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Wright MA, Kinlaw AC, McClurg AB, Carey E, Doll KM, Vines AI, Olshan AF, Robinson WR. Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt) 2024. [PMID: 38864118 DOI: 10.1089/jwh.2024.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18-44 years. Exposure: Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017. Main Outcome Measures: Using these data, we provided a RAND-based (dichotomous: inappropriate/appropriate) and Wright-based (3-level: inappropriate/ambiguous/appropriate) appropriateness rating and characterized missing information patterns associated with inappropriate ratings. Results: We analyzed 1,829 hysterectomies across 30 nonmutually exclusive primary indications for surgery. Nearly a third (32.8%) of surgeries had only one primary indication for surgery. Using the RAND-based classifier, 31.3% of hysterectomies were rated as appropriate and 68.7% as inappropriate. Using the Wright-based algorithm, 58.1% of hysterectomies were rated as appropriate, 15.7% as ambiguous, and 26.2% as inappropriate. Missing information on diagnostic procedures was the most common characteristic related to both RAND-based (46.1%) and Wright-based (51.2%) inappropriate ratings. Conclusions: The 1997 RAND classification lacked guidance for several contemporary indications, including gender-affirming care. RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care.
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Affiliation(s)
- Maya A Wright
- Tanaq Support Services LLC, Atlanta, Georgia, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Asha B McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kemi M Doll
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Ferhi M, Marwen N, Abdeljabbar A, Mannai J. Psychological Outcomes and Quality of Life After Hysterectomy for Benign Diseases: A Prospective Cohort Study. Cureus 2024; 16:e60871. [PMID: 38910628 PMCID: PMC11192439 DOI: 10.7759/cureus.60871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Background Hysterectomy is a common surgical procedure performed for benign gynecological diseases. While the physical benefits have been extensively studied, less attention has been given to its impact on psychological well-being and overall quality of life (QoL). This study aimed to assess the psychological outcomes and QoL before and after hysterectomy for benign diseases. Methodology This prospective cohort study included women undergoing hysterectomy for benign diseases at Ibn El Jazzar Hospital in Kairouan, Tunisia. The study was conducted from January 2, 2020, to December 31, 2021. We used the Short-Form-36 Health Survey (SF-36) to evaluate the QoL and the Hospital Anxiety and Depression Scale (HADS) to assess psychological outcomes preoperatively and after six months. Data entry and analysis were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA) with the significance level (p) set to 0.05. Results Of 84 assessed patients, 60 were included. Following the hysterectomy, there were improvements in QoL and psychological outcomes across all domains, regardless of whether total or subtotal hysterectomy was performed. The mean HADS score for anxiety decreased from 12.57 to 8.77 after hysterectomy and from 14.83 to 9.57 for depression. Moreover, the median SF-36 total score increased from 29.81 to 68.1. We found no statistically significant difference between the two groups in all assessed outcomes. Conclusions Hysterectomy for benign conditions, whether total or subtotal, positively impacted symptoms of depression and anxiety, as well as the overall QoL for patients. A thorough preoperative psychiatric assessment is recommended to address and support mental health outcomes in these patients. Future research should consider a larger multicenter approach for a broader application of findings.
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Affiliation(s)
- Mohamed Ferhi
- Psychiatry, Ibn El Jazzar University Hospital, Kairouan, TUN
- Psychiatry, Mohamed Taher Maamouri University Hospital, Nabeul, TUN
| | - Nadia Marwen
- Obstetrics and Gynecology, Ibn El Jazzar University Hospital, Kairouan, TUN
| | - Ameni Abdeljabbar
- Obstetrics and Gynecology, Ibn El Jazzar University Hospital, Kairouan, TUN
| | - Jihenne Mannai
- Psychiatry, Ibn El Jazzar University Hospital, Kairouan, TUN
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Moore A, Traversy G, Reynolds DL, Riva JJ, Thériault G, Wilson BJ, Subnath M, Thombs BD. Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk. CMAJ 2021; 193:E549-E559. [PMID: 33875459 PMCID: PMC8084554 DOI: 10.1503/cmaj.201967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ainsley Moore
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Gregory Traversy
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Donna L Reynolds
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - John J Riva
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Guylène Thériault
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brenda J Wilson
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Melissa Subnath
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brett D Thombs
- Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Subnath, Traversy), Ottawa, Ont.; Department of Family and Community Medicine (Reynolds), University of Toronto, Toronto, Ont.; Department of Family Medicine (Riva), McMaster University, Hamilton, Ont.; Faculty of Medicine (Thériault) McGill University, Montréal, Que.; Division of Community Health and Humanities (Wilson), Memorial University, NFLD; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
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4
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Moore A, Traversy G, Reynolds DL, Riva JJ, Thériault G, Wilson BJ, Subnath M, Thombs BD. Recommandation relative au dépistage de la chlamydia et de la gonorrhée en soins primaires chez les personnes non connues comme appartenant à un groupe à risque. CMAJ 2021; 193:E573-E584. [PMID: 33875467 PMCID: PMC8084558 DOI: 10.1503/cmaj.201967-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ainsley Moore
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Gregory Traversy
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Donna L Reynolds
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - John J Riva
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Guylène Thériault
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Brenda J Wilson
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Melissa Subnath
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
| | - Brett D Thombs
- Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Agence de la santé publique du Canada ( Subnath, Traversy), Ottawa, Ont.; Département de médecine familiale et communautaire (Reynolds), Université de Toronto, Toronto, Ont.; Département de médecine familiale (Riva), Université McMaster, Hamilton, Ont.; Faculté de médecine (Thériault), Université McGill, Montréal, Qc; Division de santé communautaire et humanités (Wilson), Université Memorial, T.-N.-L.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qc
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Pillay J, Wingert A, MacGregor T, Gates M, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences. Syst Rev 2021; 10:118. [PMID: 33879251 PMCID: PMC8056106 DOI: 10.1186/s13643-021-01658-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients' place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. METHODS We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. RESULTS Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female's risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. DISCUSSION Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733 .
