MADM median scale scores, full sample and stratified by care provider.

<p>MADM median scale scores, full sample and stratified by care provider.</p

Average prenatal appointment lengths, by care provider type (n = 1723).

<p>Average prenatal appointment lengths, by care provider type (n = 1723).</p

Box plot: MADM scores by care provider type (Sample 1 = 1344).

<p>Median and interquartile range of MADM scores by care provider group for pregnancy 1 (n = 1344). The horizontal line inside each box represents the median score for each provider group, and the upper and lower boundaries of each box represent the upper and lower quartiles. The vertical lines represent the range of scores, excluding outliers, which are represented by open circles and asterisks.</p

Corrected item to total correlations and factor loadings of MADM items.

<p>Corrected item to total correlations and factor loadings of MADM items.</p

Scale items—Mothers Autonomy in Decision Making (MADM)¹.

<p>Scale items—Mothers Autonomy in Decision Making (MADM)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0171804#t001fn001" target="_blank">¹</a>.</p

Scree plots for Samples 1, 2, and 3.

<p>When examining construct validity indicators separately for physician and midwifery consumers in Sample 1, we found that factor loadings for women who were cared for by family physicians ranged from 0.73–0.88 (n = 264), 0.80–0.92 for women under the care of obstetricians (n = 150) and 0.64–0.91 for midwives (n = 927). For all care provider groups the scree plots showed one factor with an Eigenvalue above 5; all other Eigenvalues fell clearly below 1 (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0171804#pone.0171804.g002" target="_blank">Fig 2</a>).</p

MADM median scale scores, by average length of prenatal appointments.

<p>MADM median scale scores, by average length of prenatal appointments.</p

Cronbach alphas for MADM scale, full sample and by care provider type.

<p>Cronbach alphas for MADM scale, full sample and by care provider type.</p

Dissatisfaction with decision-making experience, by care provider type.

<p>Dissatisfaction with decision-making experience, by care provider type.</p

A systematic literature review on the clinical efficacy of low dose naltrexone and its effect on putative pathophysiological mechanisms among patients diagnosed with fibromyalgia

Background: Low dose naltrexone (LDN) is used off-label by many individuals with fibromyalgia to help manage their pain. There is no current systematic literature review summarising the evidence to support this use of LDN. The objectives of this study were to evaluate if patients with fibromyalgia prescribed LDN have reduced pain scores and greater quality of life compared with those allocated to placebo in randomized controlled trials. Secondly to determine if changes in inflammatory markers and brain structure and function are observed among patients with fibromyalgia taking LDN. Methods: Systematic literature searches were conducted in MEDLINE, Embase Classic + Embase, APA PsychInfo, and The Cochrane Library from inception to May 2022. Reference lists from the selected papers were cross-checked with database search results. Results: Three studies met our inclusion criteria for the assessment of efficacy, and two studies on potential LDN mechanisms. Results indicated some evidence to suggest LDN reduces pain and increases quality of life. One study reported baseline erythrocyte sedimentation rate (ESR) predicted LDN response (=30% reduction in fibromyalgia symptoms) and a second study showed plasma concentrations of inflammatory biomarkers were lower after LDN treatment. To our knowledge, there are no brain imaging studies reporting the effect of LDN in patients with fibromyalgia. All studies were based on small sample sizes, were restricted to women and the risk of bias was assessed to be high. There is also some evidence of publication bias. Conclusion: The strength of evidence from randomized controlled trials to support the use of LDN among patients with fibromyalgia is low. Two small studies suggest ESR and cytokines may be involved in the mechanism by which LDN exerts its effects. Two trials (INNOVA and FINAL) are currently in progress, but further work is needed among men and different ethnic groups