Increasing role of abstinence and infecundity in non-use of contraceptive methods in India

This paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005–06: N=37,296; 2015–16: N=247,024), which surveyed currently married women aged 15–49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex: 10%; infrequent sex: 3%) and infecundity (menopausal/hysterectomy: 12%; subfecund/infecund: 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015–16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005–06 to 2015–16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples

Increasing role of abstinence and infecundity in non-use of contraceptive methods in India

AbstractThis paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005–06: N=37,296; 2015–16: N=247,024), which surveyed currently married women aged 15–49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex: 10%; infrequent sex: 3%) and infecundity (menopausal/hysterectomy: 12%; subfecund/infecund: 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015–16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005–06 to 2015–16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples.</jats:p

Cost-Effectiveness and Patient Outcomes of Injectable Collagenase to Treat Dupuytren's Contracture.

Introduction Dupuytren's contracture is a disabling and progressive flexion contracture of the hand that is often treated by a surgical release. Collagenase clostridium histolyticum injection (CCH-I) was introduced to the UK in 2011 as an alternative and less invasive treatment for contracture. The purpose of this study was to evaluate the cost-effectiveness and patient-reported outcome measures (PROMs) of treating Dupuytren's contracture with collagenase compared to surgery. Methods A retrospective review identified 151 patients who underwent CCH-I (n=94), limited fasciectomy (LF; n=38) and percutaneous needle fasciotomy (PNF; n=19). Outcomes included PROMs (satisfaction, QuickDASH), complication rates (recurrence, reintervention) and direct costs. Results Standardised treatment costs for CCH-I, LF and PNF were £1,125.82, £3,438.28 and £1,143.32 respectively. Collagenase presented a cost-benefit of £88,205 had the LF/PNF group undergone CCH-I. At a mean six-year follow-up, there were no significant differences in complication rates (=0.621) or QuickDASH scores (p=0.157). Collagenase-treated patients reported the highest satisfaction and lowest recurrence rates. Discussion Collagenase presents a significant cost reduction with superior PROMs relative to surgery for treating single-digit contracture. Conclusion Outpatient CCH-I is a cost-effective treatment with fewer clinical encounters, a similar risk profile to LF/PNF and high levels of patient satisfaction, which warrants serious consideration in light of overburdened waiting lists due to COVID-19

Weight Bearing Cone Beam Computed Tomography (CBCT) of the Distal Tibiofibular Syndesmosis – Differentiating Between Stable and Unstable Syndesmotic Ankle Injuries

Category: Ankle; Trauma Introduction/Purpose: Cone beam CT (CBCT) offers volumetric assessment in a single rotation, unlike conventional CT, which involves multiple slices. This enables a comprehensive three-dimensional evaluation of physiological functional anatomy under weight-bearing (WB) conditions, potentially revealing subtle changes undetectable on non-weight-bearing scans. This study aims to (A) identify normal WBCT metrics of the distal Tibiofibular Syndesmosis in uninjured ankles and (B) assess the impact of syndesmotic injuries on the tibiofibular relationship at the syndesmosis level during weight bearing. Methods: This study followed PRISMA guidelines. It included patients aged 18 or older with unilateral ankle injuries who underwent weight-bearing CBCT for occult fractures or syndesmotic instability, compared to their uninjured contralateral side. Additionally, a control group of patients with fore or midfoot injuries undergoing weight-bearing CBCT was included. Data were analyzed using Stata v17 (StataCorp LLC). Meta-analyses using the metan package (Stata Corp) estimated pooled normal CBCT metrics for both uninjured and injured ankles. A random-effects restricted maximum likelihood ratio model assessed scalar metrics and measurements performed on all ankles imaged using weightbearing CBCT. Forest plots illustrated standardized mean differences between weightbearing metrics of injured and uninjured ankles, with pooled estimates obtained with 95% CIs. Generalized linear modeling with Gaussian families evaluated the effect of participant factors on scalar CBCT metrics. Results: 559 ankles, with 408 uninjured patients and 151 patients with syndesmotic instability, were reviewed. The normal syndesmosis area averaged 112.54mm 2 (95%CI 104.59-120.49), contrasting with 157.52mm 2 (95%CI 133.79-181.24) for ankles with syndesmotic injury (p< 0.01; I2 =0.00%). The standardized mean difference of syndesmotic area between injured and contralateral uninjured sides was 29.49mm 2 (95%CI 19.52-39.46). Weight-bearing CT effectively differentiated syndesmotic injury, as evidenced by observed standardized mean differences for anterior tibiofibular distance (ATFD) (p=0.01), posterior tibiofibular distance (PTFD) (p=0.01), fibular rotation (p=0.02), and syndesmotic area (p< 0.001). Additionally, increasing age correlated with a reduction in normal syndesmotic area (β = 0.755, p=0.04). Conclusion: Syndesmotic area measurement proved most reliable, showing consistency across studies. Age-related declines underscore the need for stratified assessment, particularly in older patients, to prevent diagnostic oversights. Dynamic changes during weight bearing aid early detection and management. Syndesmotic stability assessment is crucial, as persistent instability often requires surgery. Current imaging falls short under stress, but weight-bearing CT shows promise. Normal metrics for weight-bearing CT of the uninjured tibiofibular joint lack consensus due to novelty. However, diastasis, fibular rotation, fibular translation, and syndesmotic area measurements consistently provide reliable results. Syndesmotic area measurement is notably reproducible, making it a valuable composite metric