Behavioral changes before metritis diagnosis in dairy cows.

Metritis is common in the days after calving and can reduce milk production and reproductive performance. The aim of this study was to identify changes in feeding and social behavior at the feed bunk, as well as changes in lying behavior before metritis diagnosis. Initially healthy Holstein cows were followed from 3 wk before to 3 wk after calving. Behaviors at the feed bunk were recorded using an electronic feeding system. Lying behavior was recorded using data loggers. Metritis, based upon the characteristics of vaginal discharge at d 3, 6, 9, 12 and 15 after calving, was diagnosed in 74 otherwise healthy cows. Behavior of these cows, beginning 2 wk before calving until the day of diagnosis, was compared with 98 healthy cows (never diagnosed with any health disorder, including ketosis, mastitis, and lameness) during the transition period. During the 2 wk before calving, cows later diagnosed with metritis had reduced lying time and fewer lying bouts compared with healthy cows. In the 3 d before clinical diagnosis, cows that developed metritis ate less, consumed fewer meals, were replaced more often at the feed bunk, and had fewer lying bouts of longer duration compared with healthy cows. We concluded that changes in feeding as well as social and lying behavior could contribute to identification of cows at risk of metritis.

Changes in feeding, social, and lying behaviors in dairy cows with metritis following treatment with a nonsteroidal anti-inflammatory drug as adjunctive treatment to an antimicrobial.

Dairy cows with metritis display sickness behaviors, and nonsteroidal anti-inflammatory drugs (NSAID) have the potential to reduce these responses. The objective of this study was to investigate changes in feeding, social, and lying behaviors in dairy cows with metritis that had been treated with the NSAID meloxicam. After parturition, cows were housed in a dynamic, mixed-parity group of 20 animals with access to 12 electronic feed bins, 2 electronic water bins, and 24 lying stalls in a freestall pen. Every third day after parturition, vaginal discharge was evaluated to diagnose metritis based on the presence of foul smell and characteristic visual appearance. When diagnosed with metritis, animals (n = 87) were randomly allocated to receive either a single dose of meloxicam (0.5 mg/kg of body weight subcutaneously) or a placebo solution. All metritic animals received an antimicrobial (ceftiofur) for 5 d. We measured feeding and social behaviors at the feed bunk, as well as lying behaviors, and assessed within-cow changes from the day before to the day of (d 0) NSAID treatment, and from the day before to d 1 to 5 after treatment. Generally, behaviors changed around the day of diagnosis of metritis. Compared with the placebo group, cows that received meloxicam had a greater increase in the number of visits to the feeder, but tended to show less of an increase in dry matter intake and feeding time. These differences did not persist beyond 24 h after NSAID treatment. We observed no differences in changes in number of meals and feeding rate on d 0, but from d 1 to 5 cows treated with meloxicam had a lesser decrease in the number of meals and tended to have a greater decrease in feeding rate than did placebo-treated cows. In multiparous cows on d 0 and from d 1 to 5, meloxicam treatment was associated with decreased lying times. In primiparous cows, lying time changes were similar between treatments on d 0, but lying times increased more on d 1 to 5 for meloxicam than for placebo cows. Overall, cows changed the number of lying bouts on d 0, and this increase tended to be smaller for the meloxicam cows. There were no treatment differences in changes of social behavior. In summary, we observed inconsistent and generally small effects of a single dose of meloxicam in addition to antimicrobial therapy on the behavior of cows with metritis.

Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study.

Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients.

Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study.

OBJECTIVE: To identify risk factors for pelvic inflammatory disease (PID) in female students. METHODS: We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004-2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. RESULTS: Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. CONCLUSIONS: Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT00115388).

Acupuncture for chronic pelvic inflammatory disease: a qualitative study of patients' insistence on treatment.

BACKGROUND: Acupuncture is an effective complement to pharmacological therapy in the alleviation of chronic pelvic inflammatory disease (PID). It has mild or no side effects; however, a minimum of 3 months of therapy is required to guarantee a beneficial outcome. This study investigates why patients insist on acupuncture therapy to aid recuperation. METHODS: The study included a purposive sample of 15 participants diagnosed with chronic PID who had received a course of acupuncture therapy at least twice a week for a minimum of 3 months. Semi-structured interviews were conducted, recorded, transcribed, coded and analyzed using systematic text condensation. RESULTS: Four overarching themes were identified from the participants' reasons for insisting on lengthy, but in their view important, acupuncture courses. The four overarching themes were: (1) the patients' characteristics, including pregnancy aspiration and the fear of serious gynecological disease; (2) the patient-practitioner relationship, including the acupuncturist's attitude towards the patients and the explanation of the disease from a traditional Chinese medicine (TCM) perspective; (3) the characteristics of acupuncture, including the diversification of treatment modes, the synthetical effect, and no side-effects; and (4) the clinical environment, including the exchange of experience between patients and the well-equipped setting. CONCLUSIONS: There were mixed reasons for patients diagnosed with chronic PID maintaining acupuncture treatments. Knowledge and understanding about the acupuncture-disease relationship were conducive to the patients' preference for acupuncture. Acupuncture as a complement to Western medicine should be further developed while maintaining these positive features. Participants reported feeling hope, confidence, and a sense of responsibility for their treatment during the process, although the treatments did not always have the expected outcome.

Women's experiences of pelvic inflammatory disease: implications for health-care professionals.

This study explored the health-care experiences of women diagnosed with pelvic inflammatory disease. Semi-structured interviews were conducted with 23 women diagnosed with pelvic inflammatory disease. Many women felt empowered about their health post-diagnosis; however, a smaller number reported becoming hyper-vigilant towards symptoms. Infertility was the greatest concern for women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively. The findings highlight the need for community education encouraging early presentation for the treatment of pelvic pain and emphasise the need for health practitioners to be responsive to the psychosocial aspects of pelvic inflammatory disease.

Effects of reproductive morbidity on women's lives and costs of accessing treatment in Yemen.

Research on the consequences of reproductive morbidity for women's lives and their economic and social roles is relatively under-developed. There is also a lack of consensus on appropriate conceptual frameworks to understand the social determinants of reproductive morbidity as well as their social and economic implications. We report here on an exploratory study in Yemen using quantitative (n=72 women) and qualitative methods (n=35 women), in 2005 and 2007 respectively, with women suffering from uterine prolapse, infertility or pelvic inflammatory disease (PID). It explored women's views on how reproductive morbidity affected their lives, marital security and their households, and the burden of paying for treatment. We also interviewed six health professionals about women's health care-seeking for these conditions. Sixty per cent of women reported that treatment was not affordable, and 43% had to sell assets or take out a loan to pay for care. Prolapse and PID interfered particularly in subsistence and household activities while infertility created social pressure. Reproductive morbidity is not a priority in Yemen, given its multiple public health needs and low resources, but by failing to provide comprehensive and affordable services for women, the country incurs developmental losses.

Results of a randomized controlled trial of a brief behavioral intervention for pelvic inflammatory disease in adolescents.

