20 years, 20 articles: Studies to know
20 years, 20 articles: Studies to know
What do you consider the top research articles of the past two decades? The following list is compiled from suggestions from Contraceptive Technology Update editorial advisory board member Andrew Kaunitz, MD, professor and assistant chair in the OB/GYN department at the University of Florida Health Science Center in Jacksonville; Robert Rebar, MD, professor and chairman of the department of obstetrics and gynecology at the University of Cincinnati College of Medicine; and Deborah Kowal, MA, PA, adjunct assistant professor in the Rollins School of Public Health at Emory University in Atlanta, co-author of Contraceptive Technology, and the first editor of CTU.
While noninclusive, this list offers a brief insight into the breadth of research available to family planners:
- Breast-feeding.
• Labbok MH, Hight-Laukaran V, Peterson AE, et al. Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55:327-336.
A multicenter study of the LAM was carried out to test its acceptability and efficacy. Results indicate it is highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socioeconomic strata, and industrial and developing country locales.
• Hight-Laukaran V, Labbok MH, Peterson AE, et al. Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications. Contraception 1997; 55:337-346.
A multicenter study of LAM examined method acceptability, satisfaction, and utilization in 10 populations. The results confirm that LAM is ready for widespread use in maternal and child health, family planning, and other primary health care settings.
- Depot medroxyprogesterone acetate (DMPA).
• Breast cancer and depot-medroxyprogesterone acetate: A multinational study. WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Lancet 1991; 338:833-838.
To determine whether the contraceptive injection DMPA alters the risk of breast cancer in women, a hospital-based case-control study was conducted in five participating hospitals in four countries. Results indicate that women who used DMPA for a long time and initiated use many years previously are not at increased risk of breast cancer.
- Family planning.
• Technical Guidance/Competence Working Group and World Health Organization/Family Planning and Population Unit. Family planning methods: New guidance. Population Reports. Series J, No. 44. Baltimore: Johns Hopkins School of Public Health, Population Information Program; 1996.
International reproductive health experts offer guidance on providing combined oral contraceptives, progestin-only pills, progestin-only injectables, combined injectables, Norplant implants, intrauterine devices, barrier methods, sterilization, vasectomy, lactational amenorrhea method, and natural family planning.
• Trussell J, Hatcher RA, Cates W Jr., et al. Contraceptive failure in the United States: An update. Stud Fam Plann 1990; 21:51-54.
This report updates the authors’ previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between those two probabilities provides a measure of how forgiving of imperfect use each method is.
• Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995; 333:1,517-1,521.
A total of 221 healthy women who were planning to become pregnant stopped using birth control methods and began collecting daily urine specimens and keeping daily records of whether they had sexual intercourse. Findings indicate that among healthy women trying to conceive, nearly all pregnancies can be attributed to intercourse during a six-day period ending on the day of ovulation.
- HIV/AIDS.
• Centers for Disease Control and Prevention. Pneumocystis pneumonia — Los Angeles. MMWR 1981; 30:250-252.
• Centers for Disease Control and Prevention. Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men — New York City and California. MMWR 1981; 30:305-308.
In 1981, clinical investigators in New York and California observed the first evidence of HIV/ AIDS infection in the United States: an unusual clustering of cases of rare diseases, notably Kaposi’s sarcoma, and opportunistic infections such as Pneumocystis carinii pneumonia among young, previously healthy homosexual men.
• Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331:1,173-1,180.
Scientists conducted a randomized, double-blind, placebo-controlled trial of the efficacy and safety of zidovudine in reducing the risk of maternal-infant HIV transmission. Pregnant women with mildly symptomatic HIV disease and no prior treatment with antiretroviral drugs during the pregnancy received the regimen. Zidovudine given antepartum and intrapartum to the mother and to the newborn for six weeks reduced the risk of maternal-infant HIV transmission by approximately two-thirds.
- Intrauterine devices.
• Alvarez F, Brache V, Fernandez E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988; 49:768-773.
To gain a better understanding of the mechanism of action of intrauterine devices (IUDs), a search was made for ova in the genital tracts of 115 women using no contraception and 56 women using IUDs. Fertilized ova are less likely to reach a uterine cavity containing an IUD, researchers observed, thus leading them to conclude that the principal mode of IUDs is by a method other than destruction of live embryos.
• Lee NC, Rubin GL, Borucki R. The intrauterine device and pelvic inflammatory disease revisited: New results from the Women’s Health Study. Obstet Gynecol 1988; 72:1-6.
