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An online 1-day CBT workshop improves postpartum depression measures
Postpartum depression is common; however, there is a dearth of evidence to guide care. A randomised controlled trial (RCT) in Canada compared an online 1-day cognitive behavioural therapy (CBT) workshop in addition to usual care with usual care only. The intervention led to clinically important reductions in depression scores across a range of measures and improved measures of anxiety, infant bonding, and social support. This appears to be a feasible brief intervention that could be replicated in developed healthcare settings.
JAMA Psychiatry 2021;78:1200–7. doi: 10.1001/jamapsychiatry.2021.2488
Fractional carbon dioxide laser does not improve vulvovaginal symptoms in postmenopausal women
Vaginal laser therapy has gained attention in recent years as a treatment for genitourinary symptoms of the menopause. However, the evidence base is small and follow-up periods in studies are relatively short. A double-blind RCT in Australia compared a fractional carbon dioxide vaginal laser treatment (MonaLisa Touch) with sham treatment and evaluated a series of quality of life and symptom measures at 12 months following treatment. The study detected no difference between groups for overall symptom severity, mean quality of life score, vaginal health index score or in histological comparisons between groups. Given the relative safety, effectiveness and low cost of vaginal estrogens, it is questionable whether there is a future role for laser treatment in the light of this evidence.
JAMA 2021; 326:1381–9. doi: 10.1001/jama.2021.14892
Integrating routine TB and HIV screening for patients with cough who present to primary care in high prevalence settings shortens time to diagnosis
In regions with high prevalence of untreated HIV, tuberculosis (TB) often has a high prevalence, particularly in sub-Saharan Africa. In such settings, screening for these conditions in patients with cough presenting to primary care may be a valuable opportunity to diagnose and link to care. An open-label randomised trial in Malawi compared standard care, with HIV screening alone or in combination with digital computer-assisted chest X-ray. Time to diagnosis and initiation of treatment for TB was significantly reduced in the X-ray group. Lower proportions of patients had undiagnosed HIV in both screening groups compared with standard care. In the context of the study, the chest X-ray was not likely to be cost effective (although HIV testing was); however, this may not be the case in settings with higher prevalence of TB.
PLoS Med 2021; doi: 10.1371/journal.pmed.1003752
Vaginal estrogens do not improve prolapse symptoms prior to surgical repair
Pelvic organ prolapse is a relatively common condition that can be distressing and can affect bowel, bladder and sexual function. Some international guidance has discussed the use of vaginal estrogens pre- or post-surgical repair for postmenopausal women to improve these symptoms; however, the evidence base is weak. This double-blind RCT in Austria compared a daily estrogen vaginal cream pessary with placebo for 6 weeks prior to surgical repair. There were no significant differences across any symptom domains at this timepoint. It is unclear whether participants had demonstrable vulvovaginal atrophy on examination on entry to the study and the sample size was relatively small. It does not appear that this intervention is of value in those suffering with pelvic organ prolapse.
BJOG 2021; doi: 10.1111/1471–0528.16894
Osmotic dilator insertion prior to second-trimester surgical abortion is associated with moderate pain and opioid analgesia use
Optimising pain relief during abortion care is important for patient satisfaction and experience. Pain during surgical abortion is increasingly well studied; however, there are fewer studies examining pain caused by cervical pretreatment with osmotic dilators, placed 24 hours before dilatation and evacuation. In a retrospective cohort study in the USA, women were surveyed on pain experienced overnight following insertion of dilators and use of different analgesics. More than half required opioid analgesia and use of this was associated with increasing number of cervical dilators and higher pain score. Younger and nulliparous women reported higher pain scores. While the sample size was small, this study highlights that cervical pretreatment is an aspect of second-trimester abortion care that needs further study regarding pain and the identification of more effective pain relief interventions.
Eur J Contracept Reprod Health Care 2021; doi: 10.1080/13625187.2021.1975266
Experience of physical and sexual violence common among sex workers in the UK
Selling sex in the UK is technically legal; however, many aspects of sex work are criminalised, such as solicitation in public and working together in a premises, rendering sex work illegal in practice. A survey of sex workers in London found that sexual and physical violence was experienced by more than half of the respondents, with worse outcomes among street-based sex workers compared with those who worked off-street, including violence experienced from clients and the police. For street-based sex workers, displacement (being ‘moved along’) by police was associated with higher rates of client violence. Anxiety, depression and sexually transmitted infections were common among both groups. Decriminalisation of sex work is needed, together with investment in positive interventions such as housing, mental health resources, and support for recovering from and reporting violence.
Sex Transm Infect 2021; doi: 10.1136/sextrans-2021-055088
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.