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Scalia P, Durand MA, Forcino RC, Schubbe D, Barr PJ, O’Brien N, O’Malley AJ, Foster T, Politi MC, Laughlin-Tommaso S, Banks E, Madden T, Anchan RM, Aarts JWM, Velentgas P, Balls-Berry J, Bacon C, Adams-Foster M, Mulligan CC, Venable S, Cochran NE, Elwyn G. Implementation of the uterine fibroids Option Grid patient decision aids across five organizational settings: a randomized stepped-wedge study protocol. Implement Sci 2019; 14:88. [PMID: 31477140 PMCID: PMC6721118 DOI: 10.1186/s13012-019-0933-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Uterine fibroids are non-cancerous overgrowths of the smooth muscle in the uterus. As they grow, some cause problems such as heavy menstrual bleeding, pelvic pain, discomfort during sexual intercourse, and rarely pregnancy complications or difficulty becoming pregnant. Multiple treatment options are available. The lack of comparative evidence demonstrating superiority of any one treatment means that choosing the best option is sensitive to individual preferences. Women with fibroids wish to consider treatment trade-offs. Tools known as patient decision aids (PDAs) are effective in increasing patient engagement in the decision-making process. However, the implementation of PDAs in routine care remains challenging. Our aim is to use a multi-component implementation strategy to implement the uterine fibroids Option Grid™ PDAs at five organizational settings in the USA. METHODS We will conduct a randomized stepped-wedge implementation study where five sites will be randomized to implement the uterine fibroid Option Grid PDA in practice at different time points. Implementation will be guided by the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT). There will be a 6-month pre-implementation phase, a 2-month initiation phase where participating clinicians will receive training and be introduced to the Option Grid PDAs (available in text, picture, or online formats), and a 6-month active implementation phase where clinicians will be expected to use the PDAs with patients who are assigned female sex at birth, are at least 18 years of age, speak fluent English or Spanish, and have new or recurrent symptoms of uterine fibroids. We will exclude postmenopausal patients. Our primary outcome measure is the number of eligible patients who receive the Option Grid PDAs. We will use logistic and linear regression analyses to compare binary and continuous quantitative outcome measures (including survey scores and Option Grid use) between the pre- and active implementation phases while adjusting for patient and clinician characteristics. DISCUSSION This study may help identify the factors that impact the implementation and sustained use of a PDA in clinic workflow from various stakeholder perspectives while helping patients with uterine fibroids make treatment decisions that align with their preferences. TRIAL REGISTRATION Clinicaltrials.gov , NCT03985449. Registered 13 July 2019, https://clinicaltrials.gov/ct2/show/NCT03985449.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Rachel C. Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Paul J. Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Nancy O’Brien
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Tina Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Mary C. Politi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO USA
| | | | - Erika Banks
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Tessa Madden
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO USA
| | - Raymond M. Anchan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology & Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Johanna W. M. Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Carla Bacon
- National Uterine Fibroids Foundation, Colorado Springs, CO USA
| | - Monica Adams-Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Carrie Cahill Mulligan
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | | | - Nancy E. Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
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Kannan P, Chapple CM, Miller D, Claydon-Mueller L, Baxter GD. Effectiveness of a treadmill-based aerobic exercise intervention on pain, daily functioning, and quality of life in women with primary dysmenorrhea: A randomized controlled trial. Contemp Clin Trials 2019; 81:80-86. [PMID: 31071464 DOI: 10.1016/j.cct.2019.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a treadmill-based aerobic exercise intervention on pain and associated symptoms of primary dysmenorrhea. METHODS Seventy women with primary dysmenorrhea were included in the study. The experimental group underwent supervised aerobic training for 4 weeks followed by unsupervised home exercise for the next 6 months. The control group continued usual care. The primary outcome was pain. Secondary outcomes included quality of life (QoL), daily functioning, and sleep. RESULTS After the 4-week training, compared to the control group exercise significantly improved primary outcomes pain quality (mean difference (MD) -1.9, 95% CI 3.8 to -0.04, p < .05), and intensity (MD -4.7, 95% CI -9.3 to -0.09, p < .05), but not present pain. Significant effects were also reported for pain interference (MD -1.7, 95% CI -3.4 to -0.02, p < .05) at 4 weeks; the other outcomes did not significantly differ between groups at this time. During the follow-up period of 7-months, the effect on pain improved to 22 mm (95% CI 18 to 25). Significant benefits of exercise were maintained up to 7-months for present pain, QoL and daily functioning. CONCLUSION Exercise has significant effects on primary dysmenorrhea-related pain, QoL and function. TRIAL REGISTRATION ACTRN12613001195741.
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Affiliation(s)
- Priya Kannan
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Cathy M Chapple
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Dawn Miller
- Department of Women's and Children's Health, Dunedin School of Medicine, Dunedin, New Zealand
| | | | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Schwartz ASK, Gross E, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Eberhard M, Imesch P, Imthurn B, Leeners B. The use of home remedies and complementary health approaches in endometriosis. Reprod Biomed Online 2018; 38:260-271. [PMID: 30612955 DOI: 10.1016/j.rbmo.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 10/17/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
RESEARCH QUESTION Conventional treatments are often associated with adverse effects and endometriosis pain symptoms may reoccur despite treatment. Consequently, many women use complementary health approaches (CHA) and home remedies (HR) to relieve their pain. The aim of this study was to examine the frequency and the subjectively perceived efficacy of CHA/HR use by women affected by endometriosis. DESIGN Retrospective evaluation using medical charts and a questionnaire. Women recruited in hospitals and in self-help groups were asked about the use of 'topical heat', 'repose/relaxation', 'movement/massages', 'homeopathy/phytotherapy', 'acupuncture/traditional Chinese medicine (TCM)' and 'kinesiology/physiotherapy'. RESULTS From a total of 574 women with a confirmed diagnosis of endometriosis, 359 (62.5%) applied some form of CHA/HR. Women suffering from fatiguing disease symptoms more often selected alternative therapies (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.39-7.11, P = 0.006) compared with women without these characteristics. Furthermore, women dissatisfied with healthcare provided by their treating physician, more frequently (OR 2.30, 95% CI 1.19-4.45, P = 0.013) chose the aforementioned alternative strategies. CONCLUSION As conventional therapies may not be sufficiently effective, women's needs should be closely examined, and individual treatment options should be discussed and initiated by clinicians to provide the best comprehensive treatment possible for endometriosis.
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Affiliation(s)
- Alexandra Sabrina Kohl Schwartz
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland; University Women's Hospital, Division of Gynecological Endocrinology and Reproductive Medicine, Bern 3010, Switzerland
| | - Elvira Gross
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Kirsten Geraedts
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, University Hospital, Department of Psychosomatics, Berlin 10117, Germany
| | - Monika Maria Wölfler
- University Hospital Graz, Department of Gynecology and Obstetrics, Graz 8036, Austria
| | - Felix Häberlin
- Canton Hospital St. Gallen, Department of Gynecology and Obstetrics, St. Gallen 9007, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zürich, Department of Gynecology and Obstetrics, Zürich 8036, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Department of Gynecology and Obstetrics, Schaffhausen 8208, Switzerland
| | - Patrick Imesch
- University Hospital Zürich, Department of Gynecology, Zürich 8910, Switzerland
| | - Bruno Imthurn
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Brigitte Leeners
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland.