OBJECTIVE: The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of pelvic inflammatory disease, on subsequent behaviors by patients who were urban adolescents in a community in which sexually transmitted infection was prevalent. METHODS: 121 adolescents aged 15 to 21 years with mild to moderate pelvic inflammatory disease were enrolled in a randomized trial. All participants received standardized care, completed baseline audio computerized self-interviews, received full courses of medication at discharge, and were interviewed after the 2-week treatment course. The intervention group also watched a 6-minute intervention video. MAIN OUTCOME MEASURES: Medication completion, temporary sexual abstinence during the 14-day treatment period, partner notification, partner treatment, and return for 72-hour follow-up were studied. Data were evaluated using multivariate regression analysis. RESULTS: Of the participants, 61% were located and could participate in the 2-week interview by the disease intervention specialist. The intervention participants had higher rates of 72-hour follow-up (32% vs. 16%) and partner treatment (71% vs. 53%) in bivariate analyses at a P = 0.1 level. There were no differences in medication completion (66% vs. 66%), sexual abstinence (78% vs. 89%), or partner notification (88% vs. 92%). Only the partner-treatment finding persisted in multivariate models (AOR = 3.10; 95% CI, 1.03-9.39, P = .045). CONCLUSIONS: 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. 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 efficacy of alum-containing ferrous thermal water in the management of chronic inflammatory gynaecological disorders--a randomized controlled study.

OBJECTIVES: Treatment of gynaecological disorders is a frequent, but only barely substantiated application of balneotherapy. This study investigated potential differences between the clinical symptoms, pelvic blood flow and specific laboratory parameters of patients undergoing balneotherapy with two different types of immersion: alum-containing and tap water. STUDY DESIGN: The study population comprised 40 patients (mean age: 39.4 years), randomized into two groups. All subjects took 20 min baths in 38 degrees C water every other day, for 10 occasions altogether. Study parameters were: pain relief, reduction in tissue growth, hormone levels, psychic status, and pelvic blood flow. RESULTS: Thermal water improved the clinical parameters of both groups significantly. In comparison with tap water, treatment with alum-containing water accomplished significantly greater progress, as reflected by the relief of pain elicited by handling the uterus and improvement of psychic status. Laboratory parameters (FSH, LH, prolactin, oestradiol and beta-endorphin serum levels) and the Doppler index did not change in either group. CONCLUSIONS: As demonstrated by our results, 3-week balneotherapy is a potentially useful adjunct for the management of chronic pelvic inflammatory disease, but further, long-term studies are notwithstanding necessary.

Quality of life utilities for pelvic inflammatory disease health states.

PURPOSE: Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. METHODS: We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. RESULTS: Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. CONCLUSION: PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.

Preferences for fertility in women with pelvic inflammatory disease.

OBJECTIVE: To identify the value that women with pelvic inflammatory disease (PID) assign to the health impact of future infertility. DESIGN: Cross-sectional observations on patient preferences. SETTING: Participants in an existing multicenter clinical trial of PID treatment options. PATIENT(S): Five hundred thirty-two women with signs and symptoms of PID who were identified from emergency departments and sexually transmitted disease clinics. INTERVENTION(S): Women were asked to rate whether life with future infertility was more or less meaningful than life with each of seven chronic health conditions: sinus congestion, insomnia, chronic headache, asthma, incontinence, dialysis, and paralysis. MAIN OUTCOME MEASURE(S): Preferences regarding future infertility. RESULT(S): Most respondents rated future infertility as being worse than sinus congestion and asthma but better than the health impact of incontinence, dialysis, and paralysis. There was a wide range of opinion, with 18% viewing future infertility as minor (better than all conditions) and 5% viewing it as extremely important (worse than all conditions). Future infertility ratings were influenced by race, parity, difficulty in conceiving, and views on the importance of future pregnancy. CONCLUSION(S): The majority of women with PID rate future infertility as a significant issue. Optimizing access to infertility treatment may affect the quality of life for such women.

Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease.

