RESUMO
BACKGROUND AND AIMS: Perianal Crohn's disease [CD] places a considerable burden on patients' quality of life and is complex to treat. Despite its impact and high frequency, few studies have investigated the incidence and disease course of perianal CD. The aim of this study was to assess the incidence and disease course of perianal CD in adult patients throughout a 19-year period. METHODS: The cohort comprised all individuals aged 18 years or older who were diagnosed with CD in Denmark between January 1, 1997, and December 31, 2015, according to the National Patient Registry [NPR]. RESULTS: A total of 1812 [19%] out of 9739 patients with CD were found to have perianal CD. Perianal fistulas were the most common manifestation, accounting for 943 [52%] cases. The incidence of perianal CD remained stable over time. Patients with perianal CD were found to have an increased risk of undergoing major abdominal surgery compared with patients without perianal CD (hazard ratio: 1.51, 95% confidence interval [CI]: 1.40 to 1.64, pâ <0.001) in a multivariate Cox regression analysis. The incidence rate ratios of anal and rectal cancer in perianal CD patients were 11.45 [95% CI: 4.70 to 27.91, pâ <0.001] and 2.29 [95% CI: 1.25 to 4.20, pâ =â 0.006], respectively, as compared with non-IBD matched controls. CONCLUSIONS: In this nationwide study, 19% of CD patients developed perianal disease. Patients with perianal CD were at increased risk of undergoing major surgery compared with non-perianal CD patients. The risk of anal and rectal cancer was increased in patients with perianal CD compared with non-IBD matched controls. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Assuntos
Doenças do Ânus , Doença de Crohn , Procedimentos Cirúrgicos do Sistema Digestório , Qualidade de Vida , Neoplasias Retais/epidemiologia , Adulto , Doenças do Ânus/diagnóstico , Doenças do Ânus/epidemiologia , Doenças do Ânus/psicologia , Doenças do Ânus/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Doença de Crohn/psicologia , Doença de Crohn/cirurgia , Dinamarca/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Sistema de Registros/estatística & dados numéricos , Medição de Risco/estatística & dados numéricosRESUMO
OBJECTIVES: Men who have sex with men (MSM) are a highly neglected population in the current recommendation of girls-only human papillomavirus (HPV) vaccination programmes in many countries. To better assess the cost effectiveness of HPV vaccination among men requires data on the prevalence of HPV infection in MSM using a community sample, which is still sparse in several regions. We examined the prevalence of and factors associated with anogenital HPV infection among MSM in Taiwan. METHODS: MSM 20 years of age and older were recruited from the community and social media in Taiwan in 2015-2016 and screened for HPV infection to detect 37 genotypes. MSM were seen at baseline and were/will be seen at 6, 12, 24 and 36 months. Men completed a questionnaire regarding their sexual experiences. Multivariable regression analyses were conducted to identify associated behavioural risk factors using the baseline data. RESULTS: A total of 253 MSM were recruited; 87 % were below 35 years of age. Diagnosis of HIV was reported in 4% of men; just over 20% had three or more anal sex partners in the past year. The prevalence of any tested HPV type was 29.4% at the anal site and 11% at the penile site. One quarter of MSM were infected with any of the 9-valent vaccine HPV types. Anal HPV detection was associated with having three or more receptive anal sex partners in the past year (adjusted odds ratio (aOR)=2.92, 95% CI 1.29 to 6.61) and having older sex partners (aOR=2.51, 95% CI 1.07 to 5.90). CONCLUSIONS: Our data provide the base to calculate the reproductive rate for HPV transmission in a low-risk community sample and cost-effectiveness to include men in HPV vaccination policies. Adding evidence from a community sample adds comprehensiveness for future estimates of disease transmission and vaccine effectiveness.
