Sample records for women choosing surgery

  1. Why Do Women Choose to Enter Academic Oral and Maxillofacial Surgery? (United States)

    Kolokythas, Antonia; Miloro, Michael


    To determine why women choose to enter an academic career in oral and maxillofacial surgery (OMS). An online questionnaire was developed and e-mailed to female OMS surgeons to assess the reasons women choose to pursue an academic career, the perceived positive and negative features of academia for women, and proposed measures to increase the percentage of women choosing to specialize in OMS and pursue an academic career. Thirty-one female OMS surgeons completed the questionnaire; 1 additional participant accessed the survey but did not respond to any of the questions. There were 25 full-time academics and 6 part-time academics (≥50% time commitment). Of the responders, 72% were married, and of these, 72% were married before entering academics. Forty-seven percent of the women had children, all during their academic tenure. Among the full-time academicians with children, only 2 (7.7%) reported moderate difficulty finding the time for childbirth and maternity leave, whereas 3 of the 5 part-time academics with children reported moderate or significant difficulty with childbirth and maternity leave. Factors associated with choosing and enjoying an academic career are involvement in resident-student teaching (78%), followed by colleague camaraderie and collaboration (65.6%), research potential (50%), time flexibility, and not having to deal with excessive "business" practice issues (33%). The main reason for considering leaving an academic OMS career and/or among the least enjoyable aspects of being in academics was the potential for a higher income in private practice (56%). Less significant reasons for considering leaving an academic OMS career were a more flexible work schedule in the private sector and less institutional red tape (37.5%), as well as independence/being in control and more family time (22%). Engaging residents and students by female OMS surgeons, better mentorship from academic OMS surgeons, and increasing the number of women serving in leadership

  2. Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. (United States)

    Sivell, Stephanie; Marsh, William; Edwards, Adrian; Manstead, Antony S R; Clements, Alison; Elwyn, Glyn


    Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. Where Are the Women in Orthopaedic Surgery? (United States)

    Rohde, Rachel S; Wolf, Jennifer Moriatis; Adams, Julie E


    Although women account for approximately half of the medical students in the United States, they represent only 13% of orthopaedic surgery residents and 4% of members of the American Academy of Orthopaedic Surgeons (AAOS). Furthermore, a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty. Formal investigations regarding the gender discrepancy in choice of orthopaedic surgery are lacking. (1) What reasons do women orthopaedic surgeons cite for why they chose this specialty? (2) What perceptions do women orthopaedic surgeons think might deter other women from pursuing this field? (3) What role does early exposure to orthopaedics and mentorship play in this choice? (4) What professional and personal choices do women in orthopaedics make, and how might this inform students who are choosing a career path? A 21-question survey was emailed to all active, candidate, and resident members of the Ruth Jackson Orthopaedic Society (RJOS, n = 556). RJOS is the oldest surgical women's organization incorporated in the United States. An independent orthopaedic specialty society, RJOS supports leadership training, mentorship, grant opportunities, and advocacy for its members and promotes sex-related musculoskeletal research. Although not all women in orthopaedic practice or training belong to RJOS, it is estimated that 42% of women AAOS fellows are RJOS members. Questions were formulated to determine demographics, practice patterns, and lifestyle choices of women who chose orthopaedic surgery as a specialty. Specifically, we evaluated the respondents' decisions about their careers and their opinions of why more women do not choose this field. For the purpose of this analysis, the influences and dissuaders were divided into three major categories: personal attributes, experience/exposure, and work/life considerations. The most common reasons cited for having chosen orthopaedic surgery were enjoyment of manual tasks (165 of 232

  4. Women Physicians: Choosing a Career in Academic Medicine (United States)

    Borges, Nicole J.; Navarro, Anita M.; Grover, Amelia C.


    Purpose Despite recent efforts to understand the complex process of physician career development, the medical education community has a poor understanding of why, how, and when women physicians embark on a career in academic medicine. Method In 2010, the authors phone-interviewed women physicians in academic medicine regarding why, how, and when they chose an academic medicine career. Project investigators first individually and then collectively analyzed transcripts to identify themes in the data. Results Through analyzing the transcripts of the 53 interviews, the investigators identified five themes related to why women choose careers in academic medicine: fit, aspects of the academic health center environment, people, exposure, and clincial medicine. They identified five themes related to how women make the decision to enter academic medicine: change in specialty, dissatisfaction with former career, emotionality, parental influence, and decision-making styles. The authors also identified four themes regarding when women decide to enter academic medicine: as a practicing phyisican, fellow, resident, or medical student. Conclusions Choosing a career in academic medicine is greatly influenced by the environment in which one trains and by people—be they faculty, mentors, role models, or family. An interest in teaching is a primary reason women choose a career in academic medicine. Many women physicians entering acadmic medicine chose this after or during fellowship, which is when they became more aware of academic medicine as a possible career. For many women, choosing academic medicine was not necessarily an active, planned decision; rather it was serendipitous or circumstantial. PMID:22104052

  5. Why are junior doctors deterred from choosing a surgical career? (United States)

    Rogers, Mary E; Creed, Peter A; Searle, Judy


    To identify the reasons why interns would not choose a surgical career. This qualitative study used semi-structured telephone interviews to explore the future career choices of 41 junior doctors (14 men, 27 women). Doctors were asked to identify specialties they would not take up, and state why this was the case. Thirty (73.2%) of the 41 interns nominated surgery as a specialty they would not choose. Themes relating to reasons for not wanting to pursue a surgical career included the lifestyle associated with surgery (66.7%), the culture within the surgical work environment (53.3%), the lack of interest in performing surgical work (36.7%), and the training requirements associated with surgery (33.3%). Both sexes had similar reasons for not wanting to choose a surgical career; but additionally, women referred to the male domination of surgery, and the difficulty and inflexibility of the training program as deterrents. Efforts are needed to promote interest in surgery as a career especially for women, to improve the surgical work environment so that medical students and junior doctors have exposure to positive role models and surgical placements, and to provide a more flexible approach to surgical training.

  6. Women and cosmetic breast surgery: weighing the medical, social, and lifestyle risks. (United States)

    Boulton, Tiffany N; Malacrida, Claudia


    In this article we provide a comparative analysis of qualitative, semistructured interviews with 24 women who had undergone different forms of cosmetic breast surgery (CBS). We argue that women must negotiate three types of risk: potential medical risks, lifestyle risks connected with choosing "frivolous" self-enhancements, and countervailing social risks affiliated with pressures to maximize one's feminine beauty. In addition, we highlight the challenges faced in negotiating these risks by examining the limits to traditional forms of medical informed consent provided to the women, who received little information on the medical risks associated with CBS, or who were given uncertain and contradictory risk information. Even respondents who felt that they were well informed expressed difficulties in making "wise" choices because the risks were distant or unlikely, and hence easily minimized. Given this, it is fairly understandable that the known social risks of "failed" beauty faced by the women often outweighed the ambiguous or understated risks outlined by medicine. We argue that traditional notions of informed consent and risk awareness might not be adequate for women choosing CBS.

  7. Screening options for Down syndrome: how women choose in real clinical setting. (United States)

    Lo, T K; Lai, F K; Leung, W C; Lau, W L; Ng, L S; Wong, W C; Tam, S S; Yee, Y C; Choi, H; Lam, H S W; Sham, A S Y; Tang, L C H; Chin, R K H


    To study pregnant women's preference among various screening options for Down syndrome (DS) in routine clinical setting, and its potential association with women's demographic characteristics. Women aged 35 years and older carrying singleton pregnancy were offered a variety of screening tests for DS before 14 weeks of gestation. Their preference was confirmed by the test they actually underwent. The association between women's choice of test and a number of demographic characteristics was studied using multinomial regression. Among 1967 eligible women, 619 opted for first-trimester screening test (FTS), 924 for partial integrated test (PIT), and 424 for full integrated test (FIT). Nulliparous women and working mothers were more likely to choose FTS and FIT. Women with history of subfertility were more likely to choose FIT. Women with family history of chromosomal abnormalities were more likely to choose FTS. The choice of screening test could be predicted for 49.9% of women using four demographic characteristics. Among older women of predominantly Chinese ethnicity, integrated test is a favorite alternative to FTS. Their choice of DS screening test can be predicted by their obstetric and socioeconomic characteristics. Many women show willingness to pay for a test with a lower false-positive rate.

  8. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard


    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  9. Is there still a glass ceiling for women in academic surgery? (United States)

    Zhuge, Ying; Kaufman, Joyce; Simeone, Diane M; Chen, Herbert; Velazquez, Omaida C


    Despite the dramatically increased entry of women into general surgery and surgical subspecialties, traditionally male-dominated fields, there remains a gross under-representation of women in the leadership positions of these departments. Women begin their careers with fewer academic resources and tend to progress through the ranks slower than men. Female surgeons also receive significantly lower salaries than their male counterparts and are more vulnerable to discrimination, both obvious and covert. Although some argue that female surgeons tend to choose their families over careers, studies have actually shown that women are as eager as men to assume leadership positions, are equally qualified for these positions as men, and are as good as men at leadership tasks.Three major constraints contribute to the glass-ceiling phenomenon: traditional gender roles, manifestations of sexism in the medical environment, and lack of effective mentors. Gender roles contribute to unconscious assumptions that have little to do with actual knowledge and abilities of an individuals and they negatively influence decision-making when it comes to promotions. Sexism has many forms, from subtle to explicit forms, and some studies show that far more women report being discriminately against than do men. There is a lack of same-sex mentors and role models for women in academic surgery, thereby isolating female academicians further. This review summarizes the manifestation of the glass-ceiling phenomenon, identifies some causes of these inequalities, and proposes different strategies for continuing the advancement of women in academic surgery and to shatter the glass ceiling.

  10. The influences on women who choose publicly-funded home birth in Australia. (United States)

    Catling, Christine; Dahlen, Hannah; Homer, Caroline S E


    to explore the influences on women who chose a publicly-funded home birth in one Australian state. a constructivist grounded theory methodology was used. a publicly-funded home birth service located within a tertiary referral hospital in the southern suburbs of Sydney, Australia. data were collected though semi-structured interviews of 17 women who chose to have a publicly-funded home birth. six main categories emerged from the data. These were feeling independent, strong and confident, doing it my way, protection from hospital related activities, having a safety net, selective listening and telling, and engaging support. The core category was having faith in normal. This linked all the categories and was an overriding attitude towards themselves as women and the process of childbirth. The basic social process was validating the decision to have a home birth. women reported similar influences to other studies when choosing home birth. However, the women in this study were reassured by the publicly-funded system׳s 'safety net' and apparent seamless links with the hospital system. The flexibility of the service to permit women to change their minds to give birth in hospital, and essentially choose their birthplace at any time during pregnancy or labour was also appreciated. women that choose a publicly-funded home birth service describe strong influences that led them to home birth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons. (United States)

    Seelandt, Julia C; Kaderli, Reto M; Tschan, Franziska; Businger, Adrian P


    The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. With respect to the factors that promote surgery as a profession, 40.8% (209/492) of the surgeons stated that surgery is a calling, 29.1% (149/492) of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492) of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492) of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492) of the surgeons provided problematic contextual characteristics. This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

  12. The surgeon's perspective: promoting and discouraging factors for choosing a career in surgery as perceived by surgeons.

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    Julia C Seelandt

    Full Text Available BACKGROUND: The aim of this study was to identify the factors perceived by surgeons that promote surgery as an attractive or unattractive career choice for today's graduates. In addition, it examined whether the perspectives of surgeons in different professional situations converges. The content of work, contextual work conditions, and calling to this job are discussed in the context of choosing surgery as a career. METHODS: Eight hundred sixty-nine surgeons were asked to answer open-ended questions regarding the factors that promote surgery as an attractive or unattractive career choice for today's graduates. Four hundred ninety-two surgeons participated, and 1,525 statements were analyzed using Mayring's content-analyses method. Chi-square tests were used to analyze the differences among hierarchical positions. RESULTS: With respect to the factors that promote surgery as a profession, 40.8% (209/492 of the surgeons stated that surgery is a calling, 29.1% (149/492 of the surgeons provided at least one argument related to the positive task characteristics, and 12.9% (66/492 of the surgeons provided statements related to the positive contextual factors. With respect to the factors that discourage surgery as a profession, 45.7% (234/492 of the surgeons provided at least one argument related to the discouraging work characteristics, and 67.6% (346/492 of the surgeons provided problematic contextual characteristics. CONCLUSION: This study emphasizes the importance of the calling to surgery as an important factor for choosing surgery as a career. However, the extensive workload, training, and poor work-family balance have been identified as factors that discourage graduates from choosing surgery as a career. The identified positive factors could be used to attract and maintain graduates in surgical disciplines.

  13. Description of women's personality traits and psychological vulnerability prior to choosing hormone replacement therapy

    DEFF Research Database (Denmark)

    Loekkegaard, E; Eplov, L F; Køster, A


    INTRODUCTION: Data suggest that women using hormone replacement therapy (HRT) represent a special subgroup of the general population regarding, for instance, cardiovascular risk factors and education. OBJECTIVE: To analyse if women who choose HRT are characterised a priori by high neuroticism sco...... confounders. The study suggests that selection bias among women choosing HRT may also include personality traits....... included Eysencks personality questionnaire concerning intro/extroversion and neuroticism. At the age of 45, the re-examination of the women included a test for psychological vulnerability. The participants reported whether or not they used HRT at the age of 40, 45, 51 and 60 years. The analyses comprised...

  14. Side effect experiences of South Korean women in their twenties and thirties after facial plastic surgery

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    Kim YA


    Full Text Available Young A Kim,1 Hyang-In Cho Chung2 1Department of Nursing, Jeju National University College of Nursing, Jeju-si, Republic of Korea; 2Department of Nursing, Chonnam National University College of Nursing, Gwangju, Republic of Korea Background: Rates of plastic surgery procedures have increased dramatically over the past several decades, especially for the women in South Korea.Purpose: The purpose of this study was to explore the subjective experience of South Korean women in their twenties and thirties with facial plastic surgery (FPS side effects.Participants and methods: Seven women who have suffered from FPS side effects participated in this study. Data were collected from July to September 2015 through individual in-depth interviews using open-ended questions and analyzed using Colaizzi’s method, which is a Husserlian phenomenological approach.Results: Six themes, and 25 subthemes, were found. Major themes were “choosing FPS to gain a new self”, “facing an unintended self”, “trying to accept a changed self”, “making efforts to overcome the situation”, “coming to know a new world”, and “pursuing a new lifestyle”.Conclusion: This study raises social awareness on the risk of plastic surgery side effects, which could prevent unnecessary plastic surgery. It also suggests the need for a deeper understanding of women’s biopsychosocial suffering from plastic surgery side effects. Keywords: cosmetic surgery, aesthetic plastic surgery, qualitative research, interview 

  15. Motivations for and barriers to choosing an interventional cardiology career path: results from the EAPCI Women Committee worldwide survey. (United States)

    Capranzano, Piera; Kunadian, Vijay; Mauri, Josepa; Petronio, Anna Sonia; Salvatella, Neus; Appelman, Yolande; Gilard, Martine; Mikhail, Ghada W; Schüpke, Stefanie; Radu, Maria D; Vaquerizo, Beatriz; Presbitero, Patrizia; Morice, Marie-Claude; Mehilli, Julinda


    Very few women become interventional cardiologists, although a substantial proportion of cardiologists and the majority of medical students are women. In accordance with the EAPCI Women Committee mission of attaining gender equality at the professional level, a worldwide survey was recently conducted aiming to understand better the motivations and the barriers for women in selecting interventional cardiology (IC) as a career path. A total of 1,787 individuals (60.7% women) responded to the survey. Women compared to men were less frequently married (women vs. men, 57.0% vs. 79.8%, pmen replying to why, in their opinion, women do not choose IC, on-calls and long working hours were the most frequent reasons (35.3%). Several barriers preclude women from choosing IC, including lack of opportunity, concerns regarding radiation exposure and the prejudices of their male colleagues. This highlights the need to develop new strategies for future training, education, and support of women in order to choose IC.

