Endometriosis, chronic pain, anxiety, and depression: A retrospective study among 12 million women

BACKGROUND

There is a lack of information regarding the impact of the physical symptoms associated with endometriosis and chronic pain on the mental health and well-being of affected women. Thus, our study aimed to evaluate the relationship between endometriosis, chronic pain, anxiety, and depression.

OBJECTIVE

Our study aimed to evaluate the relationship between endometriosis, chronic pain, and mental health disorders among women registered in a large database until 2014.

STUDY DESIGN

This was a retrospective population-based study involving 12,904,324 hospitalized women from the Healthcare Cost and Utilization Project (HCUP) database between 2007 and 2014. We calculated the prevalence of chronic pain, endometriosis, anxiety, and depression during the study period. We used multivariate logistic regression to examine the relationship between these variables.

RESULTS

An upward pattern was noted in the prevalence of chronic pain, while an opposite trend was seen for endometriosis during the study period. After adjusting for sociodemographic characteristics and comorbidities, including depression, the highest odds ratio of experiencing anxiety appeared in the group with both chronic pain and endometriosis (OR = 2.719, 95 % CI 2.481-2.979).

LIMITATIONS

HCUP is a cross-sectional administrative database that does not link patients' records over the years. Thus, we could not establish any temporal association between endometriosis, chronic pain, anxiety, and depression.

CONCLUSION

Potential associations were identified between endometriosis, with and without chronic pain, anxiety, and depression. We recommended that clinicians provide proper medical management of endometriosis-related pain through symptom management and adequate counseling for those suffering from anxiety and depression.

Asking questions can help: development and preliminary evaluation of a question prompt list for patients living with Heart Failure

Funding Acknowledgements

Type of funding sources: None.

Background

Discussing disease trajectories with patients living with chronic illnesses is recommended in guidelines worldwide and Heart Failure [HF] is no different. Discussions are centered around day-to-day disease management and less on illness trajectory including prognosis, symptoms, treatment options, preferences, and advanced care planning. Lack of open communication is common leading to prolonged suffering and unnecessary admissions [1] and can be improved when patients are able to initiate discussions, ask questions that are of concern to them, and engage in healthcare decision making [2,3].

A range of approaches have been employed to promote patient participation and empowerment. One such approach is the use of Question Prompt Lists [QPL]. Studies show that QPLs are linked to more questions asked, increased satisfaction, and reduced unmet information needs [3,4]. Despite this, they are less commonly used in non-oncology contexts and not available in Lebanon. Health system differences and cultural factors may influence content and impact of QPLs and as such cross-cultural adaptation is essential [5]. As the need for disclosure can vary among cultures, examining QPLs through an anthropological lens is imperative.

Purpose

To develop a culturally sensitive QPL designed to improve communication about HF illness trajectory.

Methods

A review of literature on HF QPLs was done. To address cultural and country specific needs, studies on HF from Lebanon and the Middle East were reviewed. This comprised the initial draft of a QPL that included context specific challenges and concerns. A Delphi survey inviting an interdisciplinary team of healthcare providers caring for HF patients was used to seek expert consensus regarding the draft. Sixteen experts rated each question for relevance, using a Likert scale from 0 to 4, clarity, and need to rephrase and suggested additional questions. Ratings were analyzed to determine the level of consensus. Questions that received less than 80% favorable answers [Very Relevant/Relevant and/or more than 20% indicated lack of clarity or the need to rephrase] were discussed in the second round of Delphi. Experts met and reviewed the comments provided on some questions and questions that were rated unfavorably, suggested for deletion, as well as those added by the panelists. Clarity of questions and suggestions for wording improvements was ensured.

Results

During the second round of Delphi, 12 questions were rephrased, one was dropped, and one was added. A final QPL of 42 questions and 6 categories was reached.

Conclusion

This is the first step of more research work that will aim at developing Arabic QPLs in the Middle East. The immediate next step would be repeating the Survey with patients, caregivers, and HF providers. Data will be analyzed using central tendency and levels of dispersion to assess consensus. The final QPLs will be translated to Arabic, culturally validated, and pilot tested in Lebanon.

'The newest vital sign among pregnant women attending women wellness and research Centre in Qatar: a cross-sectional study'

Background

Health literacy is a vital strategy to consider when designing health-promoting programs, and health literacy is a priority in Qatar’s national health agenda. In the context of pregnancy, inadequate health literacy has been linked to several adverse outcomes among pregnant women such as unplanned conception, smoking, and lack of multi-vitamin intake. Given the paucity of data, this study aimed to assess the level of health literacy and its determinants among pregnant women in the State of Qatar.

