Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial.

OBJECTIVE: To compare 400 and 800 microg sublingual or vaginal misoprostol 24 hours after 200 mg mifepristone for noninferiority regarding efficacy in achieving complete abortion for pregnancy termination up to 63 days of gestation. DESIGN: Placebo-controlled, randomised, noninferiority factorial trial, stratified by centre and length of gestation. Misoprostol 400 or 800 microg, administered either sublingually or vaginally, with follow up after 2 and 6 weeks. SETTING: Fifteen obstetrics/gynaecology departments in ten countries. POPULATION: Pregnant women (n = 3005) up to 63 days of gestation requesting medical abortion. METHODS: Two-sided 95% CI for differences in failure of complete abortion and continuing pregnancy, with a 3% noninferiority margin, were calculated. Proportions of women with adverse effects were recorded. OUTCOME MEASURES: Complete abortion without surgical intervention (main); continuing live pregnancies, induction-to-abortion interval, adverse effects, women's perceptions (secondary). RESULTS: Efficacy outcomes analysed for 2962 women (98.6%): 90.5% had complete abortion after 400 microg misoprostol, 94.2% after 800 microg. Noninferiority of 400 microg misoprostol was not demonstrated for failure of complete abortion (difference: 3.7%; 95% CI 1.8-5.6%). The 400-microg dose showed higher risk of incomplete abortion (P < 0.01) and continuing pregnancy (P < 0.01) than 800 microg. Vaginal and sublingual routes had similar risks of failure to achieve complete abortion (P = 0.47, difference in sublingual minus vaginal -0.7%, 95% CI -2.6-1.2%). A similar pattern was observed for continuing pregnancies (P = 0.21). Fewer women reported adverse effects with vaginal than sublingual administration and with the 400-microg dose than the 800-microg dose. Of the women, 94% were satisfied or highly satisfied with the regimens, 53% preferred the sublingual route and 47% preferred the vaginal route. CONCLUSIONS: A 400-microg dose of misoprostol should not replace the 800-microg dose when administered 24 hours after 200 mg mifepristone for inducing abortion in pregnancies up to 63 days. Sublingual and vaginal misoprostol have similar efficacy, but vaginal administration is associated with a lower frequency of adverse effects.

Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism.

OBJECTIVE: To determine the diagnostic utility of olfactory testing in patients with neurodegenerative parkinsonism. METHODS: The Sniffin' Sticks test battery for assessment of odor identification, discrimination, and threshold was applied to patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) as well as healthy controls (HC). Two different cohorts were analyzed: A PD/healthy control that included PD patients and HC as well as a PD/diseased control cohort for which patients PD, MSA and PSP were recruited. The former cohort was exploited to calculate cut-off values that discriminate PD patients from HC with a sensitivity (sensitivity-weighted cut-off) or specificity (specificity-weighted cut-off) exceeding 95%, respectively. The PD/diseased controls cohort was used to determine the diagnostic accuracy using these cut-off values in discriminating patients with neurodegenerative parkinsonism. RESULTS: PD patients (n = 67) performed significantly worse in olfactory testing than HC (n = 41) and patients with MSA (n = 23) or PSP (n = 23). There was no significant difference in olfactory function between MSA and PSP patients. Diagnostic performance of the identification subscore was similar to the sum score of the Sniffin' Sticks test (AUC identification test 0.94, AUC sum score 0.96), while threshold and discrimination subscores were inferior. In patients with parkinsonism, the specificity-weighted cut-off predicted a diagnosis of PD with a sensitivity and specificity of 76.6 and 87.0%, respectively. The discriminative value of this cut-off in separating PD from MSA was 76.7% (sensitivity) and 95.7% (specificity). The corresponding, prevalence-adjusted positive predictive value of olfactory testing exceeded 95%. CONCLUSIONS: Our data suggest that assessment of olfactory function, particularly odor identification, can be useful to discriminate PD from atypical parkinsonian disorders, particularly MSA patients.

Revealing the thermodynamic driving force for ligand-based reductions in quinoids; conceptual rules for designing redox active and non-innocent ligands.

Metal and ligand-based reductions have been modeled in octahedral ruthenium complexes revealing metal-ligand interactions as the profound driving force for the redox-active behaviour of orthoquinoid-type ligands. Through an extensive investigation of redox-active ligands we revealed the most critical factors that facilitate or suppress redox-activity of ligands in metal complexes, from which basic rules for designing non-innocent/redox-active ligands can be put forward. These rules also allow rational redox-leveling, i.e. the moderation of redox potentials of ligand-centred electron transfer processes, potentially leading to catalysts with low overpotential in multielectron activation processes.

