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1.
Background
Although the magnitude of obstetric fistulae (OF) is reported to have decreased in industrialized countries, it is still a major problem in developing countries. While the main cause of OF is prolonged obstructed labour without prompt medical attention, misconceptions about OF exist.Objective
To determine awareness and perceived causes of OF in rural areas of southern Tanzania.Methods
A cross-sectional survey was conducted among women of reproductive age, men, health personnel, birth attendants, community leaders and OF cases using qualitative and quantitative approaches.Results
More than 60% of interviewees reported to be aware of OF with a connotation of urine in the names. Perceived causes of OF include sorcery, prolonged labour, delivering by operation where doctors/nurses make mistakes perforate the urinary bladder, physique of the expecting mother, poor skills of doctors/nurses to conduct caesarean section, young or old age of an expecting mother and having sex before recovering from the operation.Conclusion
Although OF is not reported to exist, most of the interviewees were aware of them. However, were few respondents are able to mention the main cause of OF. Maternal health education is important as a strategy to minimize the spread of misconceptions about causes of OF. 相似文献2.
Background
Erectile Dysfunction (ED) is one of the major social problems causing significant distress in men. Despite the increasing difficulty in management, knowledge, and understanding of factors responsible for its development are important for prevention and care.Objectives
To assess the prevalence and risk factors for ED among men in Niger Delta Region of Nigeria, in order to determine its contextual variables.Methods
Subjects included 400 male patients attending the general outpatients'' clinic (GOPC) of the University of Uyo Teaching Hospital. Respondents completed the abridged version of the International Index of Erectile Function (IIEF-5).Results
A total of 166 (41.5%) subjects had ED; 66 (16.5%) had mild; 32 (8.0%) mild to moderate; 24 (6.0%) moderate; while 45 (11.3%) had severe 37 (9.2%) resulted from hypertension and its medications; 29 (7.3%) from diabetes; 49 (12.2%) from a combination of both and their therapies (P=0.044); 24 (6.0%) had history of previous surgery; while for 27 (6.8%) it was from undiagnosed medical conditions (p=0.001). The ED increases with age and is more among married and educated men.Conclusion
ED is a common problem among men in Niger Delta region. Therefore, efforts must be made to reduce the incidence by dealing with the factors responsible for its development. 相似文献3.
Objective
This study measured the human epididymis protein 4 (HE4) and CA125 levels in Chinese women with benign gynecological disorders.Material and methods
Sera were obtained from Chinese women prior to surgery for a pelvic mass and HE4 and CA125 levels were determined. The proportions of patients with HE4 and CA125 levels were compared.Results
There were 68 Chinese women with benign diseases. HE4 levels were less elevated than CA125 (1% V.S. 29%, P<0.001). The significant difference was observed in patients with endometriosis/endometriomas in which HE4 was not elevated patients and CA125 was elevated in 53% (P<0.001). Serum HE4 level was not elevated in patients with cystadenoma (0% V.S. 23%, P<0.001) and in patients with germ cell tumors (0% V.S. 5%, P<0.001).Conclusion
HE4 was less elevated and more suitable as a biomarker than CA125 in chinese women with benign disease. 相似文献4.
5.
