Development and initial validation of a fertility experiences questionnaire

Background

Many women throughout the world have history of subfertility (resolved or unresolved), but much remains unknown about services and treatments chosen.

Methods

We developed a mixed-mode fertility experiences questionnaire (FEQ) in 2009 through literature review and iterative pilot work to optimize question format and mode of administration. The focus of the FEQ is to collect data retrospectively on time at risk for pregnancy, fertility treatments received and declined, pregnancy, time to pregnancy and pregnancy outcomes. We conducted a validation of key elements of the FEQ with comparison to medical records in 2009 and 2010. The validation sample was selected from women initially seen at a specialized fertility treatment center in Utah in 2004.

Results

The FEQ was optimized with two components: 1) written (paper or web-based), self-administered, followed by 2) telephone- administered questions. In 63 patients analyzed, high levels of correlation were identified between patient self-report and medical records for the use of intrauterine insemination and assisted reproductive technology, pregnancy and live birth histories, time at risk for pregnancy and time to pregnancy. There was low correlation between medical records and self-report for the use of oral ovulation drugs and injectable ovulation drugs. Compared to the medical record, the FEQ was over 90 % sensitive for all elements, except injectable ovulation drugs (70 % sensitivity).

Conclusions

The FEQ accurately captured elements of fertility treatment history at 5–6 years after the first visit to a specialty clinic.

Electronic supplementary material

The online version of this article (doi:10.1186/s12978-015-0054-3) contains supplementary material, which is available to authorized users.

Quantifying the contribution of ambient and indoor-generated fine particles to indoor air in residential environments

Indoor fine particles (FPs) are a combination of ambient particles that have infiltrated indoors, and particles that have been generated indoors from activities such as cooking. The objective of this paper was to estimate the infiltration factor (Finf ) and the ambient/non-ambient components of indoor FPs. To do this, continuous measurements were collected indoors and outdoors for seven consecutive days in 50 non-smoking homes in Halifax, Nova Scotia in both summer and winter using DustTrak (TSI Inc) photometers. Additionally, indoor and outdoor gravimetric measurements were made for each 24-h period in each home, using Harvard impactors (HI). A computerized algorithm was developed to remove (censor) peaks due to indoor sources. The censored indoor/outdoor ratio was then used to estimate daily Finfs and to determine the ambient and non-ambient components of total indoor concentrations. Finf estimates in Halifax (daily summer median = 0.80; daily winter median = 0.55) were higher than have been reported in other parts of Canada. In both winter and summer, the majority of FP was of ambient origin (daily winter median = 59%; daily summer median = 84%). Predictors of the non-ambient component included various cooking variables, combustion sources, relative humidity, and factors influencing ventilation. This work highlights the fact that regional factors can influence the contribution of ambient particles to indoor residential concentrations.

PRACTICAL IMPLICATIONS

Ambient and non-ambient particles have different risk management approaches, composition, and likely toxicity. Therefore, a better understanding of their contribution to the indoor environment is important to manage the health risks associated with fine particles (FPs) effectively. As well, a better understanding of the factors Finf can help improve exposure assessment and contribute to reduced exposure misclassification in epidemiologic studies.

Ecological risk assessment of nonylphenol in coastal waters of China based on species sensitivity distribution model

Nonylphenol (NP) is an endocrine disruptor and causes feminization and carcinogenesis in various organisms. Consequently, the environmental distribution and ecological risks of NP have received wide concern. China accounts for approximately 10% of the total NP usage in the world, but the water quality criteria of NP have not been established in China and the ecological risks of this pollutant cannot be properly assessed. This study thus aims to determine the predicted no effect concentration (PNEC) of NP and to assess the ecological risks of NP in coastal waters of China with the PNEC as water quality criteria. To obtain the HC5 (hazardous concentration for 5% of biological species) and PNEC estimates, the species sensitivity distributions (SSDs) models were built with chronic toxicity data of NP on aquatic organisms screened from the US Environmental Protection Agency (USEPA) ECOTOX database. The results showed that the PNEC for NP in freshwater and seawater was 0.48 μg L(-1) and 0.28 μg L(-1), respectively. The RQ (risk quotient) values of NP in coastal waters of China ranged from 0.01 to 69.7. About 60% of the reported areas showed a high ecological risk with an RQ value ≥ 1.00. NP therefore exists ubiquitously in coastal waters of China and it poses various risks to aquatic ecosystems in the country. This study demonstrates that the SSD methodology can provide a feasible tool for the establishment of water quality criteria for emergent new pollutants when sufficient toxicity data is available.

Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy--results of a United Kingdom phase II trial (CNS 2007 04)

Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis with no chemotherapy regimen so far resulting in any significant improvement over standard radiotherapy. In this trial, a prolonged regimen (21/28d) of temozolomide was studied with the aim of overcoming O(6)-methylguanine methyltransferase (MGMT) mediated resistance. Forty-three patients with a defined clinico-radiological diagnosis of DIPG received radiotherapy and concomitant temozolomide (75 mg/m(2)) after which up to 12 courses of 21d of adjuvant temozolomide (75-100mg/m(2)) were given 4 weekly. The trial used a 2-stage design and passed interim analysis. At diagnosis median age was 8 years (2-20 years), 81% had cranial nerve abnormalities, 76% ataxia and 57% long tract signs. Median Karnofsky/Lansky score was 80 (10-100). Patients received a median of three courses of adjuvant temozolomide, five received all 12 courses and seven did not start adjuvant treatment. Three patients were withdrawn from study treatment due to haematological toxicity and 10 had a dose reduction. No other significant toxicity related to temozolomide was noted. Overall survival (OS) (95% confidence interval (CI)) was 56% (40%, 69%) at 9 months, 35% (21%, 49%) at 1 year and 17% (7%, 30%) at 2 years. Median survival was 9.5 months (range 7.5-11.4 months). There were five 2-year survivors with a median age of 13.6 years at diagnosis. This trial demonstrated no survival benefit of the addition of dose dense temozolomide, to standard radiotherapy in children with classical DIPG. However, a subgroup of adolescent DIPG patients did have a prolonged survival, which needs further exploration.

Examining the links between air quality, climate change and respiratory health in Qatar

Little information exists concerning (i) source contributions to airborne particulate pollution in Qatar, (ii) the potential impact that deteriorating air quality may have on the respiratory health of residents, and (iii) how climate change may affect respiratory health through its impact on air quality. Air quality in Qatar may be negatively affected by naturally occurring contributions including dust/sand originating from adjacent desert regions, microbial communities that may be associated with these particulates, and volatile organic compounds (VOCs) released by blooms of phytoplankton in coastal waters. Of increasing concern are anthropogenic contributions, including emissions from the rapidly growing number of vehicles, from ships travelling in the Persian Gulf, and from industrial and construction activities. We examine the relative importance of these contributions and discuss some of the expected impacts on respiratory health. We conclude by speculating on the impact that climate change may have on air quality and respiratory health around Qatar.

A practice-based randomised controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity

OBJECTIVES

The aim of this study was to evaluate the efficacy of three different interventions (non-desensitising toothpaste, desensitising toothpaste and professionally applied dentine bonding agent) in reducing dentinal hypersensitivity over a 2-week, 3-month and 6-month-period in a dental practice setting.

METHODS

This was a randomised controlled, single-blind; parallel-group trial conducted in general dental practice by a single general dental practitioner. Seventy-five subjects were randomly allocated to three groups; non-desensitising toothpaste (NDT), desensitising toothpaste (DT) and professionally applied desensitising agent (DA). Dentinal hypersensitivity was measured using a Visual Analogue Scale (VAS) to record the response from a standardised short blast of air from a triple syringe. Dentinal hypersensitivity was recorded at baseline, two weeks, three months and six months for all groups.

RESULTS

Dentinal hypersensitivity reduced significantly (p<0.0001) in both groups DT and DA, in addition the reduction in sensitivity was sustained and continued to improve over a 6-month-period. The greatest reduction in dentinal hypersensitivity was recorded in group DA.

CONCLUSIONS

The results from this study suggest that application of dentine bonding agents, to teeth diagnosed with dentine hypersensitivity provides the greatest improvement in dentine hypersensitivity at 2 weeks and 6 months. This reduction in dentine hypersensitivity is greater than that achieved by the desensitising toothpaste tested and a non-desensitising toothpaste.

Seasonal variation of nonylphenol concentrations and fluxes with influence of flooding in the Daliao River Estuary, China

Nonylphenol is an endocrine disruptor with harmful effects including feminization and carcinogenesis on various organisms. This study aims to investigate the distribution and ecological risks of nonylphenol in the Daliao River Estuary, China. Nonylphenol, together with other phenolic endocrine disruptors (bisphenol A, 4-t-butylphenol, 4-t-octylphenol, and 2,4-dichlorophenol), was detected in surface water and sediment on three cruises in May 2009, June 2010, and August 2010, respectively. A large flooding occurred during our sampling campaign in August and its effect on nonylphenol concentrations and fluxes in the estuary was therefore evaluated. The results showed that nonylphenol with a concentration range between 83.6-777 ng l(-1) and 1.5-456 ng g(-1) dw in surface water and sediment was the most abundant among the phenolic compounds, accounting for 59.1-81.0 and 79.9-92.1 % of the total phenolic concentration in surface water and sediment, respectively. The concentrations recorded in May and June were comparable, whereas those in August were considerably higher, mainly due to the flush of flooding. The flooding also caused a 50 times increase in nonylphenol flux from the estuary into the adjacent Bohai Sea. Nonylphenol concentrations in the estuary have exceeded the threshold level of undesirable effects with a potential risk of harm to local species, especially benthic organisms.

