Explaining Women's High Satisfaction With Objectively Poor Quality Childbirth Services: Armenia as a Case Study

Despite documented low-quality care in Armenia, surveys document high ratings of patient satisfaction with health care services. We explored reasons for high satisfaction in Armenia despite poor quality. Twenty-five women who recently delivered participated in this qualitative study through in-depth interviews. Patients avoided critiquing health care services because of personal relationships with and respect for providers and fear of losing services. Although they shared an understanding of what quality care should be, many were satisfied because their low expectations were met. Further mixed methods research may explain this dissonance. Until then, patient satisfaction measures need careful, contextual interpretations.     

Friendship,sexual intimacy and young people’s negotiations of sexual health

Abstract

This paper examines how young people’s friendships influence safer sexual practices. Through a thematic discourse analysis, interviews with Sydney-based young people (aged 18–25 years) and Australian-based sexual health websites for young people are considered. Interview data illustrate how friendships can support young people's sexual experiences, concerns and safeties beyond the practice of ‘safe sex’ (condom use). This is evident in friends’ practices of sex and relationship advice, open dialogue, trust and sharing experiential knowledge, as well as friend-based sex. Meanwhile, friendship discourse from selected Australian sexual health websites fails to engage with the support offered by friendship, or its value to a sexual health agenda. Foucault’s account of friendship as a space of self-invention is considered in light of these data, along with his argument that friendship poses a threat to formal systems of knowing and regulating sex. Whether sexual or not, many close friendships are sexually intimate given the knowledge, support and influence these offer to one’s sexual practices and relations. This paper argues that greater attention to friendship among sexual health promoters and researchers would improve professional engagements with young people’s contemporary sexual cultures, and better inform their attempts to engage young people through social media.     

A randomized,double-blind,vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses

BACKGROUND: Actinic keratoses (AKs) are precancerous epidermal lesions found most frequently on areas of the skin exposed to the sun. Several case studies published recently have indicated that 5% imiquimod cream, currently licensed for the treatment of genital warts, may be an effective treatment for AK. OBJECTIVE: To assess the efficacy and safety of imiquimod for the treatment of AK. DESIGN: Patients in this randomized, double-blind, vehicle-controlled study applied 5% imiquimod cream or vehicle to AK lesions 3 times per week for a maximum of 12 weeks or until lesions had resolved. In the event of an adverse reaction, application of imiquimod was reduced to 1 or 2 times per week. Rest periods were also allowed if necessary. SETTING: A specialized outpatient dermatology clinic within a state-funded hospital in Germany. PATIENTS: The study population was aged 45 to 85 years. Of 52 patients screened, 36 men and women with AK confirmed by histological diagnosis were enrolled. Patients were excluded from the study if they did not have a histological diagnosis for AK, if they were older than 85 years, or if they did not comply with the protocol. All patients had responded to a notice asking for volunteers. MAIN OUTCOME MEASURES: The number and appearance of lesions were evaluated before, during, and after treatment. All adverse effects were recorded. RESULTS: Lesions treated with 5% imiquimod cream were clinically cleared in 21 (84%) of 25 patients and partially cleared in 2 (8%). Clearance was histologically confirmed 2 weeks after the last application of imiquimod in all patients clinically diagnosed as lesion free. Only 10% of patients treated with imiquimod were clinically diagnosed with recurrence 1 year after treatment. No reduction in the size or number of AK lesions was observed in vehicle-treated patients. Adverse effects reported by patients treated with imiquimod included erythema, edema, induration, vesicles, erosion, ulceration, excoriation, and scabbing. However, imiquimod was well tolerated since all patients completed the 12-week treatment. Only a few, mild adverse reactions to the vehicle cream were reported. CONCLUSION: Application of 5% imiquimod cream for 12 weeks is an effective and well-tolerated treatment for AK.     

Pedal plexiform neurofibroma: review of the literature and case report.