Watson J Humphrey A Peters-Klimm F Hamilton W 《The British journal of general practice》2011,61(591):e645-e649
Background
Recruitment to general practice has had periods of difficulty, but is currently going through a phase of relative popularity in the UK.Aim
To explore motivators for career choice and career satisfaction among UK GP trainees and newly qualified GPs.Design and setting
Cross-sectional web-based questionnaire of GP trainees and GPs within the first 5 years of qualification in the UK.Method
All 9557 UK GP trainees and 8013 GPs who were within the first 5 years of qualification were invited to participate by email. Further publicity was conducted via general practice publications and the internet.Results
Overall, there were 2178 responses to the questionnaire (12.4% response rate, 61.5% women, 61.8% trainees). Levels of satisfaction were high, with 83% of responders stating that they would choose to be a doctor again; of these, 95% would choose to be a GP again. The most frequently cited reason for choosing general practice was ‘compatibility with family life’, which was chosen by 76.6% of women and 63.2% of men (P<0.001). Other reasons given were: ‘challenging medically diverse discipline’ (women 59.8%, men 61.8%, P = 0.350), ‘the one-to-one care general practice offers’ (women 40.0%, men 41.2%, P = 0.570), ‘holistic approach’ (women 41.4%, men 30.1%, P<0.001), ‘autonomy and independence’ (women 18.0%, men 34.8%, P<0.001), ‘communication’ (women 20.6%, men 12.2%, P<0.001), ‘negative experiences in hospital’ (women 12.8%, men 9.8%, P= 0.036), and ‘good salary’ (women 7.8%, men 14.9%, P<0.001).Conclusion
The most important reason for both women and men choosing general practice as a career in the UK is its compatibility with family life. As such, changes to UK primary care that decrease family compatibility could negatively impact on recruitment. 相似文献6.
Hanan M. Hamed Seham Awad El-Sherbini Nahla A. Barakat Tarek M. Farid Enas Abdel Rasheed 《Indian Journal of Critical Care Medicine》2013,17(2):92-98
Background:
Accurate diagnosis of acute kidney injury (AKI) is problematic especially in critically-ill patients in whom renal function is in an unsteady state.Aim:
Our aim was to evaluate the role of serum (S.) cystatin C as an early biomarker of AKI in critically-ill children.Subjects and Methods:
S. creatinine and S. cystatin C were measured in 32 critically-ill children who were at risk for developing AKI. AKI was defined by both: Risk,-injury,-failure,-loss, and-endstage renal disease (RIFLE) classification and glomerular filtration rate (GFR) <80 ml/min/1.73 m2. GFR was estimated by both Schwartz formula and S. cystatin C-based equation.Results:
S. cystatin C was not statistically higher in AKI patients compared with non-AKI by RIFLE classification (median 1.48 mg/l vs. 1.16 mg/l, P = 0.1) while S. creatinine was significantly higher (median 0.8 mg/dl vs. 0.4 mg/dl, P = 0.001). On estimating GFR by the two equations we found, a lag between rise of S. cystatin C and creatinine denoted by lower GFR by Schwartz formula in four patients, on other hand, six patients had elevated S. cystatin C with low GFR despite normal creatinine and GFR, denoting poor concordance between the two equations and the two markers. The ability of S. creatinine in predicting AKI was superior to S. cystatin with area under the curve (AUC) 0.95 with sensitivity and specificity (100% and 84.6%, respectively) using the RIFLE classification. The same findings were found when using Schwartz formula.Conclusion:
S. cystatin C is a poor biomarker for diagnosing AKI in critically-ill children. 相似文献7.
Alexandros N. Vgontzas Duanping Liao Slobodanka Pejovic Susan Calhoun Maria Karataraki Maria Basta Julio Fernández-Mendoza Edward O. Bixler 《Sleep》2010,33(9):1159-1164
Study Objectives:
Because insomnia with objective short sleep duration is associated with increased morbidity, we examined the effects of this insomnia subtype on all-cause mortality.Design:
Longitudinal.Setting:
Sleep laboratory.Participants:
1,741 men and women randomly selected from Central Pennsylvania.Measurements:
Participants were studied in the sleep laboratory and were followed-up for 14 years (men) and 10 years (women). “Insomnia” was defined by a complaint of insomnia with duration ≥ 1 year. “Normal sleeping” was defined as absence of insomnia. Polysomnographic sleep duration was classified into two categories: the “normal sleep duration group” subjects who slept ≥ 6 h and the “short sleep duration group” subjects who slept < 6 h. We adjusted for age, race, education, body mass index, smoking, alcohol, depression, sleep disordered breathing, and sampling weight.Results:
The mortality rate was 21% for men and 5% for women. In men, mortality risk was significantly increased in insomniacs who slept less than 6 hours compared to the “normal sleep duration, no insomnia” group, (OR = 4.00, CI 1.14-13.99) after adjusting for diabetes, hypertension, and other confounders. Furthermore, there was a marginally significant trend (P = 0.15) towards higher mortality risk from insomnia and short sleep in patients with diabetes or hypertension (OR = 7.17, 95% CI 1.41-36.62) than in those without these comorbid conditions (OR = 1.45, 95% CI 0.13-16.14). In women, mortality was not associated with insomnia and short sleep duration.Conclusions:
Insomnia with objective short sleep duration in men is associated with increased mortality, a risk that has been underestimated.Citation:
Vgontzas AN; Liao D; Pejovic S; Calhoun S; Karataraki M; Basta M; Fernández-Mendoza J; Bixler EO. Insomnia with short sleep duration and mortality: the Penn State Cohort. SLEEP 2010;33(9):1159-1164. 相似文献8.
