vicky3 2009-11-25 11:27
影像介入方式有助於改善骨盆腔發炎
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
【24drs.com】November 6, 2009 — 根據9月4日線上版小兒及青少年婦產科期刊(Journal of Pediatric and Adolescent Gynecology)的一篇隨機控制試驗結果，一種有社區特性的影像介入方式，有助於改善骨盆腔發炎疾病(pelvic inflammatory disease，PID)青少女之伴侶的治療比率。
第一作者、約翰霍普金斯大學醫學院的Maria Trent醫師等人寫道，雖然目前無症狀之性傳染感染症(sexually transmitted infection，STI)篩檢計畫，成功降低美國女性的PID整體比率，但青春期弱勢少女的PID比率依舊是無法接受的高。本研究的目標是檢視一種在診斷PID時提供的短期行為介入，對於隨後行為的效果；研究對象是STI盛行之都會社區的青少年。
研究樣本包括121名年紀在15至21歲、有輕微到中度PID的青少年，被隨機指派到介入組或控制組。介入組觀看一部6分鐘、有社區特性的介入影片，介紹有關PID診斷的青少女議題，包括告知伴侶且鼓勵他尋求治療、完成兩週的抗生素治療處方、回診追蹤照護、且完成治療前需禁止性行為。
所有的參與者都接受標準照護，出院時有完整的藥物療程，開始時，全部都完成影像電腦化自我訪問，完成兩週治療之後，則接受疾病介入專家訪問。
藉由多變項回歸分析評估初級研究終點，包括藥物完成率、治療期間暫時性禁止性行為、伴侶告知與治療、72小時回診追蹤率。
有61%的參與者參加兩週後的訪問。雙變項分析發現，相較於控制組，介入組的參與者有較高的72小時回診追蹤率(32% vs 16%)與伴侶治療率(71% vs 53%；P = 0.1)。
兩組的藥物完成率(66% vs 66%)、禁止性行為(78% vs 89%)、伴侶告知(88% vs 92%)皆相似。多變項模式中，兩組之間只有伴侶治療率有顯著差異(校正勝算比為3.10；95%信心區間為1.03 – 9.39；P = .045)。
Trent醫師在新聞稿中表示，好消息是，我們讓這些女孩告知她們的伴侶，並讓他們接受治療，這很好，但還有許多工作需要完成，才可以預防和治療這些感染。未來10或20年，這些女孩變成婦女時，可能會因為不孕和慢性婦科問題回來就醫。
研究限制包括，研究的各種遵從行為都無法達到統計上的顯著意義、研究樣本的種族有限無法呈現種族差異、使用面對面訪談以及自我報告遵從行為可能會有潛在的偏見，以及有很多人失去追蹤。
研究作者結論表示，診斷有骨盆腔發炎疾病時，將青少女隨機指派接受有社區特性的影片介入，則其伴侶接受治療的比率是控制組的3倍。因為伴侶治療對於間接預防性傳染疾病有其價值，此影片可能是緊急照護模式之出院計畫中重要的一環。需要其他結構面的支持，以幫助改善各個關鍵遵從行為的遵從性。
Robert Wood Johnson基金會、美國疾病控制中心、Thomas Wilson Sanitarium巴爾的摩市孩童基金會、John and Mary McCarthy基金會等支持本研究。
J Pediatr Adolesc Gynecol.。線上發表於2009年9月4日。
Video Intervention May Improve Treatment for Partners of Teen Girls With Pelvic Inflammatory Disease
By Laurie Barclay, MD
Medscape Medical News
November 6, 2009 - A community-specific video intervention may improve rates of treatment for partners of adolescent girls with pelvic inflammatory disease (PID), according to the results of a randomized controlled trial reported online in September 4 in the Journal of Pediatric and Adolescent Gynecology.
"Although the current generation of screening programs for asymptomatic sexually transmitted infection (STI) has been successful in reducing the overall rates of [PID] in women in the United States, PID rates remain unacceptably high among adolescent minority girls," write lead author Maria Trent, MD, MPH, from Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues. "The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of [PID], on subsequent behaviors by patients who were urban adolescents in a community in which [STI] was prevalent."
The study sample consisted of 121 adolescents aged 15 to 21 years with mild to moderate PID who were randomly assigned to either an intervention group or a control group. The intervention group watched a 6-minute, community-specific intervention video showing adolescent girls diagnosed with PID. Issues covered in the video included notifying the partner and urging him to seek treatment, completing the prescribed 2-week course of antibiotic treatment, returning for follow-up care, and abstaining from sexual activity until treatment was completed.
All participants received standardized care and full courses of medication at discharge, and all completed baseline audio computerized self-interviews and were interviewed by a disease intervention specialist after the 2-week treatment course had been completed.
Multivariate regression analysis allowed evaluation of primary study endpoints, including medication completion, temporary sexual abstinence during treatment, partner notification and treatment, and return for 72-hour follow-up.
The 2-week interview was attended by 61% of participants. Bivariate analyses revealed that compared with the control group, the intervention participants had higher rates of 72-hour follow-up (32% vs 16%) and partner treatment (71% vs 53%; P = 0.1).
Both groups had similar rates of medication completion (66% vs 66%), sexual abstinence (78% vs 89%), and partner notification (88% vs 92%). In multivariate models, only the rate of partner treatment was significantly different between groups (adjusted odds ratio, 3.10; 95% confidence interval, 1.03 - 9.39; P = .045).
"The good news is we got these girls to talk to their partners and get them treated, which is great, but there is clearly a whole lot of work to be done to prevent and treat these infections," Dr. Trent said in a news release. "In 10 or 20 years, these teen girls will come back to us as women suffering from infertility and chronic gynecologic problems."
Limitations of this study include inability to reach statistical significance for all the adherence behaviors studied, limited racial and ethnic diversity of the study sample, potential bias related to use of face-to-face interviews and self-reported adherence measures, and large loss to follow-up.
"Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group," the study authors conclude. "Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors."
The Robert Wood Johnson Foundation, the US Centers for Disease Control, the Thomas Wilson Sanitarium Foundation for the Children of Baltimore City, and the John and Mary McCarthy Foundation supported this study.
J Pediatr Adolesc Gynecol. Published online September 4, 2009.