Assuntos
Doenças do Ânus/virologia , Homossexualidade Masculina/estatística & dados numéricos , Infecções por Papillomavirus/epidemiologia , Adulto , Canal Anal/virologia , Doenças do Ânus/epidemiologia , Doenças do Ânus/psicologia , Estudos de Coortes , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/psicologia , Infecções por Papillomavirus/virologia , Prevalência , Características de Residência/estatística & dados numéricos , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/psicologia , Infecções Sexualmente Transmissíveis/virologia , Taiwan , Adulto JovemRESUMO
BACKGROUND: In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. OBJECTIVE: To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. METHODS: A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. RESULTS: Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). CONCLUSIONS: TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
Assuntos
Doenças do Ânus/etiologia , Doença de Crohn/complicações , Fístula do Sistema Digestório/etiologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Fatores Etários , Doenças do Ânus/patologia , Doenças do Ânus/psicologia , Doença de Crohn/patologia , Doença de Crohn/psicologia , Estudos Transversais , Fístula do Sistema Digestório/patologia , Fístula do Sistema Digestório/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Patient reported outcomes regarding perianal disease and faecal incontinence in the community-based inflammatory bowel disease population are poorly described. AIMS: To determine the impacts of perianal disease and faecal incontinence on quality of life and employment in inflammatory bowel disease patients. METHODS: For this cross-sectional study, a comprehensive survey was sent out to members of the Dutch National Crohn's and Colitis patient organisation. Validated questionnaires regarding faecal incontinence and active perianal disease were used to estimate its prevalence's. The effect on the quality of life (36-Item Short Form Survey) and on employment status (multivariate binary regression analysis) was assessed in this inflammatory bowel disease population. RESULTS: A total number of 1092 returned questionnaires (58% responders) were used for analysis; 750 respondents (69%) were female; mean age was 47 years (IQR 35-59). In 621 patients (57%) Crohn's disease, in 422 (39%) ulcerative colitis and in 49 (4%) patients unclassifiable inflammatory bowel disease was self-reported. The 114 patients (10%) with a stoma were excluded for continence related analyses. Faecal incontinence was reported in 555 patients (57%), was comparable between the different inflammatory bowel disease diagnoses and affected all 36-Item Short Form Survey subscales adversely (incontinence vs continence: Physical functioning 75 vs 84, P < 0.0001; Limitations due to physical health 49 vs 63, P < 0.0001; Limitations due to emotional problems 49 vs 64, P < 0.0001; Energy/fatigue 47 vs 53, P < 0.0001; Emotional well-being 71 vs 74, P = 0.005; Social functioning 63 vs 73, P < 0.0001; Pain 66 vs 75, P < 0.0001; General health 41 vs 48, P < 0.0001). Active perianal disease was reported in 39% Crohn's disease, 16% ulcerative colitis (84% fissures) and 20% unclassifiable inflammatory bowel disease patients. Faecal incontinence was more common in patients with perianal disease (67% vs 53%, P = 0.003). When correcting for age, disease duration, inflammatory bowel disease-related surgery and faecal incontinence, active perianal disease was independently affecting employment (OR 0.67; 95% CI 0.50-0.91; P = 0.01). CONCLUSIONS: Faecal incontinence and perianal disease are quality of life determining factors. Faecal incontinence needs more attention among clinicians, and development of new (drug) therapies needs to be focussed on perianal disease.
Assuntos
Doenças do Ânus/epidemiologia , Emprego/estatística & dados numéricos , Incontinência Fecal/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Qualidade de Vida , Adulto , Animais , Doenças do Ânus/etiologia , Doenças do Ânus/psicologia , Estudos Transversais , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/psicologia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Glândulas Perianais/patologia , Prevalência , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.
OBJETIVO: Estimar la carga por verrugas genitales (VG) en México. MATERIAL Y MÉTODOS: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. RESULTADOS: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. CONCLUSIONES: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.
Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Adulto , Doenças do Ânus/economia , Doenças do Ânus/psicologia , Doenças do Ânus/terapia , Terapia Combinada , Condiloma Acuminado/economia , Condiloma Acuminado/psicologia , Condiloma Acuminado/terapia , Efeitos Psicossociais da Doença , Feminino , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/economia , Doenças dos Genitais Masculinos/psicologia , Doenças dos Genitais Masculinos/terapia , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Medicina/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus , Prevalência , Qualidade de VidaRESUMO
Anogenital warts are a worldwide public health problem. They consist of epithelial proliferations caused by HPV, whose transmission occurs mainly through sexual intercourse. In this study, we evaluated their impact on the quality of life of adult males. We interviewed 88 men in an outpatient clinic for sexually transmitted diseases at a Brazilian public institution, using the DLQI-BRA questionnaire. Most patients (81%) presented mild or no impairment of quality of life. The main dimensions affected were sex life, symptoms, and embarrassment. The low impact on quality of life may well justify the delay in seeking medical treatment, favoring the spread of the disease.
