Breast cancer is the most commonly diagnosed cancer in females affecting 1 in every 8 women in their lifetime. In the majority of cases, surgical excision continues to be the first line of treatment by means of mastectomy or wide local excision. These surgical modalities very often result in breast or chest deformities that can have devastating psychosocial impact on patients, such as low self esteem and feeling incomplete, with adverse impact on their quality of life in terms of sexual activity, relationships, clothing, sport, swimming and other daily activities. Unfortunately, the large majority of women having breast surgery worldwide are not offered even the simplest types of reconstruction due to lack of awareness, training or resources. Even in the developed countries it is estimated that 25-50% of women are still not offered the full range of reconstruction options. This paper provides a step-by-step guide in establishing a new breast reconstruction service starting with setting up a dedicated local staff teaching program, arranging specific logistics and equipment, fulfilling administrative and legislative processes, implementing quality assurance measures, audits and patient reported outcome measures. This is derived from the author???s experience in establishing a breast reconstruction service in an NHS General Hospital in the United Kingdom. A view the current and National Guidelines for best practice is also reviewed along with sources of patient???s education material. In conclusion, no woman should be denied the right of having breast restoration surgery following the treatment of cancer. This service should be made available universally across the globe. Internet and social media platforms are powerful and cost effective educational tools for patients.
Background: Polycystic ovary syndrome is one of the most common causes of anovulatory sub-fertility in women of reproductive age-group.The therapeutic procedure for women with polycystic ovary syndrome wanting to be pregnant is ovulation induction.Different medicines have been used based on individual signs and symptoms as the most effective one is not clearly evident.Clomiphene citrate and letrozole are the most common drugs used alone or in combination with metformin to achieve pregnancy in women with polycystic ovary syndrome.In this study, the efficacy of combined clomiphene citrate-metformin is compared with letrozole-metformin in achieving pregnancy among women with polycystic ovary syndrome.Methods: A retrospective study was performed among women with polycystic ovary syndrome attending Infertility Center, Kathmandu, Nepal from January 2013 to December 2015.Samples were randomly selected from list of the record in the treatment centre within the study duration.Total 146 cases with 73 each in clomiphene citratemetformin group and letrozole-metformin group were entered into the analysis.Participants had received metformin in combination with either clomiphene citrate (100 mg) or letrozole (2.5 mg) from day 3 to 5 of their menstrual cycle.Odds ratio, with confidence interval set at 95%, was calculated to compare the efficacy between two groups. Results:The pregnancy rate of clomiphene citrate-metformin was 54.79% and letrozole-metformin was 34.25%.Patients treated with clomiphene citrate-metformin were two times more likely to get pregnant [OR: 2.33,] than those treated with letrozole-metformin.Miscarriage rate was not found to be statistically significant. Conclusion:Clomiphene citrate in combination with metformin is more likely to be effective than letrozole with metformin in achieving pregnancy.
Quality of Life (QoL) surveys are important tasks in health management for oncological patients. Ability to perform daily activities, patient satisfaction and levels of functionality are essential for evaluating QoL in breast cancer survivors. Hot flashes on tamoxifen treatment have been reported to decrease general quality of life in women with breast cancer. Long-term, disease-free survivors of breast cancer have an excellent QOL, many years after their breast cancer diagnosis. According to the World Health Organization???s International Classification of Functioning, Disability and Health (ICF), function is defined as the interactions between an individual, their health condition and the social and personal context in which they live. Breast cancer patients experience physical symptoms and psychosocial distress that adversely affect their quality of life. Healthcare providers and patients think that QoL assessments acceptable in helping breast cancer patients to overcome areas of QoL that have been affected by the disease.
