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1.
Colorectal Dis ; 25(7): 1479-1488, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37237447

RESUMEN

AIM: People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. METHOD: A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. RESULTS: A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0-100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. CONCLUSION: This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC.


Asunto(s)
Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Humanos , Persona de Mediana Edad , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/cirugía , Prioridad del Paciente , Encuestas y Cuestionarios , Emociones
2.
Colorectal Dis ; 23(1): 18-33, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32777171

RESUMEN

AIM: Approximately 20%-30% of patients with ulcerative colitis (UC) will undergo surgery during their disease course, the vast majority being elective due to chronic refractory disease. The risks of elective surgery are reported variably. The aim of this systematic review and meta-analysis is to summarize the outcomes after elective surgery for UC. METHODS: A systematic review was conducted that analysed studies reporting outcomes for elective surgery in the modern era (>2002). It was prospectively registered on the PROSPERO database (ref: CRD42018115513). Searches were performed of Embase and MEDLINE on 15 January 2019. Outcomes were split by operation performed. Primary outcome was quality of life; secondary outcomes were early, late and functional outcomes after surgery. Outcomes reported in five or more studies underwent a meta-analysis of incidence using random effects. Heterogeneity is reported with I2 , and publication bias was assessed using Doi plots and the Luis Furuya-Kanamori index. RESULTS: A total of 34 studies were included (11 774 patients). Quality of life was reported in 12 studies, with variable and contrasting results. Thirteen outcomes (eight early surgical complications, five functional outcomes) were included in the formal meta-analysis, all of which were outcomes for ileal pouch-anal anastomosis (IPAA). A further 71 outcomes were reported (50 IPAA, 21 end ileostomy). Only 14 of 84 outcomes received formal definitions, with high inter-study variation of definitions. CONCLUSION: Outcomes after elective surgery for UC are variably defined. This systematic review and meta-analysis highlights the range of reported incidences and provides practical information that facilitates shared decision making in clinical practice.


Asunto(s)
Colitis Ulcerosa , Reservorios Cólicos , Proctocolectomía Restauradora , Colitis Ulcerosa/cirugía , Humanos , Ileostomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Proctocolectomía Restauradora/efectos adversos , Calidad de Vida , Resultado del Tratamiento
3.
Colorectal Dis ; 22(6): 703-712, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31868981

RESUMEN

AIM: One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. METHOD: Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. RESULTS: Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. CONCLUSION: Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.


Asunto(s)
Enfermedad de Crohn , Fístula Rectal , Enfermedad de Crohn/complicaciones , Humanos , Investigación Cualitativa , Calidad de Vida , Fístula Rectal/etiología , Fístula Rectal/cirugía , Resultado del Tratamiento
4.
Tech Coloproctol ; 23(1): 33-41, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30725242

RESUMEN

BACKGROUND: There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS: The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS: The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS: The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.


Asunto(s)
Hemorroides/diagnóstico , Medición de Resultados Informados por el Paciente , Índice de Severidad de la Enfermedad , Adulto , Anciano , Ensayos Clínicos como Asunto , Femenino , Estado de Salud , Hemorroides/terapia , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Resultado del Tratamiento
5.
Colorectal Dis ; 20(7): 606-613, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29427466

RESUMEN

AIM: YouTube™ is an open-access, nonpeer-reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. METHOD: A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. RESULTS: The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for 'experience of surgery' (P < 0.001) and 'experience of disease' (P = 0.0015) themed videos were significantly higher than for 'disease management' themed videos. CONCLUSION: Crohn's disease patients use YouTube™ as a surgical information source. The content of patient-sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos.


Asunto(s)
Colectomía , Información de Salud al Consumidor/normas , Enfermedad de Crohn/cirugía , Difusión de la Información/métodos , Grabación en Video/normas , Información de Salud al Consumidor/métodos , Humanos , Internet , Medios de Comunicación Sociales
6.
BMC Med Inform Decis Mak ; 18(1): 104, 2018 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-30453942

