Cross-sectional study for derivation of a cut-off value for identification of an early versus delayed diagnosis of endometriosis based on analytical and descriptive research methods

BACKGROUND

Endometriosis is a benign, hormone-dependent, chronic inflammatory gynecological disease accompanied by cyclic and acyclic pelvic pain and other complaints. The long lists of research recommendations in the AWMF guideline (Burghaus et al., Geburtshilfe Frauenheilkd 81:422-46, 2021) and ESHRE Endometriosis Guideline (ESHRE Endometriosis Guideline Development Group, Endometriosis: Guideline of European Society of Human Reproduction and Embryology, 2022) show that there is still a great need for research in all aspects of the disease. Diagnostic delay, defined as the mean time between symptom onset and confirmed diagnosis, is a particular problem associated with endometriosis. Some quantitative and qualitative studies have investigated possible reasons for this. A range of physician-related (Dixon et al., Br J Gen Pract 71:e668-e676, 2021; van der Zanden and Nap, Reprod Biomed Online 32:527-31, 2016) and patient-related factors (Sayer-Jones and Sherman, Health Psychol Behav Med 9:456-79, 2021) as well as stigmatization of the topic of menstruation by society have been identified (Kruckenberg, Frauenarzt 59:2-5, 2018; Seear, Soc Sci Med 69:1220-7, 2009). The consequences of the disease being diagnosed late (or too late) on the course of disease, the quality of life and the costs of the disease have already been documented in studies (Sims Int J Environ Res Public Health 18(15):8210, 2021; Surrey Adv Ther 37:1087-99, 2020). However, a systematically derived cut-off value that clearly distinguishes between short and long delay is still lacking. Therefore, the aim of our study was to derive a threshold value for the definition of a target corridor for endometriosis diagnosis based on descriptive and analytical methods.

METHODS

Since our review of the rather sparse publications on diagnostic delay did not yield satisfactory results, we used descriptive statistics and location parameters to calculate a cut-off value for German population data from the EndoCost study. Statistical methods were used for correlation analysis of shortDD versus longDD (correlation analysis and logistic regression) and group membership (discriminant analysis).

RESULTS

Five years was identified as the cut-off value that significantly differentiated between shortDD and longDD based on various disease-related variables. This suggests that endometriosis should be definitively diagnosed within less than five years to minimize the risk of an unfavorable course of the disease.

CONCLUSION

Our findings confirmed that an early onset of endometriosis-related symptoms is the most important risk factor for a long diagnostic delay. Consequently, adolescent females should receive increased attention as an especially vulnerable group. Evidently, there is an urgent need to develop adequate concepts to improve the endometriosis education and care among this target group.

Models and evidence of intersectoral cooperation in prevention and health promotion

Background

Inter-sectoral coalitions are regarded as a key principle of health promotion. The study examines the questions of how these are defined, which scientific theories and models are available, and which methods and parameters are used for their evaluation.

Methods

The scoping review in three databases (PubMed, Web of Science, LIVIVO) included studies in English and German published in 1/2010 to 5/2018. The results were analyzed qualitatively. In addition, relevant websites and textbooks in the field of public health, health promotion and social work were subjected to a document analysis in an iterative procedure.

Results

The database searches yielded 186 hits, of which 48 publications were systematically examined. Document analysis revealed 128 materials. Six common terms on inter-sectoral cooperation (network, collaboration, partnership, coalition, cooperation, alliance) were identified. Uniform definitions and unambiguous distinctions do not exist. Overall, only a few of the identified inter-sectoral collaborations are theoretically based, nine publications present models. Only seven studies provide insights into the effectiveness of model/theory-based strategies, whereby these almost exclusively examine output parameters. In particular, there are parameters on structure and process (e.g. team functioning, coalition capacity). Qualitative success factors and barriers were identified (e.g. integration of different actors, development of new financial sources, formalization). Eight validated instruments are identified. Four studies also examine the outcome level and demonstrate intended effects on behavioral parameters.

Conclusions

For research and practice, it is necessary to sharpen the terminology of intersectoral cooperation. Existing models should be systematically used and evaluated. In the future, an evaluation of the outcome of inter-sectoral cooperation and long-term effects will be increasingly necessary.

Key messages

Inter-sectoral coalitions are an evolving field, and both their theoretical foundation and empirical testing are still in their infancy. While success factors are well investigated, evaluations at the outcomes level are particularly necessary.

Tonsillektomienachblutungen im Zeitraum von 1985 bis 2001 und Erfahrungen bei der Anwendung der Lasertonsillotomie bei Kleinkindern

BACKGROUND

Tonsillectomy is one of the most often performed surgery in our specialty. But postoperative bleeding is not only a statistic risk, it can lead to a tragic end individually. In the future and according to the DRGs, a postoperative stay in hospital for more than 6 days will be difficult to realise.

METHODS

10 052 patients after tonsillectomy were measured, 7663 were performed in the ORL-Department of Würzburg, 2389 in the ORL-Department of Augsburg. Further data was measured by questioning the parents of 65 young children after lasertonsillotomy.

PATIENTS

The patient group of the tonsillectomies included all ages, the group of the lasertonsillotomies included young children aged 1- 6 years.

RESULTS

The first spike of bleedings of the ORL-Department in Würzburg was found within the first 24 hours after surgery. A second spike showed between the 5 (th) and 7 (th) postoperative day, an other after the 8 (th) and 15 (th) postoperative day. In the ORL-Department Augsburg the main spike was found from the 7 (th) until the 9 (th) postoperative day. No postoperative bleedings were found in the lasertonsillotomies.

CONCLUSIONS

A postoperative stay in hospital is sufficient for 3 days, but should vary individually. On young children with symptomatic hyperplasia of the tonsils a lasertonsillotomy should be performed.