Characteristics and hormonal contraception use patterns of levonorgestrel 13.5 mg intrauterine device users in Sweden 2014-2016.

Objectives: The levonorgestrel-releasing intrauterine device containing 13.5 mg of levonorgestrel (LNG 13.5 mg IUD), Jaydess, was approved for contraception by the European Medicines Agency in 2013.

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices.

Objective: The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making.

Methods: APEX-IUD was a real-world (using U.

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review.

Background: Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.

Methods: This systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type.

Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion.

Objective: To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors.

Methods: The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) study was a U.S.

Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study.

Background: Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum have been associated with increased risk of uterine perforation. The aim of these analyses was to compare the incidence and risks of IUD-related uterine perforations by non-post-partum and post-partum intervals at IUD insertion, and among post-partum individuals, to assess the impact of breastfeeding on these outcomes.

Association between menorrhagia and risk of intrauterine device-related uterine perforation and device expulsion: results from the Association of Uterine Perforation and Expulsion of Intrauterine Device study.

Background: Intrauterine devices are effective instruments for contraception, and 1 levonorgestrel-releasing device is also indicated for the treatment of heavy menstrual bleeding (menorrhagia).

Objective: To compare the incidence of intrauterine device expulsion and uterine perforation in women with and without a diagnosis of menorrhagia within the first 12 months before device insertion STUDY DESIGN: This was a retrospective cohort study conducted in 3 integrated healthcare systems (Kaiser Permanente Northern California, Southern California, and Washington) and a healthcare information exchange (Regenstrief Institute) in the United States using electronic health records. Nonpostpartum women aged ≤50 years with intrauterine device (eg, levonorgestrel or copper) insertions from 2001 to 2018 and without a delivery in the previous 12 months were studied in this analysis.

Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion.

Importance: Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile.

Objective: To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion.

Design, Setting, And Participants: The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018.

Design of the Association of Uterine Perforation and Expulsion of Intrauterine Device study: a multisite retrospective cohort study.

Background: Intrauterine devices are effective and safe, long-acting reversible contraceptives, but the risk of uterine perforation occurs with an estimated incidence of 1 to 2 per 1000 insertions. The European Active Surveillance Study for Intrauterine Devices, a European prospective observational study that enrolled 61,448 participants (2006-2012), found that women breastfeeding at the time of device insertion or with the device inserted at ≤36 weeks after delivery had a higher risk of uterine perforation. The Association of Uterine Perforation and Expulsion of Intrauterine Device (APEX-IUD) study was a Food and Drug Administration-mandated study designed to reflect current United States clinical practice.

Identification and validation of uterine perforation, intrauterine device expulsion, and breastfeeding in four health care systems with electronic health records.

Objective: To validate algorithms identifying uterine perforations and intrauterine device (IUD) expulsions and to ascertain availability of breastfeeding status at the time of IUD insertion.

Study Design And Setting: Four health care systems with electronic health records (EHRs) participated: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Southern California (KPSC), Kaiser Permanente Washington (KPWA), and Regenstrief Institute (RI). The study included women ≤50 years of age with an IUD insertion.

RE: "An Estimation of the Risk of Pseudotumor Cerebri Among Users of the Levonorgestrel Intrauterine Device".

The current letter to the editor describes some of the limitations of Valenzuela et al.'s study on the association between levonorgestrel-releasing intrauterine system use and pseudotumor cerebri/idiopathic intracranial hypertension and further reinforces the authors' interpretations of the findings.

Global sensitivity analysis for systems with independent and/or correlated inputs.

The objective of a global sensitivity analysis is to rank the importance of the system inputs considering their uncertainty and the influence they have upon the uncertainty of the system output, typically over a large region of input space. This paper introduces a new unified framework of global sensitivity analysis for systems whose input probability distributions are independent and/or correlated. The new treatment is based on covariance decomposition of the unconditional variance of the output.

Random sampling-high dimensional model representation (RS-HDMR) and orthogonality of its different order component functions.

High dimensional model representation is under active development as a set of quantitative model assessment and analysis tools for capturing high-dimensional input-output system behavior based on a hierarchy of functions of increasing dimensions. The HDMR component functions are optimally constructed from zeroth order to higher orders step-by-step. This paper extends the definitions of HDMR component functions to systems whose input variables may not be independent.

Multicut-HDMR with an application to an ionospheric model.

A new High Dimensional Model Representation (HDMR) tool, Multicut-HDMR, is introduced and applied to an ionospheric electron density model. HDMR is a general set of quantitative model assessment and analysis tools for improving the efficiency of deducing high-dimensional input-output system behavior. HDMR describes an output [f(x)] in terms of its input variables (x = [x(1), x(2), em leader, x(n)]) via a series of finite, hierarchical, correlated function expansions.

Continuous intratympanic infusion of gentamicin via a microcatheter in Menière's disease.

Between 1995 and 1998, 11 patients with disabling Menière's disease were treated at our institution with a continuous gentamicin infusion into the middle ear via a microcatheter. The patients had frequent attacks of vertigo and vomiting (functional levels 3-5). Hearing threshold on the affected side was significantly worse than on the healthy side (stage 4+5).

Radiology of a rare foreign body in the nasal cavity.

We report a 76-year-old man referred because of incessant epistaxis. During presurgical investigation a radiodense mass was detected in the left nasal cavity, which turned out to be an iodoform-soaked gauze pack put in by a general practitioner some weeks previously and simply forgotten.