Methods

An analytical cross-sectional design was utilized. First, we piloted the measurement tools on 10% of the calculated sample size. Accordingly, the items of the measurement tools were revised. Next, we utilized a structured questionnaire to interview the participants about their socio-demographic characteristics, pregnancy-related factors, and the Newest Vital Sign Tool. A chi-square test was employed to investigate the association level among variables, with significance set to P < 0.05. A logistic regression model was used to identify the factors associated with a low literacy level.

Results

We found that almost four in 10 pregnant women (n = 138,45.4%) had inadequate health literacy. Furthermore, the insufficient level of health literacy was significantly associated with low educational background, decreased household income, and primigravida. However, uncontrolled glycaemia was the only significant predictor of inadequate health literacy through logistic regression. The scale was found to be reliable, with a calculated Cronbach’s alpha of 0.8.

Conclusions

Low health literacy is common among pregnant women in the State of Qatar. Thus, public health officials should focus on delivering tailored health literacy interventions to pregnant women in the country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03542-w.

Pregnancy with Takayasu's Arteritis: A Case Report and Literature Review

Takayasu's arteritis (TA) is a rare and chronic inflammatory disease of the large vessels. It affects women of reproductive age and leads to an increased risk of cardiovascular complications, such as hypertension and congestive heart failure. We are presenting a case of a pregnant woman with TA, who was seen and managed at a tertiary care institute and ultimately enjoyed a favorable outcome. Thus, multidisciplinary care for patients with TA has proven to be crucial in optimized and favorable maternal and fetal/neonatal outcomes.

The Baby-friendly Hospital Initiative and Qatar, 2016

Breastfeeding instills countless benefits that extend beyond the infant and child to the entire nation. One of the global targets set by the WHO to improve maternal, infant, and young child nutrition is to increase the rate of exclusive breast-feeding “in the first 6 months” up to at least 50% by 2025.³ Thus, as a global endeavor to promote and sustain breastfeeding, the WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) 1 year after the Innocenti Declaration of 1990. Regarding the State of Qatar, there was a 34% rate of early initiation of breastfeeding “within the first hour of birth” and a 29% rate of exclusive breastfeeding between 2010 and 2015. In Qatar during 2016, many obstacles in achieving the aforementioned global target remained. In addition, there are still no hospitals with a BFHI accreditation.

The antacid Talcid adsorbs and neutralizes all proteins secreted by H. pylori including VacA cytotoxin: a new mechanism for its ulcer-healing action?

BACKGROUND AND AIM

Helicobacter pylori culture supernatant containing VacA cytotoxin significantly inhibits gastric cell proliferation and delays healing of experimental gastric ulcers. Since cell proliferation is crucial for ulcer healing, the removal of inhibitory effects of H. pylori secreted cytotoxin would have a beneficial effect on the healing process. In this study, we determined whether the antacid Talcid can adsorb, remove, or neutralize H. pylori derived VacA cytotoxin responsible for the above deleterious actions.

METHODS

Supernatants of viable H. pylori isogenic strains producing VacA cytotoxin [VacA(+)] and with disrupted cytotoxin gene not producing cytotoxin [VacA(-)] were incubated with either placebo, Talcid 10 mg/ml, omeprazole 10 mg/ml (positive control) for 1-24 h. Treated supernatants were analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis to evaluate proteins. We also studied the effect of supernatants on epidermal growth factor stimulated Kato III cell proliferation using BrdU labeling.

RESULTS

Talcid very effectively removed from the H. pylori culture supernatant the approximately 90 kD VacA(+) cytotoxin at 3 and 24 h (99.5% removal vs. placebo-treated control; p<0.001). It also removed all other proteins, including 66-kD urease and 58-kD heat shock protein, secreted by both VacA(+) and VacA(-) H. pylori strains. Omeprazole was completely ineffective in this regard. Preincubation with Talcid completely abolished the inhibitory effect of VacA(+) H. pylori culture supernatant on epidermal growth factor stimulated Kato III cell proliferation.

CONCLUSION

Adsorption and neutralization by Talcid of all H. pylori secreted proteins may explain, at least in part, the ulcer-healing action of this drug.

Decreased endothelial nitric oxide synthase in gastric mucosa of rats with chronic renal failure

According to recent reports, chronic renal failure (CRF) increases the susceptibility of gastric mucosa to injury. Since nitric oxide plays a major role in gastric mucosal defense and injury, we investigated, in rats with CRF produced by five-sixths nephrectomy and in control rats, the expression of nitric oxide synthase(NOS) in the stomach and measured mucosal and submucosal gastric blood flow. In CRF rats, gastric mucosal blood flow was significantly reduced compared with control rats, whereas submucosal and serosal blood flow was significantly increased. CRF significantly decreased endothelial NOS (eNOS) mRNA abundance by 53% (P < 0.01) and reduced expression of eNOS protein by 42% (P < 0.01) compared with the controls. Enzyme activity of eNOS was significantly reduced in gastric mucosa of CRF rats (P < 0.05). These data are consistent with reduced gastric mucosal blood flow in CRF rats and can explain altered susceptibility of gastric mucosa to injury in CRF rats.

