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The Evidence Speaks

The Evidence Speaks (May 2018)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Nikoo M, Vogel M, Choi F, Song MJ, Burghardt J, … Barbic S, Schütz CKrausz M, et al. Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone. Int. JDrug Policy. 2018;57:18-24.

Often overlooked in other studies on medication-assisted treatment, employment is increasingly being shown to be associated with improved treatment outcomes of opioid dependence. In a secondary analysis of the data from the Study to Assess Long-term Opioid Maintenance Effectiveness (SALOME), Drs. Skye Barbic, Christian SchützMichael Krausz, and other researchers from UBC and the University of Basel aimed to assess employment and paid work among participants and determine factors associated with paid work. Other forms of income generation and “under-the-table” work were included in the study outcomes in addition to official forms of employment as a more sensitive indicator of participants’ ability and motivation to work and providing an avenue to better understand experiences with employment in this population. To assess paid work, participants were asked the number of days they were paid for work in the past 30 days at 5 time points throughout the trial. Over 800 observations were included in the final multivariable analysis that was adjusted for age, gender, treatment arms, study time points, days receiving study treatment, physical and psychological health, and crack cocaine use in the past 30 days. 98% of participants reported unemployment in their lifetime. At each time point, roughly 4% of participants reported employment in the past 30 days, which is lower than rates seen in other studies. The lower rate may be the result of inclusion criteria specifying participants with more severe and chronic disorders or due to differences between the employment program of B.C. and other vocational reintegration systems, age of participants, and other eligibility criteria. In the unadjusted model, age and university or college education were associated with higher odds of paid work in the last 30 days and poor health and crack cocaine use were associated with lower odds. Only university or college education was associated with paid work in the adjusted model, roughly doubling the odds. The authors hypothesized that this could be due to the possession of more extensive skill-based training, but could also be tied to socio-economic status which the study didn’t control for. The information from this secondary analysis serves as motivation for the provision of supported employment and occupational therapy to help close the gap between the proportion of participants paid for work and the provincial employment rate.

Hyakutake MT, Han V, Baerg L, Koenig NA, Cundiff GW, Lee T, Geoffrion R. Pregnancy-Associated Pelvic Floor Health Knowledge and Reduction of Symptoms: The PREPARED Randomized Controlled Trial. JOGC. 2018 Apr; 40(4):418-425. Epub 2018 Apr 18.

Despite nearly a quarter of adult women being affected by pelvic floor disorders such as urinary incontinence, pelvic organ prolapse, and anal incontinence, often arising first during pregnancy, antenatal education fails to routinely cover this topic. Through a randomized control trial researchers from the University of Alberta and UBC, including CHÉOS Scientist Dr. Geoffrey Cundiff and statistician Dr. Terry Lee, attempted to determine whether a pregnancy workshop would impact postpartum pelvic floor health knowledge, performance of pelvic floor muscle exercise, symptoms, condition-specific quality of life, and mode of and satisfaction with delivery. One hundred women pregnant for the first time were randomized to either receive a pelvic floor health workshop or routine prenatal care. Postpartum data were available for 37 women per group. Women who received the pelvic floor workshop scored higher on a pelvic floor knowledge questionnaire and a greater proportion reported daily performance of pelvic floor muscle exercise, higher confidence in performing the exercises, and fewer bowel symptoms. No differences were found between groups in urinary or prolapse symptoms, mode of delivery, complications, or satisfaction. The study helps fill the dearth in research on the benefits of educational workshops on pelvic floor disorder knowledge and provides a focus on pregnant women not yet explored elsewhere. It demonstrates that educational workshops can help fill the knowledge gap in antenatal education for women in their first pregnancy. The improvement in women’s confidence levels in their ability to correctly perform pelvic floor exercises suggests that workshops may also help improve self-efficacy, a factor in motivating women to perform these exercises which is important because knowledge alone is not sufficient to motivate behavioural change. These results may not be generalizable to all obstetrical patients, including those that are less educated and more racially diverse, and more research is needed on long-term strategies to prevent pelvic floor disorders.

Pels A, Mol BWJ, Singer J, Lee T, von Dadelszen P, Ganzevoort W, Asztalos E, Magee LA, on behalf of the CHIPS Study Group. Influence of Gestational Age at the Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (control of Hypertension in Pregnancy Study). Hyper. 2018 Apr 23;71(5) epub ahead of print.

Hypertension, whether due to chronic hypertension, gestation hypertension or pre-eclampsia, is a leading cause of maternal and perinatal mortality and morbidity. In light of concerns that antihypertensive therapy obstructs the growth and well-being of the fetus, the CHIPS trial, a randomized control trial conducted from 2009 to 2014, assessed how tightly blood pressure should be controlled using antihypertensive medications to optimize health of the newborn without increasing pregnancy-related complications. In comparing tight (85 mmHg) and less-tight (100 mmHg) regulation of blood pressure, the CHIPS research team, which included CHÉOS Scientist Dr. Joel Singer and statistician Dr. Terry Lee, found no significant differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications. In a secondary analysis, the CHIPS research team sought to determine whether gestational age at randomization had an impact on the effect found in the original trial.  Data from 981 women included in the trial were used to create a mixed-effects logistic regression model to examine the effect of less-tight control, by gestational age at randomization, on major study outcomes which included pregnancy loss or high-level neonatal care, preterm birth, birthweight <10th centile, serious maternal complications, and persistent severe maternal hypertension. At no gestational age were overall outcomes better if less-tight management was chosen. As seen in previous research, randomization before 25 weeks to less-tight management did result in fewer low birthweight births, but this was counter-balanced by an increase in preterm births. Also, at all gestational ages less-tight management was associated with more severe hypertension though particularly at gestational age less than 28 weeks. These findings indicate that less-tight antihypertensive therapy is not preferential for managing maternal hypertension at any gestational age as there appear to be no clear benefits for the fetus and is associated with worse outcomes for mothers.