Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation

Does regretting first vaginal intercourse have an effect on young adults' sexual behaviour?

Background The aims of this research were to determine personal differences depending on the reason for regretting or not first vaginal intercourse and its effects on sexual behaviour later on among young adults, and to assess the association between reasons for engaging in first vaginal intercourse and regretting it. Data were drawn from the 2017 Swiss national survey on youth sexual behaviours among young adults (mean age 26 years) living in Switzerland. Out of the 7142 participants, 4793 (51% females) answered the question 'Looking back now to the first time you had vaginal intercourse, do you think that…' with five possible answers: (1) I should not have done it (6.7%); (2) I should have waited longer (7.7%); (3) I should have done it earlier (7.4%); (4) It was about the right time (67.9%); and (5) I don't know (10.3%). The five groups were compared on sociodemographic and sex behaviour-related variables, analysed separately by gender. One-third of participants regretted their first experience. In the multivariate analysis, compared with the 'right time' group, all other groups were more likely to find their first experience unpleasant and to have done it with a casual partner. Those in the 'I should not have done it' and 'I should have waited longer' groups were also more likely to have done it because of external pressure, especially among females. The study results underline the significance to choose the right time and the right partner for first vaginal intercourse and the importance of including partner respect and avoiding external pressure as part of sexual education

Does the Primary Resource of Sex Education Matter? A Swiss National Study.

Sex education (SE) remains a subject of debate, including controversies on resources. The purpose of this paper was to determine the main SE resource during adolescence and its associations with personal characteristics and sexual behaviors of youths. Data were obtained from a self-administrated Swiss national survey on sexuality among young adults (mean age 26.3). Participants (N = 4978) were divided into six groups according to their main SE resource during their adolescence: Friends (1939; 38.9%), Parents (1361; 27.3%), School (n = 949; 19.1%), The Internet (399; 8.0%), Nobody (172; 3.5%) and Other (157; 3.2%). Groups were compared on sociodemographic, first sexual experiences, pregnancy, risky sexual behaviors, and undesired sexual experiences data. Males and non-heterosexual participants were overrepresented in the Internet group while, females more often reported their parents as their main SE resource. Participants in the School group reported the lowest rates of sexually transmitted infections and Friends the highest. Compared to the School group, those in the Friends, Internet, Nobody, and Other groups were more likely to report undesired sexual experiences. Few differences appeared between parents and school. Even though some resources such as friends or the Internet presented negative outcomes when they were assessed individually, we cannot deny the important place that they occupy in the lives of some youths

Создание износостойких покрытий, наплавленных в пучке релятивистских электронов

Целью работы является исследование структуры и свойств (твердости, износостойкости, коррозионной стойкости) покрытий, наплавленных в пучке релятивистских электронов, от характера их легирования с наплавочной порошковой смеси при применении в качестве главных легирующих добавок хрома, углерода и бора, нахождение оптимальных составов наплавочных смесей и получение неоднородных структур с включениями твердой фазы, обладающих в то же время высокой износостойкостью и коррозионной стойкостью и способных заменить при наплавке дорогой карбид вольфрама.The aim of this work is to study the structure and properties (hardness, wear resistance, corrosion resistance) of coatings deposited in a beam of relativistic electrons, on the nature of their alloying from the surfacing powder mixture when used as the main alloying additives of chromium, carbon and boron, finding the optimum compositions of the surfacing mixtures and obtaining heterogeneous structures with inclusions of the solid phase, which at the same time have high wear resistance and corrosion resistance and are able to replace when surfacing an expensive car tungsten bide

Hayret

Ahmet Mithat'ın Tercüman-ı Hakikat'te tefrika edilen Hayret adlı roman

Особенности ВЭД по закупке шкур животных на международных аукционах для переработки на территории ТС