Study Objectives:
We evaluated the influence of maternal self-reported habitual sleep duration during early pregnancy on blood pressure (BP) levels and risk of hypertensive disorders of pregnancy.Design:
Prospective cohort study.Setting:
Clinic-based study.Participants:
A cohort of 1,272 healthy, pregnant women.Measurements and Results:
We abstracted maternal antenatal BP values from medical records and estimated mean BP differences across hours of sleep categories in regression models, using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (95% CIs) for pregnancy induced hypertension (PIH) and preeclampsia (PE) in relation to long and short sleep duration were estimated. Mean 1st and 2nd trimester systolic (S) and diastolic (D) BP values were similar among women reporting to be short sleepers (≤ 6 h) vs. women reporting to sleep 9 hours. However, both short and long sleep duration in early pregnancy were associated with increased mean 3rd trimester SBP and DBP. For example, mean 3rd trimester SBP was 3.72, and 2.43 mm Hg higher for women reporting ≤ 6 h and 7-8 h sleep, respectively, compared with women reporting 9 h of sleep. Mean 3rd trimester SBP was 4.21 mm Hg higher for women reporting long sleep (≥ 10 h) vs. the reference group. Short and long sleep durations were associated with increased risks of PIH and PE. The ORs for very short (< 5 h) and long (≥ 10 h) sleepers were 9.52 (95% CI 1.83 to 49.40) and 2.45 (95% CI 0.74 to 8.15) for PE.Conclusions:
Our findings are consistent with a larger literature that documents elevated blood pressure and increased risks of hypertension with short and long sleep duration.Citation:
Williams MA; Miller RS; Qiu C; Cripe SM; Gelaye B; Enquobahrie D. Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. SLEEP 2010;33(10):1363-1371. 相似文献9.
Rebecca Lawton Paul T Seed Maria Kordowicz Peter Schofield André Tylee Mark Ashworth 《The British journal of general practice》2014,64(623):e354-e363
Background
Patients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality.Aim
To use a patient generated instrument (PSYCHLOPS) to define categories of concerns in patients with CHD. To define the psychometric characteristics of patients in each category.Design and setting
Cross-sectional study set in general practices in south London.Method
Of 3325 patients on the CHD registers in 15 general practices, 655 completed six baseline psychometric and functional instruments: PSYCHLOPS, HADS-Depression, HADS-Anxiety, Clinical Interview Schedule – Revised, SF12-Mental and SF12-Physical. Content analysis was used to categorise patients based on their main problem, as elicited by PSYCHLOPS. Mean psychometric scores were adjusted for confounding by age, sex, deprivation and ethnicity and calculated for each response category.Results
Response categories were: physical problems, both non-cardiac (23.2%) and cardiac (6.0%); social problems: relationship/family (18.2%), money (7.5%), work (3.1%); functional (9.8%); psychological (6.9%); miscellaneous (7.3%); ‘no problem’ (18.2%). The highest psychological distress scores were found in ‘physical, cardiac’ and ‘psychological’ categories. The ‘no problem’ category had significantly lower psychological distress and higher functional capacity than other categories.Conclusions
PSYCHLOPS enabled the identification of subtypes of CHD patients, based on a classification of self-reported problems. A high proportion of CHD patients report social problems. Psychological distress was highest in those reporting cardiac or psychological symptoms. Services should be aligned to the reported needs of patients. 相似文献10.
