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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 319-326, 2021 Apr 25.
Artículo en Chino | MEDLINE | ID: mdl-33878821

RESUMEN

Objective: To understand the current status of diagnosis and treatment regarding the protection of defecation function in Chinese surgeons performing sphincter-preserving resections (SPR) for rectal cancer in order to discover the problems existing in the function protection during SPR and provide support and reference for the standardized clinical management of rectal cancer. Methods: A cross-sectional survey was performed. Colorectal surgeons who obtained the medical qualifications and volunteered to participate in this study were included, and respondents with incomplete information were excluded. From October 18 to 22, 2020, randomized sampling was conducted among Chinese colorectal surgeons from Chinese Association of Colorectal Surgeons, Chinese Colorectal Cancer Committee, Chinese Sexology Association Anal functional Surgery Committee and National Health Commission Capacity Building and Continuing Education Committee. The questionnaire included basic information of the respondents, assessment of defecation function before SPR, intraoperative details, postoperative follow-up, evaluation and intervention of patients with low anterior resection syndrome (LARS). Observation indicator: results of the questionnaire survey. Result: A total of 231 questionnaires were collected, and 230 were effective, with an effective rate of 99.6%. Among these participants, 217 (94.3%) were males; 107 (46.5%) had medical doctor degrees; 129 (56.1%) were national commission members in colorectal surgery; 137 (59.6%) performed more than 50 SPR operations per year; 211 (91.7%) assessed defection function by auxiliary examinations before SPR. Rigid sigmoidoscopy (n=116, 55.0%) and anorectal manometer (n=81, 38.4%) were the most commonly used method. Among the 230 respondents, 64.8% (n=149) of surgeons used 2D laparoscopy for SPR surgery most commonly, and 51.3% (n=118) of surgeons performed direct colorectal anastomosis for reconstruction, and 98.3% (n=226) used staplers during anastomosis. All the surgeons indicated that they would follow up patients after SPR, and outpatient clinic was the most common method (84.4%, 184/230). When LARS occurred, 50.0% (115/230) of surgeons chose defecation function scale and 78.7% (181/230) actively provided guidance and intervention for patients. Conclusions: Chinese colorectal surgeons still have shortcomings in the protection of defecation function during SPR for rectal cancer. They do not make enough preoperative functional evaluation and postoperative functional recovery estimate for patients. The knowledge and use of defecation function scales and interventions on LARS are expected to be standardized.


Asunto(s)
Neoplasias del Recto , Cirujanos , Canal Anal/cirugía , China , Estudios Transversales , Defecación , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Neoplasias del Recto/cirugía , Encuestas y Cuestionarios , Síndrome
2.
Medicine (Baltimore) ; 100(10): e24019, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725813

RESUMEN

BACKGROUND: Irritable bowel syndrome (IBS) is a disorder which has considerable effect to patient's quality of life and social functioning. Its main symptoms include recurrent abdominal pain and/or bloating associated with abnormal stool form or frequency. The recommendable treatment of IBS is a medication including loperamide, cimetropium, tricyclic antidepressants, and selective serotonin receptor inhibitors, but it has limited effects and several side effects dissatisfy IBS patients. As an alternative therapy, Xiaoyao-san (XYS) is gaining interest for IBS patients. XYS, a traditional Chinese medicine (TCM), has wide scope of indications and it can be prescribed for various gastrointestinal disorders in TCM syndromes but there has been no systematic review on IBS. Therefore, this review aims on systematically validating the curative effect of XYS on IBS. METHODS: Electronic databases, manual search, and contact to author e-mail will be used for searching randomized controlled trials about the use of XYS for IBS. We will select studies by the predefined criteria and collect the data on study participants, interventions, control groups, outcome measurement, adverse events, and risk of bias. Primary outcome will be the efficacy rate, and secondary outcomes will be the IBS-centered indices (abdominal pain score, abdominal distension score, diarrhea or constipation score, bowel symptom severity scale), index about quality of life, and adverse events. Review Manager software and Cochrane Collaboration "risk of bias" tools will be used for meta-analysis and assessment of risk of bias. RESULTS: This review will identify the clinical evidence of XYS's effectiveness and safety for IBS according to formal evaluation aspects. CONCLUSION: This review will further support the evidence-based usage of XYS for IBS treatment. ETHICS AND DISSEMINATION: No ethical approval is required since there is no personal information collection and patient recruitment. TRIAL REGISTRATION NUMBER: Research Registry; reviewregistry986.


Asunto(s)
Defecación/efectos de los fármacos , Medicamentos Herbarios Chinos/administración & dosificación , Síndrome del Colon Irritable/tratamiento farmacológico , Administración Oral , Defecación/fisiología , Medicamentos Herbarios Chinos/efectos adversos , Humanos , Síndrome del Colon Irritable/complicaciones , Síndrome del Colon Irritable/fisiopatología , Metaanálisis como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 100(6): e24717, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578614

RESUMEN

ABSTRACT: Although the Crohn's Disease Activity Index (CDAI) is often used to evaluate the disease activity in Crohn's disease (CD), the number of liquid or soft stools cannot be precisely evaluated, and thus accurate scores cannot be calculated, in patients with enterostomy. Therefore, we created the modified CDAI (mCDAI), without the defecation frequency item from the CDAI, and examined its usefulness.Study participants comprised 9 patients with CD with enterostomy and 20 patients with CD without enterostomy. Correlations between the mCDAI and serum albumin (Alb) levels or C-reactive protein (CRP) levels were examined using regression analysis. Additionally, regression analyses were conducted in patients with CD without enterostomy to determine the Alb and CRP levels corresponding to the CDAI at its cutoff value for remission status (150). The obtained values were applied to the mCDAI regression equations to determine the equivalent mCDAI cutoff value.mCDAI and Alb levels were significantly negatively correlated (P < .0001). The mCDAI had a significant positive correlation with the CRP level and erythrocyte sedimentation rate (P = .0061 and P = .0133, respectively). From the regression analysis of patients with CD without enterostomy, the Alb and CRP levels equivalent to a CDAI of 150 were 3.85 g/dL and 0.62 mg/dL, respectively. When applying these values to the mCDAI regression formulas, the values of 113.8 and 115.2, respectively, were obtained. Thus, the cutoff value of the mCDAI indicating disease activity was estimated as 115.The mCDAI fully reflects the nutritional status and inflammatory response, and is convenient and useful for assessing disease activity over time, in patients with CD with enterostomy. A mCDAI score ≥ 115 indicates disease activity.


Asunto(s)
Enfermedad de Crohn , Ileostomía , Índice de Severidad de la Enfermedad , Adulto , Defecación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
4.
Medicine (Baltimore) ; 100(7): e24662, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607803

RESUMEN

BACKGROUND: As one of the important manifestations of neurogenic bowel dysfunction, constipation is characterized by high incidence and harmful effects. It has a negative impact on both physical and psychological health of patients. And there are no effective treatment options for this type of disease clinically. Therefore, this study is designed to examine the effect of the therapy of "combination 3 methods progression" in patients with neurogenic bowel dysfunction (constipated type). METHODS: This is a randomized, controlled, parallel-design clinical trial. A total of 60 patients with neurogenic bowel dysfunction (constipated type) will be randomly assigned to intervention group and control group. The control group will receive 4 weeks of usual rehabilitation care, the intervention group will receive 4 weeks of the therapy of "combination 3 methods progression" in addition to usual rehabilitation care. The primary outcome is the number of spontaneous bowel movement per week. Secondary outcomes are stool characteristics, degree of difficulty in defecation, level of anxiety, level of depression, and level of self-efficacy. DISCUSSION: The interventions of this protocol have been programmed to alleviate constipation in patients with neurogenic bowel dysfunction. Findings may provide preliminary evidence for clinical efficacy of the therapy of "combination 3 methods progression." TRIAL REGISTRATION: Chinese Clinical Trial Registry, IDF: ChiCTR2000041463. Registered on December 26, 2020.


Asunto(s)
Estreñimiento/terapia , Medicina China Tradicional/métodos , Intestino Neurogénico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad , Estudios de Casos y Controles , Estreñimiento/epidemiología , Estreñimiento/etiología , Estreñimiento/rehabilitación , Defecación/fisiología , Depresión , Humanos , Incidencia , Persona de Mediana Edad , Intestino Neurogénico/fisiopatología , Autoeficacia , Resultado del Tratamiento
5.
J Stroke Cerebrovasc Dis ; 30(4): 105641, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33549861

RESUMEN

OBJECTIVES: The purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. MATERIALS AND METHODS: We retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. RESULTS: The verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. CONCLUSIONS: Our results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.


Asunto(s)
Actividades Cotidianas , Cognición , Defecación , Actividad Motora , Autocuidado , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Micción , Factores de Edad , Anciano , Anciano de 80 o más Años , Árboles de Decisión , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Fuerza Muscular , Recuperación de la Función , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Torso/fisiopatología , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(4): e24286, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530217

RESUMEN

BACKGROUND: This review will assess current evidence related to the effectiveness and safety of acupoint catgut embedding therapy for functional constipation (FC) and provide efficacy assessments for clinical applications. METHODS: We will search the following databases for relevant trials: PubMed, EMBASE OVID, Cumulative Index of Nursing and Allied Health Literature, OVID MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, Cochrane library, and Scopus. We will also search the following Chinese databases for trials published in the Chinese literature: China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Database, Wan Fang Database, Chinese Biomedicine and other resources from inception to December 2020. Only randomized controlled trials comparing acupoint catgut embedding versus acupuncture or sham acupuncture or placebo or other therapies will be included. The outcomes involved mean spontaneous bowel movements, complete spontaneous bowel movements, the Bristol Stool Form Scale, the Cleveland Clinic Score, Patient Assessment of Constipation symptom and so on. The risk of bias assessment and quality of evidence for outcomes will be appraised using the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development and Evaluation guidelines. RevMan 5.3 software will be employed for the meta-analysis. RESULTS: This work will compare and arrange the comparative efficacy of acupoint catgut embedding with different treatments for FC by summarizing the current evidences. CONCLUSION: The results of this meta-analysis may help doctors determine the best treatments for patients to manage FC. ETHICS AND DISSEMINATION: This is a protocol with no patient recruitment and personal information collection, approval by the ethics committee is not required. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/XTKE2.


Asunto(s)
Puntos de Acupuntura , Terapia por Acupuntura/métodos , Catgut , Estreñimiento/terapia , Adhesión del Tejido/métodos , Adulto , Estreñimiento/fisiopatología , Defecación , Heces , Femenino , Humanos , Masculino , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
7.
Phytomedicine ; 82: 153459, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33486266

RESUMEN

BACKGROUND: There is growing interest in using herbal supplements to treat constipation; however, little evidence exists for their use. PURPOSE: This study evaluates the efficacy and safety of herbal formula MaZiRenWan (Hemp Seed Pill, HSP) in patients with functional or non-functional constipation. STUDY DESIGN: Systematic review and meta-analysis METHODS: PubMed, CENTRAL, Embase, CNKI, and Wanfang were searched through April 20, 2020 for randomized trials of HSP versus placebo or medications for all types of constipation. The primary outcomes were complete response rate, complete spontaneous bowel movement (CSBM), patient-reported satisfactory treatment rate (prSTR), and adverse events (AEs). Clinical data were analyzed using a random-effects model, and the quality of evidence was evaluated with the GRADE system. RESULTS: This review includes 1681 constipation patients from 17 moderate-to-high risk of bias trials that were conducted in east Asia. Two high-quality trials showed that HSP compared with placebo significantly increased weekly CSBM (mean difference, 0.95; 95% CI: 0.56, 1.35) and had a higher complete response rate (risk ratio [RR], 1.43; 95% CI: 1.20, 1.71) in patients with functional constipation. Low-quality evidence showed significant improvement in prSTR in HSP compared with conventional medications (RR, 1.79; 95% CI: 1.42, 2.25). Additionally, HSP use did not increase AEs compared with no HSP (p = 0.99). CONCLUSIONS: This study found that HSP was effective among Asian patients with functional constipation. Rigorous trials need to be conducted in clinical populations outside of east Asia and in those with non-functional constipation to increase the generalizability of the evidence.


Asunto(s)
Estreñimiento/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Defecación/efectos de los fármacos , Suplementos Dietéticos , Medicamentos Herbarios Chinos/efectos adversos , Medicamentos Herbarios Chinos/farmacología , Humanos
8.
Environ Sci Pollut Res Int ; 28(15): 19179-19185, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33394408

RESUMEN

With the growing awareness of the linkage among open defecation (OD), environment, and health, it is important to understand the factors responsible for OD. It is a necessary step toward developing a strategy to end open defecation for ensuring a better environment and human health. There is no such study available for Pakistan. The study, therefore, aims to bridge this gap. Using household data of Pakistan Demographic and Health Survey (PDHS) 2017-2018, an association of OD with potential predictors, analysis of variance, and a logistic regression model are employed to develop the evidence. The results suggest that place of residence, education, poverty status, social norms, geopolitical regions, and living space significantly predict the OD behavior in Pakistan. This study recommends two things: first is to facilitate the households and communities to own latrines, second is to change the behavior through intervention. However, political commitment and effective administration will be key to ascertain ending OD.


Asunto(s)
Defecación , Saneamiento , Humanos , Pakistán , Población Rural , Cuartos de Baño
9.
Sci Total Environ ; 752: 142239, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33207493

RESUMEN

Deposit-feeding benthic invertebrates are known to modify sediment structure and impact microbial processes associated with biogeochemical cycles in marine sedimentary environments. Despite this, however, there is limited information on how sediment ingestion and defecation by marine benthos alters microbial community structure and function in sediments. In the current study, we used high-throughput sequencing data of 16S rRNA genes obtained from a previous microcosm study to examine how sediment processing by the marine polychaete Capitella teleta specifically affects sediment microbiota. Here we show that both sediment ingestion and defecation by C. teleta significantly alters overall microbial community structure and function. Sediment processing by C. teleta resulted in significant enrichment of sediment microbial communities involved in sulfur and carbon cycling in worm fecal pellets. Moreover, C. teleta's microbiota was predominantly comprised of bacterial functional groups involved in fermentation, relative to microbiota found outside of the host. Collectively, results of this study indicate that C. teleta has the ability to alter microbial biogeochemical cycles in the benthic sedimentary environment by altering microbial assemblages in the worm gut, and in the sediment ingested and defecated by worms as they feed on sediment particles. In this sense, C. teleta plays an important role as an ecosystem engineer and in shaping nutrient cycling in the benthic environment.


Asunto(s)
Microbiota , Poliquetos , Contaminantes Químicos del Agua , Animales , Defecación , Sedimentos Geológicos , ARN Ribosómico 16S/genética , Contaminantes Químicos del Agua/análisis
10.
Biomed Pharmacother ; 133: 111005, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33378996

RESUMEN

BACKGROUND: The dried root and rhizome of Aster tataricus (RA), is a traditional Chinese medicine has been used for more than 2000 years with the function of antitussive, expectorant and antiasthmatic. Ancient books and modern pharmacological researches demonstrated that RA may have the function of moistening intestines and relieving constipation, but there was a lack of systematic evidence. The aim of this study was to comprehensively evaluate the efficacy and possible mechanisms of ethanol extract of Aster tataricus (ATE) in treating constipation from in vivo to in vitro. METHODS: In vivo, the ATE was studied in loperamide-induced constipation of mice. In vitro, different concentrations of ATE was tested separately or cumulatively on spontaneous and agonists-induced contractions of isolated rat duodenum strips. RESULTS: In vivo, at doses of 0.16, 0.8 g/mL, ATE showed significantly promotion of the small intestinal charcoal transit, decrease of the amount of remnant fecal, and increase of the content of fecal water in colon. In addition, ATE could effectively relieve colonic pathological damage caused by loperamide as well. In vitro, with the cumulative concentration increase of ATE from 0.8 to 6.4 mg/mL, it could significantly decrease the contraction caused by KCl or Ach, and gradually restore to near base tension value.Meanwhile, it could also partially but significantly inhibit the contractions induced by Ach and CaCl2 on rat duodenum in a concentration related manner. CONCLUSIONS: Taking all these findings together, it could be speculated that ATE may attenuate constipation mainly through antagonizing the binding of acetylcholine to muscarinic receptor, inhibiting Ca2+ influx and anti-inflammation.


Asunto(s)
Aster , Señalización del Calcio/efectos de los fármacos , Estreñimiento/tratamiento farmacológico , Defecación/efectos de los fármacos , Duodeno/efectos de los fármacos , Tránsito Gastrointestinal/efectos de los fármacos , Laxativos/farmacología , Antagonistas Muscarínicos/farmacología , Extractos Vegetales/farmacología , Animales , Antiinflamatorios/aislamiento & purificación , Antiinflamatorios/farmacología , Aster/química , Estreñimiento/inducido químicamente , Estreñimiento/metabolismo , Estreñimiento/fisiopatología , Modelos Animales de Enfermedad , Duodeno/metabolismo , Duodeno/fisiopatología , Laxativos/aislamiento & purificación , Loperamida , Ratones , Antagonistas Muscarínicos/aislamiento & purificación , Extractos Vegetales/aislamiento & purificación , Ratas Sprague-Dawley
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1131-1134, 2020 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-33353264

RESUMEN

The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.


Asunto(s)
Enfermedades del Ano , Defecación , Canal Anal/fisiopatología , Canal Anal/cirugía , Enfermedades del Ano/fisiopatología , Enfermedades del Ano/cirugía , China , Consenso , Humanos , Atención Perioperativa , Periodo Perioperatorio
12.
Wiad Lek ; 73(10): 2313-2315, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33310970

RESUMEN

OBJECTIVE: Introduction: Colorectal cancer is one of the most frequently diagnosed cancer worldwide. Abdominal pain, alteration of chronic bowel habits, changes in bowel movements and involuntary weight loss belong to typical symptoms. It is important to diagnose the disease in early stage to improve effectiveness of treatment. The aim: To present a case report of exertional dyspnoea in patient with newly diagnosed colorectal cancer without any symptoms and abnormalities in physical examination suggesting malignant process of digestive tract. PATIENTS AND METHODS: Case report: We present a 71-year-old male who has been admitted to the Department of Internal Medicine, Angiology and Physical Medicine under emergency care, where was aimed at by general practitioner to diagnose exertional dyspnoea ongoing last few weeks, which appearing after two hundred meters walk on flat surface. In the course of the diagnostic process, it turned out that the cause of dyspnoea was colorectal cancer. CONCLUSION: Conclusions: This case report shows that initial symptoms of cancer may be nonspecific and it confirms how important it is for doctors to remain vigilant in the diagnostic process.


Asunto(s)
Neoplasias del Colon , Neoplasias Colorrectales , Anciano , Defecación , Disnea , Humanos , Masculino , Caminata
13.
Arq Gastroenterol ; 57(4): 498-506, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33331483

RESUMEN

BACKGROUND: Lubiprostone is a type 2 chloride channel activator that has been shown to be efficacious and safe in the treatment for chronic constipation. OBJECTIVE: To systematically review randomized clinical trials (RCTs) assessing efficacy of lubiprostone for patients with chronic idiopathic constipation (CIC), irritable bowel syndrome with predominant constipation (IBS-C) and opioid-induced constipation (OIC). METHODS: Searches were conducted in PubMed, LILACS, Cochrane Collaboration Database, and Centre for Reviews and Dissemination. Lubiprostone RCTs reporting outcomes of spontaneous bowel movements (SBM) and abdominal pain or discomfort were deemed eligible. Meta-analysis was performed calculating risk ratios and 95% confidence intervals, using the Mantel-Haenszel method and random effects model. RESULTS: Searches yielded 109 records representing 93 non-duplicate publications, and 11 RCTs (978 CIC, 1,366 IBS-C, 1,300 OIC, total = 3,644) met inclusion criteria. Qualitative synthesis showed that for CIC patients, lubiprostone is superior to placebo in terms of SBM outcomes. Meta-analysis for CIC was feasible for full responder and SBM within 24h rates, indicating superiority of lubiprostone over placebo. For IBS-C, lubiprostone was significantly superior for all SBM outcomes in follow-ups ranging from 1 week-3 months. In terms of abdominal pain, lubiprostone provided significantly better symptoms relief, particularly after 1 month of treatment. For OIC, lubiprostone was more effective than placebo for both SBM and discomfort measures. CONCLUSION: Our findings demonstrated that lubiprostone is superior to placebo in terms of SBM frequency for CIC, IBS-C and OIC. In terms of abdominal symptoms, the most pronounced effect was seen for abdominal pain in IBS-C patients.


Asunto(s)
Estreñimiento/tratamiento farmacológico , Lubiprostona/uso terapéutico , Analgésicos Opioides , Estreñimiento/inducido químicamente , Defecación , Humanos , Síndrome del Colon Irritable/tratamiento farmacológico , Resultado del Tratamiento
14.
PLoS One ; 15(10): e0239587, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33006973

RESUMEN

Resource-deprived coastal peri-urban settlements in Southern Ghana are characterized by indiscriminate solid waste disposal and open defecation practices. Persons engaged in waste handling in such communities perform their activities with little or no personal protective equipment. They are thus confronted with the risk of faecal pollution of the hands and other bodily parts. A mixed method approach was used to investigate 280 waste handlers performing different activities to estimate recent faecal pollution of their hands and to observe the utilization of personal protective equipment and sanitation/hygiene facilities during work. The log concentration of E. coli on hands of waste handlers after work (8.60 ± 4.20 CFU/hand, mean ± standard deviation) was significantly higher compared with the E. coli log concentration before work (2.95 ± 1.89 CFU/hand, mean ± standard deviation) (p<0.001). The odds of faecal pollution was significantly higher (aOR 4.2; 95% CI: 1.9-9.1) for workers aged 35 years and above compared with those less than 35 years; and for workers at public toilet facilities (aOR 3.0; 95% CI: 1.0-8.4) compared with those who worked for private waste handling companies. Female workers were, however, 60% less likely (aOR 0.4; 95% CI: 0.2-0.8) to experience faecal pollution of their hands compared with males. The workers had limited access to water and sanitation and hygiene facilities, and about one-fifth (n = 59; 21.1%) did not use personal protective equipment during work. Waste handlers should be provided and instructed in proper use of personal protective equipment, have access to sanitation facilities and adopt improved hygiene behaviour to avoid the risk of faecal pollution and associated disease risk.


Asunto(s)
Heces , Exposición Profesional , Eliminación de Residuos , Adulto , Carga Bacteriana , Defecación , Contaminación Ambiental/prevención & control , Escherichia coli/aislamiento & purificación , Heces/microbiología , Femenino , Ghana , Mano/microbiología , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/prevención & control , Factores de Riesgo , Cuartos de Baño , Población Urbana
15.
PLoS One ; 15(10): e0239491, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33021987

RESUMEN

Open defaecation has remained a major public and environmental health concern which has gained global attention. This study explored cultural factors including superstition, taboo, norms and values influencing open defaecation behaviour among basic school pupils in the Eastern and Volta Regions all within Southern Ghana. Self-reported data were collected from 400 pupils using structured questionnaire and focus group discussions. Descriptive, bivariate and multivariate statistics were used to analyze the quantitative data. The qualitative data was analyzed using thematic content analytical procedure. The results of the study showed, superstitions, traditional norms and taboo yielded statistically significant effect sizes with pupils' open defaecation behaviour: and superstition: r = 0.728, p< 0.05; traditional norms: r = 0.425, p <0.05; taboos: r = 0.462, p<0.05. The study concluded that superstitions and traditional norm and taboo constituted the key cultural drivers influencing pupils' open defaecation behaviour in the Eastern and Volta Regions. It is recommended that the Ministry of Education should incorporate open defaecation issues into the educational curriculum and develop culturally sensitive educational programs for a massive educational campaign to stop open defaecation in the schools. To ensure that the messaging for these campaigns resonate with target audience, communication campaigns should promote a number of positive emotional and social issues related to improved social status and positive self-esteem, better growth and economic opportunities with toilet use.


Asunto(s)
Cultura , Defecación , Instituciones Académicas/estadística & datos numéricos , Conducta Social , Adolescente , Niño , Femenino , Ghana , Humanos , Masculino , Encuestas y Cuestionarios
16.
Rev. cir. (Impr.) ; 72(5): 389-394, oct. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1138729

RESUMEN

Resumen Introducción: En pacientes constipados crónicos por obstrucción de salida, la contracción paradojal del puborrectal (CPP) o "anismo" es frecuente. El tratamiento con Biofeedback y rehabilitación pelviperineal presenta resultados exitosos entre el 40-90%. Objetivo: Evaluar el resultado del tratamiento con Biofeedback y rehabilitación pelviperineal en pacientes con CPP a corto plazo. Materiales y Método: Serie de casos. Datos obtenidos prospectivamente de la Unidad de Piso Pelviano. Se incluyó pacientes entre 2008 y 2015 que cumplían criterios de constipación crónica secundaria a CPP, confirmado por manometría anorrectal y/o defeco-resonancia. Se analizaron datos demográficos, frecuencia de evacuaciones, uso de laxantes, enemas, pujo, Score de Altomare y Score de constipación de Wexner pre y post-tratamiento. Resultados: 43 pacientes, de los cuales 39 son mujeres. Edad media de 40 años (rango: 14-84). Duración de síntomas fue ≥ 5 años en el 72,5%. Mediana de sesiones de Biofeedback de 8 (6-10). El 62,8% presenta ≤ 2 evacuaciones semanales y disminuye a un 29,3% post-tratamiento (p < 0,001). El 76,2% requiere laxantes orales y el 42,9% enemas, disminuyendo a 35,1% (p < 0,001) y 5,4% (p < 0,001) respectivamente post-tratamiento. Sensación de evacuación incompleta/fragmentada en todos los intentos mejoró de 67,4% a 14,6% (p < 0,001) y el pujo excesivo en más de la mitad de intentos mejoró de 76,1% a 10,8% (p < 0,001). Score de Wexner para constipación y Altomare mejoró de 18 a 7 (p < 0,001) y de 16 a 5 (p < 0,001) respectivamente. Conclusión: El biofeedback y la rehabilitación pelviperineal son efectivas en el tratamiento de la CPP.


