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Sexually Transmitted Infections Feb 2022The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people....
What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review.
BACKGROUND
The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people.
METHODS
We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions.
MAIN RESULTS
From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options.
CONCLUSIONS
Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.
Topics: Adolescent; Chlamydia Infections; Health Promotion; Humans; Interrupted Time Series Analysis; Mass Screening; Public Health; Qualitative Research; United Kingdom; Young Adult
PubMed: 34446545
DOI: 10.1136/sextrans-2021-055142 -
BMJ Case Reports Aug 2021Solitary fibrous tumours (SFTs) are a rare mesenchymal neoplasm with an incidence of 2.8 per 100 000 of which only 1% occur in the female genital tract. Doege-Potter...
Solitary fibrous tumours (SFTs) are a rare mesenchymal neoplasm with an incidence of 2.8 per 100 000 of which only 1% occur in the female genital tract. Doege-Potter syndrome is a paraneoplastic phenomenon associated with approximately 5%-10% of SFTs and is characterised by non-islet cell hypoglycaemia due to tumour production of low molecular weight insulin-like growth factor-II. We present the fourth confirmed case of female pelvic SFT with Doege-Potter syndrome and a literature review.
Topics: Female; Humans; Congenital Abnormalities; Kidney; Kidney Diseases; Paraneoplastic Syndromes; Solitary Fibrous Tumors
PubMed: 34413033
DOI: 10.1136/bcr-2021-242447 -
Acta Obstetricia Et Gynecologica... Oct 2021Many women with benign pelvic masses, suspected of ovarian cancer, are unnecessarily referred for treatment at specialized centers. There is an unmet clinical need to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Many women with benign pelvic masses, suspected of ovarian cancer, are unnecessarily referred for treatment at specialized centers. There is an unmet clinical need to improve diagnostic assessment in these patients. Our objective was to obtain summary estimates of the accuracy of human epididymis protein (HE4) for diagnosing ovarian cancer and to compare the performance of HE4 with that of cancer antigen 125 (CA125).
MATERIAL AND METHODS
We searched PubMed, Ovid and Scopus using search terms for "pelvic masses" and "HE4", to identify studies that evaluated HE4 for diagnosing malignant ovarian masses, in adult women presenting with a pelvic mass, suspected of ovarian cancer, and with diagnosis confirmed by histopathology. Screening, data extraction and Risk of Bias assessment with the QUADAS-2 tool were done independently by two authors. We performed a meta-analysis of the accuracy of HE4 and CA125 using a random-effects bivariate logit-normal model. A study protocol was registered at PROSPERO (CRD42020158073).
RESULTS
In the 17 eligible studies, which included 3404 patients, ovarian cancer prevalence ranged from 15% to 71%. Overall, the studies were heterogeneous. All studies seemed to have recruited patients in specialized settings. A meta-analysis of seven HE4 studies resulted in a mean sensitivity of 79.4% (95% confidence interval [CI] 74.1%-83.8%) and a mean specificity of 84.1% (95% CI 79.6%-87.8%), for cut-off values of 67-72 pmol/L. Based on eight studies, the mean sensitivity of CA125 was 81.4% (95% CI 74.6%-86.2%) and the mean specificity was 56.8% (95% CI 47.9%-65.4%), at a cut-off of 35 U/ml. Given a 40% ovarian cancer prevalence, the positive predictive value (PPV) for HE4 would be 76.9% (71.9%-81.2%) vs 55.6% (50.2%-60.9%) for CA125. The negative predictive value (NPV) would be 85.9 (82.8%-88.6%) and 81.9% (76.2%-86.4%), respectively. At a 15% prevalence, the NPV would be 95.8% (95% CI 94.4%-96.7%) for HE4 and 94.4% (95% CI 92.3%-96.0%) for CA125. The PPV would be 46.9% (40.4%-53.4%) and 24.9% (21.1%-29.2%), respectively.
CONCLUSIONS
HE4 had higher specificity and similar sensitivity compared with CA125. At high prevalence, PPV was also higher for HE4, but at low prevalence, it had a similar NPV to CA125. The field would benefit from studies conducted in general settings.
Topics: Biomarkers, Tumor; CA-125 Antigen; Female; Humans; Ovarian Neoplasms; WAP Four-Disulfide Core Domain Protein 2
PubMed: 34212386
DOI: 10.1111/aogs.14224 -
Sports Medicine (Auckland, N.Z.) Oct 2021If interplanetary travel is to be successful over the coming decades, it is essential that countermeasures to minimize deterioration of the musculoskeletal system are as... (Meta-Analysis)
Meta-Analysis
BACKGROUND
If interplanetary travel is to be successful over the coming decades, it is essential that countermeasures to minimize deterioration of the musculoskeletal system are as effective as possible, given the increased duration of spaceflight associated with such missions. The aim of this review, therefore, is to determine the magnitude of deconditioning of the musculoskeletal system during prolonged spaceflight and recommend possible methods to enhance the existing countermeasures.
METHODS
A literature search was conducted using PubMed, Ovid and Scopus databases. 5541 studies were identified prior to the removal of duplicates and the application of the following inclusion criteria: (1) group means and standard deviations for pre- and post-spaceflight for measures of strength, muscle mass or bone density were reported (or provided by the corresponding author when requested via e-mail), (2) exercise-based countermeasures were included, (3) the population of the studies were human, (4) muscle function was assessed and (5) spaceflight rather than simulated spaceflight was used. The methodological quality of the included studies was evaluated using a modified Physiotherapy Evidence Database (PEDro) scale for quality, with publication bias assessed using a failsafe N (Rosenthal method), and consistency of studies analysed using I as a test of heterogeneity. Secondary analysis of studies included Hedges' g effect sizes, and between-study differences were estimated using a random-effects model.
RESULTS
A total of 11 studies were included in the meta-analyses. Heterogeneity of the completed meta-analyses was conducted revealing homogeneity for bone mineral density (BMD) and spinal muscle size (Tau < 0.001; I = 0.00%, p > 0.05), although a high level of heterogeneity was noted for lower body force production (Tau = 1.546; I = 76.03%, p < 0.001) and lower body muscle mass (Tau = 1.386; I = 74.38%, p < 0.001). The estimated variance (≤ -0.306) for each of the meta-analyses was significant (p ≤ 0.033), for BMD (- 0.48 to - 0.53, p < 0.001), lower body force production (- 1.75, p < 0.001) and lower body muscle size (- 1.98, p < 0.001). Spaceflight results in small reductions in BMD of the femur (Hedges g = - 0.49 [- 0.69 to - 0.28]), trochanter (Hedges g = - 0.53 [- 0.77 to - 0.29]), and lumbo-pelvic region (Hedges g = - 0.48 [- 0.73 to - 0.23]), but large decreases in lower limb force production (Hedges g = - 1.75 [- 2.50 to - 0.99]) and lower limb muscle size (Hedges g = - 1.98 [- 2.72 to - 1.23]).
CONCLUSIONS
Current exercise countermeasures result in small reductions in BMD during long-duration spaceflight. In contrast, such exercise protocols do not alleviate the reductions in muscle function or muscle size, which may be attributable to the low to moderate loads reported by crewmembers and the interference effect associated with concurrent training. It is recommended that higher-load resistance exercise and the use of high-intensity interval training should be investigated, to determine if such modifications to the reported training practices result in more effective countermeasures to the deleterious effect of long-duration spaceflight on the muscular system.
Topics: Bone Density; Exercise; Humans; Muscle Strength; Space Flight; Time Factors
PubMed: 34115344
DOI: 10.1007/s40279-021-01496-9 -
Frontiers in Surgery 2021To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate. We followed the PRISMA guidelines...
To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate. We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms " and " or " were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria. Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies). In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care. https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.
PubMed: 34046423
DOI: 10.3389/fsurg.2021.637180 -
Journal of the American Academy of... Apr 2021When considering surgical fixation of acetabulum and pelvis fractures in patients with obesity, a thorough understanding of the risks of potential complications is...