BACKGROUND: Maternal mental health has received an increased research interest as it has direct impact on the mother's psychosocial wellbeing and the fetus/child's health and development. Many psychosocial risks factors have found to interplay a crucial role for pregnancy, maternal and neonatal outcomes. The aim of this study was to explore the psychosocial risk factors that may affect pregnant women and examine the feasibility of the KINDEX Mum-Screen for the early detection of women at risk, in the daily practice of health professionals providing prenatal care in public health settings in Cyprus. METHODS: Mixed-methods design was carried out using the adapted Greek version of KINDEX questionnaire and reflective diaries by the midwives that conducted the interviews. Three hundred one pregnant women were interviewed in five public hospitals of Cyprus by 14 midwives. Upon conclusion of the interviews, the midwives wrote reflective diaries, and thematic analysis was conducted. RESULTS: The results of the quantitative analysis suggest that the KINDEX sum score was significantly higher for participants reporting a risk factor from the eleven risk areas. The PSS-4 was higher for those participants with financial related concerns in the future and for participants that experienced life-long intimate partner violence. From the analysis of the qualitative data, three main themes emerged: 1) health professionals should have the ability to identify psychosocial factors that affect pregnant women and babies' health in their everyday practice; 2) feasibility of the interview in public health care settings; 3) partnership between women and health professionals. CONCLUSIONS: In Cyprus, where the cesarean rates are reaching 60%, one of the highest worldwide, there are a huge space for improvement in the perinatal care provided. Health professionals should have the opportunity to use screening tools and provide evidence based, cost effective, and human rights oriented mental health and social care services. Policy makers should create strategies for promotion of psychosocial well-being of mothers during pregnancy aiming at maximizing the neonatal and perinatal outcomes, including the indirect outcomes, such as mother-child bond and child development. The KINDEX mum-screen was a well-accepted and user-friendly tool by the midwives, within a challenging public health setting. Concluding this study and based on the outcomes we consider that this is a valid prenatal screening tool for identification of psychosocial risk factors.
The author hypothesize that patient gender could have an effect on expression and communication of symptoms. Symptoms may be defined as “any subjective evidence of a health problem as perceived by the patient”. Symptoms are the result of an interpretation process. Symptom experiences are embedded in a complex interplay between biological, psychological and cultural factors. The expression of symptoms depends more on psychosocial aspects than biological. In consequence there must be a variety of interpretations of sensations, which are not equivalent to expressions of underlying disease. Moreover, this interpretation of sensations, being fundamentally of a psychosocial character, must be different according to the gender of the patient. So, symptoms of the same disease could differ between women and men, and the same symptom could have different meanings in females and males. If diagnosis of disease is based exclusively on the presence of specific symptom characteristics, we may risk not take into account the different meanings by reason of gender, and give rise to misinterpretations and misdiagnoses. The implications of this perspective are immense. There is a need for developing research designs that test alternative conceptions of symptoms as a complexity phenomenon, with gender/sex differences in health, more rigorously.
Improving the quality of obstetric care is an urgent priority in low income countries, where maternal and perinatal morbidity and mortality remain high. Clinical audit is a tool to improve quality of care. Specifically clinical audit in MNCH is a tool to reduce maternal and perinatal morbidity and mortality. Cesarean section is among “five auditable’’ MNCH scenarios according 2012 women lung foundation. This study is a one year retrospective cross-sectional study among 99 women who delivered by cesarean section from July 2016-June 2017 in Mearg general hospital in West Tigray, Ethiopia. The aim of this survey was to investigate cesarean section rate (CSR) and indications of cesarean section to improve quality of obstetric care by reducing unnecessary cesarean sections. In the study period 99 women delivered by cesarean section among 749 institutional deliveries which gives an institutional cesarean section rate of 13.2%. Medical records were retrieved for 81 mothers. The most common indications for cesarean section were cephalopelvic disproportion (CPD) in 19 women (23.5%), antepartum hemorrhage in 11 (13.6%) and obstructed labor in 10 (12.3%). Majority of the cesarean sections 75(88.9%) were done under spinal anesthesia. Seven (8.6%) mothers had no justified indication for cesarean section according to criteria based audit. From the total 99 cesarean sections there was one (1.0%) maternal death. There was significant number of cesarean sections done with medically unjustified indications but comparatively low with the country and global figure. The three common indications for CS in this study were CPD, APH, and obstructed labor. A huge percentage of lost medical files was observed. Keeping medical records is the safest, simplest and cheapest way to analyze cesarean section indications, to reduce unjustified/unnecessary cesarean sections.
