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Tanaka Y, Fujii R, Shigetoh H, Sato G, Morioka S. Can the Assessment of the Circadian Rhythm of Pain Be Shortened? A Study of Community-Dwelling Participants with Chronic Pain. J Pain Res 2024; 17:1929-1940. [PMID: 38812822 PMCID: PMC11135561 DOI: 10.2147/jpr.s452790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose This study aimed to juxtapose the circadian rhythm of pain with the conventional 7-day assessment and ascertain the feasibility of condensing the evaluation of the circadian rhythm of pain into a 3-day timeframe. Patients and Methods Seventy-three patients with pain persisting for a minimum of 3 months and a numerical rating scale (NRS) score of ≥2 were recruited from three medical centers. The circadian patterns of pain were appraised over a 7-day period by quantifying the intensity of pain at six temporal junctures each day using a 10-cm visual analog scale (VAS). Cluster analysis was performed using six standardized variables derived from the VAS score of each participant at six designated time points to identify cohorts with analogous circadian rhythms of pain. The clusters were discerned for the 7- and 3-day assessments (Tuesday-Thursday, Friday-Sunday, and Sunday-Tuesday), according to the research objectives. Cohen's kappa coefficient was calculated to gauge the intra-observer variability to assess the consistency between the outcomes of the cluster analysis for the 7-day assessment and each of the 3-day assessments. Results The highest Cohen's kappa coefficient was observed for the 3-day evaluation spanning from Friday to Sunday, indicating a substantial concordance with the results of the 7-day assessment. Conclusion Our results suggest that it may be prudent to consider implementing a condensed 3-day evaluation of the circadian rhythm of pain that is tailored to individual characteristics. This approach will allow a better understanding of the diurnal rhythms of chronic pain in patients and implement more targeted and specific pain management strategies. Furthermore, it will contribute to increased patient satisfaction through early intervention.
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Affiliation(s)
- Yoichi Tanaka
- Department of Occupational Therapy, School of Rehabilitation, Hyogo Medical University, Hyogo, Japan
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
| | - Ren Fujii
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
- Musashigaoka Clinical Research Center, Musashigaoka Hospital, Kumamoto, Japan
| | - Hayato Shigetoh
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
- Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, Japan
| | - Gosuke Sato
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Neuro Rehabilitation Research Center, Kio University, Nara, Japan
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2
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Jones GL, Budds K, Taylor F, Musson D, Raymer J, Churchman D, Kennedy SH, Jenkinson C. A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis. Hum Reprod Update 2024; 30:186-214. [PMID: 38007607 PMCID: PMC10905511 DOI: 10.1093/humupd/dmad029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/06/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women's QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms 'EHP30', 'EHP5', 'EHP-30', 'EHP-5', 'endometriosis health profile 30', and 'endometriosis health profile 5'. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs' robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the 'control and powerlessness' domain post-intervention, followed by 'pain'. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.
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Affiliation(s)
- Georgina L Jones
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Kirsty Budds
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Francesca Taylor
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Danielle Musson
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | | | - Stephen H Kennedy
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Fahrni ML, Azni MZ, Rusdi NSM, Choo CY, Isa KAM, Babar ZUD. Impact of university students' awareness and attitudes on vaccination practices for human papillomavirus, and perception on self-sampling for cervical cancer screening. J Pharm Policy Pract 2022; 15:73. [PMID: 36309713 PMCID: PMC9617449 DOI: 10.1186/s40545-022-00471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background The burden of Human Papilloma Virus (HPV)-associated cancer remains high in developing nations.
Aims To assess the impact of self-reported awareness and attitudes on vaccination practices, and the perception on self-sampling for cervical cancer screening. Methods A 12-month survey using purposive sampling of females attending an urban public university was conducted. SPSS version 25 was used to compare the responses for students enrolled in health vs non-health related programmes.