Assuntos
Doenças do Ânus/psicologia , Condiloma Acuminado/psicologia , Qualidade de Vida/psicologia , Adulto , Instituições de Assistência Ambulatorial , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.
Assuntos
Doenças do Ânus/diagnóstico , Negro ou Afro-Americano , Infecções por Chlamydia/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Gonorreia/diagnóstico , Homossexualidade Masculina , Programas de Rastreamento/métodos , Autorrelato , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Doenças do Ânus/epidemiologia , Doenças do Ânus/psicologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/psicologia , Preservativos/estatística & dados numéricos , Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/psicologia , Gonorreia/epidemiologia , Gonorreia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Relações Médico-Paciente , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Sexo Seguro/psicologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais/psicologia , Revelação da Verdade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Abstract Anogenital warts are a worldwide public health problem. They consist of epithelial proliferations caused by HPV, whose transmission occurs mainly through sexual intercourse. In this study, we evaluated their impact on the quality of life of adult males. We interviewed 88 men in an outpatient clinic for sexually transmitted diseases at a Brazilian public institution, using the DLQI-BRA questionnaire. Most patients (81%) presented mild or no impairment of quality of life. The main dimensions affected were sex life, symptoms, and embarrassment. The low impact on quality of life may well justify the delay in seeking medical treatment, favoring the spread of the disease.
Assuntos
Humanos , Masculino , Adulto , Doenças do Ânus/psicologia , Qualidade de Vida/psicologia , Condiloma Acuminado/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Instituições de Assistência AmbulatorialRESUMO
BACKGROUND: Anismus or non-relaxing puborectalis muscle (PRM), detectable with anal/vaginal ultrasound (US), is a cause of obstructed defecation (OD) and may be treated with biofeedback (BFB). Many patients with anismus are anxious and/or depressed. The aim of this prospective study was to evaluate the outcome of the novel procedure psycho-echo-BFB in patients with anismus and psychological disorders. METHODS: Patients presenting at our unit with anismus and psychological disorders between January 2009 and December 2013, and not responding to conventional conservative treatment, were enrolled in the study. All underwent four sessions of psycho-echo-BFB, carried out by two psychologists and a coloproctologist, consisting of guided imagery, relaxation techniques and anal/vaginal US-assisted BFB. A validated score for OD was used, and PRM relaxation on straining measured before and after the treatment. PRM relaxation was also measured in a control group of 7 patients with normal bowel habits. RESULTS: Ten patients (8 females, median age 47 years, range 26-72 years) underwent psycho-echo-BFB. The OD score, evaluated prior to and at a median of 25 months (range 1-52 months) after the treatment, improved in 7 out of 10 patients, from 13.5 ± 1.2 to 9.6 ± 2.2 (mean ± standard error of the mean (SEM)), p = 0.06. At the end of the last session, PRM relaxed on straining in all cases, from 0 to 7.1 ± 1.1 mm, i.e., physiological values, not statistically different from those of controls (6.6 ± 1.5 mm). Two patients reported were cured, 3 improved and 5, all of whom had undergone prior anorectal surgery, unchanged. No side effects were reported. CONCLUSIONS: Psycho-echo-BFB is safe and inexpensive and allows all patients with anismus to relax PRM on straining. Previous anorectal surgery may be a negative predictor.