Objective: To describe and compare the doctor-patient communication referred to the verbal behavior of the female patients vs. males in the family medicine consultation. Participants and Methods: Secondary analysis of existing dataset coded to explore patient-clinician verbal communication during ambulatory visits in a family medicine office in a health Centre in Toledo (Spain) was carried out. The audio recording of the consultations and verbal content analysis of the interviews, based on the identification of 6 categories of classification of behaviors of the interaction process (Proposing, Supporting/ Agreeing, Disagreeing, Giving Information, Seeking Information, and Building) was performed. A convenience sample was carried out. Other variables included were age, sex and duration of the consultation in minutes. Triangulation between different evaluators, and methodological (qualitative and quantitative) was used as a technique to control the reliability and biases. Once the qualitative study is completed, the results of the number of behaviors in the total of triadic and dyadic consultations were presented in a quantitative way (Frequencies: No, %). The bivariate comparisons were performed using the test of Chi squared and exact probability Fischer. Results: 20 consultations were included in the analysis. In interviews with women vs. males, differed only in showing more "Supporting" (39% and 29%, respectively; p=0.05), and less “Disagreement” (3% and 11% respectively; p<0.05). There were no differences in the verbal behaviors of the physician in the consultations with female vs. male patients. There were also no differences in the duration of the consultation among female patients vs. males (7’: rank: 3’-15’ vs. 7’; rank: 4’-12’). Conclusion: The verbal behavior in interview in the family medicine consultation with female patients vs. males shows only small differences. Neither men are of Mars nor the women of Venus; may be men are from North Dakota and women from South Dakota.
Background: Tetanus is a severe disease that kills one new born every eleven minutes or 134 babies each day. To prevent the infection of both mother and the newborn, tetanus toxoid immunization is given to pregnant women and women of child bearing age in Ethiopia. However, little data is available on the dropout of tetanus toxoid immunization among the reproductive age group of women in the study area. Methods: with the objective of to assess the drop out of tetanus toxoid immunization and its associated factors among the reproductive age group of women in Debrebirhan Town, Amhara region, Ethiopia, a community based cross-sectional study was conducted from March 1 to 30, 2017 on systematically sampled 422 study subjects. The data was collected using interviewer administered pretested questionnaires and the collected data was entered into Epi-data version 3.1.5, then, exported to SPSS version 20 for analysis. Descriptive statistical analysis was done and frequency distributions displayed, mean and standard deviations were calculated. Then, bivariate and multivariate logistic regression analysis was done to identify the association between independent and dependent variables. Result: The study showed that the dropout rate of tetanus toxoid was 72.3% of which tetanus toxoid vaccine 5th accounts for 29.8% of the drop out. Knowledge of the importance of TT vaccine, number of required doses for full immunization, its schedules, educational status and occupational status of the study participants were found to be significantly associated with dropout rate of TT immunization. Conclusion: The prevalence of dropout rate of tetanus toxoid immunization was high in the study area and Knowledge of the importance of TT vaccine, number of required doses for lifelong protection and, its schedules, educational and occupational status were found to be significantly associated with TT immunization dropout rate.
Introduction: Dieting, obsessive weight control practices, fears of fatness, negative body image, food and weight preoccupation and other distorted attitudes and behaviors are proven risk factors with a serious potential to facilitate the development of anorexia and bulimia nervosa and the so called “atypical ED”. They are not enough studied in Bulgaria. The purpose of this study was to assess the prevalence and the gender differences in disordered eating attitudes and behaviors in adolescents and young adults from Bulgaria. Methods: We studied two age groups 886 (80.7%) adolescents from 14 to 19 years and 212 (19.3%) young adults from 20 to 40 years, 402 male and 696 female. The respondents were Bulgarian high school students, undergraduate university students and volunteers from the general population with higher education. All participants anonymously completed the Eating attitudes and behaviors questionnaire (EABQ); Bulgarian version of the SCOFF, The Eating Disorder Diagnostic Scale (EDDS) and gave information about their age, gender, height and weight, the lowest body weight during the last three months; the frequency of measuring the body weight. We calculated three composite EDDS sub-scores. Results: The boys and girls total and composite questionnaires scores differed significantly. There were no significant gender differences in young adults, except for EABQ total score. The mean ranks in the adolescent group showed that the female subjects reported more disordered eating behavior and risky attitudes compared with the males. In both age groups, the total SCOFF and EABQ scores and the composite scores of EDDS correlated significantly and proportionally (Spearman’s correlation, p<0.01). The mean results from EABQ showed more distorted eating attitudes and behaviors in the groups above the SCOFF “Yes” risk threshold, the EABQ scores of males and females from the groups at risk and from the non-risk groups differed significantly (p<0.05). Conclusion: More than one fifth (22.5%) of the girls examined are at risk for ED development and have significantly lower BMI values than boys. The risk in adult women and in males from both age groups is smaller. EABQ showed good discriminative capacities.
