Chronic Opioid Use in Women Following Hysterectomy: Patterns and Predictors

Background: Most women are prescribed an opioid after hysterectomy. The goal of this study was to determine the association between initial opioid prescribing characteristics and chronic opioid use after hysterectomy. Methods: This study included women enrolled in a commercial health plan who had a hysterectomy between 1 July 2010 and 31 March 2015. We used trajectory models to define chronic opioid use as patients with the highest probability of having an opioid prescription filled during the 6 months post‐surgery. A multivariable logistic regression was applied to examine the association between initial opioid dispensing (amount prescribed and duration of treatment) and chronic opioid use after adjusting for potential confounders. Results: A total of 693 of 50 127 (1.38%) opioid‐naïve women met the criteria for chronic opioid use following hysterectomy. The baseline variables and initial opioid prescription characteristics predicted the pattern of long‐term opioid use with moderate discrimination (c statistic = 0.70). Significant predictors of chronic opioid use included initial opioid daily dose (≥60 MME vs \u3c40 MME, aOR: 1.43, 95% CI: 1.14‐1.79) and days\u27 supply (4‐7 days vs 1‐3 days, aOR: 1.28, 95% CI: 1.06‐1.54; ≥8 days vs 1‐3 days, aOR: 1.41, 95% CI: 1.05‐1.89). Other significant baseline predictors included older age, abdominal or laparoscopic/robotic hysterectomy, tobacco use, psychiatric medication use, back pain, and headache. Conclusion: Initial opioid prescribing characteristics are associated with the risk of chronic opioid use after hysterectomy. Prescribing lower daily doses and shorter days\u27 supply of opioids to women after hysterectomy may result in lower risk of chronic opioid use

Saving and reproducing the nation: Struggles around right-wing politics of social reproduction, gender and race in austerity Europe

This article suggests the analytic lens of cultural, social and national reproduction to understand the centrality of gendered and ethnic relations, in particular a focus on family life in contemporary UK. Proposing a theoretical focus on reproduction, the article then provides some contextualisation with wider European experiences to show connections between the political articulations across the far-right and mainstream right-wing. It argues that there is much overlap between the far-right and mainstream rightwing, conservative gender and family ideologies, where contradictory aspects of their gender and family ideals (simultaneously progressive and traditional) are articulated as care for the nation's future. Care is then articulated for the purpose of racist activism and constructing governmental belonging. The racialized migrant family plays a central role in these debates, marking the boundaries of the nation. The article explores these issues in depth through the example of material and symbolic constructions of the racialized migrant family as undeserving of care, exemplified through the UK policy of No Recourse to Public Funding

Representation of women's health in general medical versus women's health specialty journals: a content analysis

BACKGROUND: Women's health, traditionally defined, emphasises reproductive and maternal conditions without consideration of social contexts. Advocates urge a broader conceptualisation. The medical literature influences the definitions and delivery of women's health care. We compared how women's health was represented in leading general medical (GM) versus women's health specialty (WS) journals. METHODS: Original investigations published between January 1 – June 30, 1999 in leading GM (n = 514) and WS (n = 82) journals were compared. Data were collected from 99 GM and 82 WS articles on women's health. Independent reviewers conducted content analyses of sample characteristics, study design, and health topic. Each article was classified as "Traditional" (e.g. menstruation, breast cancer), "Non-traditional" (e.g. abuse, osteoporosis), or "Both." RESULTS: Of the GM articles, 53 (53.5%) focused solely on a traditional women's health topic; half were reproductive and half female cancers. In contrast, 22 (26.8%) WS articles were traditionally focused. A non-traditional topic was the sole focus of 27 (27.3%) GM articles versus 34 (41.5%) WS articles. One-fifth of GM and one-third of WS articles addressed both. RCTs dominated the GM articles, while 40% of WS articles used qualitative or mixed study designs. Leading sources of women's death and disability were not well covered in either type of journal. CONCLUSIONS: Most GM articles drew on a narrow definition of women's health. WS journals provided more balanced coverage, addressing social concerns in addition to "navel-to-knees" women's health. Since GM journals have wide impact, editorial decisions and peer review processes should promote a broader conceptualisation of women's health

Locating sex-specific evidence on clinical questions in MEDLINE: a search filter for use on OvidSP™

<p>Abstract</p> <p>Background</p> <p>Many recently published clinical studies report sex-specific data. This information may help to improve clinical decision-making for both sexes, but it is not easily accessible in MEDLINE. The aim of this project was to develop and validate a search filter that would facilitate the retrieval of studies reporting high quality sex-specific data on clinical questions.</p> <p>Methods</p> <p>A filter was developed by screening titles, abstracts and Medical Subject Headings (MeSH) in a set of 80 high quality and relevant papers, 75 of which were identified through a review of clinical guidelines and five through other means. The filter, for use on OvidSP™, consists of nine command lines for searching free text words in the title, abstract and MeSH of a paper. It was able to identify 74/80 (92.5%) of the articles from which it was derived. The filter was evaluated in a set of 622 recently published original studies on Alzheimer's disease and on asthma. It was validated against a reference of 98 studies from this set, which provided high quality, clinically relevant, sex-specific evidence. Recall and precision were used as performance measures.</p> <p>Results</p> <p>The filter demonstrated 81/98 (83%) recall and 81/125 (65%) precision in retrieving relevant articles on Alzheimer's disease and on asthma. In comparison, only 30/98 (31%) recall would have been achieved if sex-specific MeSH terms only had been used.</p> <p>Conclusion</p> <p>This sex-specific search filter performs well in retrieving relevant papers, while its precision rate is good. It performs better than a search with sex-specific MeSH. The filter can be useful to anyone seeking sex-specific clinical evidence (e.g., guideline organizations, researchers, medical educators, clinicians).</p

A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy : application to an RCT of self-help delivered by text message

BACKGROUND/AIMS: Previous evaluations of smoking cessation interventions in pregnancy have several limitations. Our solution to these limitations is the Economics of Smoking in Pregnancy (ESIP) model which estimates the lifetime cost-effectiveness of smoking cessation interventions in pregnancy from a National Health Service (NHS) and personal social services perspective. We aim to (1) describe how ESIP has been constructed, and (2) illustrate its use with trial data. METHODS: ESIP links mothers' and offspring pregnancy outcomes to estimate the burdens of smoking-related disease they experience with different rates of smoking in pregnancy, both in pregnancy and across their lifetimes. Smoking rates are inputted by model users. ESIP then estimates the costs of treating disease burdens and also mothers' and offspring life years and quality-adjusted life years (QALYs). By comparing costs incurred and healthy life following different smoking rates, ESIP estimates incremental cost-effectiveness and benefit-cost ratios for mothers or offspring or both combined. We illustrate ESIP use using data from a pragmatic randomised controlled trial that tested a smoking cessation intervention in pregnancy. RESULTS: Across women's and offspring lifetimes, the intervention proved cheaper than usual care, having a negative incremental cost of £38.37 (interquartile range £21.46-£56.96) and it improved health, demonstrating a 0.04 increase in incremental QALYs for mothers and offspring, implying it is 'dominant' over usual care. Benefit-cost ratios suggested that every £1 spent would generate a median of £14 (interquartile range £8-£20) in healthcare savings. CONCLUSIONS: Economics of Smoking in Pregnancy (ESIP) is the first economic model to link mothers' and infants' costs and benefits whilst reporting cost-effectiveness in readily-comparable units. Using ESIP with data from a trial which reported only short-term economic analysis showed that the intervention was very likely to be cost-effective in the longer-term and to generate healthcare savings