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Aim: To assess the correlation between magnetic resonance imaging (MRI) and histopathology for predicting muscular infiltration of endometriosis in the bowel wall in patients undergoing colorectal resection. Materials and methods: All consecutive patients who underwent colorectal surgery for deep endometriosis (DE) with a preoperative MRI in a single tertiary care referral hospital between 2001 and 2019 were included in a prospective cohort. MRI images were revised by a single blinded radiologist. The MRI results regarding the infiltration depth (serosal, muscular, submucosal, or mucosal) and lesion expansion of DE were compared to histopathology. Results: A total of 84 patients were eligible for evaluation. A sensitivity of 89% and positive predictive value of 97% was shown for predicting muscular involvement of the bowel wall. Conclusion: This study showed that MRI is valuable in predicting the involvement of the muscular layer of the colorectal wall. Therefore, in patients with symptomatic pelvic bowel endometriosis MRI is a useful tool in guiding the extent of colorectal surgery.

Study question To examine the hypothesis that experiences with patient-centred endometriosis care are associated with the endometriosis-specific quality of life dimensions ‘emotional wellbeing’ and ‘social support’. Summary answer Positive associations were found between experienced patient-centeredness of care and the quality of life domains ‘emotional well-being’ and ‘social support’. What is known already Women with endometriosis have lower quality of life. Furthermore, research showed that the patient-centeredness of endometriosis care could still be improved. The quality of the provided endometriosis care might impact women’s quality of life, as demonstrated in the field of fertility care. A previous explorative study identified associations between patient-centred endometriosis care and two in five dimensions of endometriosis-specific quality of life (i.e. ‘emotional well-being’ and ‘social support’) but concluded that a more focussed and adequately powered study was needed. Study design, size, duration A secondary regression analysis of two cross-sectional cohort studies was performed. Both studies investigated patient-centeredness of endometriosis care and endometriosis-specific quality of life using respectively the ENDOCARE questionnaire (ECQ) and the Endometriosis Health Profile 30 (EHP-30). In total the data from 300 women was eligible for analysis, exceeding the, according to our power calculation, required sample size of 200 women. Participants/materials, setting, methods The participating women all had surgically proven endometriosis and were recruited by one secondary and two tertiary endometriosis clinics in the Netherlands. The regression analysis focused on the previously found association between the ten dimensions of the ECQ and the EHP-30 domains ‘emotional well-being’ and ‘social support’ rather than all five EHP-30 domains. After the Bonferroni correction to limit type I errors, the adjusted p-value was 0.003 (0.05/20). Main results and the role of chance The participating women had a mean age of 35.7 years and had predominantly been diagnosed with moderate to severe (68.6%). Regarding the EHP-30 domain ‘emotional well-being’, an association was found with the following five patient-centeredness dimensions: ‘respect for patients’ values, preferences and expressed needs’ (p = 0.046, Beta=0.159), ‘coordination and integration of care’ (p = 0.013, Beta=0.193), ‘information, communication and integration of care’ (p = 0.010, Beta=0.258), ‘emotional support and alleviation of fear and anxiety’ (p = 0.010, Beta=0.178), and ‘continuity and transition’ (p = 0.015, Beta=0.179). None of the associations between the EHP-30 domain ‘emotional well-being’ and a dimension of patient-centred endometriosis care, were significant when compared to the Bonferroni corrected p-value (all p ≥ 0.010). The EHP-30 domain ‘social support’ proved to be significantly associated to the following three dimensions of patient-centered endometriosis care (in order of strength): ‘information, communication and integration of care’ (p Limitations, reasons for caution This cross-sectional studies identified associations rather than proving causality between experiencing less patient-centeredness of care and having lower quality of life. Nevertheless, it is very tangible that some causality exists, either directly or indirectly (e.g. through empowerment) and that by improving patient-centeredness, quality of life might be improved as well. Wider implications of the findings Improving the patient-centeredness of endometriosis care was already considered an important goal, but even more so given its association with women’s quality of life, which is increasingly considered the ultimate measure of health care quality. Trial registration number not applicable