Interindividual-intergroup discontinuity reduction through the anticipation of future interaction.

Consistent with the role of a long-term perspective in reducing the tendency of intergroup relations to be more competitive than interindividual relations in the context of noncorrespondent outcomes, an experiment demonstrated that anticipated future interaction reduced intergroup but not interindividual competitiveness. Further results indicated that the effect was present only for groups composed of members high in abstractness (Openness-Intellect on the Big 5 Inventory and Intuition on the Myers-Briggs Type Inventory) who trusted their opponents.

Relationship between the heart rate and E/A ratio in athletic and non-athletic males.

UNLABELLED: To clarify whether the higher E/A quotient of male athletes is a favourable change in the intrinsic relaxation properties of the left ventricle. METHODS: Peak early (E) and atrial blood flow velocities (A) were assessed by Doppler echocardiography at rest in 1237 males (939 athletes) in Hungary. Data were collected between 1993 ­ 2009. Relationship between E/A and resting heart rate (HR), was determined by linear regression analysis. RESULTS: The E/A decreased with age, the rate of decrease was slower in the physically trained subjects, except in children. In children, adolescent-young and young adult subjects E/A against HR equations of the athletic and nonathletic groups were similar, differences between the means were only due to the differences of the HR. In the 31 ­ 44 yr old males, the intercepts of the athletes' regression lines were higher. The oldest (>44 yr) active subjects showed a significant regression while sedentary males did not. CONCLUSIONS: The HR-independent beneficial effect of regular physical training on the diastolic function manifests itself at the older ages. The impact of resting HR should always be taken into consideration when assessing intergroup differences in the E/A ratio, especially when studying the effect of exercise training upon cardiac function.

The athlete's heart Part I (Review).

Importance of the athlete's heart has been arisen in the last decades.

Echocardiographic and spiroergometric data of elite Hungarian female water polo players.

In the authors' earlier study the relative aerobic power of Hungarian top-level male water polo players was found to be smaller than that of other top-level athletes, while their echocardiographic parameters proved to be the most characteristic of the athlete's heart. In the present investigation echocardiographic and spiroergometric data of female top-level water polo players were compared to those of other female elite athletes and of healthy, non-athletic subjects. Relative aerobic power in the water polo players was lower than in endurance athletes. Mean resting heart rates were the slowest in the water polo players and endurance athletes. Morphologic indicators of the heart (body size related left ventricular wall thickness and muscle mass) were the highest in the water polo players, endurance and power athletes. In respect of diastolic functions (diastolic early and late peak transmitral flow velocities) no difference was seen between the respective groups.These results indicate that, similarly to the males, top-level water polo training is associated with the dimensional parameters of the heart rather than with relative aerobic power. For checking the physical condition of female water polo players spiroergometric tests seem to be less appropriate than swim-tests with heart rate recovery studies such as the ones used in the males.

Theoretical study of the orientation rules in photonucleophilic aromatic substitutions.

The photonucleophilic aromatic substitution reactions of nitrobenzene derivatives were studied by ab initio and Density Functional Theory methods. The photohydrolysis is shown to proceed via an addition-elimination mechanism with two intermediates, except in the case of a chlorine leaving group. Depending on the substituents, the addition step, the elimination step, or the radiationless transition is the rate-determining process. The solvent effect on the SN2 Ar* reactions was evaluated by a continuum model. Next, the regioselectivity of the addition step is investigated within the framework of the so-called spin-polarized conceptual density functional theory. It is shown that the preference observed for the meta or para (with respect to the NO2 group) pathways in the addition step can be predicted by using the spin-polarized Fukui functions applied for the prereactive pi-complex.

Spin-polarized conceptual density functional theory study of the regioselectivity in ring closures of radicals.

The regioselectivity of ring-forming radical reactions is investigated within the framework of the so-called spin-polarized conceptual density functional theory. Two different types of cyclizations were studied. First, a series of model reactions of alkyl- and acyl-substituted radicals were investigated. Next, attention was focused on the radical cascade cyclizations of N-alkenyl-2-aziridinylmethyl radicals (a three-step mechanism). In both of these reactions, the approaching radical (carbon or nitrogen centered) adds to a carbon-carbon double bond within the same molecule to form a radical ring compound. In this process, the number of electrons is changing from a local point of view (a charge transfer occurs from one part of the molecule to another one) at constant global spin number Ns (both the reactant and the product ring compound are in the doublet state). It is shown that the experimentally observed regioselectivities for these ring-closure steps can be predicted using the spin-polarized Fukui functions for radical attack, f0NN(r).

