Metabolic profile of a continuous versus a cyclic low-dose combined oral contraceptive after one year of use

Objectives?To compare the effects of a combined oral contraceptive (COC) taken continuously with those of one of similar composition taken cyclically on 30 variables related to haemostasis, lipids, carbohydrates, bone metabolism, and sex hormone-binding globulin (SHBG). Methods?Randomised, open-label, multicentre, comparative substudy of a larger phase 3 trial involving 147 healthy women (age 18-?49 years). Participants received the COC either continuously (levonorgestrel [LNG] 90 µg/ethinylestradiol [EE] 20 µg) or cyclically (21/7 days pattern; LNG 100 µg/EE 20 µg). Results?After 13 pill packs, changes in total cholesterol (+0.23 vs. -?0.06 mmol/l), low-density lipoprotein cholesterol (+0.25 vs. -?0.12 mmol/l), and high-density lipoprotein cholesterol3 (-?0.06 vs. -?0.15 mmol/l) differed significantly (p<0.05) between the continuous and cyclic regimens, respectively. Increases were significantly greater (p <0.05) for protein C antigen (+11.8% vs. +6.1%) and SHBG (+791 vs. +565 nmol/l), and significantly smaller (p <0.05, ranks) for D-dimer (+19 vs. +37 µg FE/l). Conclusions?Overall, the continuous and cyclic regimens affected metabolic variables similarly. The larger increase in SHBG with the continuous COC is consistent with a higher net oestrogenic effect due to a lower daily dose of LNG. Prospective studies are required to determine the long-term effects of this continuous COC regimen. © 2011 The European Society of Contraception and Reproductive Health

Social Protection and Private Insurance: Reassessing the Role of Public Sector Versus Private Sector in Insurance

This paper first discusses the standard reasons why private insurance cannot be expected to function well and why public intervention in or public provision of insurance can improve on private market outcomes. These arguments are based on efficiency but also on equity considerations. Then the paper turns to new developments in modern societies that might affect the balance between social and private insurance. They pertain to the current working of labor markets, to the openness of our economies and the ensuing fiscal competition, and to the crediblity and commitment problems faced by the state. The paper concludes that the public sector will find it less and less affordable to provide both insurance and assistance and recommends that it focus on the latter objective by awarding tax-financed uniform benefits on the basis of specified contingencies. The Geneva Papers on Risk and Insurance Theory (1994) 19, 81–92. doi:10.1007/BF01371684