Study question How completely reported are studies on blood biomarkers of endometriosis, according to their adherence to the STARD 2015 checklist? Summary answer Studies on blood biomarkers of endometriosis are often incompletely reported, with only an overall adherence rate of 28.5% to the STARD 2015 checklist. What is known already Laparoscopy, the gold standard diagnostic method for determining endometriosis, is invasive, expensive, requires anesthesia and is associated with risk of vascular/ visceral damage. Therefore, less invasive diagnostics are needed. Many studies have been published on blood biomarkers of endometriosis with variable methodological quality. To assess applicability and risk of bias of diagnostic accuracy studies, completeness of study reporting must first be ensured. STARD 2015 checklist was introduced to guide reporting of diagnostic accuracy studies. The degree of adherence in studies on blood biomarkers of endometriosis to this 30-item STARD 2015 checklist is not known. Study design, size, duration Our systematic review included 126 studies from the 2016 Cochrane review on blood biomarkers of endometriosis. We added 84 more studies after updating the search in Pubmed, CINHAL and Web of Science, for the period May 2015- July 2021, with the keywords: endometriosis and biomarkers/ non-invasive diagnosis/ laboratory tests/ blood test, using the same eligibility criteria as in the Cochrane review. Totally, 210 studies were assessed for adherence to STARD 2015 checklist. Participants/materials, setting, methods STARD 2015 items were scored 1 if reported, or 0 if unreported. Each study received an adherence rate (percent of reported STARD items). Every item received individual item’s reporting rate (percent of its reporting across studies). Effect of publication year on study adherence and item reporting rates was examined by linear and logistic regressions, respectively. Journal impact factors were classified to tertiles and their relation to study adherence rate examined with one-way ANOVA. Main results and the role of chance Adherence rate was 28.5%, with 8.8± 3.1 reported items per study (range 2-18). Study adherence to STARD 2015 significantly increased with advancing publication years [r = 0.344 (95% CI 0.219 – 0.458), p 50% included #1 (identification as diagnostic accuracy study), #5 (prospective or retrospective), #7 (participants identification), #10a (index test), #10b (reference standard), #14 (diagnostic accuracy measures), #21a (disease severity), #21b (alternate diagnosis), and #22 (time between index test and reference standard). Items with reporting rates 20 to 50% included #6 (eligibility criteria), #8 (when/ where participants identifies), #12a (test positivity cutoff), #20 (participant characteristics) and #26 (limitations). Reporting rate < 20% seen in items #3 (background), #4 (hypothesis), #9 (consecutive /random recruitment), #13a/b (blinding of index test/ reference standard performers), #15 (intermediate results), #16 (missing data), #17 (analysis of variability), #18 (sample size), #19 (flow diagram), #23 (cross tabulation), #24 (diagnostic accuracy precision), #25 (adverse events), #27 (implications), #28 (registration), #29 (protocol), #30 (funding). Reporting improved for items: #1, #8, #10a, #10b, #12a, #14, #17, #18, #19, #20 and #25 and declined for items #9, #21a and #27 over publication years. Limitations, reasons for caution As the consequence of our choice to adhere to the methodology of the original Cochrane review, a limitation of our study is that we excluded non-English language studies and limited the search to the previously chosen 3 databases only. Wider implications of the findings With inadequately reported diagnostic accuracy studies, the derived evidence can be misleading. Our findings represent a baseline evaluation of the reporting status of studies on blood biomarkers of endometriosis. Our results can guide researchers and editors about poorly reported STARD 2015 items, aiming to improve their future reporting quality. Trial registration number PROSPERO # CRD42021259990

Study question What are the costs and effects of management based on tubal patency testing by HyFoSy compared to HSG in infertile women during fertility work-up? Summary answer Management based on the results of either HyFoSy or HSG leads to similar pregnancy rates with lower costs for management based on HyFoSy. What is known already Traditionally, tubal patency testing during the fertility work-up is performed by HSG. We recently showed in a randomised controlled trial (RCT) that in infertile women scheduled for tubal patency testing, management based on the results of either HyFoSy or HSG leads to comparable diagnostic accuracy (FOAM trial, van Welie et al, 2022 conditionally accepted). Also, HyFoSy is associated with significantly less pain, it lacks ionizing radiation and exposure to iodinated contrast medium. Moreover, it can be performed by a gynaecologist during a one-stop fertility work-up. Here, we compare the costs and effects of both tubal patency strategies. Study design, size, duration We performed an economic evaluation alongside the FOAM trial, a multi-center cohort study with embedded RCT in the Netherlands. The FOAM trial included 1,160 infertile women (18-41 years) scheduled for tubal patency testing. Women underwent, in a randomised order, both HyFoSy and HSG. The results of both tests were compared and in case of discordant results for HyFoSy or HSG women were randomly allocated to management based on the results of either HyFoSy or HSG. Participants/materials, setting, methods The economic evaluation compared costs of management based on either test within 12 months in the entire study population and in women with discordant results. For the entire study population, we compared two strategies: one that follows the management based on HyFoSy and one based on HSG. We calculated incremental cost-effectiveness ratios (ICERs): the difference in total costs and in chance of live birth. Data were analyzed using the intention to treat principle. Main results and the role of chance Between May 2015 and January 2019, we studied 1,160 women, of which 1026 (88%) women underwent both tubal tests and had data available. They were divided in three groups: women with concordant (n = 747, 48% live births), inconclusive (n = 136, 40% live births) or discordant (n = 143, 41% had a live birth after management based on HyFoSy and 49% had a live birth after management based on HSG) results. When these data were integrated in the two strategies, one based on HyFoSy and one based on HSG, the estimated chance of live birth per management strategy was 47% after HSG and 46% after HyFoSy (difference 1.2% (95%CI: -1.5% to 3.4%)). For the procedures itself, HSG costed €266 and HyFoSy €132. When costs of additional fertility treatments were incorporated, the mean total costs per couple were €1,366 for the HSG strategy and €1,250 for the HyFoSy strategy (mean difference €152 (95%CI: €149 to €155). Taking into account the 1.2% increase in live birth rate after the HSG stratey, this leads to an ICER of €10,014 for one additional live birth after HSG compared to HyFoSy. Limitations, reasons for caution The number of inconclusive results for HyFoSy was higher than anticipated. This might be explained by the learning-curve of performing HyFoSy although training was mandatory. Women underwent both tests, therefore the immediate fertility enhancing effect e.g. by using oil-based contrast, could not be determined and is therefore not incorporated. Wider implications of the findings The diagnostic accuracy of HSG and HyFoSy are comparable, while HyFoSy leads to lower costs, is associated with less pain and no ionizing radiation without exposure to iodinated contrast. HyFoSy could replace HSG as first-line tubal patency test, although the direct fertility enhancing effect of both tests should be incorporated. Trial registration number NTR 4746