Актуальность выбранной темы обусловлена тем, что особое место на российском рынке верхней одежды приходится на меховое сырье и изделия из него. С одной стороны, в условиях суровых климатических условий делают меховую одежду в России незаменимой и обеспечивают высокий спрос на эти дорогостоящие изделия в зимний период. С другой стороны, меховые изделия являются самыми дорогостоящими по сравнению с другими товарами легкой промышленности и относятся к товарам класса "люкс", т. е. к предметам роскоши. Были исследованы законодательная база, а так же товарная номенклатура мехового сырья. Проанализированы проблемы и тенденции в данной области. Итогом работы являются рекомендации, разработанные для улучшения текущей обстановки в сфере мехового сырья.The relevance of the chosen topic is due to the fact that the special place in the Russian market of outerwear is for fur raw materials and products from it. On the one hand, in conditions of severe climatic conditions, fur clothing in Russia is indispensable and provides a high demand for these expensive products in the winter. On the other hand, fur products are the most expensive compared to other products of light industry and belong to luxury goods, ie, to luxury goods. Legislative base, as well as commodity nomenclature of fur raw materials were investigated. The problems and trends in this area are analyzed. The result of the work are recommendations developed to improve the current situation in the field of fur raw materials

A case study of a mother's intertwining experiences with incest and postpartum depression

The association between childhood sexual abuse (CSA) and major depression disorder (MDD) gives reason to suspect that many mothers with postpartum depression (PPD) have a history of CSA. However, few studies have investigated how CSA and PPD are related. In this case study we explore how the experience of incest intertwines with the experience of postpartum depression. We focus on participant subject “Nina,” who has experienced both. We interviewed her three times and we analysed the interviews with Giorgi's phenomenological descriptive method to arrive at a contextualised meaning structure. Nina's intruding fantasies of men who abuse her children merge with her recollections of her own incest experiences. She may succeed in forcing these fantasies out of her consciousness, but they still alter her perceptions, thoughts, and emotions. She feels overwhelmed and succumbs to sadness, while she also is drawn towards information about CSA, which in turn feeds her fantasies. The psychodynamic concepts of repetition compulsion, transference, and projection may provide some explanation of Nina's actions, thoughts, and emotions through her past experiences. With our phenomenological stance, we aim to acknowledge Nina's descriptions of her everyday life here and now. With reference to Husserl, Heidegger, Merleau-Ponty, and Minkowski, we show that Nina's past is not a dated memory; rather it determines the structure of her consciousness that constitutes her past as her true present and future. Incest dominates Nina's world, and her possibilities for action are restricted by this perceived world. Any suspension of action implies anguish, and she resolves this by incest-structured action that in turn feeds and colours her expectations. Thus anxiety and depression are intertwined in the structure of this experience

Developing a core outcome set for future infertility research: an international consensus development study

Study question Can a core outcome set to standardize outcome selection, collection, and reporting across future infertility research be developed? Summary answer: A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCT) and systematic reviews evaluating potential treatments for infertility. What is known already: Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions, and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. Study design, size, duration: A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). Participants/materials, setting, methods: Healthcare professionals, researchers, and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. Main results and the role of chance: The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin, and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth, and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. Limitations, reasons for caution: We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition, and an arbitrary consensus threshold. Wider implications of the findings: Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection, and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Ferility and Sterility, and Human Reproduction, have committed to implementing this core outcome set. Study funding/competing interest(s): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund, and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. Hans Evers reports being the Editor Emeritus of Human Reproduction. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Annika Strandell reports consultancy fees from Guerbet. Ernest Ng reports research sponsorship from Merck. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. Trial registration number: Core Outcome Measures in Effectiveness Trials Initiative: 1023.J.M.N.Duffy, H.AlAhwany, S.Bhattacharya, B.Collura ... Bernardus Mol ... Mary Hull ... et al

Developing a core outcome set for future infertility research: an international consensus development study

STUDY QUESTION:Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed? SUMMARY ANSWER:A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY:Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION:A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS:Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE:The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION:We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS:Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S):This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER:Core Outcome Measures in Effectiveness Trials Initiative: 1023.J M N Duffy, H AlAhwany, S Bhattacharya, B Collura, C Curtis, J L H Evers ... et al