BACKGROUND
When considering surgical fixation of acetabulum and pelvis fractures in patients with obesity, a thorough understanding of the risks of potential complications is important. We performed a systematic review to evaluate whether obesity is associated with an increased risk of complications after surgical management of acetabulum and pelvis fractures.
METHODS
We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library for studies published through December 2020 that reported the effect of increased body mass index (BMI) or obesity on the risk of complications after surgical treatment of acetabulum and pelvis fractures.
RESULTS
Fifteen studies were included. Eight of the 11 studies that included infection or wound complication as end points found that increased BMI or some degree of obesity was a significant risk factor for these complications. Two studies found that obesity was significantly associated with loss of reduction. Other complications that were assessed in a few studies each included venous thromboembolism, nerve palsy, heterotopic ossification, general systemic complications, and revision surgery, but obesity was not clearly associated with those outcomes.
CONCLUSIONS
Obesity (or elevated BMI) was associated with an increased risk of complications-infection being the most commonly reported-after surgical management of acetabulum and pelvis fractures, which suggests the need for increased perioperative vigilance.
Topics: Acetabulum; Fractures, Bone; Humans; Obesity; Pelvic Bones; Pelvis
PubMed: 33872226
DOI: 10.5435/JAAOSGlobal-D-21-00058 -
Reproductive Health Feb 2021Pelvic organ prolapse remains the public health challenge globally. Existing evidences report the effect of woman's weight on the pelvic organ prolapse inconsistently... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic organ prolapse remains the public health challenge globally. Existing evidences report the effect of woman's weight on the pelvic organ prolapse inconsistently and this urges the need of pooled body weight effect on the pelvic organ prolapse. Although there was a previous work on this regard, it included papers reported before June 18/2015. Thus, updated and comprehensive evidence in this aspect is essential to devise strategies for interventions.
OBJECTIVE
This review aimed at synthesizing evidence regarding the pooled effect of body weight on the pelvic organ prolapsed.
METHODS
For this review, we searched all available articles through databases including PubMed, Web of Sciences, CINAHL, JBI library, Cochran library, PsycInfo and EMBASE as well as grey literature including Mednar, worldwide science, PschEXTRA and Google scholar. We included cohort, case-control, cross-sectional and experimental studies which had been reported between March 30, 2005 to March 30, 2020. In the effect analysis, we utilized random model. The heterogeneity of the studies was determined by I2 statistic and the publication bias was checked by Egger's regression test. Searching was limited to studies reported in the English language.
RESULTS
A total of 14 articles with 53,797 study participants were included in this systematic review (SR) and meta analysis (MA). The pooled result of this Meta analyses depict that body mass index (BMI) doesn't have statistical significant association with pelvic organ prolapse.
CONCLUSION
This review point out that women's body mass index has no significant effect on the development of pelvic organ prolapse. However, the readers should interpret the result with cautions due to the presence of considerable limitations in this work. Trial registration The protocol of this systematic review (SR) and meta analysis (MA) has been registered in PROSPERO databases with the Registration number of CRD42020186951.
Topics: Adolescent; Adult; Aged; Body Mass Index; Child; Female; Humans; Middle Aged; Obesity; Pelvic Organ Prolapse; Risk Factors
PubMed: 33608022
DOI: 10.1186/s12978-021-01104-z -
Gynecologic Oncology Apr 2021Although thromboprophylaxis is recommended to reduce death and disability from venous thromboembolism (VTE), it remains underused due to a perceived risk of bleeding,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Although thromboprophylaxis is recommended to reduce death and disability from venous thromboembolism (VTE), it remains underused due to a perceived risk of bleeding, especially in major abdominopelvic surgical patients.
METHODS
We conducted a systematic literature review to identify all eligible randomized controlled trials (RCTs), searching MEDLINE and Scopus databases through November 25, 2020. RCTs published in any language were eligible if they studied in gynecological cancer patients undergoing major abdominopelvic surgery and assessed efficacy of mechanical and pharmacological interventions. Studies with insufficient data for pooling or those comparing different doses/schedules of interventions were excluded. Outcomes of interest were composite VTE (ie, deep vein thrombosis or pulmonary embolism) and major bleeding. Relevant data were extracted for direct and network meta-analyses. Risk ratios (RR) and 95% confidence interval (CI) were estimated and the best intervention probability calculated for each outcome. This study was registered with PROSPERO (CRD42019145508).