Tumor necrosis factor alpha regulates nitric oxide synthase expression in portal hypertensive gastric mucosa of rats

Anti-tumor necrosis factor alpha (TNF-alpha) treatment decreases nitric oxide (NO) synthesis and ameliorates the hyperdynamic circulation in portal hypertensive rats. We have recently demonstrated that nitric oxide synthase isoform 3 (NOS3) is overexpressed in portal hypertensive gastric mucosa and that resultant NO overproduction probably is responsible for the increased susceptibility of the mucosa to damage. In the present study, we examined whether TNF-alpha is overexpressed in portal hypertensive gastric mucosa and whether anti-TNF-alpha treatment affects gastric NOS3 messenger RNA (mRNA) and protein expression. We examined plasma concentrations of TNF-alpha and its protein expression in gastric specimens from portal hypertensive and sham-operated rats using Western blotting and immunohistochemistry. We also measured gastric mucosal blood flow, gastric expression of NOS3 mRNA and protein, and NOS3 enzyme activity in rats with and without TNF-alpha-neutralizing antibody treatment. The TNF-alpha protein levels in portal hypertensive stomachs were significantly increased by 57% compared with levels in sham-operated controls. TNF-alpha antibody treatment normalized gastric mucosal blood flow in portal hypertensive stomachs and significantly reversed overexpression of gastric NOS3 mRNA, protein, and its enzyme activity in portal hypertensive rats by 48%, 45%, and 33%, respectively. These results suggest that TNF-alpha may regulate NOS3 expression in the portal hypertensive stomach and that anti-TNF-alpha treatment may ameliorate the pathophysiological abnormalities of portal hypertensive gastric mucosa.

Tumor necrosis factor-alpha regulates inducible nitric oxide synthase gene expression in the portal hypertensive gastric mucosa of the rat

Increased expression of both nitric oxide synthase (NOS) and tumor necrosis factor-alpha (TNF-alpha) have been implicated in the hyperdynamic circulation of portal hypertension. Since overexpression of these proteins would affect gastric mucosal defenses, which are impaired in portal hypertension, we examined the expression and interrelationships of TNF-alpha and NOS in the gastric mucosa of portal hypertensive rats. Following staged portal vein ligation, gastric strips from portal hypertensive rats were incubated in organ culture medium with or without TNF-alpha antibody. The expression of TNF-alpha and NOS mRNAs was assessed by reverse transcription-polymerase chain reaction (RT-PCR) at baseline and after 1, 2, and 6 hours of incubation. RT-PCR demonstrated a threefold increase in inducible NOS mRNA and a 50% increase in TNF-alpha mRNA expression at baseline in portal hypertensive animals as compared to sham-operated animals. In tissue incubated with TNF-alpha neutralizing antibody, inducible NOS mRNA expression was significantly decreased by 40%, 70%, and 80% after 1, 2, and 6 hours, respectively. Since increased TNF-alpha and NOS production could potentially impair gastric mucosal defenses, our findings suggest a major role for these proteins in the development of portal hypertensive gastropathy.

Portal hypertension triggers local activation of inducible nitric oxide synthase gene in colonic mucosa

Recently a new clinical entity "portal hypertensive colopathy" has been reported. It involves vascular abnormalities and bleeding. Because nitric oxide may mediate these changes, we studied whether portal hypertension affects nitric oxide synthase in portal hypertensive colonic mucosa. In portal hypertensive and sham-operated rats the following studies were done: (1) colonic mucosal blood flow, (2) quantitative histologic examination, (3) reverse transcription-polymerase chain reaction for nitric oxide synthase mRNA, (4) nitric oxide synthase activity assay, and (5) immunostaining for nitric oxide synthase. In portal hypertensive rats, colonic mucosal blood flow and the number of submucosal veins were significantly increased in comparison to sham-operated rats. The mRNA expression and enzyme activity for inducible nitric oxide synthase (but not constitutive nitric oxide synthase) were significantly increased in portal hypertensive rats. Fluorescence signal intensity for inducible nitric oxide synthase in endothelia of mucosal and submucosal veins was significantly higher in portal hypertensive rats than in sham-operated rats. Portal hypertension activates inducible nitric oxide synthase gene and protein in colonic mucosal vessels. The excess of nitric oxide generated by overexpressed inducible nitric oxide synthase may play an important role in the development of vascular and hemodynamic abnormalities characterizing portal hypertensive colopathy.