Assuntos
Doenças do Ânus/terapia , Biorretroalimentação Psicológica/métodos , Adulto , Idoso , Canal Anal/fisiopatologia , Doenças do Ânus/complicações , Doenças do Ânus/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Estudos de Casos e Controles , Terapia Combinada , Constipação Intestinal/etiologia , Defecação/fisiologia , Transtorno Depressivo/complicações , Transtorno Depressivo/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Relaxamento Muscular/fisiologia , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/psicologia , Distúrbios do Assoalho Pélvico/terapia , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Anogenital warts (GW) are among the most common sexually transmitted diseases. Few studies have investigated the quality of life (QoL) of GW patients. OBJECTIVE: We undertook an exhaustive description of the health status of GW patients and assessed disease impact on QoL. METHODS: GW patients enrolled at the Sexually Transmitted Diseases service of Rome Catholic University were administered the SF-36 questionnaire to assess health status, the Skindex-29 to evaluate the impact of dermatological aspects and the GHQ-12 questionnaire to identify patients with probable minor psychiatric non-psychotic conditions. Clinical severity was assessed with the Physician Global Assessment (PGA) and through quantitative measures. RESULTS: There was a significant association between greater disease severity and lower SF-36 values (reflecting a worse QoL). The severity parameters showed no significant differences in any of the Skindex-29 scales except for Emotions, which showed higher values (reflecting a worse QoL) in patients with severe disease assessed by PGA. The GHQ-positive patients (23.7%) consistently showed worse QoL scores on all the SF-36 scales and on all the Skindex-29 scales compared to GHQ-negative patients. CONCLUSIONS: To the best of our knowledge, this is the first study of the impact of GW on QoL to use a range of validated tools, both generic and dermatology-specific. We observed a strong influence of GW on the mental and physical components of QoL in terms of general health status (SF-36). The effects in terms of specific dermatological aspects (Skindex-29) were less significant, but still reflected an impact on patients' emotional state.
Assuntos
Doenças do Ânus/psicologia , Condiloma Acuminado/psicologia , Nível de Saúde , Qualidade de Vida/psicologia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Estudos Transversais , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Anogenital warts are one of the most prevalent sexually transmitted virus infections in the Netherlands and cause frustration, shame, and even depression. This study was performed to determine the effect of having anogenital warts on the quality of life in Dutch soldiers with the use of a dermatology-specific quality of life (QoL) questionnaire. METHODS: We used the Skindex-29 QoL questionnaire in 100 predominantly heterosexual soldiers with clinically confirmed first episode of condylomata acuminate in this study. RESULTS: Results confirmed that first episodes of anogenital warts cause high mean scores on subscale Emotions with lower scores on the subscales Symptoms and Functioning. Sex, age, educational level, anatomical site, or number of anatomical sites did not influence the outcome in this study. CONCLUSIONS: Having anogenital warts influences QoL, especially with regard to intimacy, shame, and concern. Our data show that the Skindex-29 QoL questionnaire can be easily used in these patients with good internal consistency. Clinicians should be aware of the great emotional impact of anogenital warts on their patients.
Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Militares , Infecções por Papillomavirus/epidemiologia , Qualidade de Vida , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Doenças do Ânus/psicologia , Condiloma Acuminado/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comportamento de Busca de Informação , Masculino , Militares/psicologia , Militares/estatística & dados numéricos , Países Baixos/epidemiologia , Infecções por Papillomavirus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assunção de Riscos , Autoimagem , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sexually transmitted human papillomavirus (HPV) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area. Since the HPV vaccine has been introduced, awareness of HPV infection, prevention and health-related behaviour have not been studied in a large sample of young women in Germany. OBJECTIVES: Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females. METHODS: In 2010, a postal cross-sectional survey was conducted with a random representative sample size (n = 2000) of females aged 19-35 attending Germany's largest (comprehensive) university, which was designed to obtain data about socio-demographics, the awareness of sexually transmitted HPV, genitoanal neoplasms and their prevention, HPV vaccine, immunisation and cervical cancer screening. RESULTS: Of the 547 (27.3%) participants, 69.1% had heard of HPV, 62.5% were aware of the vaccine, 14.4% were vaccinated and 6.9% reported a history of sexually transmitted infection, including HPV (2.7%). The HPV-related knowledge among those who had heard of it was high (75.1-99.7%), except of that HPV affects men (52.9%) and HPV's causative role in genital (54.2%) and anal (35.6%) warts, and smoking (11.3%) as an HPV risk factor. The lower HPV knowledge score (Assuntos
Condiloma Acuminado/prevenção & controle
, Conhecimentos, Atitudes e Prática em Saúde
, Infecções por Papillomavirus/prevenção & controle
, Vacinas contra Papillomavirus/administração & dosagem
, Neoplasias do Colo do Útero/prevenção & controle
, Adulto
, Doenças do Ânus/prevenção & controle
, Doenças do Ânus/psicologia
, Conscientização
, Condiloma Acuminado/psicologia
, Feminino
, Doenças dos Genitais Femininos/prevenção & controle
, Doenças dos Genitais Femininos/psicologia
, Alemanha
, Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18
, Humanos
, Infecções por Papillomavirus/psicologia
, Doenças Virais Sexualmente Transmissíveis/prevenção & controle
, Doenças Virais Sexualmente Transmissíveis/psicologia
, Neoplasias do Colo do Útero/psicologia
, Adulto Jovem
RESUMO
The majority of proctological diseases can be defined by a structured evaluation of the symptoms and a physical examination. Magnetic resonance imaging (MRI) and anal endosonography can detect complex anal fistulas with a high accuracy but MRI should be preferred because of its objective visualization. Functional anorectal disorders are multifactorial and show morphological and functional irregularities in different compartments of the pelvic floor which is why MR defecography is now one of the most important methods in diagnostic algorithms. Interpreting the results of anal endosonography, anal manometry and neurophysiological testing is highly demanding because of large interindividual variability. Scores are used for objective measurement of symptom severity and quality of life. In clinical practice, well validated scores evaluated in large patient groups with predetermined circumstances are needed. Bringing together morphological results with scores based on subjective perception is required to optimize diagnostics and therapy evaluation in proctology.