Background: Oil-based contrast has been shown to have a fertility-enhancing effect during hysterosalpingography (HSG) but is not yet used during transvaginal hydro laparoscopy (THL). Objective: To asses if additional tubal flushing with oil-based contrast during THL is feasible. Materials and methods: Case report with video assessment. A healthy 29-year-old woman with primary unexplained subfertility, underwent a THL under local anaesthesia. First, chromopertubation was performed by methylene blue. Afterwards, tubal flushing with 3mL oil-based contrast (Lipiodol® UltraFluid, Guerbet) was performed. Main outcome measures: In this case report we evaluated the feasibility of additional tubal flushing with oil- based contrast during THL, in terms of; the visibility of the oil-based contrast at the tubal fimbriae, the pain and acceptability scores. Results: Both fallopian tubes were patent to methylene-blue as well as to oil-based contrast. Interestingly, the oil-based contrast came out of the fallopian tube in the form of free droplets with strong internal bonding. Furthermore, some residue of the droplets was visible on the surface of the peritoneal wall in the form of oily micro-droplets. Conclusions: We present the first sub-fertile woman, in which additional tubal flushing with oil-based contrast during THL was performed. It is likely, that the residue of oily micro-droplets is also present inside the fallopian tube, where it may enhance the cilia movement by introducing lubrication. These lubricating characteristics of the oil-based contrast may be important for its fertility-enhancing effect. More research is necessary to confirm this hypothesis and the feasibility of tubal flushing with oil-based contrast during THL in more women.

Study question How do infertility patients, endometriosis patients and health care providers rate the virtual care that was provided during the first lockdown of the COVID-19 pandemic? Summary answer Patients and health care providers rate telephone- and video consultations as good alternatives during the pandemic but it cannot replace future physical consultations. What is known already Virtual alternatives to regular care such as telephone and video consultations are gaining more attention as replacement for physical consultations and are ideal for use in a social distancing situation as the COVID-19 pandemic. However, infertility and endometriosis patients often rely on physical consultations for reassurance as well as for treatments such as artificial reproductive technology and surgery. Not being able to receive these reassurances and treatments may cause stress especially as infertility patients are known to experience a high sense of urgency to obtain treatment. For patients with endometriosis, regular follow-up visits are important for continuity of care. Study design, size, duration: A cross-sectional cohort study was performed, including 555 patients and 101 health care providers in the field of infertility and endometriosis in the Netherlands. Online questionnaires were sent between May and October 2020. Participants/materials, setting, methods Patients with infertility and endometriosis patients from a university hospital and members of the respective national patients organizations, as well as health care providers in the fields of infertility and endometriosis were asked to participate. The questionnaires consisted of demographics, appraisal of telephonic and video consultations (TCs and VCs) and assessment of fertility related quality of life (FertiQoL) and patient-centeredness of endometriosis care (ENDOCARE). Main results and the role of chance The questionnaires were completed by 374 infertility patients, 181 endometriosis patients and 101 health care providers. 75.9% of the infertility patients, 64.8% of the endometriosis patients and 82.7% of the health care providers rated TCs as a good alternative for physical consultations during the COVID-19-pandemic. Only 21.3%, 14.8% and 21.3% rated TCs as a good replacement of physical consultations in general. 76.6% and 35.9% of the infertility and endometriosis patients reported to experience an increase in stress due to the altered care during the COVID-19 pandemic. 38.7% and 58.0% reported to have received sufficient information from their care givers. Infertility patients scored lower on the FertiQoL than the reference population, while the ENDOCARE results of endometriosis patients were comparable to the reference. Limitations, reasons for caution This study was limited to the Dutch population. As the organization of infertility care varies internationally, the results will not be directly applicable to other countries or health care systems. Wider implications of the findings: Virtual care options are a good alternative for infertility and endometriosis patients in situations where physical consultations are not possible. Self-reported stress is especially high in infertility patients during the COVID-19-pandemic. Health care providers should provide more information to patients in order to increase their ability to cope with stress. Trial registration number N/A