Use of clomiphene citrate in the University of Utah Community Clinics

OBJECTIVE

To determine patterns of usage of clomiphene citrate (CC) by primary care providers (obstetrician-gynecologists, family physicians, and other providers) within University of Utah Community Clinics.

STUDY DESIGN

We performed a retrospective chart review (n = 79) and followup telephone survey of patients (n = 43) who were prescribed CC in the University of Utah Community Clinics in 2006.

RESULTS

Most women who were prescribed CC had appropriate indications for therapy (65% with a diagnosis related to irregular menses and 33% with a diagnosis of female infertility), but there was variable and inconsistent monitoring of ovulation (much of which was apparently initiated by the patients). In the interview, 24 of the women (56%) said they would be fine having twins, and 14 (33%) said they would prefer to have twins if possible.

CONCLUSION

In this primary care setting, clomiphene was prescribed for appropriate indications, but the monitoring of treatment could be improved. The preference of some patients for twin gestations represents a challenge for optimum clinical care and public health.

Obesity and male infertility: a practical approach

Obesity in men is associated with infertility in numerous studies, and the temporal trend for a decline in semen parameters parallels the increasing prevalence of obesity in the developed world. In addition to impaired semen quality, fertility among obese men may be affected by decreased libido and erectile dysfunction. This spectrum of expression of hypogonadism among obese men originates from multiple interacting factors including reduced levels of gonadotropins and testosterone, altered androgen-to-estrogen ratios, insulin resistance, and sleep apnea. No evidence-based treatment that increases the likelihood of pregnancy for the infertility associated with male obesity has been demonstrated to date. Interventions associated with improvement of intermediate outcomes that include the endocrine profile, semen parameters, and sexual function may be appropriately selected based on history, physical findings, as well as endocrine and metabolic evaluation. Among these interventions are weight loss through lifestyle change, relief from sleep apnea, use of aromatase inhibitors, gonadotropin administration, phosphodiesterase inhibitors, and insulin-sensitizing agents.

An evaluation of the combined effects of phenolic endocrine disruptors on vitellogenin induction in goldfish Carassius auratus

Phenolic compounds are widely distributed in the natural environment, typically existing as a mixture at the nanogram or microgram per liter level. Among the phenolic compounds, 4-nonylphenol, 4-t-octylphenol, bisphenol A and 2,4-dichlorophenol attract the most concern due to their abundance and risks within the natural environment. The former three chemicals are known as endocrine disruptors causing feminization in various organisms, whereas the latter one requires further clarification concerning its feminization effect. This study aims to evaluate the combined effects of these chemicals using vitellogenin protein induction in male juvenile goldfish Carassius auratus as an endpoint after 15 days of exposure. The results showed that all these chemicals can induce vitellogenin with a relative potency of 4-t-octylphenol > bisphenol A > 4-nonylphenol ≫ 2,4-dichlorophenol. 2,4-dichlorophenol showed a very weak estrogenic effect with an induction of vitellogenin concentration of <1 % of positive control, and it is therefore omitted in further tests to evaluate their combined effect. The other three chemicals were mixed in two ways, at an equipotent ratio and at an equal environmental level ratio, and their combined effects were evaluated with both the toxicity units method and concentration addition model. The resulting effect of exposure to both mixtures showed that these chemicals generally exhibited an additive effect. The ecological risk of phenolic chemicals may therefore be underestimated if based on the presence of single chemicals whereas their combined effects warrant further consideration.

Methods for the drug effectiveness review project

The Drug Effectiveness Review Project was initiated in 2003 in response to dramatic increases in the cost of pharmaceuticals, which lessened the purchasing power of state Medicaid budgets. A collaborative group of state Medicaid agencies and other organizations formed to commission high-quality comparative effectiveness reviews to inform evidence-based decisions about drugs that would be available to Medicaid recipients. The Project is coordinated by the Center for Evidence-based Policy (CEbP) at Oregon Health & Science University (OHSU), and the systematic reviews are undertaken by the Evidence-based Practice Centers (EPCs) at OHSU and at the University of North Carolina. The reviews adhere to high standards for comparative effectiveness reviews. Because the investigators have direct, regular communication with policy-makers, the reports have direct impact on policy and decision-making, unlike many systematic reviews. The Project was an innovator of methods to involve stakeholders and continues to develop its methods in conducting reviews that are highly relevant to policy-makers. The methods used for selecting topics, developing key questions, searching, determining eligibility of studies, assessing study quality, conducting qualitative and quantitative syntheses, rating the strength of evidence, and summarizing findings are described. In addition, our on-going interactions with the policy-makers that use the reports are described.