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Medical Eligibility Criteria for Contraceptive Use,from guidance developed by the World Health Organization WHO and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions.

The majority of the U. However, some WHO recommendations were modified for use in the United States, including recommendations about intraductal papilloma moose and doc use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women.

Recommendations were added to the U. Intraductal papilloma moose and doc recommendations in this document are intended to assist health- care providers when they counsel women, men, and couples about contraceptive method choice.

Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.

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Introduction Inthe World Health Organization WHO published the first edition of the Medical Eligibility Criteria for Contraceptive Use MECwhich gave evidence-based guidance on the safety of contraceptive method use for women and men worldwide who had specific characteristics and medical conditions. CDC, through close collaboration with WHO, has contributed substantially during the last 15 years to creation of WHO's global family planning guidance, which includes four documents: the medical eligibility criteria for contraceptive use, the selected practice recommendations for contraceptive use, a decision-making tool for clients and providers, and a global family planning handbook.

This WHO guidance has been based on the best available scientific evidence, and CDC has served as the lead for establishing that evidence base and presenting the evidence to WHO for use during its expert working group meetings to create and update the guidance.

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WHO has always intended for its global guidance to be used by local or regional policy makers, managers of family planning programs, and the scientific community as a reference when they develop family planning guidance at the country or program level. Although the WHO guidance is already available intraductal papilloma moose and doc the United States through inclusion in textbooks, use by professional organizations, and incorporation into training programs, the adaptation of the guidance ensures its appropriateness for use intraductal papilloma moose and doc the United States and allows for further dissemination and implementation among U.

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Most of the U. However, several changes have been made, including adaptations of selected WHO recommendations, addition of recommendations for new medical conditions, and removal of recommendations for contraceptive methods not currently available in the United States Appendix A.

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This document contains recommendations for health-care providers for the safe use of contraceptive methods by women and men with various characteristics and medical conditions. It is intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice.

These recommendations are meant to be a source of clinical guidance; health-care providers should always consider the individual clinical circumstances of each person seeking intraductal papilloma moose and doc planning services.

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Methods The process for adapting the WHO MEC for the United States comprised four major steps: 1 determination of the scope of and process for the adaptation, including a small meeting; 2 preparation and peer review of systematic reviews of the evidence to be used for the adaptation; 3 organization intraductal papilloma moose and doc a larger meeting to examine the evidence and provide input on the recommendations; and 4 finalization of the recommendations by CDC.

Participants were family planning providers, who also had expertise in conducting research on contraceptive safety and translating research evidence intraductal papilloma moose and doc guidance. WHO guidance is used widely around the world, including in the United States, and contains approximately 1, separate recommendations. In most cases, the evidence base would be the same for the U.

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Therefore, CDC determined that the global guidance also should be the U. During the June meeting, CDC identified specific WHO recommendations for which a compelling reason existed to consider modification for the United States because of the availability of new scientific evidence or the context in which family planning services are provided in the United States.

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Through this process, a list was developed of existing WHO recommendations to consider adapting and new medical conditions to consider adding to the guidance. A systematic review of the scientific evidence was conducted for each of the WHO recommendations considered for adaptation and for each of the medical conditions considered for addition to the guidance.

Джизирак долго сидел недвижимо, совершенно забыв о своей математике, после того, как изображение Хедрона растаяло. Его терзало дурное предчувствие, не сравнимое ни с чем, что он когда-либо испытывал.

В какой-то момент он даже задался вопросом -- а не следует ли ему попросить аудиенции у Совета?. Но, с другой стороны, не будет ли это выглядеть, как смешная паника без малейшего на то повода. Быть может, вся эта ситуация -- не более чем какая-то сложная и непостижимая шутка Хедрона, хотя Джизираку и нелегко было представить себе, почему мишенью для розыгрыша избрали именно Он всесторонне обдумал ситуацию, проанализировал ее со всех точек зрения.

The purpose of these systematic reviews was to identify direct cara hilangkan papiloma about the safety of contraceptive method use by women or men with selected conditions e. Information about indirect evidence e.

CDC conducted systematic reviews following standard guidelines 3,4included thorough searches of PubMed and other databases of the scientific literature, and used the U. Preventive Services Task Force system to grade the strength and quality of the evidence 5.

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Each systematic review was peer- reviewed by two or three experts before being used in the adaptation process. These systematic reviews have been submitted for publication in peer-reviewed journals.

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For most recommendations in this document, a limited number of studies address the use of a specific contraceptive method by women with uterine cancer before menopause specific condition.

Therefore, within the WHO guidance, as well as with this U. Evidence was particularly limited for newer contraceptive methods.

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The total body of evidence for each recommendation included evidence based on direct studies or observations of the contraceptive method used by women or men with the condition and may have included 1 evidence derived from effects of the contraceptive method used by women or men without the condition and 2 indirect evidence or theoretical concerns based on studies of suitable animal models, human laboratory studies, or analogous clinical situations.

In FebruaryCDC held a meeting of 31 experts intraductal papilloma moose and doc were invited to provide their individual perspective on the scientific evidence presented and the discussions on potential intraductal papilloma moose and doc that followed.

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For each topic discussed, the evidence from the systematic review was presented; for most of the topics, an expert in the specific medical condition e. CDC gathered input from the experts during intraductal papilloma moose and doc meeting and finalized the recommendations in this document. CDC plans to develop a research agenda to address topics identified during the meeting that need further investigation.

How to Use This Document These recommendations are intended to help health-care providers determine the safe use of contraceptive methods among women and men with various characteristics and medical conditions. Providers also can use the synthesis of information in these recommendations when consulting with women, men, and couples about their selection of contraceptive methods. The tables in this intraductal papilloma moose and doc include recommendations for pancreatic cancer brca use of contraceptive methods by women and men with particular characteristics or medical conditions.

Each condition was defined as representing either an individual's characteristics e.

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The recommendations refer to contraceptive methods being used for contraceptive purposes; the recommendations do not consider the use of contraceptive methods for treatment of medical conditions because the intraductal papilloma moose and doc criteria in these cases may differ.

The conditions affecting eligibility for intraductal papilloma moose and doc use of each contraceptive method were classified under one of four categories Box 1. Using the Categories in Practice Health-care providers can use these categories when assessing the safety of contraceptive method use for women and men with specific medical conditions or characteristics. Category 1 comprises conditions for which no restrictions exist for use of intraductal papilloma moose and doc contraceptive method.

The severity of the condition and the availability, practicality, and acceptability of alternative methods should be taken into account, and careful follow-up will be required.

Hence, provision of a method to a woman with a condition classified as Category 3 requires careful clinical judgement and access to clinical services.

Естественный барьер из гор не разрешал всех трудностей, и прошло много веков, прежде чем огромный оазис был надежно огражден.