ABSTRACT Aims: The way people who inject drugs (PWID) feel about drug policy may be profoundly sh... more ABSTRACT Aims: The way people who inject drugs (PWID) feel about drug policy may be profoundly shaped by lived experience of stigma and the subjectivities made available in policy and practice. Using a community-based participatory research approach, this study investigated why PWID hold particular views, and considered the complexities of how lived experience and opinions about drug policy intersect within this affected community. Methods: Three qualitative focus groups were undertaken. Participants were presented with survey results arising from a previous study, and asked to interpret and explain the possible rationales underlying the opinions expressed by their peers. Findings: A duality of opinion was identified, borne from lived experience of stigmatisation, which sometimes led PWID to qualify levels of support. By exploring the rationales underlying opinions, a tension emerged between what PWID theoretically know to be effective interventions, and experiences of how policies are delivered. A sense of “within-group” stigma emerged, with sub-groups of users and drug types denoted as more “dangerous” than others. Conclusions: This study illustrates how theoretical knowledge and lived experience intersect to inform opinions about drug policy. Through in-depth discussions with the affected community, we are reminded that public opinion research is always an interpretative and sensitive pursuit.
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin... more Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Participants in leadership development programs face a big challenge once they get back to work: ... more Participants in leadership development programs face a big challenge once they get back to work: preventing the energy created during the program from evaporating over time. To sustain the learning process and effect substantive behavioral change, follow-up is needed, and a technology-based approach, with coach support, is proving effective.
PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum b-HCG>25 mIU/mL levels obt... more PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum b-HCG>25 mIU/mL levels obtained fourteen days after the embryonic transfer) clinically diagnosed pregnancy (gestational sac visualized by ultrasound four to six weeks after the embryonic transfer) and miscarriage rates in women submitted in vitro fertilization to (IVF) and intracytoplasmic sperm injection (ICSI) in a tertiary center of assisted reproduction and to correlate these rates with age. METHODS: retrospective transverse study with analysis of 1016 cycles of controlled ovarian hyperstimulation of 932 infertile women with indication of IVF (370 cycles) or ICSI (646 cycles). The patients' age ranged from 22 to 46 years. All women with age over 35 years included in the study had FSH<15 IU/L. The studied cycles were divided into two groups: the first including the cycles referring to women of 22 to 30 years and the second group, to those of 31 to 46 years. The studied variables were: pregnancy (chemical or clinical) and miscarriage rates. The c2 test was used to compare these rates between the groups. RESULTS: the total pregnancy rate was 36.42%, with a significant reduction starting at 30 years (p=0.0001). From 22 to 30 years (303 cycles) the pregnancy rate was 45.4%, while in the range from 31 to 46 years (713 cycles), it was 25.1%. The miscarriage rates were, 10.2 11,6%, respectively (p=0.6854). CONCLUSION: although the miscarriage rates did not differ between the groups, a decrease in the pregnancy rate of infertile women submitted to IVF or ICSI was observed after the age of 30 years. Thus, we recommend the gynecologists not to postpone the investigation and the referral for treatment of infertility.
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (... more PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.
A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS),... more A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20 +/- 5.02 years and treated with metformin (1500 mg/day)for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33 +/- 0.03 to 0.35 +/- 0.04 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.
Women of normal weight with polycystic ovary syndrome (PCOS) and hyperinsulinemia presented high ... more Women of normal weight with polycystic ovary syndrome (PCOS) and hyperinsulinemia presented high growth hormone (GH) levels in response to the l-dopa test, suggesting that the action of GH and insulin-like growth factor-1 (IGF-1) might be responsible for the elevation in LH and the consequent hyperandrogenic anovulation observed in normal weight women with PCOS. Insulin resistance and obesity are related to a reduction in GH secretion in obese women with PCOS.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2007
Objective: The objective was to compare agreement on the diagnosis of insulin resistance (IR) amo... more Objective: The objective was to compare agreement on the diagnosis of insulin resistance (IR) among insulin sensitivity indexes in both ovulatory women and those with polycystic ovary syndrome (PCOS). Study design: In an observational study, the 75-g oral glucose tolerance test was performed in 105 women with PCOS and 51 ovulatory women. The insulin sensitivity indexes used were insulin quantitative sensitivity check index (QUICKI), 1/homeostasis model assessmentinsulin resistance (1/HOMA-IR), area under curve for insulin (AUC-I), and the Matsuda insulin sensitivity index (COMP). For the IR diagnosis we used cut-off values described in recent publications (insulin >12 mIU/ml, 1/HOMA-IR <0.47, QUICKI 0.333, AUC-I !7000 mIU/ml 120 min, and COMP <4.75. Results: Excellent agreement was assessed among insulin, QUICKI, and 1/HOMA-IR. However, the rate of IR detected by these indexes in the PCOS group (44.8-51.4%) was lower than expected. New cut-offs were then determined based on COMP results. Using these values, 1/ HOMA-IR and QUICKI showed excellent agreement (k = 0.83) with COMP. Conclusion: The observed agreements among insulin, QUICKI and 1/HOMA-IR were higher than 93%. Therefore, clinicians may choose any of those obtaining similar results. For clinicians who prefer COMP, but are looking for a simpler test to detect IR in PCOS women, the use of QUICKI and 1/HOMA-IR with the new cut-offs seems reasonable. #
ABSTRACT Aims: The way people who inject drugs (PWID) feel about drug policy may be profoundly sh... more ABSTRACT Aims: The way people who inject drugs (PWID) feel about drug policy may be profoundly shaped by lived experience of stigma and the subjectivities made available in policy and practice. Using a community-based participatory research approach, this study investigated why PWID hold particular views, and considered the complexities of how lived experience and opinions about drug policy intersect within this affected community. Methods: Three qualitative focus groups were undertaken. Participants were presented with survey results arising from a previous study, and asked to interpret and explain the possible rationales underlying the opinions expressed by their peers. Findings: A duality of opinion was identified, borne from lived experience of stigmatisation, which sometimes led PWID to qualify levels of support. By exploring the rationales underlying opinions, a tension emerged between what PWID theoretically know to be effective interventions, and experiences of how policies are delivered. A sense of “within-group” stigma emerged, with sub-groups of users and drug types denoted as more “dangerous” than others. Conclusions: This study illustrates how theoretical knowledge and lived experience intersect to inform opinions about drug policy. Through in-depth discussions with the affected community, we are reminded that public opinion research is always an interpretative and sensitive pursuit.
