for government-approved MR services. Given that all participants were initially denied services because they were beyond the legal gestational limit for MR and there were no reported risks to any of the mothers’ health, we presume that the eight terminations performed subsequently were done illegally.ConclusionsBarriers to seeking safe MR services need to be addressed to reduce utilization of potentially unsafe alternative abortion services and to improve women’s health and well being in Bangladesh. Findings from this study indicate a need to raise awareness about legal MR services; provide information to women on where, how and when they can access these services; train more MR providers; improve the quality and safety of second trimester services; and strengthen campaigns to educate women about contraception and pregnancy risk throughout the reproductive lifespan to prevent unintended pregnancies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0199-8) contains supplementary material, which is available to authorized users.

The future of contraception: The male contraceptive pill

Nurse PrescribingVol. 12, No. 1 NewsThe future of contraception: The male contraceptive pillMaria AnguitaMaria AnguitaSearch for more papers by this authorMaria AnguitaPublished Online:20 Jan 2014https://doi.org/10.12968/npre.2014.12.1.6AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2013) Abortion statistics: England and Wales 2012. DH, London Google ScholarEberhardt J, van Wersch A, Meikle N (2009) Attitudes towards the male contraceptive pill in men and women in casual and stable sexual relationships. J Fam Plann Reprod Health Care 35: 161–5 Crossref, Google ScholarHealth and Social Care Information Centre (2013) NHS Contraceptive Services 2012-13 report. HSCIC, Leeds Google ScholarNHS Choices (2011) Can I get a vasectomy on the NHS? NHS Choices, London. http://www.nhs.uk/Conditions/contraception-guide/Pages/vasectomy-reversal-NHS.aspx (accessed 18 December 2013) Google ScholarOffice for National Statistics (2013) Conceptions in England and Wales 2011. ONS, London Google ScholarWalker S (2011) Attitudes to a male contraceptive pill in a group of contraceptive users in the UK. Journal of Men's Health 8(4): 267–73. doi: https://doi.org/10.1016/j.jomh.2011.04.003 Crossref, Google ScholarWhite CW, Choong YT, Short JL, Exintaris B et al. (2013) Male contraception via simultaneous knockout of α1A-adrenoceptors and P2X1-purinoceptors in mice. Proc Natl Acad Sci U S A doi: https://doi.org/10.1073/pnas.1318624110 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 January 2014Volume 12Issue 1ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 20 January 2014 Published in print 1 January 2014 Information© MA Healthcare LtdPDF download

Impersonating another patient in order to procure an abortion

©FFPRHC J Fam Plann Reprod Health Care 2007: 33(3) Clinical scenario Susan, an 18-year-old, presents to you in a community setting requesting a termination of pregnancy (TOP). You see from...