Search

The presence of neutralizing antibodies against SARS-CoV-2 correlates with protection against infection and severe COVID-19 disease courses. Understanding the dynamics of antibody development against the SARS-CoV-2 virus is important for recommendations on vaccination strategies and on control of the COVID-19 pandemic. This study investigates the dynamics and extent of α-Spike-Ab development by different vaccines manufactured by Johnson & Johnson, AstraZeneca, Pfizer-BioNTech and Moderna. On day 1 after vaccination, we observed a temporal low-grade inflammatory response. α-Spike-Ab titers were reduced after six months of vaccination with mRNA vaccines and increased 14 days after booster vaccinations to a maximum that exceeded titers from mild and critical COVID-19 and Long-COVID patients. Within the group of critical COVID-19 patients, we observed a trend for lower α-Spike-Ab titers in the group of patients who survived COVID-19. This trend accompanied higher numbers of pro-B cells, fewer mature B cells and a higher frequency of T follicular helper cells. Finally, we present data demonstrating that past infection with mild COVID-19 does not lead to long-term increased Ab titers and that even the group of previously infected SARS-CoV-2 patients benefit from a vaccination six months after the infection.

A 2013 review found no evidence to support the routine use of pain relief for intrauterine contraceptive (IUC) placement; however, fear of pain with placement continues to be a barrier to use for some women. This narrative review set out to identify (1) new evidence that may support routine use of pain management strategies for IUC placement; (2) procedure‐related approaches that may have a positive impact on the pain experience; and (3) factors that may help healthcare professionals identify women at increased risk of pain with IUC placement. A literature search of the PubMed and Cochrane library databases revealed 550 citations, from which we identified 43 new and pertinent studies for review. Thirteen randomized clinical trials, published since 2012, described reductions in placement‐related pain with administration of oral and local analgesia (oral ketorolac, local analgesia with different lidocaine formulations) and cervical priming when compared with placebo or controls. Four studies suggested that ultrasound guidance, balloon dilation, and a modified placement device may help to minimize the pain experienced with IUC placement. Eight publications suggested that previous cesarean delivery, timing of insertion relative to menstruation, dysmenorrhea, expected pain, baseline anxiety, and size of insertion tube may affect the pain experienced with IUC placement. Oral and local analgesia and cervical priming can be effective in minimizing IUC placement‐related pain when compared with placebo, but routine use remains subject for debate. Predictive factors may help healthcare professionals to identify women at risk of experiencing pain. Targeted use of effective strategies in these women may be a useful approach while research continues in this area.

Rates of unintended pregnancies are particularly high in young women, a finding that may be associated with their tendency not to use contraceptives correctly and/or consistently. For millennial women, busy lifestyles and associated stress may impact on daily activities including taking an oral contraceptive pill.Contraceptive pill users aged 21-29 years ('millennial' women; N = 4500) from nine countries in Europe and North and South America completed an online questionnaire on their daily habits and activities, disruptions to their routine and associated stress levels.Thirty-nine percent of surveyed participants had forgotten to take their contraceptive pill at least once in the past month; 39% also admitted not taking it at the same time each day. On average, participants had experienced two major disruptions to their daily lives in the past year, with three quarters (74%) believing these disruptions increased their stress levels. Of those who had missed at least one pill in the past year, 40% attributed it to a busy schedule and 21% to stress, among other reasons. Over half of respondents (55%) reported they were more likely to forget their pill when preoccupied.Times of stress may make it more likely for millennial women to forget to take their pill. Health care providers should be aware of typical contraceptive adherence rates among young women and ensure that contraceptive counselling sessions include discussion of lifestyle issues and potential barriers to adherence. Every woman should be counselled on all available methods, so that she can make an informed choice on what best suits her.

Background Despite the efficacy and safety of intrauterine contraceptive methods (IUCs), healthcare providers (HCPs) are sometimes reluctant to recommend their use, particularly in nulliparous women. This study sought to understand the global practitioner perceived impediments to IUC provision. Study Design We developed an online survey for HCPs administered across 4 regions comprising 15 countries. We sought their attitudes to IUC provision; their perceived barriers to IUC use, particularly in nulliparous women; as well as their knowledge of the World Health Organization Medical Eligibility Criteria (WHO MEC) for contraceptive use. Results We received 1862 responses from HCPs in 15 countries grouped into 4 regions, with an average country response rate of 18%. For analysis, the results were grouped into these regions: Latin America, 402 (21.6%); USA, 156 (8.4%); Europe and Canada, 1103 (59.2%); and Australia, 201 (10.8%). The two most frequently identified perceived barriers to IUC use in nulliparous women were difficulty of insertion (56.6%) and pelvic inflammatory disease (PID) (49.2%), but responses differed by region and HCP type. Only 49.7% recognized the correct WHO MEC category for IUC use in nulliparous women. Discussion The results of this survey confirm that, across the four regions, the two main barriers to IUC provision for nulliparous women are concern about the difficulty of insertion and PID. Providers’ knowledge of the WHO MEC was lacking universally. A global effort is required to improve understanding of the evidence and knowledge of available guidelines for IUC use.

NuvaRing is a new contraceptive device that delivers ethinylestradiol and etonogestrel and is inserted once every cycle for three weeks. In our New products review, Steve Chaplin presents the clinical data relating to its efficacy and adverse effects and Dr Tina Peers comments on its place as a birth control option. Copyright © 2009 Wiley Interface Ltd

Norplant implants are a long-term, reversible hormonal method of contraception consisting of six flexible capsules placed subdermally in the inner aspect of the non-dominant arm. Norplant implants were introduced into the UK in October 1993 although they had been used previously in some countries for up to ten years. The insertion and removal techniques require skills training and therefore it is important to assess early experience with the method. This survey looks at the first year continuation rate of Norplant implants in the UK from a total of 2,129 insertions. From these insertions, 133 removals were documented and described, using a checklist of features. The continuation rate for Norplant implants use was 96.5% at six months and 85.2% at one year. None of the reasons for discontinuation were of a serious nature. The most common reason given was menstrual change (50.4% of all removals, 3% of all women included in the survey), which is in line with other reported studies. Of the removals, 71.5% were reported as straightforward (of these 65.6% were completed within 20 minutes). In the first year of use, Norplant implants were associated with high continuation rates and the removal procedure was, in the majority of cases, completely straightforward.In early 1995 in the UK, 1577 family planning providers working in the community, who had undergone clinical training of Norplant implants as part of the Hoechst Roussel Ltd. clinical training program, completed a questionnaire designed to determine how many insertions and removals had been performed by each provider and how many had been performed by a Norplant implants trainer on the provider's patients as part of the formal training program. 195 providers completed an additional questionnaire that provided dates of all the insertions and removals done on their patients before and including February 14, 1995, and all details on each specific case. The 6-month cumulative continuation rate stood at 96.5%. The 1-year cumulative continuation rate stood at 85.2%. Menstrual change accounted for the removal in 50.4% of removal cases. 68.5% of removals did not occur under the supervision of the clinical training program. In 52.7% of these unsupervised removals, the removal was the first performed by the provider. The standard technique using straight and curved forceps was the technique used for 70.3% of removals. 71.5% of removals were classified as straightforward, 65.6% of which were done in less than 20 minutes. Supervised removals were significantly less likely to be straightforward than unsupervised removals (relative risk = 0.72). The leading features of removals were the measurement of more than one visit to complete the removal (13.5%) and that the procedure lasted more than 45 minutes (9.8%). There were no reports of contraceptive method failure. These findings suggest that Norplant has a good continuation rate and a high rate of straightforward removals.