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Mendelsohn AB, Brinkley E, Franke KM, Lang K, Myers ER, Velentgas P. Comparative effectiveness of uterine fibroids procedures using linked medical record and claims data. J Comp Eff Res 2018; 7:1209-1218. [PMID: 30451534 DOI: 10.2217/cer-2018-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS To compare durability of uterus-conserving procedures for symptomatic fibroids in terms of incidence and time to subsequent procedures. PATIENTS & METHODS We conducted a retrospective database study of 2648 patients having a uterus-conserving procedure for uterine fibroids from 2005 to 2011 with a minimum of 2 years follow-up. RESULTS Patients with myomectomy or uterine artery embolization as their index procedure had lower risk of a subsequent procedure during the study compared with patients who underwent endometrial ablation. CONCLUSION While subject to known limitations of using electronic medical record and administrative claims data, this research provides additional evidence regarding expectations for time to subsequent procedures that may be helpful for women and their healthcare providers to consider when making treatment choices.
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Affiliation(s)
| | - Emma Brinkley
- Real-World Insights, QuintilesIMS, Cambridge, MA 02139, USA
| | | | - Kathy Lang
- Real-World Insights, QuintilesIMS, Cambridge, MA 02139, USA
| | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, USA
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11
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Bossick AS, Sangha R, Olden H, Alexander GL, Wegienka G. Identifying What Matters to Hysterectomy Patients: Postsurgery Perceptions, Beliefs, and Experiences. J Patient Cent Res Rev 2018; 5:167-175. [PMID: 29774227 DOI: 10.17294/2330-0698.1581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Hysterectomy is the most common non-obstetrical surgery for women in the United States. Few investigations comparing hysterectomy surgical approaches include patient-centered outcomes. Methods The study was performed at Henry Ford Health System in Detroit, Michigan between February 2015 and May 2015. The data were collected through structured focus groups with 24 post-hysterectomy women in order to identify PCOs to employ in a subsequent cohort study of hysterectomy surgical approaches. One pilot focus group and five additional focus groups were held. Qualitative data analysis, using data from coded transcripts of focus groups, was used to identify themes.Eligible women, aged between 18 and 65 years and had an EMR documented Current Procedural Terminology (CPT™) code or an International Statistical Classification of Diseases and Related Health Problems - Ninth Edition (ICD-9) code of hysterectomy between December 2012 and December 2014 (N=1,381, N=307 after exclusions) were selected and recruited. A question guide was developed to investigate women's experiences and feelings about the experience prior and subsequent to their hysterectomy. Analysis utilized the Framework Method. Results Focus groups with women who previously had a hysterectomy revealed their pre- and post-hysterectomy perceptions. Responses grouped into topics of pre- and post-surgical experiences, and information all women should know. Responses grouped into themes of 1) decision making, 2) the procedure - surgical experience, 3) recovery, 4) advice to past self, and 5) recommendations to other women. Conclusion These findings about perceptions, beliefs, and attitudes of women having undergone hysterectomy could support health care providers deliver patient-centered care. These results informed data collection for a prospective longitudinal cohort study that is now underway. The data suggest a need for increased education and empowerment in the decision making process, while expanding on information given for post-operative expectations and somatic changes that occur post-hysterectomy.
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Affiliation(s)
- Andrew S Bossick
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Roopina Sangha
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA.,Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Heather Olden
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Gwen L Alexander
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
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Crow EM, Jeannot E. Premenstrual Syndrome: Symptomatic and Diagnosed Prevalence, Dualistic Treatment Approach - A Cross-Sectional Study in Ukraine. Int J Prev Med 2017; 8:66. [PMID: 28966755 PMCID: PMC5609352 DOI: 10.4103/ijpvm.ijpvm_18_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Diagnosing and treatment of premenstrual syndrome (PMS) still pose a challenge in the routine medical practice which usually focuses on single pharmacological therapy. Recent research suggests that the combination of treatments including complementary alternative medicine (CAM) therapies may be more beneficial. The objective of this study was to assess the percentage of diagnosed and nondiagnosed PMS/premenstrual dysphoric disorder (PMDD) based on the presence of adequate symptoms and to compare population using hormonal or pharmaceutical agents versus CAM therapies. Methods: This is a cross-sectional study targeting sample population of 160 females of potentially reproductive age done in Ukraine between May 2014 and April 2015. Results: According to declared symptoms, 29% females versus 26% previously diagnosed by a medical professional qualify for “moderate/severe PMS,” P > 0.05. In 30% persons using pharmacological agents, major side effects, namely, nausea, insomnia, headache was caused by painkillers, contraceptives, and antidepressants. Only 37.5% of study population has been using CAM therapy methods to deal with the symptoms of PMS. Of these, 22% have achieved moderate degree in relief of the symptoms long term. Conclusions: We have concluded that when dealing with the burden of PMS/PMDD, the affected treatment-seeking women should have choice and access to the variety of therapies within integrative medicine (both conventional and nonconventional).
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Affiliation(s)
- Edith Meszaros Crow
- Researcher, University of Geneva, Faculty of Medicine, Institute of Global Health, Geneva, Switzerland
| | - Emilien Jeannot
- Researcher, University of Geneva, Faculty of Medicine, Institute of Global Health, Geneva, Switzerland.,University of Applied Sciences Western Switzerland, Haute Ecole de Santé, Delémont, Switzerland
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13
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Fisher C, Hickman L, Adams J, Sibbritt D. Cyclic Perimenstrual Pain and Discomfort and Australian Women's Associated Use of Complementary and Alternative Medicine: A Longitudinal Study. J Womens Health (Larchmt) 2017; 27:40-50. [PMID: 28805552 DOI: 10.1089/jwh.2016.6253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To examine the longitudinal change in Australian women's prevalence of cyclic perimenstrual pain and discomfort and the association between their symptoms and use of complementary and alternative medicine (CAM). METHOD Data on endometriosis, premenstrual syndrome (PMS), irregular periods, heavy periods, and severe period pain were collected over a 7-year period from the Australian Longitudinal Study on Women's Health, for women aged 28 to 33 years in 2006, and at 3-year follow-ups. Changes in symptoms and patterns of CAM practitioner and therapy/product use associated with these symptoms were analyzed using longitudinal regression modeling. RESULTS Over the 7-year period, prevalence rates of PMS and heavy periods increased, while prevalence rates of endometriosis, irregular periods, and severe period pain remained stable. The most common use of CAM longitudinally associated with the perimenstrual symptoms was use of vitamins/minerals, yoga/meditation, massage therapy, herbal medicine, and aromatherapy. Excluding consultation with a naturopath/herbalist, over the 7-year survey women's use of all other CAM practitioners increased as did their use of vitamin/minerals, yoga/meditation, and Chinese medicines, while aromatherapy use declined. CONCLUSION Only the prevalence of PMS and heavy periods increased with aging in this sample of women. While overall use of CAM practitioner and self-prescribed products/therapies increased over time, CAM was chosen by women mainly to treat endometriosis and PMS. The extent to which this use reflects treatment efficacy is uncertain.