Accessibility and availability of abortion in six European countries.

OBJECTIVES: The accessibility and availability of abortion are a reflection of abortion law and the accessibility and availability of abortion services. Experiences from six European countries with different political, cultural, social and religious backgrounds (the Netherlands, France, Great Britain, Slovenia, Hungary and Turkey) are presented. RESULTS: Abortion laws in Europe range from complete prohibition to complete liberalization of abortion. Some countries demand a waiting period for the procedure, pre-abortion counseling, parental approval for minors, and in the others there are no mandatory requirements. Abortions are generally performed in authorized facilities by gynecologists or general practitioners. Abortion services are easily accessible, in terms of the law, availability of facilities and health insurance coverage of the procedure in the Netherlands, France and Slovenia. Abortion service is less accessible in United Kingdom, Hungary and Turkey, as a result of limited accessibility to abortion services or a relatively high abortion fee. In some Eastern European countries there has been a tendency in the last decade to limit the availability and access to abortion. CONCLUSIONS: In Europe abortion is generally well accessible in terms of abortion laws. There are differences in accessibility to abortion services between the countries, and in some countries, also between different areas of the country.

Medico-legal aspects of abortion in Europe.

OBJECTIVE: The practice of abortion in a particular country reflects culture, economic status, religion and the law. Various aspects of abortion in Europe - laws, rates and practices - are presented. RESULTS: Abortion is completely prohibited in Ireland and Malta. In Poland it is permitted only to save the woman's life or protect her physical health. On the grounds of protecting the woman's mental health it is also permitted in Northern Ireland, Portugal, Spain and Switzerland. On socioeconomic grounds abortion is permitted in Finland, Great Britain and Hungary. In the other European countries it is permitted on demand. Eastern Europe has the highest abortion rate (Romania 78/1000 women aged 15-44), and Western Europe has the lowest (The Netherlands 6.5/1000); the disparity may be attributable to differences in availability and use of effective contraceptives. Within the first 12 weeks of gestation, vacuum aspiration has replaced dilatation and curettage, as the most commonly used method to perform abortion. More recently, medical abortion (mifepristone with prostaglandins) in early pregnancy has been used in several European countries. CONCLUSIONS: Reduction of the need for induced abortion and prevention of unsafe abortion through the provision of appropriate legislation and good family planning services should be an integral part of health care in every country.

Continuation and compliance of contraceptive use.

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

Sexual behavior of secondary-school students in Slovenia.

OBJECTIVES: The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia. METHODS: The research was carried out on a representative sample of 4706 secondary-school students aged 15-19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996. RESULTS: The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%). CONCLUSION: By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.

Fertility survey in Slovenia, 1989.

PIP: Slovenia, an independent state since January 1992, conducted a KAP-type survey of 1117 male and female respondents aged 15-44 years between August 1989 and March 1990. The aim of the survey was to assess the social, medical, and demographic factors in low fertility and to identify fertility determinants. An explanation was needed for inadequate use of contraceptives, which were easy and inexpensive to obtain, and for reliance on abortion. The questionnaire included 180 questions on 16 topics; the same questions were asked of men and women with a few exceptions. There was a mean age of 30 years and 59% were married. 77% were employed and 59% had finished secondary school. The average number of children was 1.3; desired number of children was 2.4. 43% of women with children wished to stop childbearing. 13% desired an additional child; 32% wanted 2 or more children and 12% wanted 3 or more children. 62% believed that every woman should have a child. The ideal family of 2 children was reported by 60%. 31% favored 3 children. 58% considered a family size of 2 children appropriate for their own family. Over 75% reporting 2 children appropriate for their family size thought 2 children were ideal. 99% considered family planning as a mutual decision. 24% thought men's participation in decision making was inadequate, because men did not have sufficient opportunity to speak with a doctor. Women did not have confidence in men and wanted to make decisions alone. There were significant differences in attitudes by sex. 87% of men and 90% of women were sexually active. 41% reported that at the beginning of their sexual activity there was little discussion of contraception. Of those discussing contraception, 57% decided to use contraceptives of which 71% decided on regular use and 20% on use only during the fertile phase of the cycle. 33% of women who decided alone relied on regular use of withdrawal, and a larger number of joint decisions involved withdrawal as a method of choice. The greatest differences in subjective and objective knowledge were for condoms, diaphragm, and foam/jelly. Ever use of contraception was 85% for women and 56% for a reliable method. There were big differences between characteristics of women who used or did not use contraception. Traditional sexual behavior occurs for most Slovenians; family planning is not an accepted part of their lives.^ieng