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin... more Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Participants in leadership development programs face a big challenge once they get back to work: ... more Participants in leadership development programs face a big challenge once they get back to work: preventing the energy created during the program from evaporating over time. To sustain the learning process and effect substantive behavioral change, follow-up is needed, and a technology-based approach, with coach support, is proving effective.
PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum b-HCG>25 mIU/mL levels obt... more PURPOSE: to evaluate the rate of chemically diagnosed pregnancy (serum b-HCG>25 mIU/mL levels obtained fourteen days after the embryonic transfer) clinically diagnosed pregnancy (gestational sac visualized by ultrasound four to six weeks after the embryonic transfer) and miscarriage rates in women submitted in vitro fertilization to (IVF) and intracytoplasmic sperm injection (ICSI) in a tertiary center of assisted reproduction and to correlate these rates with age. METHODS: retrospective transverse study with analysis of 1016 cycles of controlled ovarian hyperstimulation of 932 infertile women with indication of IVF (370 cycles) or ICSI (646 cycles). The patients' age ranged from 22 to 46 years. All women with age over 35 years included in the study had FSH<15 IU/L. The studied cycles were divided into two groups: the first including the cycles referring to women of 22 to 30 years and the second group, to those of 31 to 46 years. The studied variables were: pregnancy (chemical or clinical) and miscarriage rates. The c2 test was used to compare these rates between the groups. RESULTS: the total pregnancy rate was 36.42%, with a significant reduction starting at 30 years (p=0.0001). From 22 to 30 years (303 cycles) the pregnancy rate was 45.4%, while in the range from 31 to 46 years (713 cycles), it was 25.1%. The miscarriage rates were, 10.2 11,6%, respectively (p=0.6854). CONCLUSION: although the miscarriage rates did not differ between the groups, a decrease in the pregnancy rate of infertile women submitted to IVF or ICSI was observed after the age of 30 years. Thus, we recommend the gynecologists not to postpone the investigation and the referral for treatment of infertility.
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (... more PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.
A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS),... more A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20 +/- 5.02 years and treated with metformin (1500 mg/day)for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33 +/- 0.03 to 0.35 +/- 0.04 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.
Women of normal weight with polycystic ovary syndrome (PCOS) and hyperinsulinemia presented high ... more Women of normal weight with polycystic ovary syndrome (PCOS) and hyperinsulinemia presented high growth hormone (GH) levels in response to the l-dopa test, suggesting that the action of GH and insulin-like growth factor-1 (IGF-1) might be responsible for the elevation in LH and the consequent hyperandrogenic anovulation observed in normal weight women with PCOS. Insulin resistance and obesity are related to a reduction in GH secretion in obese women with PCOS.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2007
Objective: The objective was to compare agreement on the diagnosis of insulin resistance (IR) amo... more Objective: The objective was to compare agreement on the diagnosis of insulin resistance (IR) among insulin sensitivity indexes in both ovulatory women and those with polycystic ovary syndrome (PCOS). Study design: In an observational study, the 75-g oral glucose tolerance test was performed in 105 women with PCOS and 51 ovulatory women. The insulin sensitivity indexes used were insulin quantitative sensitivity check index (QUICKI), 1/homeostasis model assessmentinsulin resistance (1/HOMA-IR), area under curve for insulin (AUC-I), and the Matsuda insulin sensitivity index (COMP). For the IR diagnosis we used cut-off values described in recent publications (insulin >12 mIU/ml, 1/HOMA-IR <0.47, QUICKI 0.333, AUC-I !7000 mIU/ml 120 min, and COMP <4.75. Results: Excellent agreement was assessed among insulin, QUICKI, and 1/HOMA-IR. However, the rate of IR detected by these indexes in the PCOS group (44.8-51.4%) was lower than expected. New cut-offs were then determined based on COMP results. Using these values, 1/ HOMA-IR and QUICKI showed excellent agreement (k = 0.83) with COMP. Conclusion: The observed agreements among insulin, QUICKI and 1/HOMA-IR were higher than 93%. Therefore, clinicians may choose any of those obtaining similar results. For clinicians who prefer COMP, but are looking for a simpler test to detect IR in PCOS women, the use of QUICKI and 1/HOMA-IR with the new cut-offs seems reasonable. #
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