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Affiliation(s)
- Carole Fisher
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney , Sydney, Australia
| | - Louise Hickman
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney , Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney , Sydney, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney , Sydney, Australia
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14
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Lamont J. Directive clinique de consensus sur la santé sexuelle de la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S79-S142. [DOI: 10.1016/j.jogc.2016.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Fisher C, Sibbritt D, Hickman L, Adams J. A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: a focus upon prevalence, patterns and applications of use and users' motivations, information seeking and self-perceived efficacy. Acta Obstet Gynecol Scand 2016; 95:861-71. [PMID: 27185060 DOI: 10.1111/aogs.12921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/09/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Complementary and alternative medicine (CAM) is used for treating cyclic perimenstrual pain and discomfort. This critical review examines women's reported CAM use, its perceived effectiveness and information relating to women's attitudes, behaviors, motivations and patterns of CAM use in its treatment. MATERIAL AND METHODS An extensive search of the main medical databases EBSCO, CINAHL, Medline, AMED and SCOPUS, as well as additional hand searches, was conducted. Papers included were confined to those that had been peer-reviewed, written in English and that contained original research into CAM use for cyclic perimenstrual pain and discomfort among adult women. RESULTS CAM, particularly herbal medicine, nutritional supplements and massage, is widely used for a range of cyclic perimenstrual pain and discomfort symptoms. A large number of CAM modalities are adopted, often simultaneously and with little professional oversight. Women's assessment of efficacy of different CAM modalities is positive, though the majority of users are self-prescribing apparently without professional guidance. Although the uptake of CAM for cyclic perimenstrual pain and discomfort is widespread, few empirical data are available regarding which women are using CAM, their motivations for doing so and, importantly, the sources through which women receive information about CAM. CONCLUSIONS This review highlights the extensive use of (often self-prescribed) CAM in a number of countries to alleviate the widespread symptoms of cyclic perimenstrual pain and discomfort. An understanding of all health care use by women with perimenstrual pain and discomfort is vital to help ensure safe, effective and coordinated health care that can lead to optimal patient outcomes.
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Affiliation(s)
- Carole Fisher
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Louise Hickman
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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16
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Fisher C, Adams J, Hickman L, Sibbritt D. The use of complementary and alternative medicine by 7427 Australian women with cyclic perimenstrual pain and discomfort: a cross-sectional study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:129. [PMID: 27189381 PMCID: PMC4870787 DOI: 10.1186/s12906-016-1119-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/13/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND To assess the prevalence of cyclic perimenstrual pain and discomfort and to detail the pattern of complementary and alternative (CAM) use adopted by women for the treatment of these symptoms. METHODS Data from the 2012 national Australian Longitudinal Study of Women's Health (ALSWH) cross-sectional survey of 7427 women aged 34-39 years were analysed to estimate the prevalence of endometriosis, premenstrual syndrome (PMS), irregular or heavy periods and severe dysmenorrhoea and to examine the association between their symptoms and their visits to CAM practitioners as well as their use of CAM therapies and products in the previous 12 months. RESULTS The prevalence of endometriosis was 3.7 % and of the perimenstrual symptoms assessed, PMS was most prevalent at 41.2 % whilst irregular bleeding (22.2 %), heavy periods (29.8 %) and severe period pain (24.1 %) were reported at lower levels. Women with endometriosis were more likely than non-sufferers to have consulted with a massage therapist or acupuncturist and to have used vitamins/minerals, yoga/meditation or Chinese medicines (p < 0.05). PMS sufferers were more likely to consult with an osteopath, massage therapist, naturopath/herbalist or alternative health practitioner and to have used all forms of CAM therapies except Chinese medicines than women who had infrequent PMS (all p < 0.05). Women with irregular periods did not have different patterns of CAM use from non-sufferers and those with heavy periods did not favour any form of CAM but were less likely to visit a massage therapist or use yoga/meditation than non-sufferers (p < 0.05). For women with severe dysmenorrhoea there was no difference in their visits to CAM practitioners compared to non-sufferers but they were more likely to use aromatherapy oils (p < 0.05) and for more frequent dysmenorrhoea also herbal medicines, Chinese medicines and other alternative therapies compared to non-sufferers (all p < 0.05). CONCLUSIONS There is a high prevalence of cyclic perimenstrual pain and discomfort amongst women in this age group. Women were using CAM differentially when they had specific symptoms of cyclic perimenstrual pain and discomfort. The use of CAM needs to be properly assessed to ensure their safe, effective use and to ascertain their significance as a treatment option enabling women with menstrual problems and their care providers to improve their quality of life.
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Chao MT, Abercrombie PD, Santana T, Duncan LG. Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain. Pain Manag Nurs 2015; 16:920-9. [PMID: 26365760 PMCID: PMC4690782 DOI: 10.1016/j.pmn.2015.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/19/2014] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted.