Background The burnout syndrome is increasingly recognized as the factor compromising the mental health of health-care workers. The demands of higher education were reported to influence the development of burnout syndrome among students. Medical students are a significant population as both future health care workers and students with high academic demands. The burnout among medical students has been studied using different questionnaires. The aim of this study was to assess the psychometric characteristics of the Study Burnout inventory for the assessment of burnout among medical students. Methods The cross-sectional study was conducted during December of 2019 among the fifth year Medical students at the five Universities in Serbia (University of Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was the Study Burnout Inventory, nine-item scale, measuring three dimensions of burnout (exhaustion from studying- EXH; cynicism toward the meaningfulness of studying-CYN; the sense of inadequacy as a student-INAD). Answers were given on a six-point Lickert scale. The assessment of psychometric characteristics of the questionnaire was done using the reliability analysis (Cronbach alpha-α) and test-retest reliability (intra-class coefficient-ICC). Sensitivity and specificity were assessed using the Receiver operation curves (ROC) compared to the total burnout assessed by the Copenhagen burnout inventory. Results A total of 493 students filled-in the questionnaire. The mean score was 28.95±8.87/54. The Cronbach alpha for the total scale was α = 0.839, for the EXH scale was α = 0.724, for the CYN scale was α = 0.767, and for the INAD scale was α = 0.431. The test-retest reliability was ICC=0.750. The total area under the curve was 0.756 (95% CI: 0.711-0.800). Conclusions The Study Burnout Inventory has good reliability and can be used for rapid assessment of burnout among Medical students, as this scale is short and convenient for the participants. Key messages The Study burnout inventory has a good reliability as a total scale. This short scale is convenient for the participants and can be used for assessment of burnout.

Background Some findings indicate that university students are at higher risk of depression despite being a socially advantaged population, showing that 15 to 25% of them develop some type of mental disorder during graduation, and depression is one of the most prevalent. The aim of this study was to investigate the prevalence of depressive symptoms and its association with gender, material status, social health, and behavioral factors among university students. Methods The research represents a cross-sectional study conducted at the University of Novi Sad, Serbia. The research involved 455 first-year students. The average age of participants was 19.3 years (72.1% girls and 27.9% boys). Patient Health Questionnaire (PHQ-9) was used to measure depressive symptoms (cut point for depressive episode ≥10). Additional questions were focused on self-assessed material status, social health, and behavioral factors (smoking and alcohol use). The binary logistic regression model was used to estimate the association between depression and observed independent variables. Results The prevalence of moderate to severe depressive episode among students was 18.0%, with no gender differences. Out of the total, 11.0% of students had suicidal thoughts or thoughts of hurting themselves. Multivariable logistic regression showed that self-assessed poor material status (OR = 2.04; 95%CI: 1.06-3.89), self-assessed poor social health (OR = 8.9; 95%CI:4.87-16.42) and smoking (OR = 2.18; 95%CI: 1.09-4.39) were significant predictors of depression among first-year university students. Conclusions High prevalence of depressive episode among university students call for the action for the promotion of mental health, particularly among those of lower socioeconomic status, and points out the importance of social health and social network in the prevention of mental disorders. Key messages Students on the first year of University should be screened for depressive symptoms. It is important to educate students on how to create a strong support network and to implement intervention programs for improving mental health through fostering healthy lifestyles change.

Introduction Serbian screening mammography programs target women 50-69 years with biennial screening. Methods Research was conducted as a cross-sectional study on a sample of 2784 women aged 50-69 years in Serbia, as a part of the Health Survey in Serbia, 2013. The association between the socio-demographic determinants as independent variables, and mammography screening (within the past 2 years) as dependent variable were examined using univariate and binary logistic regression. Multivariate model were adjusted for marital status, education, employment status, DHS Wealth Index, type of settlement and self-perceived health. The minimum level of significance was p Results Only 22.2% of women aged 50-69 have done mammograms within the past 2 years in Serbia. In binary logistic regression model as predictors for a mammogram were singled out level of education, wealth index and self-perceived health. Women with medium level of education have 1.4 times higher chance to perform a mammogram in relation to those with low education (OR = 1.4; 95%CI 1.12-1-80), while women with high level of education have 1.8 times higher chance to do a mammogram in relation to those with low education (OR = 1.8; 95%CI 1.33-2.58). Women with good financial situation were 1.4 times more likely to perform a mammogram in relation to those with poor financial situation (OR = 1.4; 95%CI 1.05-1.80). Women who perceived their health as well have 26% less chance to do a mammogram compared to those who perceived their health as a poor (OR = 0.74; 95%CI 0.56-0.97). Conclusions This study showed the disparity in the prevalence of mammography utilization. The predictors for mammogram performance among women were: high level of education, high wealth index and self-perceived health as poor. Key messages The only breast cancer screening test that has been proven effective in organized, population-based programs is mammography screening. Screening mammography reduces the risk of death due to breast cancer. It is useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.