Assuntos
Doenças do Ânus/diagnóstico , Doenças Retais/diagnóstico , Doenças do Ânus/psicologia , Doenças do Ânus/cirurgia , Defecografia , Endossonografia , Humanos , Imageamento por Ressonância Magnética , Manometria , Exame Neurológico , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/psicologia , Distúrbios do Assoalho Pélvico/cirurgia , Exame Físico , Proctoscopia , Prognóstico , Qualidade de Vida , Doenças Retais/psicologia , Doenças Retais/cirurgia , Fístula Retal/diagnóstico , Fístula Retal/psicologia , Fístula Retal/cirurgiaRESUMO
Genital warts are one of the most prevalent sexually transmitted infections in the Netherlands and cause both frustration and misinterpretation in young adults. Poor knowledge may be associated with shame and depression. We used questionnaires to study knowledge, perceived nuisance and risk perception in 100 predominantly heterosexual men with clinically-confirmed condylomata acuminata. Our data show that the majority of patients considered having warts as (very) bothersome. Results confirmed the Internet as a widely used information source. Incorrect information on the relationship between warts and both anogenital cancers and infertility was widespread. Results from knowledge questionnaires showed that higher knowledge scores were associated with higher perceived nuisance. We hypothesize that high levels of nuisance related to genital warts may stimulate the need to seek information and therefore increase knowledge. It does not seem likely that an increase of human papillomavirus-related knowledge would increase experiences of nuisance.
Assuntos
Condiloma Acuminado/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Militares/psicologia , Adulto , Doenças do Ânus/psicologia , Distribuição de Qui-Quadrado , Condiloma Acuminado/epidemiologia , Feminino , Humanos , Comportamento de Busca de Informação , Masculino , Países Baixos/epidemiologia , Papillomaviridae , Aceitação pelo Paciente de Cuidados de Saúde , Percepção , Assunção de RiscosRESUMO
BACKGROUND: Fecal and urinary incontinence may differently influence various aspects of quality of life (QOL). The main aim of the present study is to determine whether fecal and urinary incontinence measured at time 1 of the study will predict QOL at time 2 (after 4 years), above and beyond the prediction already explained by fecal and urinary incontinence at time 2. METHODS: Thirty-six adult patients from the Italian Parents' and Patients' Association for Anorectal Malformations answered items about urinary and fecal incontinence at time 1 of the study and completed the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire after 4 years from the first questionnaire. Two sets of hierarchical regression analyses were conducted with fecal and urinary incontinence serving as predictors of QOL and the different areas of QOL from the Hirschsprung Disease/Anorectal Malformation Quality of Life serving as outcome variables. RESULTS: The principal findings indicated that fecal continence is a strong predictor of QOL in the areas of social functioning, emotional functioning, and body image and that urinary incontinence predicted sexual functioning. CONCLUSIONS: It seems that one's past experience with fecal incontinence is extremely relevant to current QOL, especially for body image. Urinary incontinence contributed less in explaining QOL in our patients, but because it is very relevant for sexual functioning, it should not be disregarded.