Researchers analyzed data from the Women’s Health Study, a hospital-based, case-control study carried out in the United States from 1976 to 1978, to examine whether the risk of pelvic inflammatory disease associated with IUD use varies with a woman’s sexual behavior. Results indicate that women at low risk of acquiring sexually transmitted infections have little increase in the risk of pelvic inflammatory disease from use of an IUD.
• Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet 1998; 351:1,005-1,008.
This triple-masked, randomized, placebo-controlled trial used 11 clinic sites to enroll women who requested IUD insertion and were at low risk of sexually transmitted infection according to self-reported medical history. Women were randomly assigned azithromycin or placebo capsules to find out whether such prophylaxis reduces the rate of IUD removal within 90 days. Researchers concluded that in appropriately screened women, the risk of upper-genital-tract infection is negligible after IUD insertion, with or without the administration of prophylactic antibiotics.
- Oral contraceptives.
• Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: Further results. Contraception 1996; 54:1S-106S.
Scientists looked at the worldwide epidemiological evidence on breast cancer risk and use of hormonal contraceptives. They reviewed original data from 54 studies, which represented about 90% of the information available on the topic. The group concluded there is little difference between women who have and have not used combined oral contraceptives (OCs) in terms of the estimated cumulative number of breast cancers diagnosed during the period from starting use up to 20 years after stopping. The cancers diagnosed in women who have used OCs are, however, less advanced clinically than the cancers diagnosed in never-users.
• The Centers for Disease Control Cancer and Steroid Hormone Study. Oral contraceptive use and the risk of ovarian cancer. JAMA 1983; 249:1,596-1,599.
The Centers for Disease Control and Prevention in Atlanta published this report as part of its Cancer and Steroid Hormone Study, a multicenter case-control investigation. Researchers determined that the risk of ovarian cancer decreased with increasing duration of OC use and remained low long after cessation of use. They estimated that more than 1,700 cases of ovarian cancer are averted each year by past and current OC use among American women.
• Petitti DB, Sidney S, Bernstein A, et al. Stroke in users of low-dose oral contraceptives. N Engl J Med 1996; 335:8-15.
In a population-based, case-control study, scientists identified fatal and nonfatal strokes in female members ages 15 to 44 in a managed care setting, with matched controls randomly selected from female members who had not had strokes. Researchers concluded that stroke is rare among women of childbearing age and that low-estrogen OCs do not appear to increase the risk of stroke.
• Redmond GP, Olson WH, Lippman JS, et al. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: A randomized, placebo-controlled trial. Obstet Gynecol 1997; 89:615-622.
Scientists used a multicenter randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy of a triphasic, combination OC (norgestimate-ethinyl estradiol) in comparison with a placebo in the treatment of moderate acne vulgaris. Findings indicate that the triphasic combination of norgestimate and ethinyl estradiol is an effective treatment for moderate acne vulgaris in women with no known contraindication to OC therapy.
• Sidney S, Siscovick DS, Petitti DB, et al. Myocardial infarction and use of low-dose oral contraceptives: A pooled analysis of two U.S. studies. Circulation 1998; 98:1,058-1,063.
An analysis of findings from two population-based case-control studies was used to estimate risk of myocardial infarction (MI) in relation to use of low-dose OCs. Scientists noted no evidence of interaction between OC use and age, presence of cardiovascular risk factors, obesity, or smoking. They concluded that low-dose OCs as used in those populations are safe with respect to MI risk.
• The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral contraceptive use. N Engl J Med 1987; 316:650-655.
Researchers used data from a case-control study, the Cancer and Steroid Hor mone Study, to evaluate ovarian cancer risk reduction associated with OCs. A protective effect was seen in women who had used OCs for as little as three to six months and continued for 15 years after use ended. It was independent of specific pill formulation and histologic type of epithelial ovarian cancer. Research ers concluded OC use decreases the risk of epithelial ovarian cancer.
- Sterilization.
• Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1,161-1,170.
A multicenter prospective cohort study was conducted in U.S. medical centers, with more than 10,000 women who underwent tubal sterilization followed for eight to 14 years. Pregnancy risk was assessed by cumulative life-table probabilities and proportional hazards models. Findings indicate tubal sterilization is highly effective, but the risk of failure is higher than generally reported, persists for years after the procedure, and varies by method of tubal occlusion and age.
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