OBJECTIVE: To evaluate the morbidity from chronic pelvic pain after pelvic inflammatory disease (PID). METHODS: A total of 547 women were studied as part of the PID Evaluation and Clinical Health (PEACH) Study. Chronic pelvic pain was defined as pelvic pain reported at two or more consecutive interviews conducted every 3 to 4 months through 32 months and was graded as mild to moderate (low pain intensity) or moderate to severe (high pain intensity). Mean Medical Outcomes Study Short Form (SF-36) scores at 32 months were compared by chronic pelvic pain categories. RESULTS: The mean (+/- standard deviation) physical health composite scores and mental health composite scores from the SF-36 were progressively lower among women with increasing grade of chronic pelvic pain (physical health composite scores: no chronic pelvic pain = 87.3 +/- 10.7, mild to moderate chronic pelvic pain = 79.1 +/- 14.6, moderate to severe chronic pelvic pain = 73.6 +/- 16.0, P < .01; mental health composite scores: no chronic pelvic pain = 78.7 +/- 13.6, mild to moderate chronic pelvic pain = 69.1 +/- 15.8, moderate to severe chronic pelvic pain = 67.5 +/- 17.1, P < or = .01). Individual physical function, bodily pain, general health, vitality, social function, and mental health scores were also significantly lower among women with chronic pelvic pain and by increasing grade of pain intensity. CONCLUSION: Chronic pelvic pain after PID is associated with reduced physical and mental health.

Vulvar vestibulitis: a multi-factorial condition.

OBJECTIVE: To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non-symptomatic control group. DESIGN: A case-control study conducted in 1998. SETTING: Two clinics in northern Sweden. SAMPLE: Thirty-eight women, 18-25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls. METHODS: The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints. RESULTS: Regarding personality aspects the women with vulvar vestibulitis scored significantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a significantly higher number of somatic complaints in several areas. CONCLUSIONS: The findings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might influence their experience and management of pain and stress. A multi-factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.

Minority women with sexually transmitted diseases: sexual abuse and risk for pelvic inflammatory disease.

Mexican American and African American women (N = 617) with a sexually transmitted disease (STD) underwent a targeted physical exam and questioning regarding sexual abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship between sexual abuse and risk for PID. Sexually abused women (n = 194) reported higher PID risk behaviors, including earlier coitus, more sex partners, higher STD recurrence, and a tendency toward delayed health-seeking behavior. They also reported more severe genitourinary symptomatology, confirmed by physical exam, and presumptive diagnoses of PID. These characteristics identify sexually abused women at high risk for PID. Because of its considerable impact on risk for PID, assessment for sexual abuse is essential in clinical management of women with STD and for diagnosis of PID.

[Dyspareunia and algopareunia]. / Dyspareunie und Algopareunie.

On the basis of sexuological examination of 152 married women with pelvic inflammatory disease it is proposed to use the term of dyspareunia in patients who have pains during coitus and who are dissatisfied with the course of sexual intercourse. For probands who had unpleasant or even painful feelings during coitus but were in 93% of cases satisfied with sexual life, it would be suitable to use the term of algopareunia.

A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners.

OBJECTIVE: To investigate and compare the demographic and psychosocial profiles of women with chronic pelvic pain, chronic pain in a different site, and those with no history of pain with specific reference to a history of sexual abuse. DESIGN: A prospective comparative study. SETTING: Pelvic Pain Clinic at Leicester General Hospital NHS Trust, Pain Management Clinic at Leicester Royal Infirmary NHS Trust and two General Practices. PARTICIPANTS: Thirty women with chronic pelvic pain, 30 women with chronic pain in a different site and 30 women attending their general practitioner with no history of pain. INTERVENTIONS: A specifically designed patient profile questionnaire to identify and explore incidents of sexual and physical abuse was administered to each woman by a research psychologist for confidential self-completion. Data were also collected on other demographic, medical and psychosocial characteristics. RESULTS: Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other genital contact compared with the two comparison groups. The prevalence of physical abuse was the same in all groups. Women in the pelvic pain group were more likely to have approached their GP for symptoms not related to pelvic pain than women in the other two groups and the incidence of clinical anxiety was significantly higher in this group compared with the pain-free group. The prevalence of sexual problems was much higher in the group with pelvic pain compared with the other two groups. CONCLUSION: These findings indicate that women with chronic pelvic pain have a higher incidence of past sexual abuse compared with women in a comparison pain group and with women with no pain.