  16. The relationship is everything: Women׳s reasons for choosing a privately practising midwife in Western Australia. (United States)

    Davison, Clare; Hauck, Yvonne L; Bayes, Sara J; Kuliukas, Lesley J; Wood, Jennifer


    the purpose of this study was to describe women׳s reasons for choosing to birth with a privately practising midwife. a modified grounded theory methodology was used. the sample comprised 14 Western Australian women who had received maternity care from a privately practising midwife within the previous five years. data analysis revealed three categories: the first was conceptualised as 'I knew what I wanted from my caregiver', which included sub-categories of: I wanted continuity of care; I wanted a relationship with my care provider; and I wanted a care provider with the same childbirth philosophy as me. The second encapsulated 'I knew what I wanted from my pregnancy and birth experience,' with two sub-categories, I wanted a natural, active, intervention free pregnancy and birth and I wanted my partner and family to be included. The final category was labelled 'I was willing to get the research to get what I wanted' and incorporated two sub-categories, I researched my care options and I researched my care provider options and the evidence around pregnancy and birth to be actively involved. findings offer insight around women׳s reasons for choosing this model of midwifery care and highlight that women know exactly what they want from their caregiver. Women valued working with their midwife towards a shared goal of an intervention-free, normal birth, researched their options and found mainstream services restrictive and focused on medical risk status rather than on the individual woman. findings will be of interest to maternity care practitioners and policy makers, as they highlight why some women prefer a social model of midwifery care that reflects a family centred, individualised and holistic approach. This insight can inform the development of maternity health care practices to recognise and accommodate the needs and values of all childbearing women. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Destined to Design? How and Why Australian Women Choose to Study Industrial Design (United States)

    Lockhart, Cathy; Miller, Evonne


    Despite over three decades of legislation and initiatives designed to tackle the traditional gender divide in the science, technology and design fields, only a quarter of the registered architects in Australia are women. There are no statistics available for other design disciplines, with little known about why women choose design as a career path…

  18. Staying home to give birth: why women in the United States choose home birth. (United States)

    Boucher, Debora; Bennett, Catherine; McFarlin, Barbara; Freeze, Rixa


    Approximately 1% of American women give birth at home and face substantial obstacles when they make this choice. This study describes the reasons that women in the United States choose home birth. A qualitative descriptive secondary analysis was conducted in a previously collected dataset obtained via an online survey. The sample consisted of 160 women who were US residents and planned a home birth at least once. Content analysis was used to study the responses from women to one essay question: "Why did you choose home birth?" Women who participated in the study were mostly married (91%) and white (87%). The majority (62%) had a college education. Our analysis revealed 508 separate statements about why these women chose home birth. Responses were coded and categorized into 26 common themes. The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.

  19. Women in academic general surgery. (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F


    To portray the professional experiences of men and women in academic general surgery with specific attention to factors associated with differing academic productivity and with leaving academia. A 131-question survey was mailed to all female (1,076) and a random 2:1 sample of male (2,152) members of the American College of Surgeons in three mailings between September 1998 and March 1999. Detailed questions regarding academic rank, career aspirations, publication rate, grant funding, workload, harassment, income, marriage and parenthood were asked. A five-point Likert scale measured influences on career satisfaction. Responses from strictly academic and tenure-track surgeons were analyzed and interpreted by gender, age, and rank. Overall, 317 surgeons in academic practice (168 men, 149 women) responded, of which 150 were in tenure-track positions (86 men, 64 women). Men and women differed in academic rank, tenure status, career aspirations, and income. Women surgeons had published a median of ten articles compared with 25 articles for men (p career satisfaction was high, but women reported feeling career advancement opportunities were not equally available to them as to their male colleagues and feeling isolation from surgical peers. Ten percent to 20% of surgeons considered leaving academia, with women assistant professors (29%) contemplating this most commonly. Addressing the differences between men and women academic general surgeons is critical in fostering career development and in recruiting competitive candidates of both sexes to general surgery.

  20. In-training factors predictive of choosing and sustaining a productive academic career path in neurological surgery. (United States)

    Crowley, R Webster; Asthagiri, Ashok R; Starke, Robert M; Zusman, Edie E; Chiocca, E Antonio; Lonser, Russell R


    Factors during neurosurgical residency that are predictive of an academic career path and promotion have not been defined. To determine factors associated with selecting and sustaining an academic career in neurosurgery by analyzing in-training factors for all graduates of American College of Graduate Medical Education (ACGME)-accredited programs between 1985 and 1990. Neurological surgery residency graduates (between 1985 and 1990) from ACGME-approved training programs were analyzed to determine factors associated with choosing an academic career path and having academic success. Information was available for 717 of the 720 (99%) neurological surgery resident training graduates (678 male, 39 female). One hundred thirty-eight graduates (19.3%) held full-time academic positions. One hundred seven (14.9%) were professors and 35 (4.9%) were department chairs/chiefs. An academic career path/success was associated with more total (5.1 vs 1.9; P female trainees (2.6 vs 0.9 publications; P career but not predictive of becoming professor or chair/chief (P > .05). Defined in-training factors including number of total publications, number of first-author publications, and program size are predictive of residents choosing and succeeding in an academic career path.

  1. The impact of cosmetic surgery advertising on Swiss women's body image and attitudes toward cosmetic surgery


    Ashikali, E.-M.; Dittmar, H.; Ayers, S.


    International concern has been expressed about advertising for cosmetic surgery (British Association of Aesthetic Plastic Surgeons [BAAPS], 2005, 2008). A recent study showed that exposure to such advertising resulted in a more negative body image and attitudes toward surgery among women living in the UK (Ashikali, Dittmar, & Ayers, 2015). This study investigates the impact of cosmetic surgery advertising on women living in Switzerland, a country with relatively little advertising for cosmeti...

  2. Healthcare Use for Pain in Women Waiting for Gynaecological Surgery

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    Sarah Walker


    Full Text Available Background. Pain while waiting for surgery may increase healthcare utilization (HCU preoperatively. Objective. Examine the association between preoperative pain and HCU in the year prior to gynecological surgery. Methods. 590 women waiting for surgery in a Canadian tertiary care centre were asked to report on HCU in the year before surgery. Pain was assessed using the Brief Pain Inventory. Results. 33% reported moderate to severe pain intensity and interference in the week before surgery. Sixty-one percent (n=360 reported a total of 2026 healthcare visits, with 21% (n=126 reporting six or more visits in the year before surgery. After controlling for covariates, women with moderate to severe (>3/10 pain intensity/interference reported higher odds of overall HCU (≥3 pain-related visits to family doctor or specialist in the past year or ≥1 to emergency/walk-in clinic compared to women with no or mild pain. Lower body mass index (BMI < 30 versus ≥30 and anxiety and/or depression were associated with emergency department or walk-in visits but not visits to family doctors or specialists. Conclusions. There is a high burden of pain in women awaiting gynecological surgery. Decisions about resource allocation should consider the impact of pain on individuals and the healthcare system.

  3. Trends in characteristics of women choosing contraindicated home births. (United States)

    Zafman, Kelly B; Stone, Joanne L; Factor, Stephanie H


    To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention. The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. "Planned home births" were defined as those births in which birthplace was coded as "residence" and birth attendant was coded as "certified nurse midwife (CNM)" or "other midwife". Contraindicated home births were defined as "planned home births" from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations. A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481-1396) and as a percentage of total births (0.01%-0.04%, P95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%-69%). The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.

  4. Effect of Educational Intervention on Self-efficacy for Choosing Delivery Method among Pregnant Women in 2013

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    Zahra Taheri


    Conclusions: Our findings showed that training-based self-efficacy procedure has been effective in encouraging mothers to choose natural childbirth. Therefore, the design and implementation of curriculum-based strategies for increasing self-efficacy is suggested for pregnant women.

  5. Control and Constraint for Low-Income Women Choosing Outpatient Sterilization (United States)

    Leyser-Whalen, Ophra; Berenson, Abbey B.


    Little is known about Hispanics and their contraceptive choices in general, with some past studies detailing non-consensual sterilization. This article is based on interviews with a mostly Hispanic sample of 44 women being sterilized at a public clinic in southeast Texas with the Essure device, which entails a new outpatient sterilization procedure. These women cited relationship factors, wanting to better their and their children’s lives, and past reproductive histories as reasons for deciding on sterilization. They specifically chose Essure as a result of an apprehension of surgery and potential side effects from tubal ligation. Their choices, however, were limited by larger structural factors of work, family, the political economy, and the health care system. We conclude that this new sterilization technique provided more contraceptive choices for these women, yet more contraceptive decision making autonomy, as well as more equitable social structures, are still needed. PMID:23761929

  6. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden

    NARCIS (Netherlands)

    Fryzek, JP; Weiderpass, E; Signorello, LB; Hakelius, L; Lipworth, L; Blot, WJ; McLaughlin, JK; Nyren, O


    To determine whether women with cosmetic breast implants have distinct demographic, lifestyle, and reproductive characteristics that put them at increased risk for subsequent morbidity, the authors compared 1,369 such women to 2,211 women who had undergone breast reduction surgery, and to a random

  7. Surgery Choices for Women with DCIS or Breast Cancer (United States)

    Women diagnosed with DCIS or breast cancer may face a decision about which surgery to have. The choices of breast-sparing surgery, mastectomy, or mastectomy with reconstruction are explained and compared.

  8. What do women want in breast reconstruction? Age-adhered surgery or rejuvenation?

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    Helga Henseler


    Conclusion: The majority of women desire to recreate their own natural and ptotic breast shape in reconstructive surgery without contralateral adjusting surgery. Younger women with smaller breasts and women of all ages with a family history of breast cancer more frequently prefer an operation on only the involved side. Women opted for good rather than excellent breast symmetry.

  9. Maternal obesity surgery : effects in women, spouses and offspring


    Berglind, Daniel


    Introduction: Bariatric surgery is an important treatment for the worldwide increasing epidemic of obesity. However, the effects of such surgery on offspring epigenetic profile and effects on objectively measured physical activity and sedentary behavior in women undergoing bariatric surgery and family members are essentially unknown. Aim: The aim of this thesis was to investigate possible effects of maternal weight loss after bariatric surgery and effects on differences in maternal gest...

  10. Medical students' and interns' interest in orthopedic surgery: the gender factor. (United States)

    Schroeder, Joshua E; Zisk-Rony, Rachel Y; Liebergall, Meir; Tandeter, Howard; Kaplan, Leon; Weiss, Yoram G; Weissman, Charles


    There is an extremely small proportion of female medical students choosing to specialize in orthopedic surgery. The aim of the study was to assess medical students' and interns' interests and perceptions of orthopedic surgery and explore why women are not interested in orthopedic surgery. Questionnaires were distributed to final-year medical students and interns assessing their interests and perception of orthopedic surgery. Final-year medical students and interns. Responses were obtained from 317 students and 199 interns. Among the medical students, 15% were interested in orthopedic surgery, but only 2% were women. Both male and female students perceived orthopedics as an "action"-packed, procedure-based profession, providing instant gratification, time in the operating room, high income, and the option for private practice. Female medical students considered it boring. Among interns, 11% were interested in orthopedic surgery; however, only 2% were women. When compared with the interns who were not interested in orthopedic surgery, a greater number of the interns interested in orthopedic surgery rated time with family and a procedure-intensive profession as important. Female students and interns were also interested in other surgical fields. The increasing majority of women among medical students will reshape the future of physician workforce by dictating changes in workforce participation, working conditions, and intercollegial relationships. Orthopedic surgery will need to adapt to these realities. Published by Elsevier Inc.

  11. Consideration of Cosmetic Surgery As Part of Women's Benefit-Provisioning Mate Retention Strategy. (United States)

    Atari, Mohammad; Barbaro, Nicole; Sela, Yael; Shackelford, Todd K; Chegeni, Razieh


    Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women's consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women) in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective.

  12. Women's perceptions of their right to choose the place of childbirth: an integrative review. (United States)

    Hadjigeorgiou, Eleni; Kouta, Christiana; Papastavrou, Evridiki; Papadopoulos, Irena; Mårtensson, Lena B


    to provide a critical synthesis of published research concerning women's experiences in choosing where to give birth. an integrative literature review was conducted using three databases (MEDLINE, CINAHL and Ovid) for 1997-2009. Inclusion criteria were: (1) publication in the English language; (2) research article; (3) focus on women's perceptions for their birthplace choices; and (4) data collected during pregnancy, at birth and post partum. twenty-one research-based papers met the inclusion criteria, and these used a range of approaches and methods. Four themes were derived from the data: choice of birthplace and medicalisation of childbirth; the midwifery model of care and the rhetoric of birthplace choices; perceptions of safety shaped women's preferences; and choice is related to women's autonomy. there is considerable evidence that women worldwide wish to be able to exercise their rights and make informed choices about where to give birth. The medical model remains a strong and powerful influence on women's decisions in many countries. The midwifery model offers birthplace choices to women, while policies and culture in some countries affect midwifery practise. Perceptions of safety shaped women's preferences, and women's autonomy facilitated birthplace choices. these findings can be seen as a challenge for health professionals and policy makers to improve perinatal care based on women's needs. Local research is advisable due to cultural and health system differences. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. The WTS report on the current status of women in cardiothoracic surgery. (United States)

    Donington, Jessica S; Litle, Virginia R; Sesti, Joanna; Colson, Yolonda L


    The purpose of this work was to assess career demographics, professional activities, and career satisfaction of board-certified female cardiothoracic surgeons in the United States, 50 years after certification of the first women diplomats by the American Board of Thoracic Surgery (ABTS). All ABTS-certified women were surveyed anonymously in December 2010, using Questions were in five categories: demographics, training, practice activities, activities of nonpracticing cardiothoracic surgeons, and career satisfaction. Respondents were grouped by year of certification: group 1 (1961 to 1999) and group 2 (2000 to 2010). Broad comparisons to the entire thoracic surgery workforce were based on The Society of Thoracic Surgeons and American Association for Thoracic Surgery 2009 practice survey. Of the 204 living female diplomats, 190 were surveyed, as 14 (7%) were unavailable owing to lack of contact information. Survey response rate was 64% (121 of 190). Mean respondent's age was 48 years (range, 35 to 74), with the majority being Caucasian (94 of 121). Women spent a mean of 9.1 years in training, and 56% (68 of 121) reported non-Accreditation Council for Graduate Medical Education training time. Duration of training and resultant debt has increased over time, as respondents in group 1 (n=52) reported training for 8.5 years versus 9.5 years in group 2 (n=68; p=0.01), and a doubling of graduates with educational debt more than $100,000 from 19% to 41%, respectively (p=0.003). The average number of years in practice was 8 (range, 1 to 30), with the majority working in urban setting (65 of 106), in group practices of 2 to 10 surgeons (82 of 106), and as the sole female surgeon in their group (84 of 106). Of the 54 women with academic appointments, more than 60% (33 of 54) are at the instructor or assistant professor level, but 18% (10 of 54) are full professors. Nearly a third (16 of 54) have secured research funding, and 20% (11 of 54) have protected

  14. Choosing not to choose. (United States)

    Sunstein, Cass R


    Choice can be an extraordinary benefit or an immense burden. In some contexts, people choose not to choose, or would do so if they were asked. In part because of limitations of "bandwidth," and in part because of awareness of their own lack of information and potential biases, people sometimes want other people to choose for them. For example, many people prefer not to make choices about their health or retirement plans; they want to delegate those choices to a private or public institution that they trust (and may well be willing to pay a considerable amount to those who are willing to accept such delegations). This point suggests that however well accepted, the line between active choosing and paternalism is often illusory. When private or public institutions override people's desire not to choose and insist on active choosing, they may well be behaving paternalistically, through a form of choice-requiring paternalism. Active choosing can be seen as a form of libertarian paternalism, and a frequently attractive one, if people are permitted to opt out of choosing in favor of a default (and in that sense permitted not to choose); it is a form of nonlibertarian paternalism insofar as people are required to choose. For both ordinary people and private or public institutions, the ultimate judgment in favor of active choosing, or in favor of choosing not to choose, depends largely on the costs of decisions and the costs of errors.

  15. Women in surgery: a survey in Switzerland. (United States)

    Kaderli, Reto; Guller, Ulrich; Muff, Brigitte; Stefenelli, Ulrich; Businger, Adrian


    An increasing proportion of women work in medicine; however, only few choose surgical specialties. The objective of this study was to analyze the current situation of female surgeons and surgical residents in Switzerland concerning their personal and professional fulfillment. Of 318 female surgeons and surgical residents included in our study, 189 (59.4%) returned the anonymous questionnaire. Mentor-mentee relationships were mentioned by 110 (58.2%) of the 189 respondents. On the basis of a 7-point Likert scale, these women responded that they were moderately satisfied with their professional (mean score [SD], 2.7 [1.3]) and personal (mean score [SD], 3.0 [1.7]) lives. Of the 189 respondents, 113 (59.8%) mentioned that they felt underappreciated. The most important ways suggested for increasing the attractiveness of a surgical career for women were a reduction in workload (49 respondents [25.9%]), more flexible working hours (38 respondents [20.1%]), and better structured residency programs (23 respondents [12.2%]).