Results Of the 290 questionnaires distributed, 240 were returned (response rate = 83%) in approximately equal proportion from the faculties of Health Science and Pharmacy (n = 127), and from the Hotel and Tourism, Business Management, and Art and Design (n = 113) faculties. About one-third (28.8%) had completed 3 shots, 19.6% received the first shot, 11.4% had scheduled appointments for first shots while 40.2% were both unvaccinated and had not scheduled any appointment. Most (71%) were aware of the HPV vaccines while 50.5% were unaware that HPV vaccines were also available for men. Students enrolled in health-related programmes were 3.2 times more perceptive to the benefits of vaccination particularly in preventing spread to their partners (OR 3.2, 95% CI 1.3–3.41, p = 0.006) than their counterparts. A weak-positive correlation was observed between knowledge and vaccination practices (r = 0.2, p = 0.001). The level of knowledge on HPV and its vaccine was greater for health-related (Mdn = 6.5) than for students of non-health related (Mdn = 1.5) programmes (U = 2790.5, p-value = 0.00). Attitudes towards immunisation were influenced by perceived benefits versus risks for side effects, cost barriers, and influences of primarily their doctors and parents. The study was limited in that relationship statuses were used to estimate sexual history as direct questions were unanswered in the pilot survey. Conclusion HPV vaccine uptake for an immunisation-targeted young female population is low despite moderate knowledge levels. It is plausible that the low rates among females enrolled in particularly the non-health programmes were impacted by misperceived vaccine-associated risks, and misconception that testing and vaccination for HPV and cervical cancer were for those married or sexually active. Self-sampling could offer a potential alternative to sampling via pelvic examination, particularly for societies where premarital sex is seen as a taboo.
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Affiliation(s)
- Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, 42300, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia.
| | | | - Nurhani Syafiqah Mohd Rusdi
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, 42300, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Chee-Yan Choo
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor Branch, 42300, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Khairil Anuar Md Isa
- Faculty of Health Sciences Universiti Teknologi MARA, Selangor Branch, Puncak Alam Campus, 42300, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
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Kasaven LS, Saso S, Getreu N, O'Neill H, Bracewell-Milnes T, Shakir F, Yazbek J, Thum MY, Nicopoullos J, Ben Nagi J, Hardiman P, Diaz-Garcia C, Jones BP. Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation? Hum Reprod 2022; 37:1970-1979. [PMID: 35734904 PMCID: PMC9433842 DOI: 10.1093/humrep/deac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/29/2022] [Indexed: 11/21/2022] Open
Abstract
Age-related fertility decline (ARFD) is a prevalent concern amongst western cultures due to the increasing age of first-time motherhood. Elective oocyte and embryo cryopreservation remain the most established methods of fertility preservation, providing women the opportunity of reproductive autonomy to preserve their fertility and extend their childbearing years to prevent involuntary childlessness. Whilst ovarian cortex cryopreservation has been used to preserve reproductive potential in women for medical reasons, such as in pre- or peripubertal girls undergoing gonadotoxic chemotherapy, it has not yet been considered in the context of ARFD. As artificial reproductive technology (ART) and surgical methods of fertility preservation continue to evolve, it is a judicious time to review current evidence and consider alternative options for women wishing to delay their fertility. This article critically appraises elective oocyte cryopreservation as an option for women who use it to mitigate the risk of ARFD and introduces the prospect of elective ovarian cortex cryopreservation as an alternative.
