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- W149743244 abstract "The risk of pelvic infection in wearers of IUDs is discussed from the viewpoint of criteria used in epidemiology to indicated cause and effect. There are 3 types of statistical associations in epidemiology: spurious, or false associations; indire ct associations acting through another factor; and causal, by which exposure leads to the outcome. The evidence for IUDs leading to pelvic infection is reviewed using the criteria listed by Hill. First, a large relative risk: reported risks range from 1.5-12, usually 3-5, are not considered due to bias. Second, consistent association across all types of studies: this has been true until recently. Third, specificity of effect, meaning one exposure leads to a single outcome: this is not true for pelvic infection, which is influenced by many factors. Fourth, temporal sequence, meaning the exposure must precede the outcome; although temporal association does not prove causal association. Fifth, biologic gradient or dose-response: in this case, more infections are associated with briefer rather than longer duration of IUD use. Sixth, plausibility: that IUDs could cause infection seem plausible. Seventh, experimental or analogous argument: there are no relevant laboratory models for IUDs in women, nor can IUDs be considered like a foreign body in other tissues. Since PID is sexually transmitted, the literature on IUDs and infection is confounded by use of comparison groups with artificially low infection rates. Diagnosis of PID, and even hospitalization rates in IUD users are inflated because of subjective bias against IUDs with respect to PID, leading to selection bias in epidemiologic studies. Three recent well-designed studies with sexually active controls not using contraceptive methods that protect against STDs show no increase in incidence of PID in IUD users." @default.
- W149743244 created "2016-06-24" @default.
- W149743244 creator A5025681520 @default.
- W149743244 date "1989-05-01" @default.
- W149743244 modified "2023-09-23" @default.
- W149743244 title "IUDs and pelvic infection." @default.
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