  16. Adolescent and Young Women's Contraceptive Decision-Making Processes: Choosing "The Best Method for Her". (United States)

    Melo, Juliana; Peters, Marissa; Teal, Stephanie; Guiahi, Maryam


    To evaluate influences on adolescent and young women's contraceptive decision-making processes. We conducted 21 individual interviews with women who presented to an adolescent-focused Title X family planning clinic seeking a new contraceptive method. Data were collected using a semi-structured interview guide, audio-taped and transcribed. Three researchers independently coded the transcripts using grounded theory; codes were organized into overarching themes and discrepancies were resolved. After identification of themes, we organized the conceptual framework of the decision-making process using the transtheoretical model of behavior change in which participants move through 4 stages: (1) contemplation, (2) preparation, (3) action, and (4) maintenance. When contemplating contraception, most of our participants were highly motivated to avoid pregnancy. During preparation, participants gathered information related to their contraceptive concerns. Participants cited peers as primary informants and healthcare providers as experts in the field. Participants integrated information received with their personal concerns about contraception initiation; the most common concerns were effectiveness, method duration, convenience, and side effects. When participants acted on choosing a contraceptive method they described how it fit their individual needs. They considered their contraceptive experiences unique and not necessarily applicable to others. During maintenance, they acted as informants for other peers, but most commonly expressed that each individual must choose "the best method for her." When adolescent and young women select a contraceptive method they balance the benefits and risks of available methods portrayed by peers and provider in the context of their personal concerns. Peer influence appeared to be greatest when participants shared contraceptive concerns and goals. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by

  17. Association of Cataract Surgery With Mortality in Older Women: Findings from the Women's Health Initiative. (United States)

    Tseng, Victoria L; Chlebowski, Rowan T; Yu, Fei; Cauley, Jane A; Li, Wenjun; Thomas, Fridtjof; Virnig, Beth A; Coleman, Anne L


    Previous studies have suggested an association between cataract surgery and decreased risk for all-cause mortality potentially through a mechanism of improved health status and functional independence, but the association between cataract surgery and cause-specific mortality has not been previously studied and is not well understood. To examine the association between cataract surgery and total and cause-specific mortality in older women with cataract. This prospective cohort study included nationwide data collected from the Women's Health Initiative (WHI) clinical trial and observational study linked with the Medicare claims database. Participants in the present study were 65 years or older with a diagnosis of cataract in the linked Medicare claims database. The WHI data were collected from January 1, 1993, through December 31, 2015. Data were analyzed for the present study from July 1, 2014, through September 1, 2017. Cataract surgery as determined by Medicare claims codes. The outcomes of interest included all-cause mortality and mortality attributed to vascular, cancer, accidental, neurologic, pulmonary, and infectious causes. Mortality rates were compared by cataract surgery status using the log-rank test and Cox proportional hazards regression models adjusting for demographics, systemic and ocular comorbidities, smoking, alcohol use, body mass index, and physical activity. A total of 74 044 women with cataract in the WHI included 41 735 who underwent cataract surgery. Mean (SD) age was 70.5 (4.6) years; the most common ethnicity was white (64 430 [87.0%]), followed by black (5293 [7.1%]) and Hispanic (1723 [2.3%]). The mortality rate was 2.56 per 100 person-years in both groups. In covariate-adjusted Cox models, cataract surgery was associated with lower all-cause mortality (adjusted hazards ratio [AHR], 0.40; 95% CI, 0.39-0.42) as well as lower mortality specific to vascular (AHR, 0.42; 95% CI, 0.39-0.46), cancer (AHR, 0.31; 95% CI, 0

  18. Gynecological Surgery and Low Back Pain in Older Women (United States)

    Ericksen, Jeffery; Pidcoe, Peter E.; Ketchum-McKinney, Jessica M.; Burnet, Evie N.; Huang, Emily; Wilson, James C.; Hoogstad, Vincent


    Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women. PMID:23569659

  19. Dry eye following cataract surgery in Women Over 50 Years Old

    Directory of Open Access Journals (Sweden)

    N. Bazzazi


    Full Text Available Introduction: Dry eye is a common problem amongst post-menopausal women. Cataract surgery may worsen symptoms of dry eye and this can inflence the quality of life in patients. Ths study was performed to evaluate the incidence and severity of dry eye symptoms aftr phacoemulsifiation surgery. Methods: Ths case-series study was performed on 43 women aged over 50 years during 2013-2014. Patients underwent phacoemulsifiation surgery on one eye. Symptoms of the operated and contra lateral eye were analyzed by χ2 statistical test and SPSS softare, preoperative and one month aftr the surgery. Results: One month aftr the surgery, the mean value of incidence and severity of dry eye in operated and non-operated eyes were 90.06 ± 3.5, 80.96 ± 3.55, 71.11 ± 3.52, and 63.51 ± 3.04, respectively. Th diffrence between the two groups was signifiant (P > 0.001. Schirmer’s test, TBUT and corneal staining showed no signifiant diffrence (P ≥ 0.05. conclusions: Cataract surgery may lead to worsening of dry eye symptoms. Treatment of dry eye before cataract surgery is an important issue to prevent ocular surface damage.

  20. Women's preference of cosmetic results after gynecologic surgery. (United States)

    Goebel, Kathryn; Goldberg, Jeffrey M


    To determine the cosmetic appeal of different incision types used in gynecologic surgery. One hundred women between the ages of 20 and 40 years were shown 4 color photographs of a female abdomen with incision sites marked for Pfannenstiel, minilaparotomy, traditional laparoscopy, and robotic-assisted laparoscopy. The women were asked to rank the photographs on cosmetic appeal alone. An additional photograph depicting single-port laparoscopy was then added, and patients were asked to again rank the photographs. Participants were also asked basic demographic information and prior surgical history. Office practice. One hundred women between the ages of 20 and 40. Participants. Minilaparotomy was ranked as the most appealing incision among the first set of photographs by 74% of the participants, and the remaining 26% preferred traditional laparoscopy. Robotic-assisted laparoscopy was ranked as the least appealing scar type by 42%, and no patient selected it as their first choice. Sixty-four percent preferred the appearance of a single-port laparoscopic scar when that option was added. The only demographic variable that reached statistical significance was the presence of prior abdominal surgery. Patients without prior surgery ranked minilaparotomy as more cosmetically appealing. When several minimally invasive surgical approaches are possible, the patient should be counseled regarding the cosmetic results of each. Patients in this study strongly preferred the appearance of minilaparotomy and single-port incisions over full Pfannenstiel or robotic incisions. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  1. Women in academic surgery: why is the playing field still not level? (United States)

    Seemann, Natashia M; Webster, Fiona; Holden, Helen Alyx; Moulton, Carol-Anne E; Baxter, Nancy; Desjardins, Christine; Cil, Tulin


    The purpose of this study was to explore career satisfaction and advancement for women in academic surgery. A 48-item web-based survey was emailed to women surgeons in academic centers across Canada, exploring career advancement, family planning, mentorship, discrimination, and career satisfaction. The survey response rate was 38% (81 of 212); 18% of participants felt they experienced gender discrimination in medical school, 36% in residency, 12% in fellowship, and 41% as staff surgeons. More than half felt that their gender had played a role in the career challenges they faced. Responses to open-ended questions suggested that many surgeons struggled to balance their academic careers with family life. Despite this, participants rated their career satisfaction very highly. There remain ongoing challenges for women in academic surgery including lack of gender equality, appropriate mentorship, and accommodations for surgeons with families. Continued advancement of women in academic surgery is dependent on addressing these concerns. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Gender differences in the learning and teaching of surgery: a literature review. (United States)

    Burgos, Carmen M; Josephson, Anna


    To explore evidence concerning gender differences in teaching and learning in surgery to guide future initiatives. This systematic review was conducted searching in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and PubMed. All studies related to gender differences in surgical education, teaching or learning of surgery at an undergraduate level were included. Data was extracted and critically appraised. Gender differences in learning, teaching, skills acquisition, perceptions and attitudes, interest on surgery, personality and factors influencing interest in surgical careers were differentiated. There is an underrepresentation of women in surgical academia, due to lack of role models and gender awareness. It is not clear whether or not gender itself is a factor that affects the learning of surgical tasks. Female students pursuing a surgical career had experienced sexual harassment and gender discrimination that can have an effect on the professional identity formation and specialty choice. There are differences in personality among female and male students interested in surgery. Gender is a determining factor to choose surgery, with a consistent lower proportion of women compared interested in pursuing a surgical career. Mentoring and personality fit are important in medical student's specialty selection. Female students are more likely to be discouraged from pursuing a surgical career by a lack of female role models. Bias against women in surgery still exists. There is a lack of studies that investigate the role of women in the teaching of surgery.

  3. Development and pilot‐testing of a Decision Aid for use among Chinese women facing breast cancer surgery (United States)

    Au, Angel H.Y.; Lam, Wendy W.T.; Chan, Miranda C.M.; Or, Amy Y.M.; Kwong, Ava; Suen, Dacita; Wong, Annie L.; Juraskova, Ilona; Wong, Teresa W.T.; Fielding, Richard


    Abstract Background  Women choosing breast cancer surgery encounter treatment decision‐making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. Aims  Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. Methods  Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four‐day post‐consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. Results  The original DA was read/partially read by 66/22% (n = 84) of women, whilst the revised version was read/partially read by 74/16% (n = 35), including subliterate women (χ2 = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P utility, [except for the ‘treatment options’ (χ2 = 5.50, P = 0.019) and ‘TDM guidance’ (χ2 = 8.19, P = 0.004) sections] without increasing anxiety (F = 0.689, P = 0.408; F = 3.45, P = 0.073). Conclusion  The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial. PMID:21223468

  4. Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study. (United States)

    Sitras, Vasilis; Šaltytė Benth, Jūratė; Eberhard-Gran, Malin


    To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women's decisions to use EDA. Longitudinal cohort study. Akershus University Hospital, Norway. 2596 women with singleton pregnancies and intended vaginal delivery. Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward. Preference for EDA was indicated by the questionnaire item "I would prefer an epidural regardless" on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32. Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (plabour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)]. Fear of childbirth is significantly associated with women's choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.

  5. Personality Traits and Decision on Breast Reconstruction in Women after Mastectomy. (United States)

    Miśkiewicz, Halina; Antoszewski, Bogusław; Iljin, Aleksandra


    The aim of the study was evaluation of the correlation between selected personality traits in women after mastectomy and their decision on breast reconstruction. The study was conducted between 2013‑2015, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, and Department of Oncological and Breast Surgery, CZMP. Comparative analysis comprised 40 patients, in whom mastectomy and breast reconstruction was done, and 40 women after breast amputation, who did not undergo reconstructive surgery. Basing on self-constructed questionnaire, five features of personality were evaluated in these women: pursue of success in life, ability to motivate others, openness to other people, impact of belonging to a social group on sense of security and the importance of opinion of others about the respondent. Apart from the questionnaire, in both groups of women a psychologic tool was used (SUPIN S30 and C30 tests) to determine the intensity of positive and negative emotions. Women who did not choose the reconstructive option were statistically significantly older at mastectomy than women who underwent breast reconstruction. There were statistically significant differences between both groups in response to question on being open to other people and value of other people's opinion. The differences in responses to question on the impact of belonging to a social group on personal sense of safety were hardly statistically significant. In psychometric studies there were significant differences in responses to SUPIN C30 test for negative emotions and S-30 for positive emotions. The level of negative emotions - feature of group A was in 47.5% in the range of high scores and in 47.5% within low and low-average scores. Among women from group B 57.5% had high scores, while 37.5% low and average scores. There were significant differences in the results of positive emotions evaluation in S-30. Women who did not undergo breast reconstruction usually had

  6. Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery. (United States)

    Labrague, Leodoro J; McEnroe-Petitte, Denise M


    The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery. © The Author(s) 2014.

  7. Choosing Fighting Competitors Among Men: Testosterone, Personality, and Motivations. (United States)

    Borráz-León, Javier I; Cerda-Molina, Ana Lilia; Rantala, Markus J; Mayagoitia-Novales, Lilian


    Higher testosterone levels have been positively related to a variety of social behaviors and personality traits associated with intrasexual competition. The aim of this study was to evaluate the role of testosterone levels and personality traits such as aggressiveness, competitiveness, and self-esteem on the task of choosing a fighting competitor (a rival) with or without a motivation to fight. In Study 1, a group of 119 men participated in a task for choosing a rival through pictures of men with high-dominant masculinity versus low-dominant masculinity. Participants completed three personality questionnaires and donated two saliva samples (pre-test and post-test sample) to quantify their testosterone levels. We found that the probability of choosing high-dominant masculine men as rivals increased with higher aggressiveness scores. In Study 2, the task of choosing rivals was accompanied by motivations to fight (pictures of women with high or low waist-to-hip ratio [WHR]). In this context, we observed that the probability of choosing dominant masculine men as rivals depended on the WHR of the women. Overall, average levels of post-test testosterone, aggressiveness, and high self-esteem increased the probability to fight for women with low WHR independently of the dominance masculinity of the rivals. Our results indicate that human decisions, in the context of intrasexual competition and mate choice, are regulated by physiological and psychological mechanisms allowing men to increase their biological fitness. We discuss our results in the light of the plasticity of human behavior according to biological and environmental forces.

  8. Attitudes toward Cosmetic Surgery in Middle-Aged Women: Body Image, Aging Anxiety, and the Media (United States)

    Slevec, Julie; Tiggemann, Marika


    Our study investigated factors that influence attitudes toward cosmetic surgery in middle-aged women. A sample of 108 women, aged between 35 and 55 years, completed questionnaire measures of body dissatisfaction, appearance investment, aging anxiety, media exposure (television and magazine), and attitudes toward cosmetic surgery (delineated in…

  9. Materialism, Sociocultural Appearance Messages, and Paternal Attitudes Predict College Women's Attitudes about Cosmetic Surgery (United States)

    Henderson-King, Donna; Brooks, Kelly D.


    Rates of cosmetic surgery procedures have increased dramatically over the past several decades, but only recently have studies of cosmetic surgery attitudes among the general population begun to appear in the literature. The vast majority of those who undergo cosmetic surgery are women. We examined cosmetic surgery attitudes among 218…

  10. Venous thromboembolism in women undergoing pelvic reconstructive surgery with mechanical prophylaxis alone. (United States)

    Montoya, T Ignacio; Leclaire, Edgar L; Oakley, Susan H; Crane, Andrea K; Mcpencow, Alexandra; Cichowski, Sara; Rahn, David D


    The objective of this study was determine the frequency of symptomatic perioperative venous thromboembolism (VTE) and risk factor(s) associated with VTE occurrence in women undergoing elective pelvic reconstructive surgery using only intermittent pneumatic compression (IPC) for VTE prophylaxis. A multi-center case-cohort retrospective review was conducted at six clinical sites over a 66-month period. All sites utilize IPC as standard VTE prophylaxis for urogynecological surgery. VTE cases occurring during the same hospitalization and up to 6 weeks postoperatively were identified by ICD9 code query. Four controls were temporally matched to each case. Information collected included demographics, medical history, route of surgery, operative time, and intraoperative characteristics. Univariate and multivariate backward stepwise logistic regression analyses were performed to identify potential risk factors for VTE. Symptomatic perioperative VTE was diagnosed in 27 subjects from a cohort of 10,627 women who underwent elective urogynecological surgery (0.25 %). Univariate analysis identified surgical route (laparotomy vs others), type of surgery ("major" vs "minor"), history of gynecological cancer, surgery time, and patient age as risk factors for VTE (P h. In our study cohort, the frequency of symptomatic perioperative VTE was low. Laparotomy, age ≥ 70 years, and surgery duration ≥ 5 h were associated with VTE occurrence.

  11. Do Women With Breast Cancer Who Choose Adjunctive Integrative Oncology Care Receive Different Standard Oncologic Treatment? (United States)

    Standish, Leanna J; Dowd, Fred; Sweet, Erin; Dale, Linda; Andersen, M Robyn


    To determine if women with breast cancer who choose adjunctive naturopathic oncology (NO) specialty care receive different standard oncologic treatment when compared with breast cancer patients who receive only standard care. Women with breast cancer stages 0 to 4, aged 18+ who spoke English and sought care from outpatient naturopathic doctor clinics were enrolled in an observational study of clinical and quality of life outcomes. Women who sought NO care 2 or more times within the first 2 years postdiagnosis were identified as NO cases. A matched comparison group of breast cancer patients were identified using the Western Washington Cancer Surveillance System(CSS). A longitudinal cohort design. In addition to self-report data, the CSS provided data on demographics, stage at the time of diagnosis, and initial treatment. Oncology medical records were abstracted in order to provide additional information on standard oncologic treatment for all participants. Cohorts were well matched with regard to demographic, histologic, and prognostic indicators at the time of diagnosis. Approximately 70% of women in both cohorts received standard oncologic care that met the National Comprehensive Cancer Network guidelines. There were no statistically significant differences between the cohorts in treatment received. Fewer women in the NO cohort with estrogen receptor-positive breast cancer appear to have received antiestrogen therapy. Women in both cohorts appear to receive guideline-concordant care. However, women who receive adjunctive NO care may be less likely to receive antiestrogen therapy.

  12. Women surgeons in the new millennium. (United States)

    Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph


    Women are increasingly entering the surgical profession. To assess professional and personal/family life situations, perceptions, and challenges for women vs men surgeons. National survey of American Board of Surgery-certified surgeons. A questionnaire was mailed to all women and men surgeons who were board certified in 1988, 1992, 1996, 2000, or 2004. Of 3507 surgeons, 895 (25.5%) responded. Among these, 178 (20.3%) were women and 698 (79.7%) were men. Most women and men surgeons would choose their profession again (women, 82.5%; men, 77.5%; P = .15). On multivariate analysis, men surgeons (odds ratio [OR], 2.5) and surgeons of a younger generation (certified in 2000 or 2004; OR, 1.3) were less likely to favor part-time work opportunities for surgeons. Most of the surgeons were married (75.6% of women vs 91.7% of men, P women surgeons (OR, 5.0) and surgeons of a younger generation (OR, 1.9) were less likely to have children. More women than men surgeons had their first child later in life, while already in surgical practice (62.4% vs 32.0%, P women surgeons vs 79.4% of men surgeons (P women surgeons than men surgeons thought that maternity leave was important (67.8% vs 30.8%, P work (86.5% vs 69.7%, P Women considering a surgical career should be aware that most women surgeons would choose their profession again. Strategies to maximize recruitment and retention of women surgeons should include serious consideration of alternative work schedules and optimization of maternity leave and child care opportunities.

  13. [Use of contraception and reasons for choosing abortion among abortion applicants]. (United States)

    Hansen, S K; Birkebaek, J S; Husfeldt, C; Munck, C B; Nøddebo, S M; Petersson, B H


    The object of this study was to describe a group of women applying for legal abortion in relation to their use of contraception and reasons for choosing an abortion. During a period of 13 months (1991-92) a questionnaire was distributed to women applying for legal abortion at Hillerød Hospital in Denmark. Three hundred and thirty-nine women participated. Fifty-nine percent of the women had become pregnant although they had used contraception. As seen in other studies, women still state demographic factors as their most important reasons for choosing an abortion. Women with two or more children do not want to have more children. Single women do not want children without being in a stable relationship. Furthermore occupation and education were frequently stated as important reasons for having an abortion. Economy and housing were not main reasons but contributory factors. Thirty percent of the women expressed ambivalence about the choice of abortion at the time when the abort was due.

  14. Choosing Spouse in Iran

    Directory of Open Access Journals (Sweden)

    Seyed Zia'


    Full Text Available Each society and culture, according to its condition and requirements, makes special circumscriptions, criterions and norms in choosing a spouse. In every culture one may have several alternatives of his/her own opposite sex as a spouse, but spouse choosing is never accidental. In every culture, besides the circumscriptions which is due to the personal values and desires, there are some circumscriptions which are imposed by the society. Till some decades ago, the family organization was responsible for spouse choosing in Iran, but today each person's role has become more important; although cultural and social conditions have some effect on it. Therefore, nowadays spouse choosing is analyzed as an important social action and many theories have been provided for understanding the patterns of the spouse choosing. In this study and in a theoretical level, two important theories (similar spouses and different spouses are presented as two corrival theories and then according to similarities of these theories, the indicators of the study are made. After that, by using the survey research method throughout the country and the statistical population of five thousand people, we experimentally assess the indicators of the study and these two theories of the spouse choosing.            Results show the domination of the similar spouses' theory in Iran. They also show that approximately 90% of people in the external traits, 89% in the psycho-emotional traits, 93% in the personal traits, 68% in the social level characteristics and 88% in the religious beliefs, follow the patterns of the similar spouses' theory.The analytical results also conclusively show that different groups in Iran choose persons who have more similarity with them in the external, psycho-emotional and personal traits as well as the social level and religious characteristics. Although it should be noted that among men and women, the strangeness and weakness of these patterns are

  15. Psychosocial predictors in consideration of cosmetic surgery among women. (United States)

    Nerini, Amanda; Matera, Camilla; Stefanile, Cristina


    This study aimed to analyze the influence of psychosocial factors on the consideration of cosmetic surgery. The authors hypothesized that the internalization of thin ideals and social comparisons mediate the relationship between media pressure, family and peer influence (appearance conversations, perception of teasing, and peer attributions), and the desire to pursue cosmetic surgery. The study participants were 429 Italian women (mean age, 33 years). They completed a questionnaire containing the Appearance Conversations With Friends Scale, the Perception of Teasing Scale for Friends, the Peer Attribution Scale, the "Pressure and Internalization-General" subscales of the Sociocultural Attitudes Towards Appearance Questionnaire-3, the Feedback on Physical Appearance Scale, the Physical Appearance Comparison Scale, and the "Consider" subscale of the Acceptance of Cosmetic Surgery Scale. Hierarchical linear regression was performed. The results indicated that media pressure and appearance conversations with peers predicted the outcome variable through the full mediation of internalization of thin ideals. The relation between peer attributions and interest in cosmetic surgery was partially mediated by internalization of thin ideals. Although social comparison was significantly related to both sociocultural variables and consideration of cosmetic procedures, it was not a significant mediator of this relationship. Neither family influence nor perception of teasing predicted the outcome variable. Overall, these results provide important information about the factors implicated in the consideration of cosmetic surgery by women. This research confirms that cosmetic surgeons need to adopt a base psychological approach. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  16. Association between urinary incontinence in women and a previous history of surgery

    DEFF Research Database (Denmark)

    Mommsen, S.; Foldspang, Anders; Elving, L.


    In a cross-sectional study, 85% of 3114 women responded to a questionnaire on urinary incontinence and a history of abdominal, gynaecological and urological surgery. In 1987 the prevalence of urinary incontinence was 17%; 63% had undergone surgery, mainly gynaecological, and almost one......-third of the respondents had had more than one operation. Bivariate and multivariate analysis showed stress urinary incontinence to be associated with previous exposure to surgery....

  17. Young adult women's experiences of body image after bariatric surgery

    DEFF Research Database (Denmark)

    Jensen, Janet F; Hoegh-Petersen, Mette; Larsen, Tine B


    AIM: To understand the lived experience of body image in young women after obesity surgery. BACKGROUND: Quantitative studies have documented that health-related quality of life and body image are improved after bariatric surgery, probably due to significant weight loss. Female obesity surgery...... candidates are likely to be motivated by dissatisfaction regarding physical appearance. However, little is known about the experience of the individual woman, leaving little understanding of the association between bariatric surgery and changes in health-related quality of life and body image. DESIGN...... analysed by systematic text condensation influenced by Giorgi's phenomenological method and supplemented by elements from narrative analysis. FINDINGS: The analysis revealed three concepts: solution to an unbearable problem, learning new boundaries and hopes of normalization. These revelatory concepts were...

  18. Does Depth Matter? Factors Affecting Choice of Vulvoplasty Over Vaginoplasty as Gender-Affirming Genital Surgery for Transgender Women. (United States)

    Jiang, David; Witten, Jonathan; Berli, Jens; Dugi, Daniel


    Gender-affirming vaginoplasty aims to create the external female genitalia (vulva) as well as the internal vaginal canal; however, not all patients desire nor can safely undergo vaginal canal creation. Our objective is to describe the factors influencing patient choice or surgeon recommendation of vulvoplasty and to assess the patient's satisfaction with this choice. Gender-affirming genital surgery consults were reviewed from March 2015 until December 2017, and patients scheduled for or who had completed vulvoplasty were interviewed by telephone. We report demographic data and the reasons for choosing vulvoplasty as gender-affirming surgery for patients who either completed or were scheduled for surgery, in addition to patient reports of satisfaction with choice of surgery, satisfaction with the surgery itself, and sexual activity after surgery. In total, 486 patients were seen in consultation for trans-feminine gender-affirming genital surgery: 396 requested vaginoplasty and 39 patients requested vulvoplasty. 30 Patients either completed or are scheduled for vulvoplasty. Vulvoplasty patients were older and had higher body mass index than those seeking vaginoplasty. The majority (63%) of the patients seeking vulvoplasty chose this surgery despite no contra-indications to vaginoplasty. The remaining patients had risk factors leading the surgeon to recommend vulvoplasty. Of those who completed surgery, 93% were satisfied with the surgery and their decision for vulvoplasty. Vulvoplasty creates the external appearance of female genitalia without creation of a neovaginal canal; it is associated with high satisfaction and low decision regret. This is the first study of factors impacting a patient's choice of or a surgeon's recommendation for vulvoplasty over vaginoplasty as gender-affirming genital surgery; it also is the first reported series of patients undergoing vulvoplasty only. Limitations of this study include its retrospective nature, non-validated questions

  19. Social Support for Women Who Have Undergone Bariatric Surgery. (United States)

    Ogle, Jennifer Paff; Park, Juyeon; Damhorst, Mary Lynn; Bradley, Linda Arthur


    We explored the role that social support plays in the lives of women who have undergone bariatric surgery. We conducted in-depth interviews with 13 women who had had bariatric surgery (M age = 53.0 years) and analyzed the data using constant comparison processes. We found that individuals in participants' lives offered support by acting as role models and providing information, offering empathy and expressions of concern and caring, assisting with everyday responsibilities, and serving as companions. In turn, these forms of support guided participants' behavior, calmed their concerns, enhanced their self-esteem, relieved them of daily responsibilities, and offered them companionship in their bariatric journeys. Consistent with the existing theory, differently situated individuals specialized in offering particular types of support. Although participants appreciated the support received, many indicated a desire for more or "better" support, pointing to a need for resources guiding supporters in how to best offer support to bariatric patients. © The Author(s) 2015.

  20. Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study. (United States)

    Guldberg, Rikke; Kesmodel, Ulrik Schiøler; Brostrøm, Søren; Kærlev, Linda; Hansen, Jesper Kjær; Hallas, Jesper; Nørgård, Bente Mertz


    To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. A historical population-based cohort study. Denmark. Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.

  1. [The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery]. (United States)

    Ko, I-Chen; Lo, Tsia-Shu; Lu, Yu-Ying; Tsao, Lee-Ing


    The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

  2. Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery. (United States)

    Bond, Dale S; Vithiananthan, Siva; Leahey, Tricia M; Thomas, J Graham; Sax, Harry C; Pohl, Dieter; Ryder, Beth A; Roye, G Dean; Giovanni, Jeannine; Wing, Rena R


    Sexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery. The FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2-36). A FSFI total cutoff score of sexual arousal disorder and healthy controls. Of the 102 women, 61 (59.8%) had FSFI total scores of sexual arousal disorder group (all P values sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.

  3. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy. (United States)

    Kumari, Archana; Nigam, Aruna


    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed.

  4. An Exploratory Study of Reintegration of Women Following Obstetric Fistula Surgery in West Pokot, Kenya

    Directory of Open Access Journals (Sweden)

    Anne M. Khisa


    Full Text Available Globally, obstetric fistula has been eradicated in developed countries although it continues to pose challenges to women living in sub-Saharan Africa and Asia. The condition continues to contribute to maternal morbidity in Kenya, causing immense physical and psychological suffering and disrupts women’s socioeconomic life. Following corrective surgery, experiences of Pokot women in their quest for social reintegration, a broadly neglected aspect of their healing process, are documented in an exploratory study. Primary data were collected over a 2-month period in rural Kenya using in-depth interviews with women who had undergone surgery and key informants. Thematic data analysis based on grounded theory revealed avenues for reintegration including successful surgery, family and community support, counseling, follow-up care, income generating activities, and skill training.

  5. Why choose cardiothoracic surgery as a career? (United States)

    Gopaldas, Raja R; Bakaeen, Faisal G; Chu, Danny; Coselli, Joseph S; Cooley, Denton A


    The future of cardiothoracic surgery faces a lofty challenge with the advancement of percutaneous technology and minimally invasive approaches. Coronary artery bypass grafting (CABG) surgery, once a lucrative operation and the driving force of our specialty, faces challenges with competitive stenting and poor reimbursements, contributing to a drop in applicants to our specialty that is further fueled by the negative information that members of other specialties impart to trainees. In the current era of explosive technological progress, the great diversity of our field should be viewed as a source of excitement, rather than confusion, for the upcoming generation. The ideal future cardiac surgeon must be a "surgeon-innovator," a reincarnation of the pioneering cardiac surgeons of the "golden age" of medicine. Equipped with the right skills, new graduates will land high-quality jobs that will help them to mature and excel. Mentorship is a key component at all stages of cardiothoracic training and career development. We review the main challenges facing our specialty--length of training, long hours, financial hardship, and uncertainty about the future, mentorship, and jobs--and we present individual perspectives from both residents and faculty members.

  6. “What Motivates Her”: Motivations for Considering Labial Reduction Surgery as Recounted on Women's Online Communities and Surgeons' Websites

    Directory of Open Access Journals (Sweden)

    Sandra Zwier, PhD


    Conclusions: Feelings of emotional and psychosexual distress in addition to functional distress are a highly prevalent motivation among women considering labial reduction surgery. Emotional distress appears to be greater and more freely emphasized when women communicate on online communities, while functional issues appear to receive greater notice on surgery provider's websites. Zwier S. “What motivates her”: Motivations for considering labial reduction surgery as recounted on women's online communities and surgeons' websites. Sex Med 2014;2:16–23.

  7. Factors that Can Promote or Impede the Advancement of Women as Leaders in Surgery: Results from an International Survey. (United States)

    Kawase, Kazumi; Carpelan-Holmström, Monika; Kwong, Ava; Sanfey, Hilary


    Compared with male surgeons, women have less success advancing their careers and are underrepresented in leadership positions in surgery. The purpose of this study is to identify the qualifications necessary to become leaders in surgery and the career barriers faced by women surgeons in various cultural environments. A survey was performed with women surgeons in Japan, USA, Finland, and Hong Kong, China, to assess various barriers faced by women surgeons in the respective countries. To develop appropriate survey tool, a preliminary questionnaire was distributed to leaders in surgery and also in various organizations worldwide. The response rate was 23 % with 225 of 964 survey returned. Japanese women surgeons identify lacked family support as impeding a successful surgical career. US women surgeons feel more latent gender discrimination. Finnish women surgeons are less likely to need to sacrifice work-life balance, when holding leadership positions. Women surgeons worldwide are highly motivated to develop their career and agree the percentage of women surgeons in leadership positions should be increased. Women surgeons in different countries perceive different challenges. We must develop strategies and should not hesitate to negotiate to overcome these issues to reach leadership positions in surgery. This may be accomplished through networking worldwide to improve current conditions and obstacles.

  8. Psychological distress in women with breast and gynecological cancer treated with radical surgery. (United States)

    Gómez-Campelo, Paloma; Bragado-Álvarez, Carmen; Hernández-Lloreda, Maria José


    The objective of this study is to compare psychological distress (body image disturbance,self-esteem, depression, and anxiety) in women with breast or gynecological cancer treated by radical surgery. Additionally, another objective is to analyze the association between psychological distress and sociodemographic characteristics, medical history, and social support to produce a prediction model for the outcome measures. A cross-sectional study was carried out with 100 women who had undergone radical surgery for breast or gynecological cancer. Both groups were divided into the following: younger than 50 years old and 50 years old or older. Body Image Scale, Rosenberg's Self-Esteem Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used. Age had a significant main effect on psychological distress but the type of cancer did not.Younger women showed significantly greater distress than older women (p-valuesself-esteem, the variables were: being younger, post-adjuvant therapy side effects,and dissatisfaction with social support. And for higher anxiety, the sole variable included was post-adjuvant therapy side effects. Both mastectomy and hysterectomy/oophorectomy cause similar psychological distress in younger women, but mastectomy causes greater distress in older women than hysterectomy/oophorectomy.

  9. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute. (United States)

    Novellis, Pierluigi; Bottoni, Edoardo; Voulaz, Emanuele; Cariboni, Umberto; Testori, Alberto; Bertolaccini, Luca; Giordano, Laura; Dieci, Elisa; Granato, Lorenzo; Vanni, Elena; Montorsi, Marco; Alloisio, Marco; Veronesi, Giulia


    Robotic surgery is increasingly used to resect lung cancer. However costs are high. We compared costs and outcomes for robotic surgery, video-assisted thoracic surgery (VATS), and open surgery, to treat non-small cell lung cancer (NSCLC). We retrospectively assessed 103 consecutive patients given lobectomy or segmentectomy for clinical stage I or II NSCLC. Three surgeons could choose VATS or open, the fourth could choose between all three techniques. Between-group differences were assessed by Fisher's exact, two-way analysis of variance (ANOVA), and Wilcoxon-Mann-Whitney test. P values open surgery. Age, physical status, pulmonary function, comorbidities, stage, and perioperative complications did not differ between the groups. Pathological tumor size was greater in the open than VATS and robotic groups (P=0.025). Duration of surgery was 150, 191 and 116 minutes, by robotic, VATS and open approaches, respectively (Popen groups. Estimated costs were 82%, 68% and 69%, respectively, of the regional health service reimbursement for robotic, VATS and open approaches. Robotic surgery for early lung cancer was associated with shorter stay and more extensive lymph node dissection than VATS and open surgery. Duration of surgery was shorter for robotic than VATS. Although the cost of robotic thoracic surgery is high, the hospital makes a profit.