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Affiliation(s)
- Lorraine S Kasaven
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Cutrale Perioperative and Ageing Group, Sir Michael Uren Hub, Imperial College London, London, UK
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalie Getreu
- Translational Ovarian Physiology and Pathophysiology, Institute for Women's Health, University College London, London, UK
| | - Helen O'Neill
- Genome Editing and Reproductive Genetics Group, Institute for Women's Health, University College London, London, UK
| | | | - Fevzi Shakir
- Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, London, UK
| | | | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | | | - Cesar Diaz-Garcia
- IVI London, IVIRMA Global, London, UK.,EGA Institute for Women's Health, University College London, London, UK
| | - Benjamin P Jones
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Chao X, Liu Y, Fan Q, Shi H, Wang S, Lang J. The role of the vaginal microbiome in distinguishing female chronic pelvic pain caused by endometriosis/adenomyosis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:771. [PMID: 34268384 PMCID: PMC8246188 DOI: 10.21037/atm-20-4586] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/04/2021] [Indexed: 12/30/2022]
Abstract
Background This study aimed to investigate the specific vaginal microbiome in the differential diagnosis of endometriosis/adenomyosis (EM/AM)-associated chronic pelvic pain (CPP) from other types of CPP, and to explore the role of the vaginal microbiome in the mechanism of EM/AM-associated CPP. Methods We recruited 37 women with EM/AM-associated CPP, 25 women with chronic pelvic pain syndrome (CPPS) without EM/AM, and 66 women without CPPS into our study. All of the participants were free from human papillomavirus (HPV) infection. Sequencing of barcoded 16S rRNA gene fragments (V4) was used to determine the vaginal microbiome composition on the Illumina HiSeq2500 System. Taxonomic and functional bioinformatics analyses were performed using t-test, linear discriminant analysis effect size (LEfSe), MetaStat, and PICRUSt algorithms. Results At the species level, EM/AM-associated CPP was found to be associated with a predominance of Clostridium butyricum, Clostridium disporicum, Alloscardovia omnicolens, and Veillonella montpellierensis, and a concomitant paucity of Lactobacillus jensenii, Lactobacillus reuteri, and Lactobacillus iners. When the relative abundance of Clostridium disporicum was over 0.001105% and that of Lactobacillus reuteri was under 0.1911349%, the differential diagnostic sensitivity and specificity were 81.08% and 52.0%, respectively. When serum CA125 was combined, the sensitivity increased to 89.19%, but the specificity remained at 52.0%. The PICRUSt results identified 7 differentially regulated pathways within the 3 groups that may be of relevance. Conclusions Compared to that of CPPS patients without EM/AM and women without CPPS, the vaginal microbiome of patients with EM/AM-associated CPP shows significantly higher alpha (phylogenetic) diversity, as well as higher counts of Clostridium butyricum, Clostridium disporicum, Alloscardovia omnicolens, and Veillonella montpellierensis. These differences in the vaginal microbiome may interfere with local functional pathways, which could provide a direction for innovative metabolite-specific targeted treatment. The combination of vaginal biomarkers and serum CA125 may provide an original method to differentiate EM/AM-associated CPP.
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Affiliation(s)
- Xiaopei Chao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yang Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Qingbo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Abstract
May-Thurner syndrome (MTS), or iliac vein compression syndrome, is a pelvic condition that involves compression of the iliac veins resulting in endothelial damage. This condition is typically asymptomatic and often missed in primary care. As progression occurs over time, symptoms related to venous hypertension may be present including acute extremity pain and swelling, pelvic pain, venous claudication, deep venous thrombosis, or chronic development of venous insufficiency. A case report is provided to enhance primary health care providers' knowledge of MTS and promote early detection and recognition to enhance positive and expedited outcomes.
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Roy H, Offiah I, Dua A. Neuromodulation for Pelvic and Urogenital Pain. Brain Sci 2018; 8:brainsci8100180. [PMID: 30274287 PMCID: PMC6209873 DOI: 10.3390/brainsci8100180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affecting the pelvic and urogenital area is a major clinical problem with heterogeneous etiology, affecting both male and female patients and severely compromising quality of life. In cases where pharmacotherapy is ineffective, neuromodulation is proving to be a potential avenue to enhance analgesic outcomes. However, clinicians who frequently see patients with pelvic pain are not traditionally trained in a range of neuromodulation techniques. The aim of this overview is to describe major types of pelvic and urogenital pain syndromes and the neuromodulation approaches that have been trialed, including peripheral nerve stimulation, dorsal root ganglion stimulation, spinal cord stimulation, and brain stimulation techniques. Our conclusion is that neuromodulation, particularly of the peripheral nerves, may provide benefits for patients with pelvic pain. However, larger prospective randomized studies with carefully selected patient groups are required to establish efficacy and determine which patients are likely to achieve the best outcomes.
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Affiliation(s)
- Holly Roy
- Neurosurgery Department, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Ifeoma Offiah
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Anu Dua
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
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