Background Social determinants of health determine the extent to which a person possesses the physical, social and personal resources to stay healthy and achieve personal aspirations, satisfy needs, and cope with the environment. Methods Data from a cross-sectional study - The 2013 National Health Survey in Serbia was used. The study involved 1840 women aged 20 years and over in the Province of Vojvodina. The research instrument was a specially designed questionnaire. Multivariate logistic regression was implemented to assess the association between self-rated health as a dependent variable and social-demographic characteristics of women as independent variables (age, type of settlement, marital status, material status - DHS Wealth Index (WI), level of education, employment status, social support (Oslo-3 Social Support Scale), smoking and alcohol consumption. Results Out of a total 38.8% of women had a low level of education, according to WI 49.3% were poor, 21.9% were unemployed and 11.5% had poor social support. Every third woman was a smoker (31.9%) and 21.3% self-rated their health as poor. The number of women with poor health increased significantly with the decrease in social support, level of education and WI (from 14.3% among women with strong social support to 36.0% with poor social support, from 8.5% among highly educated to 31,4% among the low educated, from 11.1% among the rich to 24.4% among the poor). Multivariate logistic regression indicated that poor social support (OR = 3.96; 95%CI=2.34-6.70), low level of education (OR = 2.87; 95%CI=1.47-5.58), WI category of poor (OR = 1.77; 95%CI=1.10-2.84), ex smoking (OR = 2.49; 95%CI=1.51-4.08) and smoking (OR = 2.16; 95%CI=1.42-3.29) were significantly associated with poor self-rated health. Conclusions The research shows that there is a strong association between social determinants and self-rated health, which demands multi-disciplinary strategies to improve health and reduce health inequalities. Key messages Protecting the health of women is not only a basic human right, it is also crucial for health and economic development. Social determinants of health are leading causes of the health inequalities and demand an adequate health policy development at local, as well as at the national level.

Background Medical education is both academically and emotionally demanding. The demands of medical school can influence the development of anxiety among medical students. The aim of this study was to assess the prevalence of anxiety and factors associated with it among the fifth year medical students at the five universities in Serbia. Methods The cross-sectional study was conducted during December of 2019 and included a total of 493 students at the five Universities in Serbia (Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was developed based on the questionnaires from similar research and included the sections on social characteristics, lifestyle characteristics, study engagement, Beck depression inventory, Copenhagen burnout inventory, and Zung anxiety scale. Based on the score on Zung anxiety scale students were classified in two groups: with anxiety (scores ≥45) and without anxiety (scores 20-44). Results The mean Zung anxiety scale score was 35.39±8.31 (minimum=20, maximum=69). A total of 64/493 students (13%) was in the group with anxiety. The multivariate logistic regression analysis with the anxiety as an outcome variable showed that anxiety was associated with female sex (OR: 4.20, 95% CI: 1.41-12.50), higher scores on Beck depression inventory (OR: 1.18, 95% CI: 1.12-1.26), and total burnout (OR: 3.98, 95% CI: 1.66-9.54). Conclusions This study shows that students with anxiety have a higher likelihood of higher scores on Beck depression inventory and a higher likelihood of having burnout syndrome. The clustering of mental health problems, along with the high prevalence of anxiety among medical students is alarming. Key messages One in eight medical students in Serbia has scores on Zung anxiety scale indicative of at least mild anxiety. The anxiety was associated with female gender, higher score on Beck depression inventory and total burnout.

Background The best surgical technique for managing ovarian endometriomas is still widely debated, though the current standard is stripping cystectomy. The use of plasma energy as a treatment option is a relatively new concept and little data is currently available on this method. The aim of this study was to determine the feasibility of the use of plasma energy in our daily clinical practice by looking at various postoperative outcomes. Methods Twenty-one women previously diagnosed with uni- or bilateral ovarian endometriomas by transvaginal ultrasound, associated with pelvic pain and/or infertility, were included in this retrospective cohort study performed in a tertiary endometriosis referral centre. All women underwent endometriotic cyst ablation using plasma energy. At follow up postoperative pain, number of days until return to work following surgery, postoperative pregnancy rate and recurrence rate were determined. Results This study demonstrates a significant decrease in the proportion of patients reporting pain postoperatively when comparing the number of patients with dysmenorrhoea, dyspareunia, and chronic pelvic pain pre- and postoperatively. In addition, the median number of days until women returned to work postoperatively was 9 days (interquartile range (IQR) 8-11 days). The postoperative pregnancy rate was 46.2% (6 of 13 women wishing to conceive) and the recurrence rate was 9.5%. Conclusions In conclusion, plasma energy is a promising alternative to stripping cystectomy, as comparable results for postoperative pregnancy and recurrence rates can be observed. However, further research is necessary to draw firm conclusions when comparing these two techniques.