  10. Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices. (United States)

    Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R


    This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Inadequately marketing our brand: Medical student awareness of acute care surgery. (United States)

    Montgomery, Stephanie C; Privette, Alicia R; Ferguson, Pamela L; Mirdamadi, Meena; Fakhry, Samir M


    Despite focused national efforts to promote acute care surgery (ACS), little is known about medical student awareness of ACS as a career choice. The impending shortage of general surgeons emphasizes the need to increase interest in this comprehensive surgical specialty. The goal of this study was to determine whether students would be more likely to consider choosing ACS if they were aware of the specialty and its benefits. A survey was distributed electronically to medical students at our institution, a Level I trauma center with an active ACS service. The survey asked questions regarding specialty choice and factors that were used in making that decision. Also included were questions regarding their familiarity and affinity for ACS. The survey was returned by 518 students. Each medical school year was proportionately represented. Twenty-one percent of the students reported surgery as their career choice; however, women were half as likely to choose surgery as men. When asked to define ACS, 23% of all students gave the correct response. Only 8.9% of the students in the preclinical years correctly defined ACS. Even in the clinical years, 54% were unaware of ACS as a specialty. Students reported that the top factors that influenced their choice were controllable lifestyle, predictable schedule, and a positive medical school role model. When asked to identify what would make ACS appealing, a 50-hour work week was deemed most influential. When given the definition of ACS with approximate pay and on-call hours, 41.5% of the students and 75% of those interested in surgery would be likely to choose ACS as a career. This study highlights that awareness of ACS as a specialty is lacking. This may reflect inadequate marketing of our "brand" both locally and nationally. Focused efforts at familiarizing students with ACS and increased role modeling may increase interest in ACS.

  12. The effects of radiotherapy and surgery on the sexual function of women treated for cervical cancer

    International Nuclear Information System (INIS)

    Flay, Linda D.; Matthews, John H.L.


    Purpose: This study investigated the short- and medium-term effects of pelvic radiotherapy and surgery on the sexual function of women treated for cervical cancer. Methods and Materials: Sixteen women with Stages I, II, or III disease referred for radiotherapy treatment were assessed. Six had undergone prior hysterectomy. The women were assessed with questionnaires prior to radiotherapy, at completion of radiotherapy, and at 6 weeks and 14 weeks after radiotherapy treatment. The clinical findings at routine follow-up were noted. Results: The study showed significant changes in sexual activity and satisfaction as a result of treatment. This was due to a number of physical and psychological factors. The level of sexual activity was lowest at completion of radiotherapy treatment. A feeling of vaginal shortening was the most frequent reason and was more common in women who were treated with surgery and radiotherapy. Dyspareunia, bleeding, and concern of bleeding and/or recurrence were all significant factors. Conclusions: The questionnaires were an effective way of assessing women's sexual function. Radiotherapy caused sexual dysfunction in one-half of women. Combined treatment with radiotherapy and surgery results in a higher risk than radiotherapy alone. Women with cervical cancer and undergoing radiotherapy treatment require considerable counseling and support

  13. Reasons Why Women Choose Home Birth

    Directory of Open Access Journals (Sweden)

    Mary Angelie P. Andrino


    Full Text Available Maternal deaths in the Philippines remain high. These deaths are mostly due to the large proportion of home births, complications of pregnancy and delivery, and lack of access to facilities and competently trained staff. Utilizing a descriptive, one-shot survey design, the study aimed to determine the reasons why women in a municipality in Iloilo prefer home birth. The respondents were interviewed using a validated questionnaire. Descriptive statistics were used to analyze and interpret the findings. The study revealed that the proportion of home births progressively declined from 2012 to 2014. Birth being imminent or inevitable is the number one reason that supports home birth. Autonomy, safety, affordability, readily available birthing equipment and supplies, accessibility of birth attendant, remote access by going to the birthing center, lack of transportation, and bad weather conditions also led women to give birth at home. Women from the rural areas of the municipality utilized available resources in the community which prompted the predominance of home deliveries assisted by traditional birth attendants (TBAs and even midwives, who were readily available nearby. This study recommends continuous improvement in existing maternal health interventions and strategies through engagement of women in policy planning, improvement of health service delivery, infrastructural enhancement, better care practices and continuous health education.

  14. A Qualitative Study on Experiences After Vulvar Surgery in Women With Lichen Sclerosus and Sexual Pain. (United States)

    Brauer, Marieke; van Lunsen, Rik H W; Laan, Ellen T M; Burger, Matthé P M


    Lichen sclerosus (LS) of the vulva can profoundly affect sexual interaction because of painful fissures and narrowing of the vaginal introitus. Successful surgical treatment is usually defined as restoration of (pain-free) penetrative sexual activity. To evaluate the impact of surgery on (dyadic) sexual functioning and pleasure and psychological well-being. Nineteen women with anogenital LS participated in audiotaped, qualitative, individual interviews after surgery to re-enable sexual intercourse. Physical, sexual, and psychological experiences were analyzed using the constant comparative method. Vulvar surgery resulted in a decrease of sexual pain in 13 of 19 patients (68%). Of these 13 patients, 4 were completely free of pain and the other 9 patients expressed a shift from preoperative sexual pain to postoperative sexual discomfort. These women reported improved sexual functioning, increased sexual activity and intimacy with the partner, and reinstated feelings of being an adequate woman and sexual partner. In 1 of the 19 patients (5%), surgery did not result in decreased sexual pain, yet she continued to have intercourse. Five of the 19 patients (26%) stopped having intercourse because of pain; one woman had secondary vaginismus and another woman, in retrospect, had premorbid generalized unprovoked vulvodynia. Four of these women were unable to communicate with their partner about sexual matters and to change their sexual repertoire (satisfactorily) once they had ceased intercourse (attempts). Eighteen women (95%) reported a decrease of LS symptoms in daily life. Vulvar surgery seems an effective treatment for most women with LS who experience sexual pain owing to anatomic or epithelial changes and who wish to resume intercourse. To assess whether women might benefit from such surgery and/or whether (additional) sexual counseling is indicated, preoperative sexological couple-based consultation is needed. This consultation should exclude comorbid vaginismus and

  15. Why aren't women choosing STEM academic jobs? Observations from a small-group discussion at the 2016 American Society for Microbiology annual meeting. (United States)

    Adamowicz, Elizabeth M


    This commentary summarizes a small-group discussion that recently occurred at the American Society for Microbiology annual general meeting, ASM Microbe, in Boston, Massachusetts, on 16-20 June 2016, on the topic 'why are so few women choosing to become academics?' Specifically, the discussion focused on asking what the actual and perceived barriers to academic STEM careers women face, and possible solutions to address them which would make women more likely to seek out academic careers. The conclusions reached suggest that, despite improvement in recent years, women and minorities still face complex barriers to STEM academic careers, and further research is needed to determine the best solutions to this problem. © FEMS 2017. All rights reserved. For permissions, please e-mail:

  16. Bariatric Surgery in Obese Women of Reproductive Age Improves Conditions That Underlie Fertility and Pregnancy Outcomes: Retrospective Cohort Study of UK National Bariatric Surgery Registry (NBSR). (United States)

    Edison, Eric; Whyte, Martin; van Vlymen, Jeremy; Jones, Simon; Gatenby, Piers; de Lusignan, Simon; Shawe, Jill


    The aims of this study are the following: to describe the female population of reproductive age having bariatric surgery in the UK, to assess the age and ethnicity of women accessing surgery, and to assess the effect of bariatric surgery on factors that underlie fertility and pregnancy outcomes. Demographic details, comorbidities, and operative type of women aged 18-45 years were extracted from the National Bariatric Surgery Registry (NBSR). A comparison was made with non-operative cases (aged 18-45 and BMI ≥40 kg/m 2 ) from the Health Survey for England (HSE, 2007-2013). Analyses were performed using "R" software. Data were extracted on 15,222 women from NBSR and 1073 from HSE. Women aged 18-45 comprised 53 % of operations. Non-Caucasians were under-represented in NBSR compared to HSE (10 vs 16 % respectively, p years (Wilcoxon test p year postoperatively from 48.2 ± 8.3 to 37.4 ± 7.5 kg/m 2 (t test, p fertility and pregnancy outcomes. A prospective study is required to verify these effects.

  17. Repair of the threatened feminine identity: experience of women with cervical cancer undergoing fertility preservation surgery. (United States)

    Komatsu, Hiroko; Yagasaki, Kaori; Shoda, Rie; Chung, Younghui; Iwata, Takashi; Sugiyama, Juri; Fujii, Takuma


    Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

  18. Choosing early pregnancy termination methods in Urban Mozambique

    NARCIS (Netherlands)

    Mitchell, Ellen M. H.; Kwizera, Amata; Usta, Momade; Gebreselassie, Hailemichael


    Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration

  19. Can Flaxseed Help Satisfy Appetite in Women Subjected to Bariatric Surgery?

    Directory of Open Access Journals (Sweden)

    Gigliane Cosendey-Menegati


    Full Text Available Background: Bariatric surgery is considered the most effective immediate weight loss method for the morbidly obese, despite widely reported weight regain after a few years. Appetite, satiety and satiation control are essential to maintaining a long-term result post-surgery. Dietary fatty acids composition may be implicated in the satiety. As flaxseed is a food high in linolenic acid, we aimed to verify the influence of flaxseed fat on appetite and satiety of women after bariatric surgery.Material and methods: Six women who underwent bariatric surgery at least 2 years before participated in a single-blind crossover trial that compared the effect of two isocaloric meals on satiety, one containing whole golden flaxseed (high in polyunsaturated fatty acids and fiber (G1 and another withdefatted flaxseed (high in fiber (G2, with one week of washout period. This variable was estimated by visual analogue scales in both meals at baseline (T0, immediately after ingestion (T1 and 60, 120, and 180 minutes after the meal (T60, T120 and T180. Fasting anthropometric, body composition, laboratory tests (glucose and lipids and dietary variables, were evaluated while fasting.Results: The volunteers were obese and had excess central adiposity, even after two years of surgery and still showed habitual fibre intake below recommended levels. G1 had reduced hunger after 180 minutes compared to G2 (P=.046. Other parameters related to appetite and satiety did not differ between groups.Conclusions: Less hunger was observed after 180 minutes in whole golden flaxseed meal compared with the defatted flaxseed meal, indicating that the whole golden flaxseed meal, possibly, supports obesity treatment in the long-term after bariatric surgery by controlling appetite and satiety sensations.

  20. How Undergraduate Women Choose STEM Careers (United States)

    Hughes, Roxanne


    In 2010 women represented half of the US population and over half of current graduates from college (57%) but less than a third of undergraduate degrees in science and engineering (STEM). This underrepresentation is worse in certain fields such as physics (21%), and engineering (22%) compared to 52% in chemistry. This underrepresentation is not only a social and cultural issue, but it is also cause for alarm in regard to the United States' ability to maintain its technological and economic dominance in the global economy. STEM fields provide valuable contributions to the nation's economic and environmental security (Augustine, 2005; Chang, 2009; Riegle-Crumb and King, 2010; Robelen, 2010; Tessler, 2008), paying practitioners well and bringing in revenue for successful businesses and governments (National Science Board [NSB], 2008; Riegle-Crumb and King). Consequently, addressing the underrepresentation of women and increasing their persistence in STEM fields will increase the number of scientists and engineers contributing to these fields, which could, in turn, improve the nation's economy, safety, and technological revenues. Research indicates that there are internal and external factors that affect the ability of women to see future success in STEM and to identify with the STEM and consequently persist. This presentation will summarize the current literature on issues affecting undergraduate women's retention in STEM as well as present strategies to improve this retention. Part of this presentation will draw from my own research studies in this area. The findings from my study and others reveal that only women who participate in redefinition strategies related to their marginalized status are able to persist; those who cannot redefine their marginality in relation to the dominant discourse of STEM begin to lose interest or doubt their competence in the field, resulting in their departure from STEM.

  1. Do Highly Educated Women Choose Smaller Families?


    Hazan, Moshe; Zoabi, Hosny


    Conventional wisdom suggests that in developed countries income and fertility are negatively correlated. We present new evidence that between 2001 and 2009 the cross-sectional relationship between fertility and women's education in the U.S. is U-shaped. At the same time, average hours worked increase monotonically with women's education. This pattern is true for all women and mothers to newborns regardless of marital status. In this paper, we advance the marketization hypothesis for explainin...

  2. [Surgery or physiotherapy for urinary stress incontinence; what is the preferred treatment in women?

    NARCIS (Netherlands)

    Labrie, J.; Berghmans, L.C.M.; Fischer, K.; Lagro-Janssen, A.; Vaart, C.H. van der


    OBJECTIVE: To compare midurethral sling surgery and pelvic floor physiotherapy as initial treatment in women with moderate to severe urinary stress incontinence. DESIGN: Multicentre randomised trial. METHOD: The study population was made up of women aged 35 to 80 years with moderate to severe stress

  3. Salivary cortisol and binge eating disorder in obese women after surgery for morbid obesity. (United States)

    Larsen, Junilla K; van Ramshorst, Bert; van Doornen, Lorenz J P; Geenen, Rinie


    Binge eating episodes characterized by loss of control are hypothesized to be accompanied by changes in hypothalamic pituitary adrenal (HPA) axis functioning. Cortisol is an end product of this neuroendocrine stress system. The aim of this study was to examine the cortisol levels and the awakening cortisol response (ACR) in obese persons showing binge eating after surgery for morbid obesity. Sixteen obese women with binge eating disorder (BED) and 18 obese women without BED participated in the study. Means+/-SD: age 43 +/- 15, body mass index 40 +/- 8. Salivary cortisol, anthropometric assessments, and the eating disorder examination interview were taken. Women with BED showed a significantly lower waist-to-hip ratio and cortisol levels during the day than women without BED, whereas the ACR did not differ. Our cross-sectional study in a small sample generates the hypothesis that neuroendocrine regulation differs between obese women with and without BED after obesity surgery. This finding needs replication in future studies that should also examine the causal direction of the observed association.

  4. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. (United States)

    Recio-Saucedo, Alejandra; Gerty, Sue; Foster, Claire; Eccles, Diana; Cutress, Ramsey I


    Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Trachoma and women: latrines in Ethiopia and surgery in Southern Sudan

    Directory of Open Access Journals (Sweden)

    Paul M Emerson


    Full Text Available Although there may be an underlying biological reason that more women are affected by trachoma and trichiasis, the role of women as childcare providers is a likely cause. In most countries where trachoma is endemic, girls grow up in environments where one of their primary activities is taking care of their younger family members and siblings. This continues into adulthood, with women carrying the main responsibility of caring for children. During their lifetime, women therefore spend more time in direct contact with children who may be infected. Ethiopia and Southern Sudan are two locations with an exceedingly high burden of trachoma. Projects focusing on environmental improvement (in Ethiopia and increasing access to surgery (in Southern Sudan have made significant progress towards reducing the impact of the disease on women. These examples show how trachoma programmes can address the particular needs of women while designing interventions aimed at eliminating blinding trachoma in the community as a whole.

  6. Bariatric Surgery Improves Hyperandrogenism, Menstrual Irregularities, and Metabolic Dysfunction Among Women with Polycystic Ovary Syndrome (PCOS). (United States)

    Christ, Jacob P; Falcone, Tommaso


    To characterize the impact of bariatric surgery on reproductive and metabolic features common to polycystic ovary syndrome (PCOS) and to assess the relevance of preoperative evaluations in predicting likelihood of benefit from surgery. A retrospective chart review of records from 930 women who had undergone bariatric surgery at the Cleveland Clinic Foundation from 2009 to 2014 was completed. Cases of PCOS were identified from ICD coding and healthy women with pelvic ultrasound evaluations were identified using Healthcare Common Procedure Coding System coding. Pre- and postoperative anthropometric evaluations, menstrual cyclicity, ovarian volume (OV) as well as markers of hyperandrogenism, dyslipidemia, and dysglycemia were evaluated. Forty-four women with PCOS and 65 controls were evaluated. Both PCOS and non-PCOS had significant reductions in body mass index (BMI) and markers of dyslipidemia postoperatively (p PCOS had significant reductions in androgen levels (p irregular menses (p PCOS, independent of preoperative BMI and age, preoperative OV associated with change in hemoglobin A1c (β 95% (confidence interval) 0.202 (0.011-0.393), p = 0.04) and change in triglycerides (6.681 (1.028-12.334), p = 0.03), and preoperative free testosterone associated with change in total cholesterol (3.744 (0.906-6.583), p = 0.02) and change in non-HDL-C (3.125 (0.453-5.796), p = 0.03). Bariatric surgery improves key diagnostic features seen in women with PCOS and ovarian volume, and free testosterone may have utility in predicting likelihood of metabolic benefit from surgery.

  7. A Systematic Review of the Factors that Patients Use to Choose their Surgeon. (United States)

    Yahanda, Alexander T; Lafaro, Kelly J; Spolverato, Gaya; Pawlik, Timothy M


    Given surgery's inherent risks, a patient should be able to make the most informed decisions possible in selecting surgical treatment. However, there is little information on what factors patients deem important when choosing a surgeon. We performed a systematic review of the literature focused on how patients select surgical care, focusing on identification of factors that influence patient choice as well as important sources of information used by patients. A search of all available literature on factors associated with choice of surgeon/surgical care, as well as sources of information used by patients before undergoing surgery, was conducted using the MEDLINE/PubMed electronic database. Of the 2315 publications identified, 86 studies met inclusion criteria. Overall, patients draw upon a wide range of factors when choosing surgical care. Surgeon reputation and competency stood out as the most valued professional attributes. Patients also often selected surgeons based on their interpersonal skills. Many patients chose surgical care using hospital, rather than surgeon, characteristics. For these patients, hospital reputation and hospital distance were factors of primary importance. Importantly, most patients relied on word-of-mouth and physician referrals when choosing a surgeon. Patients also expressed interest in quality information on surgeons, indicating that these data would be useful in decision-making. Patients draw upon a myriad of factors when choosing a surgeon and the circumstances surrounding patients' decisions maybe differ based on sociodemographic, cultural, as well as other factors. Additional information on how patients choose surgeons or hospitals will help providers assist patients in finding their preferred caregivers.