Background
Primary Cytomegalovirus (CMV) infection during pregnancy is a frequent and serious threat to the fetus. As there is no vaccine alternative measures are needed to prevent congenital CMV infection.Objective
This study determined CMV Immunoglobulin G (IgG) antibody among pregnant women in order to ascertain the immune status of mothers to guide policy makers.Methods
A semi-structured questionnaire was initially administered to obtain information on demographic details, stage of pregnancy and risk factors. Blood was collected by venipuncture from 180 women attending the antenatal clinic in Murtala Mohammed Specialist Hospital Kano, Kano State, Nigeria. Sera samples were screened using CMV IgG ELISA kit (Dialab, Austria).Results
Out of 180 pregnant women, 164 (91.1%) were seropositive. Based on stages of pregnancy 6/6(100%), 52/60(86.7%) and 106/114(93.0%) were seropositive among women in the first, second and third trimesters respectively.Conclusion
Seroprevalence of pregnant women to CMV Ig G is high, hence the need for CMV - IgM screening to know the extent of active infection. There is also need for public enlightenment on the methods of transmission, effective prevention and control strategies. 相似文献11.
Background
Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places.Objectives
To determine the prevalence of UTI, associated uropathogens and their antimicrobial susceptibility.Methods
A cross section study carried out at Mulago hospital outpatients'' department. Midstream urine samples (MSU) were collected from 399 women, who gave informed consent and fulfilled other study criteria. Quantitative culture method, identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique were applied to the isolates.Results
Out of 399 MSU samples, 40 pure significant bacterial growths (≥105 colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli, 23 (57.5%), Staphylococcus aureus, 9 (22.5%), Enterococci spp, 6 (15%) and Klebsiella pneumoniae, 2 (5.0%). Overall, sensitivities were: nitrofurantoin (98.3%), cefuroxime (89.3%), and cotrimoxazole (20%) by all uropathogens isolated.Conclusions
Culture positive UTI among adult non-pregnant women are a common problem, occurring in 10% of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT.Recommendations
Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women. 相似文献12.
Satoyo Ikehara Hiroyasu Iso Chigusa Date Shogo Kikuchi Yoshiyuki Watanabe Yasuhiko Wada Yutaka Inaba Akiko Tamakoshi the JACC Study Group 《Sleep》2009,32(3):295-301
Study Objectives:
To examine sex-specific associations between sleep duration and mortality from cardiovascular disease and other causes.Design:
Cohort study.Setting:
Community-based study.Participants:
A total of 98,634 subjects (41,489 men and 57,145 women) aged 40 to 79 years from 1988 to 1990 and were followed until 2003.Interventions:
N/A.Measurements and Results:
During a median follow-up of 14.3 years, there were 1964 deaths (men and women: 1038 and 926) from stroke, 881 (508 and 373) from coronary heart disease, 4287 (2297 and 1990) from cardiovascular disease, 5465 (3432 and 2033) from cancer, and 14,540 (8548 and 5992) from all causes. Compared with a sleep duration of 7 hours, sleep duration of 4 hours or less was associated with increased mortality from coronary heart disease for women and noncardiovascular disease/noncancer and all causes in both sexes. The respective multivariable hazard ratios were 2.32 (1.19–4.50) for coronary heart disease in women, 1.49 (1.02–2.18) and 1.47 (1.01–2.15) for noncardiovascular disease/noncancer, and 1.29 (1.02–1.64) and 1.28 (1.03–1.60) for all causes in men and women, respectively. Long sleep duration of 10 hours or longer was associated with 1.5- to 2-fold increased mortality from total and ischemic stroke, total cardiovascular disease, noncardiovascular disease/noncancer, and all causes for men and women, compared with 7 hours of sleep in both sexes. There was no association between sleep duration and cancer mortality in either sex.Conclusions:
Both short and long sleep duration were associated with increased mortality from cardiovascular disease, noncardiovascular disease/noncancer, and all causes for both sexes, yielding a U-shaped relationship with total mortality with a nadir at 7 hours of sleep.Citation:
Ikehara S; Iso H; Date C; Kikuchi S; Watanabe Y; Wada Y; Inaba Y; Tamakoshi A. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. SLEEP 2009;32(3):259–301. 相似文献13.
