Purpose:The objective of the current study was to evaluate the correlation between obesity and the use of depo-medroxyprogesterone (DMPA) in regards to weight gain and changes in bleeding patterns.
Materials and Methods:A retrospective chart review of women receiving 150mg DMPA via intramuscular injection at inpatient and outpatient clinics at the University of Mississippi Medical Center (UMMC) between June 1, 2012 to December 31, 2016 was conducted. Body mass indices (BMI) were assessed at baseline and at the time of final injection. Race, medical history, age at first DMPA injection, number and timing of injections, reported side effects, indication for DMPA use, and reason for discontinuation, if applicable were collected.Results: Of the 240 patients included in the study, 3.4% were underweight, 30.8% were normal weight, 23.3% were overweight, 15% were Class I obese, 9.6% were Class II obese, and 17.9% were Class III obese. 87.9% of the population were African American. Contraception was the most common indication for use. Women gained (2.40kg; 95% CI 1.34 -3.45) while they were on DMPA (p<0.01), which after adjusting for confounding variables was associated with age at initial injection (beta coefficient = −0.13; p=0.01). Amenorrhea was the most commonly reported change in bleeding pattern among these women.
Conclusion:Women who started DMPA at an earlier age gained the most weight over time, independent of initial BMI. Similar rates of amenorrhea were found among all BMI categories.
BackgroundPaediatricians write Child protection medical reports when a child has a medical assessment as part of a section 47 enquiry where there are concerns of abuse or neglect. These reports are routinely shared with children’s social care and often shared with other safeguarding agencies.As such it is important that the written opinion and findings of paediatricians are clear and understood by all.AimsTo review a selection of regional child protection medical reports and to analyse the readability and language used when stating opinion. The information was then used to undertake a multi-agency survey to explore how ‘what was being said’ was ‘being understood’.Methods5 Regional NHS trusts identified 88 child protection medical reports written between Jan 2016 to Jan 2017. These were analysed by a named safeguarding professional in each trust. This analysis included the extraction of statements used in the reports to summarise opinion and the readability level using an imbedded Microsoft office programme that provides a result comparable to school age literacy level. This information was then collated and analysed between the trusts.The extracted statements were then used to undertake a multiagency survey to explore how different professionals interpret statementsResults35 different statements were used in the report opinions. Two statements were used commonly. These were ‘consistent’ as in ‘this mark is consistent with’ and ‘likely/unlikely’A quarter of disseminated reports had spelling errors and 27% were felt to have no clear opinionOnly 17% had a readability level likely to be readable to most adults of all literacy abilities29 professionals completed the survey, primarily from safeguarding social work or paediatric background.The statement with the best concordance between practitioners and shortest range of responses was ‘this is highly likely to be due to non-accidental injury’. For this statement the surety of the practitioner that the presentation was due to child abuse was 90% (range 75% to 99%)There was discordance amongst practitioners in many responses and the surety range was often wide.
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