  8. In vitro fertilization outcome in women with endometriosis & previous ovarian surgery

    Directory of Open Access Journals (Sweden)

    Sonja Pop-Trajkovic


    Full Text Available Background & objectives: Women with endometriosis often need in vitro fertilization (IVF to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. Methods: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH levels. Outcome measures included number of follicles, number of ocytes, peak oestradiol (E2 concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. Results: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. Interpretation & conclusions: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

  9. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. (United States)

    Smith, C E; Gerdes, E; Sweda, S; Myles, C; Punjabi, A; Pinchak, A C; Hagen, J F


    We evaluated whether warming i.v. fluids resulted in less hypothermia (core temperature 30 min were randomized to two groups: fluid warming at 42 degrees C or control (room temperature fluids at approximately 21 degrees C). All patients received general anesthesia with isoflurane, tracheal intubation, standard operating room blankets and surgical drapes, and passive humidification of inspired gases. Tympanic membrane (core) temperatures were measured at baseline and at 15-min intervals after induction. The incidence of shivering and postoperative requirement for meperidine and/or radiant heat were evaluated. Core temperatures were lower in the control compared with the warm fluid group at the end of surgery (35.6 +/- 0.1 degrees C vs 36.2 +/- 0.1 degrees C; P unit or the incidence of shivering between the groups. We conclude that fluid warming, in conjunction with standard heat conservation measures, was effective in maintaining normothermia during outpatient gynecological surgery; however, there was no improvement in patient outcome. Women who received i.v. fluid at body temperature had significantly higher core temperatures during and after outpatient gynecological surgery compared with women who received i.v. fluids at the temperature of the operating room.

  10. Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia. (United States)

    Gele, Abdi A; Salad, Abdulwahab M; Jimale, Liban H; Kour, Prabhjot; Austveg, Berit; Kumar, Bernadette


    Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services.

  11. Comparison of dietary habits and plans for dietary changes in black and white women seeking bariatric surgery. (United States)

    McLean, Kendall L; Moore, Carolyn E; Miketinas, Derek C; Champagne, Catherine M


    Achieving weight loss after bariatric surgery depends on the individual's ability to sustain lifestyle changes involving dietary modifications. Presurgical dietary assessment is critical to evaluate usual dietary habits and identify the need for intervention before surgery. The objective of this study was to identify usual dietary habits of black and white women seeking bariatric surgery and to examine potential differences between these ethnic groups. An additional aim was to describe participants' plans to change dietary behaviors after surgery. This study examined data from an observational study sponsored by a benefits management group in Louisiana. In this cross-sectional study, a presurgical dietary assessment interview questionnaire collected information on dietary habits. Participants (n = 200) were adult women being screened for bariatric surgery; 54% were white, and 46% were black. Descriptive statistics were calculated and differences between groups were tested using 2-way analysis of the variance. Participants reported consuming fast food 2.9 ± 2.6 times per week, fried foods 2.1 ± 1.8 times per week, and desserts 3.4 ± 3.2 times per week. Blacks reported more frequent consumption of fast food (P<.01), sugar-sweetened sodas (P<.05), and sugar-sweetened tea (P<.01) compared with whites. Plans for changing dietary behaviors after surgery were similar between ethnic groups. Findings indicated that frequent consumption of fast foods, fried foods, desserts, and sugar-sweetened beverages was common among women seeking bariatric surgery. Blacks tended to consume these foods and beverages more often than whites. Current dietary habits and future plans to change dietary behaviors should be addressed before surgery for success. Follow-up studies investigating the assessment instrument's ability to predict dietary adherence and weight loss after surgery are warranted. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All

  12. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent


    INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estim......INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy...... women was high the first 2 years of the follow-up period with almost 800 women operated yearly. More than one third (n = 2,872) of all women operated for POP were operated less than 5 years after the hysterectomy with a median of 8.6 years. The cumulated incidence of POP surgery after hysterectomy...... with follow-up of up to 32 years was 12 %; 50 % (n = 5,451) of all POP surgeries were in the posterior compartment. The mean age of women undergoing a first POP surgery after hysterectomy was 60 years. CONCLUSIONS: POP after hysterectomy occurs as a long-term complication of hysterectomy; 12...

  13. Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery. (United States)

    Matsuo, Koji; Johnson, Marian S; Im, Dwight D; Ross, Malcolm S; Bush, Stephen H; Yunokawa, Mayu; Blake, Erin A; Takano, Tadao; Klobocista, Merieme M; Hasegawa, Kosei; Ueda, Yutaka; Shida, Masako; Baba, Tsukasa; Satoh, Shinya; Yokoyama, Takuhei; Machida, Hiroko; Ikeda, Yuji; Adachi, Sosuke; Miyake, Takahito M; Iwasaki, Keita; Yanai, Shiori; Takeuchi, Satoshi; Nishimura, Masato; Nagano, Tadayoshi; Takekuma, Munetaka; Shahzad, Mian M K; Pejovic, Tanja; Omatsu, Kohei; Kelley, Joseph L; Ueland, Frederick R; Roman, Lynda D


    To examine survival of women with stage IV uterine carcinosarcoma (UCS) who received neoadjuvant chemotherapy followed by hysterectomy. This is a nested case-control study within a retrospective cohort of 1192 UCS cases. Women who received neoadjuvant chemotherapy followed by hysterectomy based-surgery for stage IV UCS (n = 26) were compared to those who had primary hysterectomy-based surgery without neoadjuvant chemotherapy for stage IV UCS (n = 120). Progression-free survival (PFS) and cause-specific survival (CSS) were examined. The most common regimen for neoadjuvant chemotherapy was carboplatin/paclitaxel (53.8%). Median number of neoadjuvant chemotherapy cycles was 4. PFS was similar between the neoadjuvant chemotherapy group and the primary surgery group (unadjusted-hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.75-1.89, P = 0.45). Similarly, CSS was comparable between the two groups (unadjusted-HR 1.13, 95%CI 0.68-1.90, P = 0.64). When the types of neoadjuvant chemotherapy regimens were compared, women who received a carboplatin/paclitaxel regimen had better survival outcomes compared to those who received other regimens: PFS, unadjusted-HR 0.38, 95%CI 0.15-0.93, P = 0.027; and CSS, unadjusted-HR 0.21, 95%CI 0.07-0.61, P = 0.002. Our study found that there is no statistically significant difference in survival between women with stage IV UCS who are tolerated neoadjuvant chemotherapy and those who undergo primary surgery. © 2017 Wiley Periodicals, Inc.

  14. Mentoring women in academic surgery: overcoming institutional barriers to success. (United States)

    Hoover, Eddie L


    Women now comprise 50% of Caucasian matriculants to medical school; 66.6% of African Americans, 48% of Hispanics and 51.3% of Asians beginning medical school are also women. This trend is likely to continue since women now earn 57% of all undergraduate degrees, and they earn more degrees in the health professions and biological sciences than men. Black and Hispanic women now earn 66% and 60% of bachelor's degrees in their respective ethnic groups. Overall, women are concentrated at the lowest faculty ranks at medical schools, with 70% holding the rank of instructor or assistant professor. Women continue to experience difficulty with recruitment, retention, promotion and pay issues compared to men. They also experience additional gender-specific issues, including primary responsibility for rearing families and quality-of-life issues in some specialties, including most of the surgical disciplines. Clearly, there is an evolving population shift at work here; the pool of candidates for medical school faculty positions is likely to be evenly split between men and women for Caucasians, Hispanics and Asians, while the African-American pool is likely heavily weighted in favor of the women. Women are beginning to garner more Latin honors recognition at graduation as well and the definition of the "best and the brightest" is being redefined. Therefore, institutions must continue to identify the barriers that deter women from entering surgery, to develop research tools to understand how to improve the process of developing leadership skills among women and to insure a "buy-in" of their male counterparts when components of the plan are being implemented.

  15. Improvement in cardiovascular risk in women after bariatric surgery as measured by carotid intima-media thickness: comparison of sleeve gastrectomy versus gastric bypass. (United States)

    Gómez-Martin, Jesús M; Aracil, Enrique; Galindo, Julio; Escobar-Morreale, Héctor F; Balsa, José A; Botella-Carretero, José I


    Bariatric surgery may diminish cardiovascular risk (CVR) and its associated mortality. However, studies that compare these effects with different techniques are scarce. To evaluate the changes in CVR as estimated by carotid intima-media thickness (IMT) after obesity surgery in women with high CVR as defined by the presence of metabolic syndrome. Academic hospital. We studied 40 severely obese women, of whom 20 received laparoscopic Roux en Y gastric bypass (RYGB) and 20 received sleeve gastrectomy (SG). Twenty control women matched for age and cardiovascular risk were also included. Patients and controls were evaluated at baseline and 1 year after surgery or conventional treatment with diet and exercise, respectively. Only 18 of the 20 women in the control group were available for analysis after 1 year. None of the women who had bariatric surgery was lost to follow-up. Mean carotid IMT decreased 1 year after surgery irrespective of the surgical technique used, whereas no changes were observed in the control women who had conventional therapy (Wilks´ λ = .802, P = .002 for the interaction, P = .011 for RYGB versus controls, P = .002 for SG versus controls, P = .349 for RYGB versus SG). Both RYGB and SG decrease CVR as measured by carotid IMT in obese women. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Potential protective role of bariatric surgery against breast cancer in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Irina Balescu


    Full Text Available Obesity is a major public health problem worldwide especially due to the metabolic disorders which seem to be induced by an excessive amount of adipose tissue. Therefore attention was focused on evaluating the role of bariatric surgery in order to offer a better control of the comorbidities such as diabetes mellitus, arterial hypertension or dyslipidemia which are widely accepted as causes of increased morbidity and mortality among obese patients. Once these benefits have been widely demonstrated, attention was focused on studying the potential protective role of bariatric surgery against development of various malignancies such a breast, endometrial, pancreatic or even colorectal cancer. This is a literature review regarding the potential protective role of bariatric surgery against breast cancer among obese women worldwide.

  17. Gender Inequality for Women in Plastic Surgery: A Systematic Scoping Review. (United States)

    Bucknor, Alexandra; Kamali, Parisa; Phillips, Nicole; Mathijssen, Irene; Rakhorst, Hinne; Lin, Samuel J; Furnas, Heather


    Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.

  18. The material and social predicaments of home: women's experiences after aortocoronary bypass surgery. (United States)

    Angus, J


    Several authors argue that women's lives are conditioned by social locations such as class, race, ethnicity, age, and chronic illness or (dis)ability. Patterns of advantage and disadvantage, domination and oppression are formed which constitute the groundwork of women's health. An institutional ethnography was designed to follow the experiences of 18 women on their return home following aortocoronary bypass surgery. Using the narratives of 3 women as examples, the author highlights the everyday activities pursued by the women in the first month after their return home. The author describes the circumstances under which the activities occurred and discusses the social relations reflected in the descriptions. From this analysis it is argued that research and substantive work would benefit from a more critical understanding of women's different experiences of the home and of home care.

  19. Preoperative risk assessment among women undergoing bilateral prophylactic mastectomy for cancer risk reduction. (United States)

    Rueth, Natasha M; McMahon, Melissa; Arrington, Amanda K; Swenson, Karen; Leach, Joseph; Tuttle, Todd M


    Cancer risk assessment is an important decision-making tool for women considering irreversible risk-reducing surgery. Our objective was to determine the prevalence of BRCA testing among women undergoing bilateral prophylactic mastectomy (BPM) and to review the characteristics of women who choose BPM within a metropolitan setting. We retrospectively reviewed records of women who underwent BPM in the absence of cancer within 2 health care systems that included 5 metropolitan hospitals. Women with invasive carcinoma or ductal carcinoma in situ (DCIS) were excluded; neither lobular carcinoma in situ (LCIS) nor atypical hyperplasia (AH) were exclusion criteria. We collected demographic information and preoperative screening and risk assessment, BRCA testing, reconstruction, and associated cancer risk-reducing surgery data. We compared women who underwent BRCA testing to those not tested. From January 2002 to July 2009, a total of 71 BPMs were performed. Only 25 women (35.2%) had preoperative BRCA testing; 88% had a BRCA mutation. Compared with tested women, BRCA nontested women were significantly older (39.1 vs. 49.2 years, P < 0.001), had significantly more preoperative biopsies and mammograms and had fewer previous or simultaneous cancer risk-reducing surgery (oophorectomy). Among BRCA nontested women, common indications for BPM were family history of breast cancer (n = 21, 45.6%) or LCIS or AH (n = 16, 34.8%); 9 nontested women (19.6%) chose BPM based on exclusively on cancer-risk anxiety or personal preference. Most women who underwent BPM did not receive preoperative genetic testing. Further studies are needed to corroborate our findings in other geographic regions and practice settings.

  20. Development of a teaching tool for women with a gynecologic malignancy undergoing minimally invasive robotic-assisted surgery. (United States)

    Castiglia, Luisa Luciani; Drummond, Nancy; Purden, Margaret A


    Women undergoing minimally invasive robotic-assisted surgery for a gynecologic malignancy have many questions and concerns related to the cancer diagnosis and surgery. The provision of information enhances coping with such illness-related challenges. A lack of print materials for these patients prompted the creation of a written teaching tool to improve informational support. A booklet was developed using guidelines for the design of effective patient education materials, including an iterative process of collaboration with healthcare providers and women who had undergone robotic-assisted surgery, as well as attention to readability. The 52-page booklet covers the trajectory of the woman's experience and includes the physical, psychosocial, and sexual aspects of recovery.

  1. Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study. (United States)

    Rigg, Elizabeth Christine; Schmied, Virginia; Peters, Kath; Dahlen, Hannah Grace


    In Australia the choice to birth at home is not well supported and only 0.4% of women give birth at home with a registered midwife. Recent changes to regulatory requirements for midwives have become more restrictive and there is no insurance product that covers private midwives for intrapartum care at home. Freebirth (planned birth at home with no registered health professional) with an unregulated birth worker who is not a registered midwife or doctor (e.g. Doula, ex-midwife, lay midwife etc.) appears to have increased in Australia. The aim of this study is to explore the reasons why women choose to give birth at home with an unregulated birth worker (UBW) from the perspective of women and UBWs. Nine participants (five women who had UBWs at their birth and four UBWs who had themselves used UBWs in the past for their births) were interviewed in-depth and the data analysed using thematic analysis. Four themes were found: 'A traumatising system', 'An inflexible system'; 'Getting the best of both worlds' and 'Treated with love and respect versus the mechanical arm on the car assembly line'. Women interviewed for this study either experienced or were exposed to mainstream care, which they found traumatising. They were not able to access their preferred birth choices, which caused them to perceive the system as inflexible. They interpreted this as having no choice when choice was important to them. The motivation then became to seek alternative options of care that would more appropriately meet their needs, and help avoid repeated trauma through mainstream care. Women who engaged UBWs viewed them as providing the best of both worlds - this was birthing at home with a knowledgeable person who was unconstrained by rules or regulations and who respected and supported the woman's philosophical view of birth. Women perceived UBWs as not only the best opportunity to achieve a natural birth but also as providing 'a safety net' in case access to emergency care was required.

  2. Women’s Attitudes towards the Option to Choose between Karyotyping and Rapid Targeted Testing during Pregnancy

    Directory of Open Access Journals (Sweden)

    Angelique J. A. Kooper


    Full Text Available Objectives. Pregnant women, referred because of an increased risk of fetal Down syndrome, who underwent an invasive prenatal procedure were offered a choice between karyotyping and rapid targeted testing. This study aims to assess women’s attitudes and experiences towards what option to choose. Methods. A retrospective multicentre survey (2008–2010 was conducted among 1370 women. General questions were asked about decision making issues, followed by personal questions about their experiences in choice making, test preference, influence of others, and possible regrets. Results. In total, 90.1% of the respondents (N=825 indicated that pregnant women are able to choose, although 33.1% stated that the choice can best be made by a professional. 18.4% indicated that making a choice places a burden on women. In 96.4%, respondents preferred to have the option to choose again in case of a next pregnancy, whereas 2.7% preferred the choice to be made by a professional. Regret was indicated by 1.2%. Decision making was influenced by others in 64.9%. A slightly higher preference for karyotyping was indicated by 52.7% of the respondents. Conclusions. Positive attitudes and experiences were expressed towards the option to choose. Respondents took decisions freely, although sometimes influenced by a partner or a professional, to follow their individual perspectives.