Mohammad Amin Fallahzadeh Sophia T. Abdehou Jafar Hassanzadeh Fatemeh Fallhzadeh Mohammad Hossein Fallahzadeh Leila Malekmakan 《Indian Journal of Critical Care Medicine》2015,19(6):311-315
Introduction:
Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality.Materials and Methods:
In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied.Results:
From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%).Conclusion:
We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes. 相似文献14.
15.
Laila Simpson Sutapa Mukherjee Matthew N. Cooper Kim L. Ward Jessica D. Lee Annette C. Fedson Jane Potter David R. Hillman Fanzca Peter Eastwood Lyle J. Palmer Jason Kirkness 《Sleep》2010,33(4):467-474
Study Objectives:
To describe sex differences in the associations between severity of obstructive sleep apnea (OSA) and measures of obesity in body regions defined using both dual-energy absorptiometry and traditional anthropometric measures in a sleep-clinic sample.Design:
A prospective case-series observational study.Setting:
The Western Australian Sleep Health Study operating out of the Sir Charles Gairdner Hospital Sleep Clinic, Perth, Western Australia.Participants:
Newly referred clinic patients (60 men, 36 women) suspected of having OSA.Interventions:
N/AMeasurements and Results:
Obstructive sleep apnea severity was defined by apnea-hypopnoea index from laboratory-based overnight polysomnography. Body mass index, neck, waist and hip circumference, neck-to-waist ratio, and waist-to-hip ratio were measured. Dual energy absorptiometry measurements included percentage fat and lean tissue. Multivariate regression models for each sex were developed. In women, percentage of fat in the neck region and body mass index together explained 33% of the variance in apnea-hypopnea index. In men, percentage of fat in the abdominal region and neck-to-waist ratio together accounted for 37% of the variance in apnea-hypopnea index.Conclusions:
Regional obesity is associated with obstructive sleep apnea severity, although differently in men and women. In women, a direct influence of neck fat on the upper airway patency is implicated. In men, abdominal obesity appears to be the predominant influence. The apnea-hypopnea index was best predicted by a combination of Dual Energy Absorptiometry-measured mass and traditional anthropometric measurements.Citation:
Simpson L; Mukherjee S; Cooper MN; Ward KL; Lee JD; Fedson AC; Potter J; Hillman Fanzca DR; Eastwood P; Palmer LJ; Kirkness J. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. SLEEP 2010;33(4):467-474 相似文献16.
Background
In low-resource settings, cryotherapy can be cost-effective, affordable, and a first-line treatment for cervical intraepithelial neplasia (CIN) of any grade.Objectives
To report the acceptability, safety and effectiveness of cryotherapy for women with cervical intraepithelial neoplasia (CIN) in Western Kenya.Methods
Visual inspection with acetic acid (VIA)-positive women and those suspected of having cervical cancer based on an initial evaluation at a primary health facility were referred to the district hospital for colposcopy and additional evaluation using visual inspection with Lugol''s iodine (VILI) and/or visual inspection with acetic acid and magnification (VIAM). Cryotherapy was offered immediately to women diagnosed with appropriate CIN lesions based on colposcopy or after waiting for a confirmatory cervical biopsy and a follow up visit occurred one year later.Results
Ninety one 91 women 30 to 39 years of age had CIN appropriate for cryotherapy. Approximately 36% (24/67) were due for their 1 year follow up visit and 20 of 24 (83.3%) attended. Complete data were available for 18 of 20 (90%) and 13 (72.2%) had no sign of CIN. No serious adverse events were reported 1 to 3 months after cryotherapy. All respondents reported that the treatment experience was acceptable.Conclusions
Cryotherapy was acceptable, safe and effective. 相似文献17.