RESUMEN

BACKGROUND: To identify publicly available internet resources and assess their likelihood to support women making informed decisions about, and between, fertility preservation procedures before starting their cancer treatment. METHODS: A survey of publically available internet resources utilising an environmental scan method. Inclusion criteria were applied to hits from searches of three data sources (November 2015; repeated June 2017): Google (Chrome) for patient resources; repositories for clinical guidelines and projects; distribution email lists to contact patient decision aid experts. The Data Extraction Sheet applied to eligible resources elicited: resource characteristics; informed and shared decision making components; engagement health services. RESULTS: Four thousand eight hundred fifty one records were identified; 24 patient resources and 0 clinical guidelines met scan inclusion criteria. Most resources aimed to inform women with cancer about fertility preservation procedures and infertility treatment options, but not decision making between options. There was a lack of consistency about how health conditions, decision problems and treatment options were described, and resources were difficult to understand. CONCLUSIONS: Unless developed as part of a patient decision aid project, resources did not include components to support proactively women's fertility preservation decisions. Current guidelines help people deliver information relevant to treatment options within a single disease pathway; we identified five additional components for patient decision aid checklists to support more effectively people's treatment decision making across health pathways, linking current with future health problems.


Asunto(s)
Información de Salud al Consumidor , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Preservación de la Fertilidad , Internet , Neoplasias/terapia , Adulto , Información de Salud al Consumidor/estadística & datos numéricos , Femenino , Humanos , Internet/estadística & datos numéricos
7.
Phys Rev Lett ; 119(4): 042502, 2017 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-29341742

RESUMEN

We report the first result for the electron-antineutrino angular correlation (a coefficient) in free neutron ß decay from the aCORN experiment. aCORN uses a novel method in which the a coefficient is proportional to an asymmetry in proton time of flight for events where the ß electron and recoil proton are detected in delayed coincidence. Data are presented from a 15 month run at the NIST Center for Neutron Research. We obtained a=-0.1090±0.0030(stat)±0.0028(sys), the most precise measurement of the neutron a coefficient reported to date.

8.
Tech Coloproctol ; 21(6): 461-469, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28643034

RESUMEN

BACKGROUND: Decision-making in perianal Crohn's fistula (pCD) is preference sensitive. Patients use the internet to access healthcare information. The aim of this study was to assess the online information and patient decision aids relating to surgery for pCD. METHODS: A search of Google™ and the Decision Aids Library Inventory (DALI) was performed using a predefined search strategy. Patient-focussed sources providing information about pCD surgery were included in the analysis. Written health information was assessed using the International Patient Decision Aids Standards (IPDAS) and DISCERN criteria. The readability of the source content was assessed using the Flesch-Kincaid score. RESULTS: Of the 201 sources found, 187 were excluded, leaving 14 sources for analysis. Three sources were dedicated to pCD, and six sources mentioned pCD-specific outcomes. The most common surgical intervention reported was seton insertion (n = 13). The least common surgical intervention reported was proctectomy (n = 1). The mean IPDAS and DISCERN scores were 4.43 ± 1.65 out of 12 (range = 2-8) and 2.93 ± 0.73 out of 5 (range = 1-5), respectively. The mean reading ease was US college standard. CONCLUSIONS: We found no patient decision aids relating to surgery for pCD. The online sources relating to surgery for pCD are few, and their quality is poor, as seen in the low IPDAS and DISCERN scores. Less than half of the sources mentioned pCD-specific outcomes, and three sources were solely dedicated to providing information on pCD. Healthcare professionals should look to create a patient tool to assist decision-making in pCD.


Asunto(s)
Información de Salud al Consumidor/estadística & datos numéricos , Enfermedad de Crohn/complicaciones , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Fístula Rectal/cirugía , Comprensión , Información de Salud al Consumidor/métodos , Información de Salud al Consumidor/normas , Humanos , Internet , Fístula Rectal/etiología
9.
Hum Reprod ; 28(5): 1221-30, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23442755