  3. Posttraumatic growth in women after breast cancer surgery – preliminary results from a study of Polish patients

    Directory of Open Access Journals (Sweden)

    Aleksandra Andysz


    Full Text Available Background The aim of the study was to answer the following research questions: What percentage of women after breast cancer surgery experienced posttraumatic growth (PTG? Which aspect of PTG was experienced to the greatest extent by the participants? Do age at the day of survey, age at diagnosis, time since diagnosis, type of surgery, non-surgical methods of treatment, participation in rehabilitation or physical activity significantly differentiate participants in PTG? Participants and procedure Forty-seven women after breast cancer surgery participated in the study. Posttraumatic growth was measured with the Polish version of the Posttraumatic Growth Inventory (PTGI consisting of 4 scales: Self-Perception (SP, Relating to Others (RO, Appreciation of Life (AL and Spiritual Change (SC. The demographic, disease and treatment related variables were controlled. Results Forty-three percent of participants experienced high, 23% moderate, and 34% little or no PTG. Posttraumatic growth manifested itself mainly positive changes in relationships with others. Age at the day of the survey did not correlate significantly with scores of PTGI. Age at diagnosis correlated significantly with total PTG (ρ = –0.37, p = .012, SP (ρ = –0.33, p = .029, RO (ρ = –0.40, p = .008 and AL (ρ = –0.39, p = .010. Women aged ≤ 50 at the day of the survey had significantly higher scores of AL than women > 50 (U = 117.50, p = .042. Women who were physically active at the day of the survey had significantly higher scores in total PTG (U = 118.50, p = .008, SP (U = 7.28, p = .007 and RO (U = 108.00, p = .003. Time since diagnosis, type of treatment and participation in rehabilitation after the surgery did not differentiate respondents significantly in PTG. Conclusions Posttraumatic growth was experienced by a considerable percentage of participants. The average level of PTG was moderate. Women physically active at the time of the survey showed higher levels of PTG

  4. Current surgical treatment option, utilizing robot-assisted laparoscopic surgery in obese women with endometrial cancer: Farghalys technique

    International Nuclear Information System (INIS)

    Farghaly, S.A.


    Background: Endometrial cancer is the most prevalent cancer of the female genital tract in North America. Minimally invasive laparoscopic-assisted surgery and panniculectomy in obese women with endometrial cancer are associated with an improved lymph node count, and lower rate of incisional complications than laparotomy. Methods: Technique for robot-assisted laparoscopic surgery for obese women with endometrial cancer is detailed. Results: Robot-assisted laparoscopic surgical staging, pelvic and para-aortic lymphadenectomy and panniculectomy allow us to avoid the use of postoperative pelvic radiation which is recommended in women with histopathology high-risk findings: deep myometrial invasion or high grade histology. The procedure has the advantage of three-dimensional vision, ergonomic, intuitive control, and wristed instrument that approximate the motion of the human hand. Conclusion: Robot-assisted laparoscopic surgical staging, and panniculectomy in these patients are a safe, and effective alternative to laparoscopic, and laparotomy surgery. It is an ideal tool for performing the complex oncologic procedures encountered in endometrial cancer staging that requires delicate retroperitoneal, pelvic and para-aortic lymph node dissection, while maintaining the principles of oncologic surgery but in a minimally invasive fashion.

  5. The longitudinal trajectory of post-surgical % total weight loss among middle-aged women who had undergone bariatric surgery

    Directory of Open Access Journals (Sweden)

    Dong-Chul Seo


    Full Text Available Middle-aged women are at a higher risk of being obese. We examined the trajectory of post-surgical % total weight loss (%TWL among middle-aged female bariatric patients. We fitted sequential generalized estimating equations models to analyze a sample of women who received bariatric surgery in 1995–2012, aged 40–65 years at the time of surgery (N = 158,292 whose pre-operative body mass index (BMI was ≥30 kg/m2 in the Bariatric Outcomes Longitudinal Database. The %TWL computed by 100% × (pre-surgery BMI − post-surgery BMI / pre-surgery BMI showed different trajectories depending on type of surgery. For gastric banding, %TWL increased rapidly right after bariatric surgery and started to decrease around 1 year after surgery. For Roux-en-Y gastric bypass (RYGB and sleeve gastrectomy, %TWL overall did not show remarkable changes from around 1 year after surgery. The highest increase in %TWL was observed in patients whose pre-operative BMI was 40 or higher and those who had undergone RYGB (ps < 0.001. Whereas the trajectories of %TWL among patients with sleeve gastrectomy and gastric banding did not differ much between different pre-operative BMI groups, the trajectories for RYGB were notably different between different pre-operative BMI groups (ps < 0.001. Middle-aged female bariatric patients are likely to achieve the highest %TWL if they receive RYGB and if their pre-operative BMI is 40 or higher. Further research is warranted to corroborate the present study's finding on the long-term effect of different types of bariatric surgery on %TWL among middle-aged women.

  6. Selective impairment of attention networks during propofol anesthesia after gynecological surgery in middle-aged women. (United States)

    Chen, Chen; Xu, Guang-hong; Li, Yuan-hai; Tang, Wei-xiang; Wang, Kai


    Postoperative cognitive dysfunction is a common complication of anesthesia and surgery. Attention networks are essential components of cognitive function and are subject to impairment after anesthesia and surgery. It is not known whether such impairment represents a global attention deficit or relates to a specific attention network. We used an Attention Network Task (ANT) to examine the efficiency of the alerting, orienting, and executive control attention networks in middle-aged women (40-60 years) undergoing gynecologic surgery. A matched group of medical inpatients were recruited as a control. Fifty female patients undergoing gynecologic surgery (observation group) and 50 female medical inpatients (control group) participated in this study. Preoperatively patients were administered a mini-mental state examination as a screening method. The preoperative efficiencies of three attention networks in an attention network test were compared to the 1st and 5th post-operative days. The control group did not have any significant attention network impairments. On the 1st postoperative day, significant impairment was shown in the alerting (p=0.003 vs. control group, p=0.015 vs. baseline), orienting (pAttention networks of middle-aged women show a varying degree of significant impairment and differing levels of recovery after surgery and propofol anesthetic. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure. (United States)

    Abdel-Hady, El-Said; Constantine, Glyn


    To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.

  8. Bariatric Surgery Reduces Serum Anti-mullerian Hormone Levels in Obese Women With and Without Polycystic Ovarian Syndrome. (United States)

    Chiofalo, Francesco; Ciuoli, Cristina; Formichi, Caterina; Selmi, Federico; Forleo, Raffaella; Neri, Ornella; Vuolo, Giuseppe; Paffetti, Patrizia; Pacini, Furio


    Obesity in fertile women has negative effect on fertility. Anti-mullerian hormone (AMH) represents a good index of fertility, and it is considered a marker of ovarian reserve and of polycystic ovarian syndrome (PCOS) gravity. Previous studies evaluated the relationship between obesity and AMH with contradictory results. The aim of the study was to investigate the relationship between obesity and AMH and the changes of AMH in obese women in reproductive age submitted to bariatric surgery. Fifty-five obese patients between 18 and 39 years with (29 patients) and without PCOS (26 patients) were compared with a control group of normal weight women with (24 patients) and without PCOS (19 patients). Fourteen obese women with PCOS and 18 without PCOS underwent to bariatric surgery. Serum AMH, testosterone, androstenedione, and DHEAS were performed in all patients before and 1 year after surgical intervention. AMH was significantly higher in the PCOS groups (p < 0.001), both in obese (5.84 ± 3.94 ng/ml) and non-obese women (7.35 ± 4.39 ng/ml). AMH was positively related to testosterone (p < 0.0001), androstenedione (p = 0.0005), and DHEAS (p = 0.003). After bariatric surgery, AMH levels were reduced in the both PCOS (p = 0.02) and non-PCOS group (p = 0.04). AMH levels are elevated in PCOS patients regardless of the body weight. Bariatric surgery is effective in the normalization of AMH levels (a possible indirect marker of better fertility) only in obese patients with PCOS.

  9. Pain evaluation during gynaecological surveillance in women with Lynch syndrome. (United States)

    Helder-Woolderink, Jorien; de Bock, Geertruida; Hollema, Harry; van Oven, Magda; Mourits, Marian


    To evaluate perceived pain during repetitive annual endometrial sampling at gynaecologic surveillance in asymptomatic women with Lynch syndrome (LS) over time and in addition to symptomatic women without LS, undergoing single endometrial sampling. In this prospective study, 52 women with LS or first degree relatives who underwent repetitive annual gynaecological surveillance including endometrial sampling of which 33 were evaluated twice or more and 50 symptomatic women without LS who had single endometrial sampling, were included. Pain intensity was registered with VAS scores. Differences in pain intensities between subsequent visits (in LS) and between the two groups were evaluated. The use of painkillers before endometrial sampling was registered. If women with LS decided for preventive surgery, the reason was recorded. The LS group reported a median VAS score of 5.0 (range 0-10) at the first surveillance (n = 52) and at the second visit (n = 24). Women who repeatedly underwent endometrial sampling more often used painkillers for this procedure. During the study period 7/52 (13 %) women with LS choose for preventive surgery, another 4/52 (8 %) refused further endometrial sampling. Painful endometrial sampling was mentioned as main reason to quit screening. The median VAS score of the 50 symptomatic women was 5.0 (range 1-9). Endometrial sampling, irrespective of indication, is a painful procedure, with a median VAS score of 5.0. During subsequent procedures in women with LS, the median pain score does not aggravate although one in five women chose an alternative for endometrial sampling.

  10. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid C; Neumann, Gudrun


    -up by hospital data files, general practitioner, death certificate, and autopsy report. Revision of histopathology by a single pathologist. Main outcome measures: Survival and relapse by clinical data, stage, and type of surgery. RESULTS: The incidence of AGCT was 1.37 per year per 100,000 women (95% CI: 1.08, 1.......68). The median follow-up time was 15 years and for the 79 surviving women 22 years. Stage I was found in 94% of cases. Relapse occurred in 24% of women in stage I and 100% of the other stages. Survival in stage I was 95%, 89% and 84% after 5, 10 and 20 years respectively. Increased survival of stage I......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  11. Understanding the life experiences of Brazilian women after bariatric surgery: a qualitative study. (United States)

    Magdaleno, Ronis; Chaim, Elinton Adami; Turato, Egberto Ribeiro


    The increase in bariatric surgeries has called into question the aspects that contribute to or impair the results. Psychosocial factors directly influence the results of the surgery, but a lot of controversy exists in relation to the degree of influence of these factors. We propose a qualitative investigation to understand the significance of the surgery for women and how these factors influence the outcomes. This study is a clinical-qualitative method, through the semi-directed interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5-3 years, following the definition of emergent categories and qualitative content analysis. The experience of acceptance and social reinsertion is a motivating factor to keep up the challenge of weight loss; social discrimination is a risk factor leading to losing the stimulus to continue the process; the recuperation of self-esteem and personal identity is a factor that improves the quality of life and psychopathological symptoms; disillusionment is an important risk factor, linked principally to the experiences of failure. We observe the necessity of qualitative studies that serve the health team in the handling of these patients, aiming for a greater understanding of their psychological dynamics and of the meanings that weight loss has for them.

  12. Genetic Testing and Post-Testing Decision Making among BRCA-Positive Mutation Women: A Psychosocial Approach. (United States)

    Hesse-Biber, Sharlene; An, Chen


    Through an analysis of an online survey of women who tested positive for the BRCA genetic mutation for breast cancer, this research uses a social constructionist and feminist standpoint lens to understand the decision-making process that leads BRCA-positive women to choose genetic testing. Additionally, this research examines how they socially construct and understand their risk for developing breast cancer, as well as which treatment options they undergo post-testing. BRCA-positive women re-frame their statistical medical risk for developing cancer and their post-testing treatment choices through a broad psychosocial context of engagement that also includes their social networks. Important psychosocial factors drive women's medical decisions, such as individual feelings of guilt and vulnerability, and the degree of perceived social support. Women who felt guilty and fearful that they might pass the BRCA gene to their children were more likely to undergo risk reducing surgery. Women with at least one daughter and women without children were more inclined toward the risk reducing surgery compared to those with only sons. These psychosocial factors and social network engagements serve as a "nexus of decision making" that does not, for the most part, mirror the medical assessments of statistical odds for hereditary cancer development, nor the specific treatment protocols outlined by the medical establishment.

  13. Women's experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study. (United States)

    Hermansen, Anna; Peolsson, Anneli; Kammerlind, Ann-Sofi; Hjelm, Katarina


    To explore and describe women's experiences of daily life after anterior cervical decompression and fusion surgery. Qualitative explorative design. Fourteen women aged 39-62 years (median 52 years) were included 1.5-3 years after anterior cervical decompression and fusion for cervical disc disease. Individual semi-structured interviews were analysed by qualitative content analysis with an inductive approach. The women described their experiences of daily life in 5 different ways: being recovered to various extents; impact of remaining symptoms on thoughts and feelings; making daily life work; receiving support from social and occupational networks; and physical and behavioural changes due to interventions and encounters with healthcare professionals. This interview study provides insight into women's daily life after anterior cervical decompression and fusion. Whilst the subjects improved after surgery, they also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge about aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after anterior cervical decompression and fusion.

  14. Qualitative and quantitative analysis of women's perceptions of transvaginal surgery. (United States)

    Bingener, Juliane; Sloan, Jeff A; Ghosh, Karthik; McConico, Andrea; Mariani, Andrea


    Prior surveys evaluating women's perceptions of transvaginal surgery both support and refute the acceptability of transvaginal access. Most surveys employed mainly quantitative analysis, limiting the insight into the women's perspective. In this mixed-methods study, we include qualitative and quantitative methodology to assess women's perceptions of transvaginal procedures. Women seen at the outpatient clinics of a tertiary-care center were asked to complete a survey. Demographics and preferences for appendectomy, cholecystectomy, and tubal ligation were elicited, along with open-ended questions about concerns or benefits of transvaginal access. Multivariate logistic regression models were constructed to examine the impact of age, education, parity, and prior transvaginal procedures on preferences. For the qualitative evaluation, content analysis by independent investigators identified themes, issues, and concerns raised in the comments. The completed survey tool was returned by 409 women (grouped mean age 53 years, mean number of 2 children, 82% ≥ some college education, and 56% with previous transvaginal procedure). The transvaginal approach was acceptable for tubal ligation to 59%, for appendectomy to 43%, and for cholecystectomy to 41% of the women. The most frequently mentioned factors that would make women prefer a vaginal approach were decreased invasiveness (14.4%), recovery time (13.9%), scarring (13.7%), pain (6%), and surgical entry location relative to organ removed (4.4%). The most frequently mentioned concerns about the vaginal approach were the possibility of complications/safety (14.7%), pain (9%), infection (5.6%), and recovery time (4.9%). A number of women voiced technical concerns about the vaginal approach. As in prior studies, scarring and pain were important issues to be considered, but recovery time and increased invasiveness were also in the "top five" list. The surveyed women appeared to actively participate in evaluating the technical

  15. Salivary Cortisol and Binge Eating Disorder in Obese Women After Surgery for Morbid Obesity


    Larsen, Junilla K.; van Ramshorst, Bert; van Doornen, Lorenz J. P.; Geenen, Rinie


    Background Binge eating episodes characterized by loss of control are hypothesized to be accompanied by changes in hypothalamic pituitary adrenal (HPA) axis functioning. Cortisol is an end product of this neuroendocrine stress system. Purpose The aim of this study was to examine the cortisol levels and the awakening cortisol response (ACR) in obese persons showing binge eating after surgery for morbid obesity. Method Sixteen obese women with binge eating disorder (BED) and 18 obese women with...

  16. Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women. (United States)

    Wullschleger, M F; Imboden, S; Wanner, J; Mueller, M D


    What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women? Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery. The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before. However, previous studies focus on medical benchmarks without including the patient's perspective in a quantitative manner. A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013. Women diagnosed with endometriosis and with at least one specific laparoscopic surgery in the past were enrolled in the study. The study investigated the effect of the minimally invasive surgery on health and on quality of work life of affected women. Questions used were obtained from the World Endometriosis Research Foundation (WERF) Global Study on Women's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study. Of the 587 women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%) were included in the study. Our data show that 62% (n = 130) of the study population declared endometriosis as influencing the job during the period prior to surgery, compared with 28% after surgery (P work due to endometriosis was reduced from 2.0 (4.9) to 0.5 (1.4) hours per week (P working performance after the surgery averaged out at 5.7% (12.6%) compared with 17.5% (30.5%) before this treatment (P performed. A bias due to selection, information and negativity effects within a

  17. Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

    NARCIS (Netherlands)

    Zijlstra, H.; Middendorp, H. van; Devaere, L.; Larsen, J.K.; van Ramshorst, B.; Geenen, R.


    Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and

  18. Impact of surgery on quality of life of women with obstetrical fistula: a qualitative study in Burkina Faso. (United States)

    Désalliers, Julie; Paré, Marie-Eve; Kouraogo, Salam; Corcos, Jacques


    Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery. This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1-2 years after surgery directly in the women's village of origin. Thirty-nine participants were recruited between 2012 and 2015. The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present. Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.