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Affiliation(s)
- Maria T. Chao
- Osher Center for Integrative Medicine and the Division of General Internal Medicine, University of California, San Francisco, UCSF Box# 1726, San Francisco, CA 94143-1726
| | - Priscilla D. Abercrombie
- Department of Obstetrics, Gynecology & Reproductive Sciences; Community Health Systems, School of Nursing; Osher Center for Integrative Medicine; SFGH Women’s Health Center, University of California, San Francisco, UCSF Box# 1726, San Francisco, CA 94143-1726
| | - Trilce Santana
- Osher Center for Integrative Medicine, University of California, San Francisco, UCSF Box# 1726, San Francisco, CA 94143-1726
| | - Larissa G. Duncan
- Osher Center for Integrative Medicine and Department of Family and Community Medicine, University of California, San Francisco, UCSF Box# 1726, San Francisco, CA 94143-1726
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Gé P, Vaucel E, Jarnoux M, Dessaux N, Lopes P. [Study of the sexuality of women after a total hysterectomy versus subtotal hysterectomy by laparoscopy in Nantes CHU]. ACTA ACUST UNITED AC 2015; 43:533-40. [PMID: 26074090 DOI: 10.1016/j.gyobfe.2015.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To research the differences in the sexuality and sexual satisfaction for 2 groups of women after a hysterectomy only by laparoscopy for benign pathologies, with or without conservation of the cervix. METHODS Retrospective monocentric study, in Nantes CHU, of 46 women divided into two groups. Three validated questionnaires were used (PISQ-12, DSFI, ultra-short Questionnaire of depression). RESULTS There is no difference in the scores between the 2 tests in sexuality post-surgically between the 2 groups. But there exists a significant improvement in the postoperative sexuality according to the questionnaire PISQ-12 in the hysterectomy subtotal group, which is not found in the hysterectomy total group. The score of the questions about the orgasm also seems to improve in the hysterectomy subtotal group with some features statistically significant. CONCLUSION This study confirms the improvement of the sexual function after hysterectomy. In spite of the absence of proof of interest in the conservation of the cervix in the literature, our study seems to show an improvement on certain criteria in the evaluation of sexuality in the hysterectomy subtotal group, in particular on the orgasm. A proposal for a future study with a more detailed questionnaire on the orgasm would allow to better specify the role of the cervix.
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Affiliation(s)
- P Gé
- DIU gynécologie-obstétrique, 9, rue St-Aventin, 53200 Azé, France.
| | - E Vaucel
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - M Jarnoux
- Service d'urologie, CHU d'Angers, 4, rue Larey, 49933 Angers cedex 9, France
| | - N Dessaux
- 3, boulevard Magenta, 35000 Rennes, France
| | - P Lopes
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Chao MT, Abercrombie PD, Nakagawa S, Gregorich SE, Learman LA, Kuppermann M. Prevalence and use of complementary health approaches among women with chronic pelvic pain in a prospective cohort study. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:328-40. [PMID: 25279935 PMCID: PMC4329048 DOI: 10.1111/pme.12585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to examine the prevalence of and factors associated with use of complementary health approaches among women with chronic pelvic pain (CPP). DESIGN We analyzed data from the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives, a prospective cohort study of women seeking care for noncancerous pelvic problems with intact uteri at enrollment. Among a subset of 699 participants who reported having CPP, we analyzed the prevalence of complementary health approaches used and associated patient sociodemographic and clinical characteristics, health-related quality of life, attitudes and beliefs, and conventional health care practices. RESULTS At baseline, slightly over one-half (51%) of women with CPP used at least one complementary health approach in the past year, including acupuncture (8%), special foods or diets (22%), herbs (27%), and vitamins and minerals (29%). During follow-up surveys conducted annually for 4 years, a substantial proportion of women (44.8%) used complementary health approaches at more than half of the assessments. Users of complementary health approaches were more likely to undergo a hysterectomy or oophorectomy or to use gonadotropin-releasing hormone agonists or opioids during the study compared with nonusers. Women with CPP who used complementary health approaches also had more optimal health-related quality of life measured by the Pelvic Problem Impact Questionnaire (31.6 vs 25.6, P < 0.001). CONCLUSION(S) Many women with CPP consistently use complementary health approaches. The substantial interest in and high prevalence of complementary health approaches used alongside conventional medical approaches highlight the need for better understanding of multimodal approaches to address the complex condition of CPP.
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Affiliation(s)
- Maria T Chao
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California, USA
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Diaz OV, Guendelman S, Kuppermann M. Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems. Womens Health Issues 2014; 24:649-55. [PMID: 25442708 DOI: 10.1016/j.whi.2014.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 07/05/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions. METHODS We conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up. RESULTS Women with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11-7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant. CONCLUSION Low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.
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Affiliation(s)
- O Vanessa Diaz
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California; Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California
| | - Sylvia Guendelman
- Maternal and Child Health Program, School of Public Health, University of California, Berkeley, California
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California; Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, California; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California.
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Jacoby VL, Jacoby A, Learman LA, Schembri M, Gregorich SE, Jackson R, Kuppermann M. Use of medical, surgical and complementary treatments among women with fibroids. Eur J Obstet Gynecol Reprod Biol 2014; 182:220-5. [PMID: 25445104 DOI: 10.1016/j.ejogrb.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.
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Affiliation(s)
- Vanessa L Jacoby
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA.
| | - Alison Jacoby
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
| | - Lee A Learman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, USA
| | - Michael Schembri
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
| | - Steven E Gregorich
- Medicine, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
| | - Rebecca Jackson
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
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Singh JK, Learman LA, Nakagawa S, Gregorich SE, Kuppermann M. Sleep problems among women with noncancerous gynecologic conditions. J Psychosom Obstet Gynaecol 2014; 35:29-35. [PMID: 24393058 DOI: 10.3109/0167482x.2013.868880] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of and identify factors associated with poor sleep quality and short sleep duration among women with noncancerous gynecologic conditions. STUDY DESIGN We conducted a cross-sectional analysis of 838 pre-menopausal women aged 31-54 who enrolled in a study of pelvic problems, hysterectomy and intervention alternatives in 2003/2004. Primary outcomes were poor sleep quality and short sleep duration (six or less hours on average) in the four weeks preceding the interview; hypothesized correlates included sociodemographic characteristics, pelvic problem impact, measured by the Pelvic Problem Impact Questionnaire (PPIQ), and depression, measured by the Patient Health Questionnaire (PHQ). RESULTS One-third (33.7%) of the participants reported having poor sleep quality and nearly half (46.8%) reported short sleep duration. In multivariable models, women with major depressive disorder were more likely than those who were not depressed to experience poor sleep quality (adjusted odds ratio (aOR) 4.15, 95% confidence interval (CI) 2.36-7.28, p < 0.001). Women with higher PPIQ scores also were more likely to experience poor sleep quality (aOR 1.59, 95% CI 1.27-1.98, p < 0.001) and short sleep duration (aOR 1.37, 95% CI 1.11-1.69, p < 0.003). Finally, women who self-identified as African-American (aOR 2.81, 95% CI 1.83-4.32, p < 0.001) or Asian/Pacific Islander (aOR 2.32, 95% CI 1.32-4.09, p < 0.003) were more likely than White women to have short sleep duration. CONCLUSIONS Sleep problems are prevalent among women with noncancerous gynecologic conditions, and are associated with depression and high pelvic problem impact. Providers should be proactive in inquiring about and offering solutions for sleep difficulties experienced by their patients.