RESULTS
We identified 1990 studies; 20 RCTs (4970 patients) were eligible. The overall risk of bias was of some concern. In direct meta-analyses, antithrombins were superior to unfractionated heparin in preventing composite VTE (RR 0.69; 95% CI 0.48-0.99), with no difference detected in the rate of major bleeding for any pairwise comparison. In network meta-analyses, graduated compression stockings plus low-molecular-weight heparin (LMWH) was top-ranked for prevention of composite VTE, whereas sequential compression devices (SCD) ranked second, after no treatment, for major bleeding. In a clustered ranking plot, SCD plus LMWH provided optimal balance between efficacy and safety.
CONCLUSIONS
SCD plus LMWH might be safe and effective in VTE prevention following gynecological cancer surgery. However, the patient's bleeding risk should be considered to balance the risk and benefit of treatment.
Topics: Abdomen; Anticoagulants; Female; Genital Neoplasms, Female; Gynecologic Surgical Procedures; Heparin, Low-Molecular-Weight; Humans; Network Meta-Analysis; Pelvis; Postoperative Complications; Randomized Controlled Trials as Topic; Stockings, Compression; Venous Thromboembolism
PubMed: 33563489
DOI: 10.1016/j.ygyno.2021.01.027 -
Annals of Palliative Medicine Mar 2021Laser therapy has recently been proposed as a novel treatment for stress urinary incontinence (SUI) due to offering several advantages. This study aimed to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laser therapy has recently been proposed as a novel treatment for stress urinary incontinence (SUI) due to offering several advantages. This study aimed to evaluate the safety and efficacy of laser treatment of SUI by a meta-analysis.
METHODS
The systematic review registration number is INPLASY202080001. A comprehensive search to identify relevant studies was conducted using the PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases with a cutoff date of 1 November, 2020. Outcome measures were extracted based on subjective and objective indexes, including International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and objective measurements "1-hour pad test" (1-hour test under standardized conditions). Score changes before and after treatment were evaluated through meta-analysis. Subgroup analysis was performed according to geographic region, type of urinary incontinence (UI), severity of UI, age, and body mass index (BMI).
RESULTS
Sixteen published clinical research studies, involving 899 patients with SUI, were included in this study. After laser treatment, the change in the ICIQ-SF score at 1, 2, and 6 months was -5.49 (95% CI: -6.74--4.24; I2=91%, P<0.01), -4.97 (95% CI: -6.24--3.71), and -5.48 (95% CI: -6.15--4.81), respectively. The improvement in 1-hour pad weight test results at 1, 3, and 12 months post treatment was -5.59 (95% CI: -6.93--4.25), -4.96 (95% CI: -6.73--3.20), and -5.82 (95% CI: -6.77--4.87), respectively. The PISQ-12 score increased by 5.39 (95% CI: 1.20-9.58) following treatment. Subgroup analysis identified the type and severity of UI as the potential source of heterogeneity. Adverse effects were reported in 6 of the 16 trials and affected only a small number of patients. Most adverse events were mild or moderate and required no medical intervention or resolved in a few days.
CONCLUSIONS
Vaginal laser therapy appears to be a safe, effective, and minimally invasive treatment option for SUI that can be well tolerated by patients.
Topics: Female; Humans; Laser Therapy; Lasers; Pelvic Organ Prolapse; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence, Stress
PubMed: 33549008
DOI: 10.21037/apm-20-1440 -
Acta Obstetricia Et Gynecologica... Mar 2021Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis.
MATERIAL AND METHODS
Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5.
RESULTS
Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled.
CONCLUSIONS
Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.
Topics: Adult; Fecal Incontinence; Female; Humans; Obstetric Labor Complications; Pelvic Organ Prolapse; Pregnancy; Pregnancy Complications; Risk Factors; Urinary Incontinence
PubMed: 33064839
DOI: 10.1111/aogs.14027