RESUMEN

STUDY QUESTION: Does surgical and low-dose progestin treatment differentially affect endometriosis-associated severe deep dyspareunia in terms of sexual functioning, psychological status and health-related quality of life? SUMMARY ANSWER: Surgery and progestin treatment achieved essentially similar benefits at 12-month follow-up, but with different temporal trends. WHAT IS ALREADY KNOWN: Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results. STUDY DESIGN, SIZE, DURATION: Patient preference, parallel cohort study with 12-month follow-up. The effect of conservative surgery at laparoscopy versus treatment with a low dose of norethisterone acetate per os (2.5 mg/day) in women with persistent/recurrent severe deep dyspareunia after first-line surgery was compared. PARTICIPANTS/MATERIALS AND SETTING, METHODS: A total of 51 patients chose repeat surgery and 103 progestin treatment. Variations in sexual function, psychological well-being and quality of life were measured by means of the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS) and the Endometriosis Health Profile-30 (EHP-30). MAIN RESULTS AND THE ROLE OF CHANCE: Four women in the surgery group and 21 women in the progestin group withdrew from the study for various reasons. Total FSFI scores, anxiety and depression scores and EHP-30 scores improved immediately after surgery, but worsened with time, whereas the effect during progestin use increased more gradually, but progressively, without overall significant between-group differences at 12-month follow-up. A tendency was observed towards a slightly better total FSFI score after surgery at the end of the study period. LIMITATIONS, REASONS FOR CAUTION: Treatments were not randomly allocated, and distribution of participants as well as of dropouts between study arms was unbalanced. However, the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions. WIDER IMPLICATIONS OF THE FINDINGS: Both surgery and medical treatment with progestins are valuable options for improving the detrimental impact of endometriosis-associated dyspareunia on sexual functioning and quality of life. Women should be aware of the pros and cons of both options to decide which one best suits their needs. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by a research grant from the University of Milan School of Medicine (PUR number 2009-ATE-0570). None of the authors have a conflict of interest.


Asunto(s)
Dispareunia/tratamiento farmacológico , Dispareunia/cirugía , Endometriosis/tratamiento farmacológico , Endometriosis/cirugía , Progestinas/uso terapéutico , Adolescente , Adulto , Estudios de Cohortes , Depresión/complicaciones , Dispareunia/psicología , Endometriosis/psicología , Femenino , Humanos , Laparoscopía , Noretindrona/análogos & derivados , Noretindrona/uso terapéutico , Acetato de Noretindrona , Prioridad del Paciente , Calidad de Vida , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
10.
Colorectal Dis ; 15(7): 848-57, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23451900

RESUMEN

AIM: Many women undergoing sacral neuromodulation for faecal incontinence have coexisting pelvic floor dysfunction. We used a global pelvic-floor assessment questionnaire to evaluate the effect of sacral neuromodulation on non-bowel related symptomatology. METHOD: The electronic Personnel Assessment Questionnaire - Pelvic Floor (ePAQ-PF) is a validated Web-based electronic pelvic floor questionnaire. Women with faecal incontinence underwent assessment using the ePAQ. Pre- and poststimulator data were analysed over a 4.5-year period. RESULTS: Forty-three women (mean age 56.5 years; median follow up 6.8 months) were included. All (100%) had urinary symptoms, 81.4% had vaginal symptoms and 85.7% described some sexual dysfunction. There was a significant improvement in faecal incontinence and in bowel-related quality of life (P < 0.005) as well as in irritable bowel syndrome (IBS)-related symptoms (P < 0.01) and in bowel-related sexual heath (P < 0.01). Symptoms of vaginal prolapse significantly improved (P = 0.05). There was also improvement in symptoms of overactive bladder (P = 0.005) and in urinary-related quality of life (P < 0.05). A global health improvement was reported in 58.1%, mainly in bowel evacuation (P < 0.01) and in vaginal pain and sensation (P < 0.05). In sexually active female patients, significant improvements in vaginal and bowel-related sexual health were seen (P < 0.005). Improvement in general sex life following stimulation was reported in 53.3%. CONCLUSION: A Web-based electronic pelvic-floor assessment questionnaire has demonstrated global improvement in pelvic floor function in bowel, urinary, vaginal and sexual dimensions in women following sacral neuromodulation for faecal incontinence.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Trastornos del Suelo Pélvico/terapia , Prolapso de Órgano Pélvico/terapia , Nervios Espinales , Incontinencia Urinaria/terapia , Incontinencia Fecal/complicaciones , Femenino , Humanos , Neuroestimuladores Implantables , Persona de Mediana Edad , Trastornos del Suelo Pélvico/complicaciones , Prolapso de Órgano Pélvico/complicaciones , Calidad de Vida , Región Sacrococcígea , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/terapia , Encuestas y Cuestionarios , Resultado del Tratamiento , Incontinencia Urinaria/complicaciones
11.
Reprod Biomed Online ; 25(2): 180-9, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22687324

