Introducing reproductive life plan-based information in contraceptive counselling: an RCT

STUDY QUESTION

Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase women's knowledge of reproduction, and of the importance of folic acid intake in particular?

SUMMARY ANSWER

The RLP-based information increased women's knowledge of reproduction including knowledge of folic acid intake.

WHAT IS KNOWN ALREADY

Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease.

STUDY DESIGN, SIZE, DURATION

The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate).

MAIN RESULTS AND THE ROLE OF CHANCE

There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1.

LIMITATIONS, REASONS FOR CAUTION

As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution.

WIDER IMPLICATIONS OF THE FINDINGS

The provision of RLP-based information seems to be a feasible tool for promoting reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)

Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov Identifier NCT01739101.

Desmoid tumour (aggressive fibromatosis) of the colon mimics malignancy on dual time-point 18F-FDG PET/CT imaging

A 58-year-old female who presented with a lower gastrointestinal bleed was referred for an (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT after a colonoscopy revealed a submucosal mass in the ascending colon. The PET/CT confirmed the presence of an FDG-avid mass in the ascending colon with no other FDG-avid abnormalities. Dual time-point imaging was performed and showed a significant increase in FDG uptake in the mass, which raised strong suspicion of a colon malignancy. Although an initial biopsy of the mass did not show evidence of neoplasia, a decision was made to proceed with a right hemicolectomy based on high clinical and imaging suspicion of malignancy. Histological evaluation of the hemicolectomy revealed a benign colon desmoid tumour.

[Isolated ileal perforation after blunt abdominal trauma]

Perforating injuries to the small bowel due to a blunt abdominal trauma are rare. Especially in the case of an isolated injury where diagnostic investigations have failed, it may result in delayed therapy and a prolonged clinical course. Here, we report on an isolated ileal perforation caused by a blunt abdominal trauma in setting of a domestic accident.

[De Garengeot appendicitis--rare variant of a common medical condition]

De Garengeot hernia is an extremely rare pathological finding. Here, we report the case of a 69-year-old woman who presented with acute appendicitis within a femoral hernia. Although exceptionally rare, the clinician needs to be aware of this variation in order to avoid complications arising due to delays in diagnosis and therapy.

Physiological, psychological and behavioural characteristics of men and women with faecal incontinence

BACKGROUND

The factors leading to faecal incontinence in males are less well understood than those in females. In this prospective study we aimed to compare the physiological, anatomical, psychological and behavioural characteristics of male and female patients presenting with symptoms of faecal incontinence.

METHOD

One hundred and nine patients presenting with symptoms of faecal incontinence were studied. They underwent anorectal physiological studies, endoanal ultrasonography, and completed a St Mark's Incontinence Score, a locally developed pad questionnaire, a bowel symptom questionnaire, the Short Form 36 (SF-36) Health Survey questionnaire, the Hospital Anxiety and Depression Scale and the Maudsley Obsessive Compulsive Inventory.

RESULTS

Thirty-four men (mean age 59 years, SD 14 years, range 33-80) and 75 women (mean age 55 years, SD 15 years, range 21-86) participated in the study. Twenty-one patients (38% of men and 11% of women) had normal manometry and endoanal ultrasonography. There was no significant difference in the resting pressures of men compared with women, but men had significantly higher squeeze pressures. Rectal capacity was significantly higher in men but anal and rectal electrosensitivities were the same. Men placed a tissue at the anus more commonly than women while women were more likely to use a pad and to carry a spare pair of underwear around with them. Psychological profiles were very similar in the two sexes.

CONCLUSIONS

Nearly 40% of men with faecal incontinence report it in the absence of a definable functional or structural sphincter abnormality. There are differences in physiological characteristics and coping behaviours of men and women with faecal incontinence.

[Metabolic consequences in patients with intestinal stoma]

In addition to psychological stress, stomas may lead to metabolic consequences. Colostomies normally cause only minor physiological problems; however, patients with ileostomies are at risk for severe metabolic disturbances. The small intestine essentially manages the balance of water and electrolytes and the absorption of nutrition. In special circumstances such as or short-bowel syndrome, dangerous consequences like kidney disorders may arise. Basic therapeutic strategies such as enteral or parenteral substitution are discussed.

A phase I study of intravenous tetra-O-methyl nordihydroguaiaretic acid in patients with refractory malignancy

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Background: Tetra-o-methyl nordihydroguaiaretic acid (terameprocol-also EM-1421 or M4N) is a semi-synthetic derivative of a naturally occurring plant lignan. Terameprocol blocks cell cycle progression by inhibiting expression of the Sp1-dependent cdk1 gene and promotes apoptosis by inhibiting survivin. Methods: A dose escalation, open-label study enrolled patients (pt) with malignancies refractory to surgery, radiation therapy, and/or chemotherapy. Terameprocol was administered daily by intravenous infusion for 5 days (d) every 28 d over 30 minutes, with dose escalation (100, 200, 375, 750, 1,500, 2,200, and 3,300 mg) in cohorts of 3–6 pt. Tumor measurement (CT and PET scans) was performed at baseline and every 2 to 4 cycles. Pt at the 2,200mg and 3,300mg doses had circulating tumor cells (CTC) measured prior to dosing. Pharmacokinetics (PK) was evaluated for the first 2 cycles. Results: Twenty nine pt (17 male), median age 61 years, with gynecological (21%), lung (17%), colorectal (17%), or other cancer (45%) were enrolled. All pt were evaluable for toxicity and 21 pt for efficacy. At the highest dose (3,300 mg/d), dose limiting toxicity (DLT) of metabolic acidosis/respiratory failure considered drug related was observed in 1 of 3 pt, and no additional pt was enrolled at this dose. The next lower dose cohort (2,200 mg/d) was expanded (11 pt) and no DLT has been observed. Best response by RECIST criteria included a partial response in 1 pt and stable disease in 6 pt. Three pt discontinued for reason other than progression, and 11 had progressive disease. Pharmacokinetics demonstrated dose linearity. The volume of distribution was 300–1,000 liters, and the half-life ∼ 20–30 hours. No obvious trend was seen in CTCs. Across all doses, 108 adverse events, with 10 severe events, were observed. Conclusions: Terameprocol is well tolerated up to a dose of 2,200 mg and warrants further evaluation. Expansion continues at this dose level. There is clinical benefit in this refractory population that warrants further investigation.

No significant financial relationships to disclose.