Plexiform neurofibroma typically occurs in the setting of neurofibromatosis type 1, and is included in the diagnostic criteria for neurofibromatosis. Plexiform neurofibromas generally affect larger peripheral nerves and are uncommon in the foot and ankle. While there are several reports of large neurofibromas involving the foot, they have been described on the plantar aspect. We report the first known case of plexiform neurofibroma involving the deep peroneal nerve of the foot. A review of the literature is also presented.     

Diabetes insipidus and two consecutive pregnancies: a case report and review of the literature

We report a case of a woman with a preexisting diabetes insipidus (DI), who had two consecutive uncomplicated pregnancies. Both pregnancies resulted after spontaneous conception and had a similar uneventful course. At the time of conception the patient was receiving 1-desamino-8D-arginine-vasopressin (DDAVP) 30 microg/d which maintained a urinary volume of 2-3 l/day. Pre-existing DI can be handled carefully and result in an uncomplicated pregnancy. In such cases careful monitoring of the patient's fluid balance and liver enzymes, as well as monitoring for pre-eclampsia and oligohydramnios during pregnancy are essential.     

The a-wave latency in control subjects and patients with retinal diseases

PURPOSE: To determine the a-wave latency of the electroretinograms (ERGs) recorded from control subjects and patients with retinal diseases. METHODS: The a-wave latency and implicit time (IT) were measured retrospectively from the ERGs of 40 control subjects and 99 patients. The patients included 9 with complete congenital stationary night blindness (cCSNB), 13 with achromatopsia or cone dystrophy, 5 with supernormal and delayed rod ERG syndrome, and 72 with retinitis pigmentosa (RP). To assess whether latency measurements can be obtained reliably by different observers from patients with smaller a-wave amplitudes and noisier baselines, the a-wave latency and IT of the ERG of the right eye of 10 control subjects and 10 patients with RP were measured by three observers. RESULTS: The mean a-wave latency measured for the same 10 control ERGs by three observers differed by less than 1 millisecond while the mean IT differed by 1.7 milliseconds. For 10 ERGs from RP patients, the mean for the a-wave latency measured by the three observers differed by less than 2.0 milliseconds and by 1.1 millisecond for the IT. The coefficient of variation varied from 24.8% to 36.7% for the latency and from 11.5% to 16.0% for the IT. The a-wave latencies elicited by the 0-dB stimulus under scotopic and photopic conditions from the 40 control subjects were not statistically different. The a-wave latency in patients with cCSNB did not differ significantly from that in control subjects. The longer a-wave latency in patients with achromatopsia suggested that the rods have a longer latency than cones. The scotopic and photopic a-wave latencies were significantly longer in RP patients. The longer latency in RP patients was not due to smaller a- or b-wave amplitudes. CONCLUSIONS: The a-wave latency can be measured as reliably as the IT in control subjects but the reliability is not as good for the latency as for the IT in RP patients. The larger coefficients of variation in RP patients were most likely due to the measurements being made from RP patients at different stages of their disease. Our results suggest that the a-wave latency in control subjects is determined by cones under both scotopic and photopic conditions. The longer a-wave latency in RP patients suggests that the rods and cones are altered over a significant area of the retina.     

Cancer incidence and mortality patterns in women with anorexia nervosa

Caloric restriction in animals is an effective way to reduce carcinogenesis. Anorexia nervosa (AN) is considered a model of extreme caloric restriction in humans. The aim of our study was to assess cancer incidence and mortality in women with AN. A total of 6,009 women with at least one inpatient treatment for AN during the period 1973–2003 were included in the study. Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) were calculated. Overall, there was no statistically significant difference in cancer incidence compared to women in the general population. At a statistically significant or borderline significant level, a higher incidence for lung cancer and cancer of lymphoid, hematopoietic and related tissue was observed along with a reduced breast cancer incidence. Women with AN had twice as high mortality from cancer in general, and more specifically from melanoma, cancers of genital organs and cancers of ill‐defined, secondary and unspecified sites. The increased lung cancer incidence may be due to smoking habits among women with AN. The worse prognosis with higher mortality from melanoma, cancers of genital organs and cancers of ill‐defined, secondary and unspecified sites may be explained by AN‐specific attitudes toward seeking medical care, adherence to treatment or worse biological precondition due to starvation and cachexia.