RESUMO
OBJECTIVE: To compare the incidence of expulsion for different copper intrauterine device (IUD) shapes. STUDY DESIGN: We conducted a secondary analysis of the ongoing, prospective, non-interventional European Active Surveillance Study on LCS12 (EURAS-LCS12). Users of newly inserted IUDs were recruited in 10 European countries via a network of approximately 1200 clinicians. We restricted the analysis to copper IUD users. In the main analysis, we classified copper IUDs by shape [Nova-T frame, Tatum-T frame, Multiload frame, frameless IUDs and intrauterine balls], without differentiation of size. We calculated the cumulative incidence, crude, and adjusted hazard ratios for expulsion. Covariates included in the adjusted analyses were age, BMI, parity, education, income, IUD user status, marital status, length of device, heavy menstrual bleeding, and clinician's experience. RESULTS: We included 26,381 copper IUD users from the EURAS-LCS12 dataset for this study. The most frequently used IUD shape was the Nova-T frame (14,724 [55.8%]) followed by the Tatum-T frame (4276 [16.2%]), frameless IUDs (3374 [12.8%]), Multiload frame (2962 [11.2%]), and intrauterine balls (IUBs) (1045 [4.0%]). Cox regression analysis regarding expulsions yielded an adjusted hazard ratio of 0.8 (95% CI, 0.7-1.0), 1.3 (95% CI, 1.0-1.8), 1.6 (95% CI, 1.2-2.1) and 3.6 (95% CI, 2.7-4.9) for Nova-T frame IUD, frameless IUDs, Multiload frame IUDs and IUBs versus Tatum-T frame IUD, respectively. CONCLUSION: The risk of expulsion following placement of a copper IUD is related to IUD shape, with Nova-T frame and Tatum-T frame IUDs demonstrating the lowest risk. IMPLICATIONS: Our finding of a higher risk of expulsion observed with Multiload frame, frameless, and intrauterine ball copper IUDs compared to Tatum-T frame and Nova-T frame devices during real world use has clinical importance. Clinicians may choose to use these data when counseling patients.
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RESUMO
Despite the rising number of lung cancers recognized as occupational disease, occupational lung cancers are still under-reported. To improve the recognition of occupational lung cancer, we implemented at the Léon-Bérard Cancer Centre, a questionnaire-based process to identify occupational exposures in these patients and improve compensation. Between January 2010 and December 2011, 91 lung cancer patients responded to a questionnaire. An "occupational cancer" consultation was proposed to patients reporting exposure to carcinogens or jobs with risk of exposure. Fifty-one patients were seen in consultation (34 following the questionnaire and 17 directly addressed by the oncologist). A suspicion of high or average imputability was identified in 31 (60.8%) patients and a compensation process seemed possible for 27 (61.4%). Asbestos was the most common carcinogen identified. Among 17 compensation processes engaged, 12 succeeded and one is ongoing. The complexity of the administrative process seems to be an obstacle for patients and perpetuates inequality. The implementation of our approach increased the identification and the compensation of occupational lung cancer. Our approach responds to the objectives of the National Cancer Plan and helps to improve the overall care of patients with cancer. This approach has been awarded by the national label in 2011 "Year of the patients and their rights".
