Analysis of 369 abortions conducted by mifepristone (RU486) associated with sulprostone in a French family planning center

OBJECTIVE: To investigate the use of oral mifepristone (RU486; Roussel-Uclaf, Paris, France) associated with IM injection of sulprostone (Schering, Lys-Lez-Lannoy, France) for the induction of legal abortion (7 weeks of amenorrhea in France). DESIGN: An uncontrolled observational study. SETTING: A public family planning center in Paris. PATIENTS: Three hundred sixty-nine (369) pregnant women with up to 7 weeks amenorrhea undergoing legal abortion. INTERVENTIONS: Six hundred milligrams (600 mg) of oral mifepristone followed 48 hours later by an IM injection of 250 micrograms of sulprostone. MAIN OUTCOME MEASURES: Frequency of complete abortion and the need for subsequent surgical evacuation, hospitalization, and blood transfusion. Measurement of the beta-hCG concentration before and 14 days after the oral administration of mifepristone. RESULTS: There was complete abortion in 93.2% of the cases. Of the 25 failures, 8 were continued pregnancies, 6 terminated pregnancy but without expulsion of the conceptus, and 11 were placenta retentions. Eight women required short hospitalization, but none needed blood transfusion. Among the 25 failures, 23 had a beta-hCG concentration > 500 IU/mL [sensitivity 92%, specificity 83%]. CONCLUSION: The sequential use of oral mifepristone and IM injection of sulprostone is effective in inducing abortion up to 7 weeks of amenorrhea. Nevertheless the risk of maternal morbidity associated with sulprostone and also the risk of fetal malformations in cases of continued pregnancy indicate that this method should only be used in specialist centers.     

Rasch modeling and the measurement of social participation

Social participation is the main outcome of physical rehabilitation programs. The aim of this study is to improve the measurement of social participation, using an instrument called the Assessment of Life Habits Scale and the Rasch model. The interval level measurement, the dimensionality and the generalizability of the item hierarchy were verified. The data from a large sample of people with spinal cord injury was analyzed and specific results were compared with expert opinions. The main properties of the instrument were satisfactory and the agreement with expert opinion was high. Principal component analysis showed multidimensionality. The item difficulty hierarchy obtained with spinal cord injury experts was different from the one obtained with traumatic brain injury experts, indicating a different difficulty level of items in relation to each population characteristics. We conclude that the instrument is appropriate for the measurement of social participation and suggest ways to improve the instrument.     

Conceptualizing access to and understanding of information

Universal Access in the Information Society - Many citizens face situations where they have difficulty accessing and understanding information, particularly due to insufficient literacy skills....