Introduction Women suffer from many diseases that are associated with low level of physical activity. The aim of this paper was to estimate the association between physical activity and self- perceived health of women in the Province of Vojvodina. Methods Research was conducted as a cross-sectional study on a sample of 1356 women aged 20-65 years in Vojvodina, as a part of the National Health Survey in Serbia, 2013. Physical activity was analysed through 3 domains of physical activity - as leisure time physical activity, walking and cycling for transportation and physical activity at work. Univariate and binary logistic regression was used to estimate the association of poor self-perceived health as dependent variable with 3 domains of physical activity. Multivariate model were adjusted for age, type of settlement, DHS Wealth Index, education and employment status. Results One of twelve women was physically active in leisure time 150 minutes and more (8.1%), 50.0% of women walked for transportation 150 minutes and more weekly, while 16.5% cycled 150 minutes and more weekly. Women who never walked for transportation had 9.17 time higher chance to self-perceived their health as poor compared to those who are active 150 minutes and more weekly (OR = 9.17; 95%CI 4.16-20.18), while women who are inactive at work had 1.74 higher chance to self-perceived their health as poor compared to working active women (OR = 1.74; 95%CI 1.14-2.66). Conclusions Physical activity at work and in the form of walking for transportation showed as predictors of poor self-perceived health. Key messages Regular physical activity can improve womens’ health and help prevent many of the diseases and conditions that are major causes of death and disability for women around the world. Physical activity can contribute to building self-esteem and confidence and can provide a vehicle for social integration and equality for women in society.

Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx.We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model.Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)).The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John WileySons Ltd.

Aim The aim of this study was to evaluate how many patients with endometriosis have concomitant irritable bowel syndrome (IBS) and/or constipation according to the Rome III criteria. Furthermore, the value of an additional gastroenterological consultation with therapeutic advice was evaluated. Method Patients with proven endometriosis were included in a prospective, single-centre study. A questionnaire was undertaken regarding IBS and chronic constipation. Patients with symptoms consistent with the Rome III criteria for IBS were referred to our gastroenterological outpatient clinic. Results In total 101 patients were included. Endometriosis was diagnosed surgically in 97% and visually in the vagina in 3%. Fifteen per cent of the patients with endometriosis also had IBS and 14% of the patients with endometriosis had functional constipation without IBS. Of the 22 patients finally presenting to the gastroenterologist, five had a significant stenotic rectosigmoid lesion and were treated surgically. The remaining 17 patients were treated conservatively. Defecation symptoms improved in 86% and pain was reduced in 64%. Conclusion In patients with endometriosis, 29% also had IBS or constipation. Referral to a gastroenterologist resulted in improvement of defaecation in 86%, and 64% reported a reduction in the degree of pain. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

To compare the effect of various oestrogen and oestrogen/progestin preparations on bone density over a 2-year follow-up period in early postmenopausal women.A retrospective study on 315 women followed in a menopause clinic.Antero-posterior lumbar spine bone densitometry was performed at baseline and between 18 and 24 months (mean 22 months) after initiation of hormone therapy. Participants were divided into six groups: women taking conjugated equine oestrogen (CEE) (n = 30); CEE plus sequential monthly medroxyprogesterone acetate (MPA) (n = 52); CEE plus sequential bimonthly MPA (n = 51); oral estradiol plus sequential monthly norethisterone acetate (n = 52); transdermal estradiol plus sequential monthly MPA (n = 30). A control group (n = 100) was composed of nonusers of hormones.Hormone users, as a whole (n = 215), increased their bone mineral density (BMD) by 2.9% (4.8) as compared to the controls who lost 3.5% (3.4; P0. 001). There were similar gains in BMD amongst the five study groups. Calcium supplementation was associated with better results in all women: users of hormones and calcium had a gain in BMD of 4.5% (4.8) compared to only 1.5% (4.5) in those on hormones but without calcium (P0.001); amongst the controls, women using calcium lost 1.4% (2. 4), whilst nonusers of calcium lost 3.7% (2.4; P0.001). A dose-response curve was found between basal BMD and the effect of hormone therapy: women with osteoporosis (T-score75%) demonstrated the largest increase in BMD - 6.3% (4.6), osteopenia (T-score 75-85%) was associated with a gain of 3.2% (5.6), low-borderline values (T-score 86-100%) gave a modest increase of 1.3% (4.3), and those with more than average BMD values (T-score100%) actually lost bone despite hormone treatment [-2.1% (4.1)].All hormone regimens had a similar bone conserving effect. Basal BMD value may serve as a predictor for the success of treatment. Calcium supplementation should be recommended in all postmenopausal women.