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Affiliation(s)
- Jaspreet K Singh
- Departments of Obstetrics, Gynecology & Reproductive Sciences, University of California , San Francisco, CA , USA
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Jackson LJ, Auguste P, Low N, Roberts TE. Valuing the health states associated with Chlamydia trachomatis infections and their sequelae: a systematic review of economic evaluations and primary studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:116-130. [PMID: 24438725 DOI: 10.1016/j.jval.2013.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Economic evaluations of interventions to prevent and control sexually transmitted infections such as Chlamydia trachomatis are increasingly required to present their outcomes in terms of quality-adjusted life-years using preference-based measurements of relevant health states. The objectives of this study were to critically evaluate how published cost-effectiveness studies have conceptualized and valued health states associated with chlamydia and to examine the primary evidence available to inform health state utility values (HSUVs). METHODS A systematic review was conducted, with searches of six electronic databases up to December 2012. Data on study characteristics, methods, and main results were extracted by using a standard template. RESULTS Nineteen economic evaluations of relevant interventions were included. Individual studies considered different health states and assigned different values and durations. Eleven studies cited the same source for HSUVs. Only five primary studies valued relevant health states. The methods and viewpoints adopted varied, and different values for health states were generated. CONCLUSIONS Limitations in the information available about HSUVs associated with chlamydia and its complications have implications for the robustness of economic evaluations in this area. None of the primary studies could be used without reservation to inform cost-effectiveness analyses in the United Kingdom. Future debate should consider appropriate methods for valuing health states for infectious diseases, because recommended approaches may not be suitable. Unless we adequately tackle the challenges associated with measuring and valuing health-related quality of life for patients with chlamydia and other infectious diseases, evaluating the cost-effectiveness of interventions in this area will remain problematic.
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Affiliation(s)
- Louise J Jackson
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peter Auguste
- Warwick Evidence, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK.
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Yee LM, Kaimal AJ, Nakagawa S, Houston K, Kuppermann M. Predictors of postpartum sexual activity and function in a diverse population of women. J Midwifery Womens Health 2013; 58:654-61. [PMID: 24325662 DOI: 10.1111/jmwh.12068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The purpose of this study was to identify predictors of postpartum sexual activity and functioning in a diverse population of women using the Sexual Health Outcomes in Women Questionnaire (SHOW-Q). METHODS This was a prospective study of 160 postpartum women assessing relationships between demographic factors, mode of birth, depression, breastfeeding, and sexual activity and function. Questionnaires were administered over the telephone 8 to 10 weeks postpartum and in person 6 to 8 months postpartum. Primary outcomes were sexual activity at 8 to 10 weeks postpartum and global and subscale SHOW-Q scores at 6 to 8 months postpartum; the primary predictor was mode of birth. Associations were assessed using multiple linear and logistic regression analyses. RESULTS Seventy-five percent of this population (n = 140 at 8-10 weeks, n = 129 at 6-8 months) gave birth vaginally, and 60.7% resumed sexual activity by 8 to 10 weeks postpartum. Only multiparity was associated with increased odds of having resumed sexual activity by 8 to 10 weeks postpartum (adjusted odds ratio [aOR], 2.44; P = .03), whereas older age was associated with decreased odds (aOR, 0.92; P = .02) of having resumed sexual activity. Women who were depressed (effect estimate, -13.3; P = .01), older (-1.1, P = .01), or exclusively breastfeeding (-16.5, P < .001) had significantly poorer sexual satisfaction, whereas multiparous women reported better sexual satisfaction (11.1, P = .03). A significant relationship between mode of birth and SHOW-Q scores did not emerge, although we did observe a trend toward lower SHOW-Q scores among women who underwent cesarean compared with those giving birth vaginally. DISCUSSION Multiparity and younger age predict early resumption of sexual activity, whereas depression and breastfeeding are associated with poorer postpartum sexual functioning. The relationship between mode of birth and resumed sexual activity or postpartum sexual function remains uncertain.
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Contributions of hysterectomy and uterus-preserving surgery to health-related quality of life. Obstet Gynecol 2013; 122:15-25. [PMID: 23787923 DOI: 10.1097/aog.0b013e318292aea4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To document the long-term effect of surgical interventions for noncancerous uterine conditions on health-related quality of life. METHODS The Study of Pelvic Problems, Hysterectomy and Intervention Alternatives, conducted between 1998 and 2008, was a longitudinal study of 1,503 women with intact uteri experiencing abnormal uterine bleeding with or without leiomyomas, chronic pelvic pain, or pressure resulting from leiomyomas. Baseline and follow-up questionnaires included three condition-specific measures (Pelvic Problem Resolution, Pelvic Problem Impact Overall, and Pelvic Problem Impact on Sex) and five generic measures (Short Form-12 Mental and Physical Component Summaries, Current Health Utility, Feelings about Heath, and Satisfaction with Sex). We modeled changes over time in these patient-reported outcomes stratified by the most invasive treatment undergone (hysterectomy [13.7%], uterus-preserving surgery [9.0%], or nonsurgical therapy [77.3%]). RESULTS Participants in all three groups reported significant improvement on all condition-specific measures and two of the five generic measures (Current Health Utility and Feelings about Health) from enrollment to final interview (all P values <.01). In general, greater improvements were experienced by women who had surgery. Trajectories modeled around the dates of surgery showed dramatic improvements after hysterectomy and, to a lesser degree, after uterus-preserving surgery. Although women who underwent uterus-preserving surgery tended to show immediate improvement, women who underwent hysterectomy experienced a 6-month delay in improvement in some outcomes with trajectories converging by 4 years postsurgery. CONCLUSION Women seeking care for noncancerous uterine conditions can expect to experience improvement over time. Those who opt for surgery may experience most improvement. Understanding health-related quality-of-life trajectories may enhance counseling for women deciding between hysterectomy and alternative interventions. LEVEL OF EVIDENCE II.
