RESUMEN
Chronic pelvic pain (CPP) affects 2.1-24% of women. Frequently, no underlying pathology is identified, and the pain is difficult to manage. Gabapentin is prescribed for CPP despite no robust evidence of efficacy. We performed a pilot trial in two UK centres to inform the planning of a future multicentre RCT to evaluate gabapentin in CPP management. Our primary objective was to determine levels of participant recruitment and retention. Secondary objectives included estimating potential effectiveness, acceptability to participants of trial methodology, and cost-effectiveness of gabapentin. Women with CPP and no obvious pelvic pathology were assigned to an increasing regimen of gabapentin (300-2700 mg daily) or placebo. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to six months. The analyses by treatment group were by intention-to-treat. Interviews were conducted to evaluate women's experiences of the trial. A probabilistic decision analytical model was used to estimate cost-effectiveness. Between September 2012-2013, 47 women (34% of those eligible) were randomised (22 to gabapentin, 25 to placebo), and 25 (53%) completed six-month follow-up. Participants on gabapentin had less pain (BPI difference 1.72 points, 95% CI:0.07-3.36), and an improvement in mood (HADS difference 4.35 points, 95% CI:1.97-6.73) at six months than those allocated placebo. The majority of participants described their trial experience favorably. At the UK threshold for willingness-to-pay, the probabilities of gabapentin or no treatment being cost-effective are similar. A pilot trial assessing gabapentin for CPP was feasible, but uncertainty remains, highlighting the need for a large definitive trial.
Asunto(s)
Aminas/uso terapéutico , Analgésicos/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Dolor Pélvico/tratamiento farmacológico , Ácido gamma-Aminobutírico/uso terapéutico , Adolescente , Adulto , Aminas/economía , Analgésicos/economía , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/economía , Análisis Costo-Beneficio , Ácidos Ciclohexanocarboxílicos/economía , Femenino , Gabapentina , Humanos , Modelos Estadísticos , Evaluación de Resultado en la Atención de Salud , Manejo del Dolor/métodos , Dolor Pélvico/economía , Proyectos Piloto , Estudios Prospectivos , Adulto Joven , Ácido gamma-Aminobutírico/economíaRESUMEN
Guidelines issued by a number of bodies highlight the importance of providing information on fertility for young adults receiving a cancer diagnosis. However, previous research has established that provision is uneven and even when information is available, counselling may not be offered. This paper draws on interviews with 15 professionals and 30 younger adults (17-39 years) following a diagnosis of cancer at one tertiary referral centre. Sociological insights highlight the disruption to biographies, plans, identities and personal values involved in acknowledging and responding to the impact of cancer on fertility. Patients and professionals are involved in making difficult decisions in a rapidly evolving situation, in terms of both progression of cancer and advances in treatments for cancer and fertility preservation. It is argued that the constellation of knowledge and skills required does not readily map onto existing professional roles and we suggest that it may be appropriate to provide further training or even to draw on the services of specialist 'oncofertility' counsellors.
Asunto(s)
Consejo , Infertilidad/psicología , Neoplasias/psicología , Adolescente , Humanos , Neoplasias/terapiaRESUMEN
BACKGROUND: Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law's role in (a) her daughter-in-law's ANC uptake; and (b) the decision-making process about using ANC services in Nepal. METHODS: In-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities. RESULTS: Our findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC. CONCLUSION: Mothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources.