Validation of the Drug Abuse Screening Test (Dast-10): A Study on Illicit Drug Use among Chinese Pregnant Women

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Levonorgestrel-releasing intrauterine system (Mirena®) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: A randomised controlled trial

Background: Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long-term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel-releasing intrauterine system (LNG-IUS) may be a useful form of prolonged progestogen therapy for endometriosis. Aims: To evaluate and compare the efficacy and safety of LNG-IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients' acceptance. Methods: A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG-IUS and 15 had three-monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student's t-test and chi-square test. Results: Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG-IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG-IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm2) than Depot MPA users (-0.030, -0.017 g/cm2) in both hip and lumbar regions. Conclusions: Levonorgestrel-releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG-IUS users showed a better compliance. After three years, bone gain was noted with LNG-IUS, but bone loss with depot MPA. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.link_to_subscribed_fulltex

A new policy for prenatal screening and diagnosis of Down syndrome for pregnant women with advanced maternal age in a public hospital

Objective. Before April 2006, women with singleton pregnancy and advanced maternal age (AMA, 35 years and older) were offered either direct invasive tests or a variety of screening tests for Down syndrome (DS) with routine anomaly scan at 1820 weeks. After April 2006, to reduce procedure-related fetal loss, invasive test was performed only for positive screening result or the presence of major fetal anomaly on ultrasound. We reviewed our 2-year experience after the policy change. Methods. Two-year data after policy change were compared to the 1-year historic control before policy change. Results. A total of 2257 eligible women were counselled in the 2 years after policy change. The uptake of screening was 96.7%. The overall detection rate for DS was 90% (18/20) at a false positive rate of 10.9%. The number of invasive tests performed to diagnose one case of DS was reduced 7-fold from 97 to 13. Conclusions. The number of direct invasive tests was markedly reduced. With effective DS screening policy, it is possible to do away with direct invasive testing for the majority of women with AMA. © 2010 Informa UK Ltd.link_to_subscribed_fulltex

Will private general practitioners alter their knowledge, attitude and practice towards counselling and performing cervical smears for their patients?

Objective: To investigate if the knowledge, attitude and practice (KAP) on cervical cancer screening of private general practitioners (GPs) can be modified by education. Design: A controlled cross-over trial of continuing medical education (CME). Subjects: 116 volunteer GPs in private practice who responded to a CME invitation were assigned to study (pap smear workshop, 60) and control (women's health workshop, 56) groups. Sixty-one were randomised while 55 were allocated by date of availability, before knowing which topic occurred on which dates. Main outcome measures: KAP results from self-administrated questionnaires before and 4 months after the workshop. Results: Ninety-four (81% of 116) attended the workshops (46 intervention and 48 controls). Among the 78 doctors (83% of 94) who completed both pre- and post-test questionnaires, while attitude was unchanged, knowledge (in 3 out of 8 items) and behaviour (self-reported Pap smear performing frequency and opportunistic advice for screening) were significantly improved only in the study group. Conclusion: Private GPs acquired more knowledge and reported positive changes in behaviour after an interactive CME workshop. More research is needed in how to maximise the screening capabilities of private GPs and thereby increase the screening rate for cervical cancer in Hong Kong.link_to_subscribed_fulltex

Screening options for Down syndrome: How women choose in real clinical setting

Objective: To study pregnant women's preference among various screening options for Down syndrome (DS) in routine clinical setting, and its potential association with women's demographic characteristics. Methods: Women aged 35 years and older carrying singleton pregnancy were offered a variety of screening tests for DS before 14 weeks of gestation. Their preference was confirmed by the test they actually underwent. The association between women's choice of test and a number of demographic characteristics was studied using multinomial regression. Results: Among 1967 eligible women, 619 opted for first-trimester screening test (FTS), 924 for partial integrated test (PIT), and 424 for full integrated test (FIT). Nulliparous women and working mothers were more likely to choose FTS and FIT. Women with history of subfertility were more likely to choose FIT. Women with family history of chromosomal abnormalities were more likely to choose FTS. The choice of screening test could be predicted for 49.9% of women using four demographic characteristics. Conclusions: Among older women of predominantly Chinese ethnicity, integrated test is a favorite alternative to FTS. Their choice of DS screening test can be predicted by their obstetric and socioeconomic characteristics. Many women show willingness to pay for a test with a lower false-positive rate. Copyright © 2009 John Wiley & Sons, Ltd.link_to_subscribed_fulltex