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Pickett H. Case Series: Acupuncture and Pelvic Pain. Med Acupunct 2013. [DOI: 10.1089/acu.2013.0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heather Pickett
- Department of Family Medicine, Nellis Air Force Base Family Medicine Residency, Mike O'Callaghan Federal Medical Center, Las Vegas, NV
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Health Concerns That Affect Female Sexuality. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012. [DOI: 10.1016/s1701-2163(16)35357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bastianelli C, Farris M, Benagiano G. Use of the levonorgestrel-releasing intrauterine system, quality of life and sexuality. Experience in an Italian family planning center. Contraception 2011; 84:402-8. [PMID: 21920196 DOI: 10.1016/j.contraception.2011.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 12/02/2010] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The levonorgestrel-releasing intrauterine system (LNG-IUS) was first marketed in 1990 in Finland. Since then, it has been approved in approximately 120 countries throughout the world, with almost 50 million women-years of cumulative experience to date. Its high contraceptive effectiveness and favorable bleeding profile, leading to significant reduction of menstrual bleeding both in women with idiopathic menorrhagia and in those with normal menstrual bleedings, have been the key to the success of the system. At the same time, women need to be provided adequate preinsertion counseling about changes in menstrual bleeding to be expected. In the Italian context, it is important to highlight during counseling that amenorrhea is not harmful but can lead to health benefits such as an increase in iron blood stores and blood hemoglobin concentration. STUDY DESIGN To evaluate contraceptive efficacy, compliance and the effect of changes in menstrual cyclicity on quality of life and sexuality of the LNG-IUS (Mirena®), 156 women attending the Family Planning Clinic to request contraception were enrolled in the study and inserted with the device. RESULTS Menstrual blood flow decreased in all users, in terms of both quantity and duration; although spotting was present in 93.7% of the women, it disappeared within 6 months in the majority of cases. Amenorrhea occurred in 29.5% of all women, with onset within the first six cycles postinsertion. Data from the EuroQuality of Life-5D and Female Sexual Function Index questionnaires showed improvement in the quality of life, with a decrease in intercourse-related pain and an improvement in sexual desire. CONCLUSIONS Although in Italy intrauterine contraception is poorly accepted, once started on LNG-IUS, women found that the device represents a safe and effective contraceptive modality, with valuable noncontraceptive benefits, especially in the presence of heavy or prolonged bleeding.
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Affiliation(s)
- Carlo Bastianelli
- Department of Obstetrics and Gynecology, Sapienza University of Rome, Rome, Italy.
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Learman LA, Gregorich SE, Schembri M, Jacoby A, Jackson RA, Kuppermann M. Symptom resolution after hysterectomy and alternative treatments for chronic pelvic pain: does depression make a difference? Am J Obstet Gynecol 2011; 204:269.e1-9. [PMID: 21376168 DOI: 10.1016/j.ajog.2010.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/29/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether depression influences treatment outcomes and to identify predictors of symptom resolution among women with chronic pelvic pain (CPP). STUDY DESIGN Analysis of 701 women with CPP in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives prospective cohort study, which included 153 women (22%) with depression. We conducted multivariable analyses to evaluate the influence of depression on pre-/posttreatment differences in symptoms and health-related quality of life and to identify other predictors of symptom improvement. RESULTS CPP treatments included hysterectomy (9%), other surgical treatments (9%), hormonal medications (50%), narcotic analgesics (47%), physical therapy (12%), and nonprescription medications (93%). Depression predicted lower gains in health perception (P < .05) but not in symptom resolution, sexual functioning, or other aspects of health-related quality of life. Symptom resolution was predicted by hysterectomy (P < .001), entering menopause (P < .001), and pretreatment satisfaction with sex (P = .039). CONCLUSION Depression does not influence substantially treatment-related gains in CPP symptom resolution and health-related quality of life. Coexisting depression should not delay treatment for CPP.
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Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause. Am J Obstet Gynecol 2011; 204:272.e1-7. [PMID: 21376169 DOI: 10.1016/j.ajog.2010.12.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/29/2010] [Accepted: 12/27/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether age at first uterus-preserving treatment (UPT) predicts symptom resolution among women with common pelvic problems. STUDY DESIGN We conducted an analysis of 557 participants in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives cohort who reported having undergone a UPT. We performed multivariable regression modeling age at first UPT, hysterectomy, menopause, and other covariates to predict symptom resolution. RESULTS Mean ± SD age at enrollment was 42.7 ± 4.7 years; mean follow-up time was 4.4 ± 2.7 years. Sixteen percent of the women underwent hysterectomy; 37% of the women entered menopause. Hysterectomy was a strong predictor of symptom resolution (P < .001). Compared with women who were younger (first UPT at age <40 years), older women reported greater symptom resolution, even after the data were controlled for hysterectomy use and menopausal status (P = .028). CONCLUSION Women who are ≥40 years old when they undergo their first uterus-preserving treatment experience greater symptom resolution than younger women. Framing UPTs as hysterectomy alternatives may be accurate only for a subset of women who are >40 years old.
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Prevalence and incidence of urinary incontinence in a diverse population of women with noncancerous gynecologic conditions. Female Pelvic Med Reconstr Surg 2010; 16:284-289. [PMID: 21423570 DOI: 10.1097/spv.0b013e3181ee6864] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: To determine the prevalence and incidence of urinary incontinence (UI) in a diverse cohort of women presenting with noncancerous gynecologic conditions and to assess factors associated with UI prevalence and incidence. METHODS: We conducted a secondary analysis of data from SOPHIA (Study of Pelvic Problems, Hysterectomy and Intervention Alternatives), a longitudinal study of women with noncancerous gynecologic conditions (bleeding, pelvic pain, and symptomatic fibroids). UI was defined as incontinence in the last 4 weeks as reported on interviewer-administered annual questionnaires. We also evaluated the type of UI: stress (SUI), urge (UUI) or mixed incontinence (MUI). RESULTS: The study population of 907 women was 40.8% White, 28.0% African American, 17.3% Latina and 8.1% Asian. The mean age was 44.1 ± 5.4 years and 48.5% had an annual household income of ≤$50,000. The overall prevalence of any UI was 51.1%. At baseline, SUI was the most common at 39.4% followed by UUI at 23.7% and MUI at 18.9%. The average annual incidence for any UI was 4.2%. 13% of the women who underwent hysterectomy developed incident UI after their surgery. In multivariable logistic regression analysis, prevalent UI was associated with the following: age in decades (OR 1.6, 95% CI 1.2, 2.2), Latina race/ethnicity compared to white (OR 2.1, 95% CI 1.3, 3.3), and parity (OR 1.7, 95% CI 1.2, 2.4). None of the factors evaluated were associated with incidence of UI. CONCLUSION: Urinary incontinence is very common in women seeking care for noncancerous gynecologic conditions, particularly among older, parous Latinas.