RESUMEN

Stress arousal may compromise the feedback regulation of the hypothalamo-pituitary-adrenal axis, releasing stress-related biomarkers and thereby affecting establishment of pregnancy. This study examined the relationship between stress and recurrent miscarriage (RM) and the impact of stress on establishment of pregnancy. The stress status of 45 patients with unexplained RM and 40 fertile women was investigated with the Fertility Problem Inventory (FPI), Perceived Stress Scale (PSS), Positive and Negative Affect Schedule, peripheral natural killer (NK) cells and cortisol. Patients with unexplained RM had significantly higher scores on the FPI (P<0.05, adjusted OR 1.02), PSS (P<0.05, adjusted OR 1.13) and Negative Affect scale (P<0.05, adjusted OR 1.12) and lower scores on the Positive Affect scale (P<0.05, adjusted OR 0.89) than fertile controls. Patients who had live births (n=20) during the study period had significantly lower scores in the Positive Affect scale (P<0.05, adjusted OR 1.17) than those who miscarried (n=10). There was a little association between psychological stress measurements and biochemical stress measurements. These results suggest that stress is a risk factor of RM. Within women with RM, moderate stress appears to be associated with improved pregnancy outcome.


Asunto(s)
Aborto Habitual/epidemiología , Aborto Habitual/etiología , Estrés Psicológico/complicaciones , Afecto/fisiología , Recuento de Células , Inglaterra/epidemiología , Femenino , Humanos , Hidrocortisona/sangre , Células Asesinas Naturales/fisiología , Embarazo , Factores de Riesgo , Estadísticas no Paramétricas , Encuestas y Cuestionarios
12.
Int J Qual Health Care ; 24(5): 517-24, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22879372

RESUMEN

OBJECTIVE: To develop and establish the psychometric properties of an instrument to measure face validity, feasibility and utility of patient questionnaires used during health care. DESIGN: Our instrument, QQ-10, is a 10-item self-completed questionnaire, which was developed during the evaluation of another questionnaire (ePAQ-PF), to assess patients' views on questionnaire use during health care. SETTING: Urogynaecology Department, Royal Hallamshire Hospital, Sheffield, UK. PARTICIPANTS: The Sheffield maternity patient user group identified 10 key themes relating to patients' views on using questionnaires; these themes translated into 10 statements, each using the same 5-point Likert response scale. INTERVENTION: Not applicable. Outcome Measures Principal component analysis established the factor structure of our instrument. Internal reliability was assessed using Cronbach's alpha. Construct validity was assessed using Spearman's rho. RESULTS: Factor analysis yielded two meaningful factors: Value and Burden, both achieving Cronbach's alpha scores >0.7. Significant correlations were found between scores for Value and communication experience and between scores for Burden and barriers to health care. CONCLUSIONS: Our instrument offers a valid, reliable measure of patients' views relating to value and burden of using health-related quality of life questionnaires. Its two domains show good internal reliability and with its free text items, it may offer a valuable, standardized assessment of face validity and utility of other questionnaires used in health care.


Asunto(s)
Atención a la Salud/métodos , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Psicometría , Reproducibilidad de los Resultados , Adulto Joven
13.
Phys Rev Lett ; 107(10): 102301, 2011 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-21981496

RESUMEN

We report the results of an improved determination of the triple correlation DP·(p(e)×p(v)) that can be used to limit possible time-reversal invariance in the beta decay of polarized neutrons and constrain extensions to the standard model. Our result is D=[-0.96±1.89(stat)±1.01(sys)]×10(-4). The corresponding phase between gA and gV is ϕAV=180.013°±0.028° (68% confidence level). This result represents the most sensitive measurement of D in nuclear ß decay.