Yundeok Kim Soo Jeong Kim Dohyu Hwang Jieun Jang Shin-Young Hyun Yu Ri Kim Jin Seok Kim Yoo Hong Min June-Won Cheong 《Yonsei medical journal》2014,55(6):1568-1575
Purpose
The modified Glasgow Prognostic Score (mGPS) consisting of serum C-reactive protein and albumin levels, shows significant prognostic value in several types of tumors. We evaluated the prognostic significance of mGPS in 285 patients with diffuse large B cell lymphoma (DLBCL), retrospectively.Materials and Methods
According to mGPS classification, 204 patients (71.5%) had an mGPS of 0, 57 (20%) had an mGPS of 1, and 24 (8.5%) had an mGPS of 2.Results
Our study found that high mGPS were associated with poor prognostic factors including older age, extranodal involvement, advanced disease stage, unfavorable International Prognostic Index scores, and the presence of B symptoms. The complete response (CR) rate after 3 cycles of R-CHOP chemotherapy was higher in patients with mGPS of 0 (53.8%) compared to those with mGPS of 1 (33.3%) or 2 (25.0%) (p=0.001). Patients with mGPS of 0 had significantly better overall survival (OS) than those with mGPS=1 and those with mGPS=2 (p=0.036). Multivariate analyses revealed that the GPS score was a prognostic factor for the CR rate of 3 cycle R-CHOP therapy (p=0.044) as well as OS (p=0.037).Conclusion
mGPS can be considered a potential prognostic factor that may predict early responses to R-CHOP therapy in DLBCL patients. 相似文献18.
19.
Michelle IA Rijnders Sita Nys Christel Driessen Christian JPA Hoebe Rogier M Hopstaken Guy J Oudhuis Arno Timmermans Ellen E Stobberingh 《The British journal of general practice》2010,60(581):902-906
Background
The extent to which GPs serve as a reservoir for antibiotic-resistant Staphylococcus aureus is unknown and not well studied.Aim
To determine the prevalence of nasal S. aureus carriage among GPs in the Netherlands, as well as the antimicrobial resistance and the genotypes of isolated S. aureus.Design of study
Observational, point-prevalence, and cross-sectional study.Setting
GPs attending the annual conference of the Dutch College of General Practitioners in 2006.Method
Nasal swabs were randomly taken from 395 GPs and analysed for the presence of S. aureus. Antimicrobial susceptibility was determined by a microbroth dilution method and the genotypes by spa typing, which was associated with multilocus sequence typing.Results
Of the GPs, 129/395 (33%; 95% confidence interval [CI] = 28 to 37%) were carriers of S. aureus. No meticillin-resistant S. aureus (MRSA) was found. Resistance was observed to penicillin (71%; 95% CI = 63 to 79%), fusidic acid (7%; 95% CI = 3 to 13%), and clarithromycin (6%; 95% CI = 3 to 12%). In 72% of the isolates, an MRSA-related genotype of S. aureus was found.Conclusion
The low antibiotic resistance found among S. aureus of GPs suggests that GPs are not a reservoir of antibiotic-resistant S. aureus strains. The relatively high resistance to fusidic acid, which has not previously been described in the Netherlands and is mostly because of antibiotic use, suggests that patients infect GPs and not the other way round. GPs may be at risk for nasal carriage of S. aureus with an MRSA-related genotype. 相似文献20.