Assuntos
Canal Anal/anormalidades , Doenças do Ânus/psicologia , Incontinência Fecal/psicologia , Qualidade de Vida , Doenças Retais/psicologia , Reto/anormalidades , Doenças Urológicas/psicologia , Adolescente , Adulto , Doenças do Ânus/complicações , Doenças do Ânus/congênito , Defecação , Incontinência Fecal/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/complicações , Doenças Retais/congênito , Inquéritos e Questionários , Fatores de Tempo , Micção , Doenças Urológicas/etiologia , Adulto JovemRESUMO
BACKGROUND: Perianal Crohn's disease can affect quality of life across physical, functional, and psychosocial domains. Little is known about how patients prioritize factors affecting their quality of life. OBJECTIVE: This study aimed to determine which factors are considered by patients to be the most important and most unfavorable to their quality of life, and to gauge the relative impact of perianal and nonperianal symptoms. DESIGN: This cross-sectional study involves a mailed questionnaire and medical records audit. SETTINGS: Recruitment was from the database of 2 specialists at a single tertiary-level teaching hospital. Surveys were completed in the community. PATIENTS: Patients with Crohn's disease who had been seen in the preceding 10 years with documented perianal disease were recruited to participate. Of 130 patients invited, 69 (53%) returned a survey. MAIN OUTCOME MEASURES: Patients rated the importance of 16 quality-of-life factors spanning multiple domains. Patient utility was also elicited through use of trade-off scenarios. RESULTS: The mean age of participants was 42.7 years and 62% were female. Eighty percent of patients had undergone prior surgery. Anal pain or discomfort was considered the most important factor for patients, rated highly important by 40%. Physical symptoms were rated more important and adverse than functional, psychosocial, and body image factors. The presence of a long-term perianal drain was predictive of high ratings of importance for the majority of factors investigated. Perianal symptoms did not contribute more than nonperianal symptoms to overall utility. LIMITATIONS: This study was limited by its small sample size, single-institution bias, self-completion questionnaire, and response rate. CONCLUSIONS: Patients with perianal Crohn's disease experience significant impairment of quality of life. Physical symptoms are felt to be the most important and unfavorable. The patient experience of long-term perianal drains warrants further study.
Assuntos
Doenças do Ânus/psicologia , Doença de Crohn/psicologia , Qualidade de Vida , Adulto , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Psychiatric and psychological morbidity is often associated with skin diseases. Recent research has focused on the epidemiological and clinical aspects of human papillomavirus infection, whereas the psychosocial and emotional factors related to the disease have not been well established. We describe the experience of a 22-year-old male who, after being diagnosed of condyloma acuminata, developed a major depressive disorder.
Assuntos
Doenças do Ânus/complicações , Condiloma Acuminado/complicações , Transtorno Depressivo Maior/etiologia , Antidepressivos/uso terapêutico , Doenças do Ânus/patologia , Doenças do Ânus/psicologia , Condiloma Acuminado/patologia , Condiloma Acuminado/psicologia , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Masculino , Adulto JovemRESUMO
The aim of this validation study was to assess the measurement properties of the CECA (Spanish acronym for the Specific Questionnaire for Condylomata Acuminata) in patients with anogenital condylomas. A total of 247 patients aged > 18 years completed the questionnaire on 2 occasions as well as the Dermatology Life Quality Index (DLQI). The CECA questionnaire showed good internal consistency (Cronbach's alpha values of 0.86 and 0.91 in the emotional and sexual activity dimensions) and good testretest reliability (intraclass correlation coefficient 0.76 emotional dimension, 0.82 sexual activity dimension). Patients with de novo lesions and those with more extensive lesions and larger number of warts showed poorer health-related quality of life. CECA and DLQI scores correlated moderately. Patients whose lesions cleared at follow-up or with a reduction of >or= 50% showed a better improvement of health-related quality of life. The CECA questionnaire is a valid, reliable and sensitive tool for the assessment of health-related quality of life in patients with anogenital warts.
Assuntos
Doenças do Ânus/psicologia , Condiloma Acuminado/psicologia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/psicologia , Qualidade de Vida , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Comportamento SexualRESUMO
Lichen sclerosus (LS) is a skin condition that affects genital and extra genital epithelia in both males and females of all ages and it may occur in association with other autoimmune disease. Currently, the first line effective treatment is an ultra-potent topical corticosteroid. The long-term sequelae of LS include scarring, malignancy, which is rare, and psychosexual disfunction, which is common.