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Preferences for surveillance strategies for women treated for high-grade precancerous cervical lesions. Gynecol Oncol 2010; 118:108-15. [PMID: 20553960 DOI: 10.1016/j.ygyno.2010.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 04/29/2010] [Accepted: 05/01/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Data are lacking on how women view alternative approaches to surveillance for cervical cancer after treatment of high-grade cervical intraepithelial neoplasia. We measured and compared patient preferences (utilities) for scenarios with varying surveillance strategies and outcomes to inform guidelines and cost-effectiveness analyses of post-treatment surveillance options. METHODS English- or Spanish-speaking women who had received an abnormal Pap test result within the past 2 years were recruited from general gynecology and colposcopy clinics and newspaper and online advertisements in 2007 and 2008. Participation consisted of one face-to-face interview, during which utilities for 11 different surveillance scenarios and their associated outcomes were elicited using the time tradeoff metric. A sociodemographic questionnaire also was administered. RESULTS 65 women agreed to participate and successfully completed the preference elicitation exercises. Mean utilities ranged from 0.989 (undergoing only a Pap test, receiving normal results) to 0.666 (invasive cervical cancer treated with radical hysterectomy or radiation and chemotherapy). Undergoing both Pap and HPV tests and receiving normal/negative results had a lower mean utility (0.953) then undergoing only a Pap test and receiving normal results (0.989). Having both tests and receiving normal Pap but positive HPV results was assigned an even lower mean utility (0.909). 15.9% of the respondents gave higher utility scores to the Pap plus HPV testing scenario (with normal/negative results) than to the "Pap test alone" scenario (with normal results), while 17.5% gave the Pap test alone scenario a higher utility score. CONCLUSIONS Preferences for outcomes ending with normal results but involving alternative surveillance processes differ substantially. The observed differences in utilities have important implications for clinical guidelines and cost-effectiveness analyses.
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Long-Term Outcomes of the Total or Supracervical Hysterectomy (TOSH) Trial. Female Pelvic Med Reconstr Surg 2010; 16:49-57. [PMID: 22229107 DOI: 10.1097/spv.0b013e3181cec343] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Participants in the multi-center, randomized Total or Supracervical Hysterectomy (TOSH) trial showed within-group improvement in pelvic floor symptoms 2 years post-surgery and no differences between supracervical (SCH) versus total hysterectomy (TAH). This study describes longer term outcomes from the largest recruiting site. STUDY DESIGN: Questionnaires addressing pelvic symptoms, sexual function, and health-related quality of life were administered. Linear models and McNemar's test were utilized. RESULTS: Thirty-seven participants (69%) responded (19 TAH, 18 SCH); mean follow up was 9.1±0.7 years. No between-group differences emerged in urinary incontinence, voiding dysfunction, pelvic prolapse symptoms and overall health related quality of life (HRQOL). Within-group analysis showed significant improvement in the ability to have and enjoy sex (P = 0.002) and in the SF-36 physical component summary score (P = 0.03) among women randomized to TAH. CONCLUSION: 9 years after surgery, TOSH participants continue to experience improvement and show no major between-group differences in lower urinary tract or pelvic floor symptoms conferring no major benefit of SCH over TAH.
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Huang AJ, Luft J, Grady D, Kuppermann M. The day-to-day impact of urogenital aging: perspectives from racially/ethnically diverse women. J Gen Intern Med 2010; 25:45-51. [PMID: 19908103 PMCID: PMC2811605 DOI: 10.1007/s11606-009-1135-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 09/08/2009] [Accepted: 09/17/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Urogenital symptoms affect up to half of women after menopause, but their impact on women's day-to-day functioning and wellbeing is poorly understood. METHODS Postmenopausal women aged 45 to 80 years reporting urogenital dryness, soreness, itching, or pain during sex were recruited to participate in in-depth focus groups to discuss the impact of their symptoms. Focus groups were homogenous with respect to race/ethnicity and stratified by age (for White or Black women) or language (for Latina women). Transcripts of sessions were analyzed according to grounded theory. RESULTS Six focus groups were conducted, involving 44 women (16 White, 14 Black, 14 Latina). Five domains of functioning and wellbeing affected by symptoms were identified: sexual functioning, everyday activities, emotional wellbeing, body image, and interpersonal relations. For some participants, symptoms primarily affected their ability to have and enjoy sex, as well as be responsive to their partners. For others, symptoms interfered with everyday activities, such as exercising, toileting, or sleeping. Participants regarded their symptoms as a sign that they were getting old or their body was deteriorating; women also associated symptoms with a loss of womanhood or sexuality. Additionally, participants reported feeling depressed, embarrassed, and frustrated about their symptoms, and expressed reluctance to discuss them with friends, family, or health care providers. CONCLUSIONS Urogenital symptoms can have a marked impact on sexual functioning, everyday activities, emotional wellbeing, body image, and interpersonal relations after menopause. Clinicians may need to question women actively about these symptoms, as many are reluctant to seek help for this problem.
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Affiliation(s)
- Alison J Huang
- Department of Medicine, University of California, San Francisco, CA, USA.
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Learman LA, Huang AJ, Nakagawa S, Gregorich SE, Kuppermann M. Development and validation of a sexual functioning measure for use in diverse women's health outcome studies. Am J Obstet Gynecol 2008; 198:710.e1-8; discussion 710.e8-9. [PMID: 18538161 DOI: 10.1016/j.ajog.2008.03.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/23/2007] [Accepted: 03/10/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the psychometric properties of the Sexual Health Outcomes in Women Questionnaire (SHOW-Q). STUDY DESIGN SHOW-Q was developed to assess the impact of pelvic problems on sexual desire, frequency, satisfaction, orgasm, and discomfort. A total of 1833 English- or Spanish-speaking women enrolled in 5 studies across the United States completed relevant items at baseline and, for 4 studies, periodically thereafter. Participants also completed measures of pelvic symptomatology and health-related quality-of-life including mental and physical component scales (MCS, PCS). RESULTS Factor analysis revealed a 12-item scale with high internal consistency reliability (Cronbach's alpha = 0.86) and 4 reliable subscales (alpha = 0.73 to 0.84). Among sexually active women, SHOW-Q scores showed statistically significant correlations (P < .001) with MCS (0.267), PCS (0.378), body image (.360), and symptom resolution (.237). The SHOW-Q subscales were also correlated with these other measures at baseline and over time. CONCLUSION SHOW-Q is a reliable, valid, and sensitive measure of sexual functioning for use in diverse women's health outcome studies.
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