14.
Qual Life Res ; 20(7): 1011-22, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21359974

RESUMEN

PURPOSE: To develop and psychometrically evaluate two questionnaires measuring both positive and negative postnatal health of mothers (M-PHI) and fathers (F-PHI) during the first year of parenting. METHODS: The M-PHI and the F-PHI were developed in four stages. Stage 1: Postnatal women's focus group (M-PHI) and postnatal fathers' postal questionnaire (F-PHI); Stage 2: Qualitative interviews; Stage 3: Pilot postal survey and main postal survey; and Stage 4: Test-retest postal survey. RESULTS: The M-PHI consisted of a 29-item core questionnaire with six main scales and five conditional scales. The F-PHI consisted of a 27-item questionnaire with six main scales. All scales achieved good internal reliability (Cronbach's α 0.66-0.87 for M-PHI, 0.72-0.90 for F-PHI). Intraclass correlation coefficients demonstrated high test-retest reliability (0.60-0.88). Correlation coefficients supported the criterion validity of the M-PHI and the F-PHI when tested against the Short-Form-12 (SF-12), Edinburgh Postnatal Depression Scale (EPDS) and the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS). CONCLUSION: The M-PHI and F-PHI are valid, reliable, parent-generated instruments. These unique instruments will be invaluable for practitioners wishing to promote family-centred care and for trialists and other researchers requiring a validated instrument to measure both positive and negative health during the first postnatal year, as to date no such measurement has existed.


Asunto(s)
Padre/psicología , Estado de Salud , Encuestas Epidemiológicas/instrumentación , Madres/psicología , Responsabilidad Parental , Atención Posnatal , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios/normas , Reino Unido
16.
J Pediatr Adolesc Gynecol ; 34(5): 643-648, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33548448

RESUMEN

STUDY OBJECTIVE: To characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion. DESIGN: Cross-sectional survey. SETTING: Secondary schools in West Midlands, England. PARTICIPANTS: A total of 442 girls, aged 15-19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES: The questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it. RESULTS: Period pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it. CONCLUSION: Most secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents' familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.


Asunto(s)
Endometriosis , Menstruación , Adolescente , Estudios Transversales , Dismenorrea/etiología , Endometriosis/diagnóstico , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Instituciones Académicas , Encuestas y Cuestionarios
17.
Reprod Biomed Online ; 20(6): 861-5, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20378408

RESUMEN

There is continuing debate concerning the relationship between cigarette smoking and premature ovarian failure. The aim of this retrospective data analysis was to investigate whether smoking has a measurable effect on early follicular serum concentrations of inhibin B hormone, FSH and anti-Müllerian hormone (AMH) in women of reproductive age. A database containing data on age, smoking status and serum concentrations of inhibin B, FSH and AMH was analysed. Pearson's correlation coefficient was calculated to determine the correlation between hormone concentrations and age. One-way analysis of variance was used to determine any significant difference in age between smoking categories and a univariate general linear model was used to compare geometric means and geometric mean ratios of hormone concentrations in relation to smoking status. Serum concentrations of inhibin B were significantly lower in women who had ever smoked cigarettes: F(2,332) = 3.371, P = 0.036. There was no statistically significant difference in FSH or AMH concentrations although a trend towards lower AMH concentrations in smokers was observed. This analysis provides evidence of an advancement of ovarian ageing in women who smoke cigarettes and is relevant to women of childbearing age who wish to avoid premature decline in fertility.


Asunto(s)
Hormonas/sangre , Nicotiana , Fumar/sangre , Adulto , Humanos , Persona de Mediana Edad , Estudios Retrospectivos
18.
Rev Sci Instrum ; 91(10): 105102, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33138601

RESUMEN

An important consideration when designing a magnetostatic cavity for various applications is to maximize the ratio of the volume of field homogeneity to the overall size of the cavity. We report a design of a magnetically shielded solenoid that significantly improves the transverse field gradient averaged over a volume of 1000 cm3 by placing compensation coils around the holes in the mu-metal end caps rather than the conventional design in which the compensation coils are placed on the main solenoid. Our application is polarized 3He-based neutron spin filters, and our goal was to minimize the volume-averaged transverse field gradient, thereby the gradient induced relaxation time, over a 3He cell. For solenoids with end cap holes of different sizes, additional improvements in the field gradient were accomplished by introducing non-identical compensation coils centered around the non-identical holes in the end caps. The improved designs have yielded an overall factor of 7 decrease in the gradient in the solenoid, hence a factor of 50 increase in the gradient induced relaxation time of the 3He polarization. The results from both simulation and experiments for the development of several such solenoids are presented. Whereas our focus is on the development of magnetically shielded solenoids for 3He neutron spin filters, the approach can be applied for other applications demanding a high level of field homogeneity over a large volume.