Hypothyroidism, which is a common disorder among postmenopausal women, may be associated with higher than average bone mineral content. Contrarily, treatment with L-thyroxine may cause a significant bone loss. The aim of our study was to evaluate the effects of hormone-replacement therapy (HRT) on bone density in women with subclinical hypothyroidism treated with L-thyroxine. A total of 73 postmenopausal women with thyroid-stimulating hormone (TSH) levels5 mU/l and normal free thyroxine values, who never used HRT or L-thyroxine, were divided into three groups according to the treatment given during a 3-year follow-up period: 34 women received only HRT; 20 women received HRT and L-thyroxine, and the remaining 19 women received neither medications. A euthyroid control group included 41 postmenopausal women with TSH levels between 0.5 and 1.5 mU/l, who were using HRT since the initial visit. Lumbar spine bone density measurements were performed at baseline and study termination. Taken as a whole, the hypothyroid women had a non-significant higher baseline bone mineral density (BMD) as compared to the euthyroid controls (1.068 +/- 0.19 g/cm2 vs. 1.024 +/- 0.15). After 3 years, both the euthyroid and hypothyroid women on HRT only had an increase in BMD (0.032 +/- 0.04 g/cm2 and 0.028 +/- 0.05 g/cm2, respectively; p0.001 for both, compared to baseline). Hypothyroid women using no medication had a decrease of 0.034 +/- 0.07 g/cm2 in BMD, and those receiving both HRT and L-thyroxine lost the most: 0.04 +/- 0.08 g/cm2 (p0.05 for both, compared to baseline). The addition of L-thyroxine thus prevented the beneficial effect of HRT on BMD. Thyroid hormone replacement is recommended only when overt symptoms of hormone deficiency occur. In such cases, a single bone-conserving treatment with HRT may not suffice.

The aim of this study was to evaluate how many patients with endometriosis have concomitant irritable bowel syndrome (IBS) and/or constipation according to the Rome III criteria. Furthermore, the value of an additional gastroenterological consultation with therapeutic advice was evaluated.Patients with proven endometriosis were included in a prospective, single-centre study. A questionnaire was undertaken regarding IBS and chronic constipation. Patients with symptoms consistent with the Rome III criteria for IBS were referred to our gastroenterological outpatient clinic.In total 101 patients were included. Endometriosis was diagnosed surgically in 97% and visually in the vagina in 3%. Fifteen per cent of the patients with endometriosis also had IBS and 14% of the patients with endometriosis had functional constipation without IBS. Of the 22 patients finally presenting to the gastroenterologist, five had a significant stenotic rectosigmoid lesion and were treated surgically. The remaining 17 patients were treated conservatively. Defecation symptoms improved in 86% and pain was reduced in 64%.In patients with endometriosis, 29% also had IBS or constipation. Referral to a gastroenterologist resulted in improvement of defaecation in 86%, and 64% reported a reduction in the degree of pain.

To analyse the incidence and mortality of melanoma in the province of Vojvodina - the north part of Serbia- from the epidemiologic and clinical point of view.In this retrospective study, we used databases of the Cancer Registry of Vojvodina, Oncology Institute of Vojvodina in Sremska Kamenica; Clinical Centre of Vojvodina in Novi Sad; Institute of Public Health of Vojvodina in Novi Sad; and Institute of Public Health of Serbia in Belgrade.The incidence and mortality of melanoma in Vojvodina is permanently increasing over the last three decades. The number of newly diagnosed and deceased patients was higher in men and in women in Vojvodina than in central Serbia. Considering the incidence rate, the region of Vojvodina would be placed in the middle of the European countries. The results are more unfavorable with mortality, especially in male population, similar to the range of higher mortality rates among European countries.These upsetting facts call for improvement of primary and secondary prevention. Education of the population, continuous efforts to recognize groups of population at high risk for developing melanoma and detection of early phases of the disease increases the chances for cure and significantly reduces treatment costs.

A 52-year-old woman with known endometriosis was treated with a levonorgestrel-containing IUD for irregular vaginal blood loss. Two weeks later she was admitted with signs ofpelvic inflammatory disease (PID) and was treated with antibiotics. As no clinical improvement ensued, laparoscopy was performed which demonstrated an infected endometriosis cyst in her right ovary. Ovariectomy was performed. In a 29-year-old woman with a symptomatic endometriosis cyst in the right ovary, PID was also suspected. After an initially good response to antibiotic therapy her condition deteriorated. Laparotomy revealed an infected endometriosis cyst. It was drained with subsequent cystectomy. A third, 43-year-old, woman with known endometriosis was admitted with signs of PID. Although she had a good clinical response to antibiotic therapy, her C-reactive protein (CRP) level remained elevated. Diagnostic laparoscopy demonstrated a large abscess in the right ovary. Ovariectomy was performed. Histology showed signs of an infected endometriosis cyst. All these women presented with PID and, in addition, a cystic adnexal mass on ultrasonography. The incidence oftubo-ovarian and ovarian abscesses is higher in the presence of an endometriosis cyst. Irrespective of the presence of an endometriosis cyst, antibiotics should be the first line of treatment. Reduction in the size of the abscess is not a useful parameter for monitoring conservative treatment when an infected endometriosis cyst is present. If it is decided to perform surgery on the infected endometriosis cyst, drainage of the abscess is usually not sufficient: excision of the endometriosis cyst is the only adequate therapy.

