Journal of Contraception Reproductive Health Care - The European ...

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The 8th Congress of The European Society of Contraception Abstracts of Invited Speakers IS-25 Organisation of (specific) services A. Imhoff-Köprülü Profamilia chorweiler e.V., Cologne, Germany The author reports about an advisory centre for pregnancy, conflict of pregnancy, family planning, contraception, and interruption, called Profamilia chorweiler e.V. (e.V. means: ‘registered society’), placed in a district of Cologne, where more than half of the inhabitants are not German natives. She will give you an idea about the multiprofessional team working there, how they have been working, the variety of consultants coming, and why both the German society and the politicians think that it is important to have such advisory centres for women (and couples), when they are in a conflict of having a baby or not. In her report, she will also look back on the 52 years since the Profamilia society was founded. She will tell you about the Profamilia ideology of contraception and family planning, about its organisation, its legitimisation and its financing. In the appendix you will find (1) an extract of a law concerning Profamilia’s work, and (2) a list of Profamilia’s offered services. IS-26 How we measure risk in epidemiological terms? T. Farley WHO, Geneva, Switzerland The word risk is used in many different and frequently misunderstood ways. The different types of risk used in epidemiology and public health will be defined and illustrated, together with several misconceptions as to what these mean in practice. 24 The European Journal of Contraception and Reproductive Health Care
The 8th Congress of The European Society of Contraception Abstracts of Invited Speakers IS-27 How do we communicate risk? A. Herxheimer UK Cochrane Centre, UK We do it badly, for two quite different reasons: (1) the concept of probability of harm is difficult to convey and explain clearly, particularly in a brief consultation, and (2) we use the word ‘risk’ as a euphemism for ‘harm’, though strictly it denotes only ‘probability’. We must communicate that all interventions in health care can cause harms as well as benefits, and that an intervention is only worth using when the benefits clearly outweigh the harms. Both the benefits and the harms of an intervention have four distinct dimensions 1 – (a) the kind of benefit or harm; (b) their intensity and duration; (c) the probability that they will occur; (d) if they occur, their possible effects on the person’s life. We want people if possible to understand the important benefits and harms that we believe they should consider before choosing or accepting a treatment, and to help them compare these with the benefits and harms of other treatments, and of no treatment. Clinicians cannot communicate these complex matters without thorough preparation and help; patients/clients need time to take them in and opportunities to discuss them and ask questions. This means that both written and spoken communication is needed, often on more than one occasion. A written summary enables all the professionals in a community to use the same information as the basis for their conversations with patients, who should then get consistent messages from whichever doctors, nurses, pharmacists, etc, they encounter. That can help them to understand the concepts, to minimise misconceptions and misunderstandings, and so to save time and regrets. A complication that can rarely be considered, let alone explained, is that the benefits and harms of medicines vary greatly with dosage and duration of use, as well as with the users’ individual characteristics; unfortunately rather little is known about these important variations. 1. Herxheimer A. Benefit, risk and harm. Australian Prescriber 2001; 24:8. IS-28 Coping with scares H. P. G. Schneider Department of Obstetrics and Gynaecology, University of Muenster, Germany Synthetic sex steroid hormones have extensively been employed for a great variety of indications, such as menstrual cycle disturbances, menopausal complaints, infertility, threatened or recurrent abortion, endometriosis, acne, adjuvant treatment of breast cancer and others. Substantial information was obtained about sex steroids interfering with metabolic processes in the body. Need for caution was pointed out to those patients with a history of cancer or of thromboembolism. Within the first years following the introduction of oral contraception (OC), the risk of venous thromboembolic disease was extended to acute myocardial infarction, stroke, and hypertension. These early studies were probably substantially biased by the tendency to overdiagnose thrombotic disease among pill users. In addition to vascular phenomena, a variety of disorders such as neoplasms, diseases of the liver and biliary system, diseases of the reproductive, central nervous and immune system, skin conditions and others have extensively been studied in OC users with regard to pharmacodynamics, pharmacokinetics and their influence on biochemical parameters indicative of metabolic function. Almost all of the available data originate from studies performed in developed countries. It can be questioned whether the findings also apply to developing countries. Today, many women still believe there are substantial risks involved using OCs. While some fears appear justified, many involve outright misconceptions. As a result of increasing knowledge, with time our views about the health applications of OC use have changed dramatically. Current low-dose pills have been associated with a decreased risk of circulatory disorders, minimal influence on metabolic function and minimal, if any, and clinically insignificant impact in healthy women. In addition, OCs have been proven to provide several powerful health benefits which fully outweigh the risks involved. In particular, these concern diminished risks for ovarian and endometrial cancer. Other beneficial impacts include reduction of the risk of benign breast disease, functional ovarian cysts, pelvic inflammatory disease and various effects on or related to the menstrual cycle. There were many lessons to be learned during the process of public acceptance of long-term OC use. The oral contraceptive scares of 1977 (thromboembolism), 1983 (breast or cervical cancer) and 1987 (breast cancer) and 1995 (differential risks for venous thromboembolism between desogestrel- and gestodene-based combined OCs) have documented the necessity of knowledgeable interpretation of epidemiologic data. Optimally, valid causal research in population studies should incorporate the complimentary roles of clinical medicine, biology, and statistics, with the latter serving as the servant rather than the master. The European Journal of Contraception and Reproductive Health Care 25
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