19.
J Med Genet ; 45(3): 142-6, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17959715

RESUMEN

BACKGROUND AND OBJECTIVE: Methylating agents are effective chemotherapy agents for Hodgkin lymphoma, but are associated with the development of second primary cancers. Cytotoxicity of methylating agents is mediated primarily by the DNA mismatch repair (MMR) system. Loss of MLH1, a major component of DNA MMR, results in tolerance to the cytotoxic effects of methylating agents and persistence of mutagenised cells at high risk of malignant transformation. We hypothesised that a common substitution in the basal promoter of MLH1 (position -93, rs1800734) modifies the risk of cancer after methylating chemotherapy. METHODS: 133 patients who developed cancer following chemotherapy and/or radiotherapy (n = 133), 420 patients diagnosed with de novo myeloid leukaemia, 242 patients diagnosed with primary Hodgkin lymphoma, and 1177 healthy controls were genotyped for the MLH1 -93 polymorphism by allelic discrimination polymerase chain reaction (PCR) and restriction fragment length polymorphism assay. Odds ratios and 95% confidence intervals for cancer risk by MLH1 -93 polymorphism status, and stratified by previous exposure to methylating chemotherapy, were calculated using unconditional logistic regression. RESULTS: Carrier frequency of the MLH1 -93 variant was higher in patients who developed therapy related acute myeloid leukaemia (t-AML) (75.0%, n = 12) or breast cancer (53.3%. n = 15) after methylating chemotherapy for Hodgkin lymphoma compared to patients without previous methylating exposure (t-AML, 30.4%, n = 69; breast cancer patients, 27.2%, n = 22). The MLH1 -93 variant allele was also over-represented in t-AML cases when compared to de novo AML cases (36.9%, n = 420) and healthy controls (36.3%, n = 952), and was associated with a significantly increased risk of developing t-AML (odds ratio 5.31, 95% confidence interval 1.40 to 20.15), but only in patients previously treated with a methylating agent. CONCLUSIONS: These data support the hypothesis that the common polymorphism at position -93 in the core promoter of MLH1 defines a risk allele for the development of cancer after methylating chemotherapy for Hodgkin lymphoma. However, replication of this finding in larger studies is suggested.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Antineoplásicos Alquilantes/efectos adversos , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/genética , Neoplasias Primarias Secundarias/etiología , Proteínas Nucleares/genética , Polimorfismo Genético , Adolescente , Adulto , Anciano , Alelos , Secuencia de Bases , Estudios de Casos y Controles , Metilación de ADN , Cartilla de ADN/genética , Reparación del ADN/genética , Femenino , Humanos , Leucemia Mieloide Aguda/inducido químicamente , Leucemia Mieloide Aguda/etiología , Leucemia Mieloide Aguda/genética , Masculino , Persona de Mediana Edad , Homólogo 1 de la Proteína MutL , Neoplasias Primarias Secundarias/inducido químicamente , Neoplasias Primarias Secundarias/genética , Regiones Promotoras Genéticas , Factores de Riesgo
20.
Hum Fertil (Camb) ; 11(3): 173-85, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18925472

RESUMEN

In recent years there has been an increasing demand for the design, development and use of questionnaires that can assess patients' experiences of health and illness or their health-related quality of life (HRQoL). The application of these questionnaires in research and clinical practice provides information from the patient's perspective on the ways in which symptoms and treatments can affect their daily well-being and functioning. The aim of this paper is to report on the ways in which information on the HRQoL of women with polycystic ovary syndrome (PCOS) can be collected. With particular reference to PCOS-associated infertility, this paper will discuss the types of questionnaires that are currently available. It will discuss the benefits and limitations of the disease-specific PCOS questionnaire, and the other generic and condition-specific tools that have been used in the existing PCOS literature. Recommendations for future researchers interested in measuring HRQoL outcomes in women with PCOS-associated infertility are also made.


Asunto(s)
Infertilidad Femenina/psicología , Síndrome del Ovario Poliquístico/psicología , Encuestas y Cuestionarios/normas , Femenino , Humanos , Infertilidad Femenina/etiología , Síndrome del Ovario Poliquístico/complicaciones , Calidad de Vida
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