To investigate the effect of postmenopausal oral and transdermal hormone therapy on plasma levels of C-reactive protein (CRP), we performed a randomised, double-blind, double-dummy, placebo-controlled, 15-month study. One hundred and fifty-two healthy hysterectomised postmenopausal women received daily either placebo (n = 49), or transdermal 17beta-oestradiol (E(2)) 50 micro g (tE(2) group, n = 33), or oral E(2) 1 mg (oE(2) group, n = 37), or oral E(2) 1 mg combined with gestodene 25 micro g (oE(2) + G group, n = 33) for thirteen 28-day treatment cycles, followed by four cycles placebo for each group. Data were collected at baseline and in cycles 4, 13 and 17. In cycle 13, CRP was significantly increased in the oE(2) group compared to placebo (P = 0.004). The median percentage change from baseline versus placebo was +75% (P0.001). In cycle 17, significantly lower values were observed in the oE(2) group compared to cycle 13 and to the placebo group (-49%, P0.001). There were no significant changes versus placebo in the other groups. In conclusion, oral E(2) significantly increased CRP levels. This change was larger than the increase found during oral E(2) + G. Transdermal E(2) did not affect CRP levels.

Objectives: To look for possible association between past history of ovulation induction and age at menopause. Design: Women attending our postmenopausal outpatient clinic were asked to fill questionnaires with demographic data, obstetrical history (including treatment for infertility), and medical details related to menopause. Patients: The study group (n=31) consisted of women with a history of ovulation induction, and a control group (n=200) included women who did not experience such intervention. Results: The age at the final menstrual bleeding was 46.4±5 in the study group, and 50±4 for the control group (P

Beta human chorionic gonadotropin (beta-hCG) is expressed in human fetal tissue and cancer cells of various histologic types. It is degraded to the beta-core fragment (beta cf-hCG) which is concentrated in urine, and is known as urinary gonadotropin peptide (UGP). The objective of this study was to assess 1) the value of urinary gonadotropin peptide (UGP) as a single test and the combination of UGP with CA 125 as a diagnostic test in predicting the benign or malignant origin of gynecologic disease, 2) the influence of surgical removal of the tumor on the levels of UGP and CA 125, 3) the influence of the urinary concentration on the UGP levels in relation to the test results. PATIENTS, MATERIALS, METHODS AND STATISTICS: Serum and urine were collected from 31 gynecological patients with malignant and non-malignant disease, preoperatively, and 1 week and 6 weeks after surgery. Optimal cut-off levels were determined by Receiver Operating Characteristic-curves (ROC). Sensitivity (SENS), specificity (SPEC), positive (PPV) and negative predictive value (NPV) and overall test accuracy (ACC) for their ability to discriminate benign from malignant masses were calculated. Logistic regression analysis was performed to calculate the contribution of CA 125, UGP and UGP/creatinine (UGP/creat) to a model predicting malignancy.The optimal cut-off level for UGP was found 1 fmol/l, for UGP/creat 1.33 fmol/mg creatinine and for CA 125 100 kU/L. The distribution of the urinary creatinine values varied considerably (median = 8.3 mmol/l, range 0.6-25.8 mmol/l). The correlation coefficient (r) between log UGP and log CA 125 was 0.44 (p = 0.001) and between log UGP/creat and log CA 125 0.53 (p0.0001).UGP may be used as a tumor maker in gynecological disease. However, CA 125 as single test discriminates malignant from benign disease better than UGP or UGP/creat. In a logistic model the combination of CA 125 with UGP and UGP/creat predicts the benign or malignant character in 89% of the study population. Significant changes in UGP and UGP/creat levels were seen after removal of benign tumors, however, this was not found in ovarian cancer patients. Correction of the UGP values for the urinary concentration improved the results slightly.

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis. Serum Lp(a) concentrations increase after menopause, and postmenopausal estrogen replacement appears to decrease Lp(a) levels. In a randomized, double blind study, we examined the effects of 6-month treatment with daily 17 beta-estradiol (E2; 2 mg, orally) continuously combined with one of four dosages [2.5 mg (n = 41), 5 mg (n = 38), 10 mg (n = 38), and 15 mg (n = 20)] of dydrogesterone on fasting serum Lp(a) concentrations in 137 healthy postmenopausal women. At baseline, no significant differences were noted among the four treatment groups. During the study period of 6 months the median serum Lp(a) concentration decreased significantly from 128 mg/L (range, 5-1660) to 110 mg/L (range, 1-1530) in the total population, corresponding to a reduction of 13% (P0.001). The percent changes in serum Lp(a) correlated positively with the percent changes in serum E2 at 3 as well as 6 months of therapy (r = 0.38; P0.001 and r = 0.35; P0.001, respectively). A dose response of dydrogesterone on serum Lp(a) was not found. In addition, serum lipids and (apo)lipoproteins improved significantly in all four treatment groups. In conclusion, oral E2 continuously combined with dydrogesterone has beneficial effects on the lipid and lipoprotein profile and is effective in lowering Lp(a) concentrations in postmenopausal women.