Introduction: In patients with chronic constipation by obstructive defecation syndrome Paradoxical Puborectalis Contraction or "anismus" is important. Successful results for Biofeedback treatment and Pelviperineal Rehabilitation it described between 40-90%. Aim: To evaluate the outcome of biofeedback and pelviperineal rehabilitation in patients with CPP in the short-term. Materials and Method: Case series. Data was obtained from the prospective database of Pelvic Floor Unit of Universidad Católica de Chile. Patients with anismus were included between 2008 and 2015. Diagnostic criteria were chronic constipation patients by anismus with anorectal manometry and/or defecoresonancy that confirms this disorder and discards other causes of obstruted defecation síndrome. Demographic variables, frequency of bowel movements, use of laxatives, enemas, pushing, Altomare Score and Wexner constipation Score were analyzed pre and post-treatment. Results: Series of 43 patients, 39 of whom where women. Median age: 40 years (range: 14-84). Duration of symptoms ≥ 5 years in 72.5%. Median of Biofeedback sessions: 8 (range 6-10). Pre-treatment, 62.8% had ≤ 2 evacuations weekly and 29.3% post-treatment (p < 0.001). Oral laxatives were required in 76.2% and 42.9% enemas, decreasing to 35.1% (p < 0.001) and 5.4% (p < 0.001) post-treatment respectively. Feeling of incomplete/evacuation fragmented all the time improved from 67.4% to 14.6% (p < 0.001) and excessive pushing in more than half of time improved from 76.1% to 10.8% (p < 0.001). Wexner Score for and Altomare Score improved from 18 to 7 (p < 0.001) and 16 to 5 (p < 0.001) respectively. Conclusion: Adult with chronic constipation by anismus can be treated effectively with Biofeedback and Pelviperineal Rehabilitation.


Asunto(s)
Humanos , Biorretroalimentación Psicológica/métodos , Estreñimiento/terapia , Defecación , Estudios Prospectivos , Diafragma Pélvico/fisiopatología , Estreñimiento/fisiopatología
17.
Am J Trop Med Hyg ; 103(5): 2012-2018, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32996450

RESUMEN

In countries without adequate access to improved sanitation, government-imposed restrictions during the COVID-19 pandemic can impact toilet usage. In India, where millions have recently transitioned to using a toilet, pandemic-related barriers to use might increase open defecation practices. We assessed changes in reported defecation practices in peri-urban communities in Tamil Nadu. Field assistants conducted phone surveys in 26 communities in two districts from May 20, 2020 to May 25, 2020. They asked respondents about their access to a toilet, whether they or a family member left their house to defecate in the past week, and whether specific practices had changed since the lockdown. Among 2,044 respondents, 60% had access to a private toilet, 11% to a public or community toilet, whereas 29% lacked access to any toilet facility. In our study, 92% of the respondents did not change their defecation behaviors in the 2 months following the pandemic-related lockdown. About a third (27%) reported that they or a family member left their house daily to defecate amid lockdown measures. A majority of those with private toilets (91%) or with public toilets (69%) continued using them. Respondents with private toilet access were more likely to report an increased frequency of handwashing with soap (prevalence ratio [PR]: 1.78, 95% CI: 1.04-3.05) since the lockdown. The lack of private toilets contributes to the need to leave the house amid a lockdown. Maintaining shared toilets require disinfection protocols and behavioral precautions to limit the risk of fomite transmission. Robust urban COVID-19 control strategies should include enhanced sanitation facility management and safe usage messaging.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Higiene , Pandemias/prevención & control , Neumonía Viral/prevención & control , Saneamiento/métodos , Cuartos de Baño/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aparatos Sanitarios/provisión & distribución , Betacoronavirus , Estudios Transversales , Defecación , Femenino , Desinfección de las Manos , Humanos , India , Masculino , Persona de Mediana Edad , Adulto Joven
18.
PLoS One ; 15(9): e0238627, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915831

RESUMEN

People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people's perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.


Asunto(s)
Defecación/ética , Salud Pública/normas , Saneamiento/normas , Conducta Social , Adolescente , Adulto , Anciano , Atención/fisiología , Defecación/fisiología , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Salud Pública/tendencias , Clase Social , Encuestas y Cuestionarios , Adulto Joven
19.
Cochrane Database Syst Rev ; 8: CD011625, 2020 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-32761813

