Hormonal contraception and risk of breast cancer: a critical look.

Today health professionals are not only required to know medicine, but scientific reading, interpretation, and communication of new data. The new information about contraception and hormonal therapies must be analyzed by gynecologists to determine whether or not the new data are applicable to their patients and if it has an impact on their health. Recently a new study of hormonal contraceptives and the risk of breast cancer was published. In this study, the investigators found an elevation of the relative risk of breast cancers on the users versus the nonusers of hormonal contraception. After analyzing the publication and other data available, it is our opinion that it is a very low increase of the risk and its impact should be evaluated case by case, not forgetting to take into account the numerous beneficial effects that hormonal contraception have.

Computer-guided implant surgery and full-arch immediate loading with prefabricated-metal framework-provisional prosthesis created from a 3D printed model.

OBJECTIVE: In this article, we describe the planning phase and clinical procedure where a CAD CAM 3D printed master model was utilized to create a prefabricated-titanium reinforced-fixed provisional prosthesis for a full-arch immediate loading after computer-guided implant placement. CLINICAL CONSIDERATIONS: The clinical procedure should be performed based on digital planning through an advanced surgical planning software and following the guidelines of full-arch immediate loading protocol. The fact that the master model is fabricated under a computer-assisted design and computer-assisted manufacturing approach before implant placement makes the whole process considerably easier, faster, more precise and cheaper. CONCLUSIONS: The use of a prefabricated-metal framework-provisional prosthesis for full-arch immediate loading created from a 3D printed master model seems to be a predictable treatment option when computer-guided implant surgery is performed. CLINICAL SIGNIFICANCE: The presented article described an interesting and innovative technique to optimize implant treatment based on digital technologies and 3D printing. The presented technique will help to diminish treatment costs and times especially for immediate loading procedures in fully edentulous patients because it allows to fabricate a prosthetic structure prior implant placement based on a 3D printing process.

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Women's Health Initiative estrogen plus progestin clinical trial: a study that does not allow establishing relevant clinical risks.

OBJECTIVE: This study aims to determine time differences (differences in restricted mean survival times [RMSTs]) in the onset of invasive breast cancer, coronary heart disease, stroke, pulmonary embolism, colorectal cancer, and hip fracture between the placebo group and the conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg group of the Women's Health Initiative (WHI) trial based on survival curves of the original report and to provide adequate interpretation of the clinical effects of a given intervention. METHODS: Distribution of survival function was obtained from cumulative hazard plots of the WHI report; Monte Carlo simulation was performed to obtain censored observations for each outcome, in which assumptions of the Cox model were evaluated once corresponding hazard ratios had been estimated. Using estimation methods such as numerical integration, pseudovalues, and flexible parametric modeling, we determined differences in RMSTs for each outcome. RESULTS: Obtained cumulative hazard plots, hazard ratios, and outcome rates from the simulated model did not show differences in relation to the original WHI report. The differences in RMST between placebo and conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg (in flexible parametric modeling) were 1.17 days (95% CI, -2.25 to 4.59) for invasive breast cancer, 7.50 days (95% CI, 2.90 to 12.11) for coronary heart disease, 2.75 days (95% CI, -0.84 to 6.34) for stroke, 4.23 days (95% CI, 1.82 to 6.64) for pulmonary embolism, -2.73 days (95% CI, -5.32 to -0.13) for colorectal cancer, and -2.77 days (95% CI, -5.44 to -0.1) for hip fracture. CONCLUSIONS: The differences in RMST for the outcomes of the WHI study are too small to establish clinical risks related to hormone therapy use.

Comportamientos sexuales de adolescentes y jóvenes adultos en comunidades de Honduras / Adolescents youngsters Sexual behaviorus in communities in Honduras

OBJETIVOS. En Honduras, con altas tasas de infecciones de transmisión sexual y VIH/sida y violencia, resulta urgente conocer los comportamientos relacionados con las prácticas sexuales de los adolescentes y adultos. MATERIAL Y MÉTODOS. Este estudio, ha pretendido recoger a través de una etnografía las principales manifestaciones de la sexualidad de los/las jóvenes en comunidades de obreros/as del Distrito Central, Valle de Sula y costa atlántica del país. RESULTADOS. Se encontró que las conductas sexuales se conforman y se refuerzan dentro y a partir de grupos primarios. La formación que reciben niños y adolescentes enfatiza en que la niña aprenda a ser complaciente, obediente, sumisa, pasiva y cariñosa; el niño a ser rebelde, voluntarioso, agresivo, con la convicción de que ser hombre es mejor que ser mujer. El doble y contradictorio proceso de socialización se traduce en æÉxito inmediato, sexo temprano. Ambos aprenden a mentir desde muy temprano, rasgo potenciado por la extendida indolencia ante los fenómenos sociales, políticos y culturales. Un importante vacío detectado es la ignorancia acerca de la sexualidad y el desconocimiento sobre su propio organismo. CONCLUSIONES. Es necesario vigilar los comportamientos condicionantes de epidemias como sida y violencia, aplicar sistemas de consejería para atender a los niños y jóvenes, y lograr acuerdos básicos entre los grupos que establecen políticas de educación y conducen procesos de persuasión dirigidos a jóvenes y adultos...