RESUMEN

BACKGROUND: Postpartum constipation, with symptoms, such as pain or discomfort, straining, and hard stool, is a common condition affecting mothers. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones, and haematinics used in pregnancy can increase the risk of postpartum constipation. Eating a high-fibre diet and increasing fluid intake are usually encouraged. Although laxatives are commonly used in relieving constipation, the effectiveness and safety of available interventions for preventing postpartum constipation should be ascertained. This is an update of a review first published in 2015. OBJECTIVES: To evaluate the effectiveness and safety of interventions for preventing postpartum constipation. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, and two trials registers ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019), and screened reference lists of retrieved trials. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) comparing any intervention for preventing postpartum constipation versus another intervention, placebo, or no intervention in postpartum women. Interventions could include pharmacological (e.g. laxatives) and non-pharmacological interventions (e.g. acupuncture, educational and behavioural interventions). Quasi-randomised trials and cluster-RCTs were eligible for inclusion; none were identified. Trials using a cross-over design were not eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the search to select potentially relevant trials, extracted data, assessed risk of bias, and the certainty of the evidence, using the GRADE approach. We did not pool results in a meta-analysis, but reported them per study. MAIN RESULTS: We included five trials (1208 postpartum mothers); three RCTs and two quasi-RCTs. Four trials compared a laxative with placebo; one compared a laxative plus a bulking agent versus the same laxative alone, in women who underwent surgical repair of third degree perineal tears. Trials were poorly reported, and four of the five trials were published over 40 years ago. We judged the risk of bias to be unclear for most domains. Overall, we found a high risk of selection and attrition bias. Laxative versus placebo We included four trials in this comparison. Two of the trials examined the effects of laxatives that are no longer used; one has been found to have carcinogenic properties (Danthron), and the other is not recommended for lactating women (Bisoxatin acetate); therefore, we did not include their results in our main findings. None of the trials included in this comparison assessed our primary outcomes: pain or straining on defecation, incidence of postpartum constipation, or quality of life; or many of our secondary outcomes. A laxative (senna) may increase the number of women having their first bowel movement within 24 hours after delivery (risk ratio (RR) 2.90, 95% confidence interval (CI) 2.24 to 3.75; 1 trial, 471 women; low-certainty evidence); may have little or no effect on the number of women having their first bowel movement on day one after delivery (RR 0.94, 95% CI 0.72 to 1.22; 1 trial, 471 women; very low-certainty evidence); may reduce the number of women having their first bowel movement on day two (RR 0.23, 95% CI 0.11 to 0.45; 1 trial, 471 women; low-certainty evidence); and day three (RR 0.05, 95% CI 0.00 to 0.89; 1 trial, 471 women; low-certainty evidence); and may have little or no effect on the number of women having their first bowel movement on day four after delivery (RR 0.22, 95% CI 0.03 to 1.87; 1 trial, 471 women; very low-certainty evidence), but some of the evidence is very uncertain. Adverse effects were poorly reported. Low-certainty evidence suggests that the laxative (senna) may increase the number of women experiencing abdominal cramps (RR 4.23, 95% CI 1.75 to 10.19; 1 trial, 471 women). Very low-certainty evidence suggests that laxatives taken by the mother may have little or no effect on loose stools in the baby (RR 0.62, 95% CI 0.16 to 2.41; 1 trial, 281 babies); or diarrhoea (RR 2.46, 95% CI 0.23 to 26.82; 1 trial, 281 babies). Laxative plus bulking agent versus laxative only Very low-certainty evidence from one trial (147 women) suggests no evidence of a difference between these two groups of women who underwent surgical repair of third degree perineal tears; only median and range data were reported. The trial also reported no evidence of a difference in the incidence of postpartum constipation (data not reported), but did not report on quality of life. Time to first bowel movement was reported as a median (range); very low-certainty evidence suggests little or no difference between the two groups. A laxative plus bulking agent may increase the number of women having any episode of faecal incontinence during the first 10 days postpartum (RR 1.81, 95% CI 1.01 to 3.23; 1 trial, 147 women; very low-certainty evidence). The trial did not report on adverse effects of the intervention on babies, or many of our secondary outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to make general conclusions about the effectiveness and safety of laxatives for preventing postpartum constipation. The evidence in this review was assessed as low to very low-certainty evidence, with downgrading decisions based on limitations in study design, indirectness and imprecision. We did not identify any trials assessing educational or behavioural interventions. We identified four trials that examined laxatives versus placebo, and one that examined laxatives versus laxatives plus stool bulking agents. Further, rigorous trials are needed to assess the effectiveness and safety of laxatives during the postpartum period for preventing constipation. Trials should assess educational and behavioural interventions, and positions that enhance defecation. They should report on the primary outcomes from this review: pain or straining on defecation, incidence of postpartum constipation, quality of life, time to first bowel movement after delivery, and adverse effects caused by the intervention, such as: nausea or vomiting, pain, and flatus.


Asunto(s)
Estreñimiento/prevención & control , Fibras de la Dieta/uso terapéutico , Laxativos/uso terapéutico , Trastornos Puerperales/prevención & control , Adulto , Defecación , Fibras de la Dieta/efectos adversos , Femenino , Humanos , Laxativos/efectos adversos , Perineo/lesiones , Periodo Posparto , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo
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