  19. Women's choice of childbirth setting. (United States)

    Mackey, M C


    As part of a larger study on women's views of the childbirth experience, this study was focused on women's choice of childbirth setting. Sixty-one Lamaze-prepared, married multigravidae between the ages of 21 and 37 and experiencing a normal pregnancy were interviewed twice: at 36-38 weeks gestation in their homes and during their postpartum stay in the hospital. Data were collected using (a) two semistructured interview guides consisting of open-ended questions about choosing a caregiver and the place of birth and about describing the actual childbirth experience, (b) a self-administered sociodemographic questionnaire, and (c) an obstetrical and infant data form. The tape-recorded interviews were transcribed verbatim. Qualitative data analysis was focused on reasons for choosing a hospital and a physician, reasons for choosing or not choosing a birthing room, and the outcomes of the decisions. An understanding of women's childbirth needs as reflected in their choices can suggest areas where flexibility might be built into maternity care programs.

  20. Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer. (United States)

    Burton, Maria; Kilner, Karen; Wyld, Lynda; Lifford, Kate Joanna; Gordon, Frances; Allison, Annabel; Reed, Malcolm; Collins, Karen Anna


    To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results. (United States)

    Austin, P; Spyropoulos, E; Lotenfoe, R; Helal, M; Hoffman, M; Lockhart, J L


    To evaluate a group of women with voiding dysfunction and a low maximum flow rate (MFR) (less than or equal to 12 mL/s) after surgery for stress urinary incontinence (SUI); to establish diagnostic parameters indicating obstruction in an attempt to determine treatment selection; and to evaluate preliminary surgical results. Eighteen women who underwent anti-incontinence surgery for SUI were diagnosed as having infravesical obstruction (IO). Thirteen women (group A [72%]) presented with clinically predominant symptoms of urgency, frequency, intermittency, and a variable vesical residual volume (RV), and five (group B [28%]) had as their most significant symptoms a high vesical RV and urinary tract infection that had been managed with intermittent catheterization (IC). The diagnosis of IO, suspected after clinical history, was established after physical examination and cystoscopic, cystographic and urodynamic investigations. Bladder instability was demonstrated in 6 group A patients (46%) and 1 group B patient (20%) (P = NS). Mean MFRs were 8.07 and 7.2 mL/s, respectively, in both groups (P = NS). Mean maximal voiding pressures (MVPs) were 20.23 and 5 cm H20, and mean RVs were 57.46 and 174 mL, respectively; both differences were statistically very significant (P <0.01 and P <0.001, respectively). High to normal MVPs occurred in 2 patients overall (11%). Bladder neck overcorrection, midurethral distortion, and postsurgical cystocele were demonstrated in both groups in 11 (85%), 0, and 2 (15%) patients in group A and 3 (60%), 2 (40%), and 3 (60%) patients in group B, respectively (P = NS). Patients in group A were treated surgically with cystourethrolysis and a repeated, less obstructive anti-incontinence operation. In group B 2 women (40%) had a similar surgical procedure; 1 (20%) underwent isolated urethrolysis; and 2 (40%) are currently maintained with IC. Among these 18 patients with voiding dysfunction after anti-incontinence surgery, a primary diagnosis of IO was

  2. Surgery versus physiotherapy for stress urinary incontinence. (United States)

    Labrie, Julien; Berghmans, Bary L C M; Fischer, Kathelijn; Milani, Alfredo L; van der Wijk, Ileana; Smalbraak, Dina J C; Vollebregt, Astrid; Schellart, René P; Graziosi, Giuseppe C M; van der Ploeg, J Marinus; Brouns, Joseph F G M; Tiersma, E Stella M; Groenendijk, Annette G; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E; Adriaanse, Albert H; Schram, Aaltje; Roovers, Jan-Paul W R; Lagro-Janssen, Antoine L M; van der Vaart, Carl H


    Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

  3. Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis. (United States)

    Hollander, Martine; de Miranda, Esteriek; van Dillen, Jeroen; de Graaf, Irene; Vandenbussche, Frank; Holten, Lianne


    Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. Until now there were no qualitative data on women's motivations for these choices in the Dutch maternity care system where integrated midwifery care and home birth are regular options in low risk pregnancies. We aimed to examine women's motivations for birthing outside the system in order to provide medical professionals with insight and recommendations regarding their interactions with women who have birth wishes that go against medical advice. An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with 28 women on their motivations for going against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. A focus group was held for a member check of the findings. Four main themes were found: 1) Discrepancy in the definition of superior knowledge, 2) Need for autonomy and trust in the birth process, 3) Conflict during negotiation of the birth plan, and 4) Search for different care. One overarching theme emerged that covered all other themes: Fear. This theme refers both to the participants' fear (of interventions and negative consequences of their choices) and to the providers' fear (of a bad outcome). Where for some women it was a positive choice, for the majority of women in this study the choice for a home birth in a high risk pregnancy or an unassisted childbirth was a negative one. Negative choices were due to previous or current negative experiences with maternity care and/or conflict surrounding the birth plan. The main goal of working with women whose birthing choices do not align with medical advice should not be to coerce them into the framework of protocols and guidelines but to prevent negative choices. Recommendations for maternity caregivers can be summarized as

  4. How do women value work shortly after breast cancer surgery and are their valuations associated with being on sick leave? (United States)

    Petersson, Lena-Marie; Nilsson, Marie I; Alexanderson, Kristina; Olsson, Mariann; Wennman-Larsen, Agneta


    To investigate how working women, in different age and educational groups who have recently had breast cancer surgery, value work (in terms of importance, satisfaction, and dedication), and whether their valuations are associated with sick leave. This cross-sectional study investigated the value of work and its relation to sickness absence among women in Sweden who had had breast cancer surgery, were aged 20-63 years, and worked before diagnosis (n = 605). A questionnaire was distributed at inclusion, about 4-8 weeks after surgery. Inferential statistics and logistic regression were used to estimate odds ratio (ORs) with 95 % confidence intervals (CIs). Two-thirds of the women viewed work as one of the most important things in their lives; 86 % stated that their job provided personal satisfaction; and 54 % rated their vocational situation as satisfying. Older women (≥52 years) were more vocationally satisfied (p = 0.021), as too were those with higher education (p = 0.035). Women with higher education were also more dedicated to their work (p = 0.020). Univariate analyses revealed associations of low vocational satisfaction, younger age and wanting to change profession with sickness absence. Low vocational satisfaction (OR 2.38, 95 % CI 1.66-3.41) and younger age (women valued work highly, even as one of the most important things in their lives. Accordingly, it is essential to include aspects of work early on in these patients' treatment and rehabilitation plans.

  5. Factors Influencing Japanese Women to Choose Two-Year Colleges (United States)

    Anzai, Shinobu


    Two-year colleges in Japan have traditionally absorbed the major portion of female college entrants due at least partially to long-held gender stereotypes: women are to prepare themselves for marriage and homemaking at a two-year college. Recently, Japanese women began to explore selfhood outside the traditional realm of motherhood and womanhood.…

  6. Do women spend longer on wait lists for coronary bypass surgery? Analysis of a population-based registry in British Columbia, Canada

    Directory of Open Access Journals (Sweden)

    Kuramoto Lisa


    Full Text Available Abstract Background Studies have shown patients who are delayed for surgical cardiac revascularization are faced with increased risks of symptom deterioration and death. This could explain the observation that operative mortality among persons undergoing coronary artery bypass surgery (CABG is higher among women than men. However, in jurisdictions that employ priority wait lists to manage access to elective cardiac surgery, there is little information on whether women wait longer than men for CABG. It is therefore difficult to ascertain whether higher operative mortality among women is due to biological differences or to delayed access to elective CABG. Methods Using records from a population-based registry, we compared the wait-list time between women and men in British Columbia (BC between 1990 and 2000. We compared the number of weeks from registration to surgery for equal proportions of women and men, after adjusting for priority, comorbidity and age. Results In BC in the 1990s, 9,167 patients aged 40 years and over were registered on wait lists for CABG and spent a total of 136,071 person-weeks waiting. At the time of registration for CABG, women were more likely to have a comorbid condition than men. We found little evidence to suggest that women waited longer than men for CABG after registration, after adjusting for comorbidity and age, either overall or within three priority groups. Conclusion Our findings support the hypothesis that higher operative mortality during elective CABG operations observed among women is not due to longer delays for the procedure.

  7. Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience. (United States)

    Bogani, Giorgio; Tagliabue, Elena; Signorelli, Mauro; Chiappa, Valentina; Carcangiu, Maria Luisa; Paolini, Biagio; Casarin, Jvan; Scaffa, Cono; Gennaro, Massimiliano; Martinelli, Fabio; Borghi, Chiara; Ditto, Antonino; Lorusso, Domenica; Raspagliesi, Francesco

    To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. A prospective study (Canadian Task Force classification II-1). A gynecologic oncology referral center. Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Minimally invasive risk-reduction surgery. Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p = .02). Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  8. Home birth after hospital birth: women's choices and reflections. (United States)

    Bernhard, Casey; Zielinski, Ruth; Ackerson, Kelly; English, Jessica


    The number of US women choosing home birth is increasing. Little is known about women who choose home birth after having experienced hospital birth; therefore, the purpose of this research was to explore reasons why these women choose home birth and their perceptions regarding their birth experiences. Qualitative description was the research design, whereby focus groups were conducted with women who had hospital births and subsequently chose home birth. Five focus groups were conducted (N = 20), recorded, and transcribed verbatim. Qualitative content analysis was undertaken allowing themes to emerge. Five themes emerged from the women's narratives: 1) choices and empowerment: with home birth, women felt they were given real choices rather than perceived choices, giving them feelings of empowerment; 2) interventions and interruptions: women believed things were done that were not helpful to the birth process, and there were interruptions associated with their hospital births; 3) disrespect and dismissal: participants believed that during hospital birth, providers were more focused on the laboring woman's uterus, with some experiencing dismissal from their hospital provider when choosing to birth at home; 4) birth space: giving birth in their own home, surrounded by people they chose, created a peaceful and calm environment; and 5) connection: women felt connected to their providers, families, newborns, and bodies during their home birth. For most participants, dissatisfaction with hospital birth influenced their subsequent decision to choose home birth. Despite experiencing challenges associated with this decision, women expressed satisfaction with their home birth. © 2014 by the American College of Nurse-Midwives.

  9. Ovarian cancer surgery

    DEFF Research Database (Denmark)

    Seibaek, Lene; Blaakaer, Jan; Petersen, Lone Kjeld


    PURPOSE: The study objective was to survey general health and coping in women undergoing ovarian cancer surgery, and subsequently to develop and test a supportive care intervention. METHODS/MATERIALS: Women who underwent surgery on the suspicion of ovarian cancer participated in a follow...... standard levels. Concerning mental health, levels were below standard during the entire period, but did improve with time, also in women in whom the potential cancer diagnosis was refuted. The preoperative differences between these groups leveled out postoperatively in terms of physical health. At the end...

  10. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery 1 (United States)

    Silva, Carolina de Mendonça Coutinho e; Vargens, Octavio Muniz da Costa


    ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. PMID:27579935

  11. Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. (United States)

    Flink, Benjamin J; Long, Chandler A; Duwayri, Yazan; Brewster, Luke P; Veeraswamy, Ravi; Gallagher, Katherine; Arya, Shipra


    Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women

  12. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    Directory of Open Access Journals (Sweden)

    Dennis AC


    Full Text Available Alexis C Dennis1 Sarah M Wilson1–3 Mary V Mosha4 Gileard G Masenga4 Kathleen J Sikkema1,5,6 Korrine E Terroso1 Melissa H Watt1 1Duke Global Health Institute, Duke University, 2Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Kilimanjaro Christian Medical Center, Moshi, Tanzania; 5Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; 6Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa Objective: An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.Patients and methods: The study used a mixed-methods design to analyze cross-sectional surveys (n=59 and in-depth interviews (n=20.Results: Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.Conclusion: Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic

  13. Ovarian surgery for symptom relief in women with polycystic ovary syndrome. (United States)

    Lepine, Sam; Jo, Junyoung; Metwally, Mostafa; Cheong, Ying C


    Polycystic ovary syndrome (PCOS) is a common endocrine condition, affecting approximately one in 10 women. PCOS is defined by two of three features: oligo- or anovulation, clinical or biochemical hyperandrogenism or both, or polycystic ovaries.Women with PCOS can have a wide range of health problems, including infrequent and irregular periods, unwanted hair growth and acne, and subnormal fertility. Long-term health concerns include an increased risk of heart disease, diabetes and the development of precancerous disease of the womb. To assess the effectiveness and harms of ovarian surgery as a treatment for symptomatic relief of hirsutism, acne and menstrual irregularity in PCOS. We searched the Cochrane Gynaecology and Fertility Group specialized register, CENTRAL, MEDLINE, Embase and PsycINFO (from inception to 17 October 2016). We handsearched citation lists, registers of ongoing trials and conference proceedings. We included randomized controlled trials (RCTs) of women undergoing ovarian drilling in comparison to no treatment, medical treatment, or other forms of surgical treatment for the symptoms of PCOS. We used standard methodological procedures recommended by Cochrane. The primary outcome measures were improvement in menstrual regularity and androgenic symptoms of PCOS (hirsutism, acne); the secondary outcome measures included harms, change of body mass index (BMI), waist circumference, androgen levels, metabolic measures and quality of life. We assessed the quality of the evidence using GRADE methods. We included 22 RCTs (2278 women analyzed) of participants with PCOS and symptoms of acne, hirsutism or irregular menstrual cycles, all of which included laparoscopic ovarian drilling (LOD) as an intervention.Two studies reported their funding source (Farquhar 2002 - supported in part by the Auckland Medical Research Foundation; Sarouri 2015 - the authors thank the Vice Chancellor for Research of Guilan University of Medical Sciences for funding this project

  14. Additional Surgery after Breast-Conserving Surgery Varies Widely (United States)

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  15. Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence - a cohort study

    DEFF Research Database (Denmark)

    Sørensen, Rikke Guldberg; Kesmodel, Ulrik Schiøler; Brostrøm, Søren


    OBJECTIVE: To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics...... from the date of surgery were extracted from a prescription database. MAIN OUTCOME MEASURES: Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. RESULTS: A total of 2151 women had a primary surgical procedure...... for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed...

  16. Experiences of young women living with developmental dysplasia of the hip: insight into their experiences of surgery and recovery. (United States)

    Gambling, Tina S; Long, Andrew F


    To explore the experiences of young women with developmental dysplasia of the hip explicating the impact of peri-acetabular osteotomy surgery and recovery in the short and longer term. Postings of five, selected women on an online active message board aimed at women with developmental dysplasia of the hip were analysed. Interest lay on their postings after they had had peri-acetabular osteotomy surgery. Data analysis was performed through the approach of interpretive phenomenological analysis. The time length of the postings for the cases ranged from 1 year to 6 years, and the number of postings varied substantially, from 48 to 591. Two major concepts were prominent across participants' accounts. The first concept, 'body image', centred on affects on the women's self-esteem and body image. The second, 'the long road to recovery', highlighted 'the emotional and physical battle of learning to walk' and concerns with 'saving my joints'. Developmental dysplasia of the hip potentially provides a critical case for exploration of the process of how a disability can affect confidence, self-esteem and body image. Recovery from this condition requires enormous effort, resilience and commitment from the women.

  17. Tumour bed boost radiotherapy for women after breast-conserving surgery. (United States)

    Kindts, Isabelle; Laenen, Annouschka; Depuydt, Tom; Weltens, Caroline


    Breast-conserving therapy, involving breast-conserving surgery followed by whole-breast irradiation and optionally a boost to the tumour bed, is a standard therapeutic option for women with early-stage breast cancer. A boost to the tumour bed means that an extra dose of radiation is applied that covers the initial tumour site. The rationale for a boost of radiotherapy to the tumour bed is that (i) local recurrence occurs mostly at the site of the primary tumour because remaining microscopic tumour cells are most likely situated there; and (ii) radiation can eliminate these causative microscopic tumour cells. The boost continues to be used in women at high risk of local recurrence, but is less widely accepted for women at lower risk. Reasons for questioning the boost are twofold. Firstly, the boost brings higher treatment costs. Secondly, the potential adverse events are not negligible. In this Cochrane Review, we investigated the effect of the tumour bed boost on local control and side effects. To assess the effects of tumour bed boost radiotherapy after breast-conserving surgery and whole-breast irradiation for the treatment of breast cancer. We searched the Cochrane Breast Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to 1 March 2017), Embase (1980 to 1 March 2017), the World Health Organization International Clinical Trials Registry Platform, and on 1 March 2017. We also searched the European Society of Radiotherapy and Oncology Annual Meeting, the St Gallen Oncology Conferences, and the American Society for Radiation Oncology Annual Meeting for abstracts. Randomised controlled trials comparing the addition and the omission of breast cancer tumour bed boost radiotherapy. Two review authors (IK and CW) performed data extraction and assessed risk of bias using Cochrane's 'Risk of bias' tool, resolving any disagreements through discussion. We entered data into Review Manager 5 for

  18. Axillary lymph nodes and arm lymphatic drainage pathways are spared during routine complete axillary clearance in majority of women undergoing breast cancer surgery. (United States)

    Szuba, A; Chachaj, Z; Koba-Wszedybylb, M; Hawro, R; Jasinski, R; Tarkowski, R; Szewczyk, K; Bebenek, M; Forgacz, J; Jodkowska, A; Jedrzejuk, D; Janczak, D; Mrozinska, M; Pilch, U; Wozniewski, M


    Alterations in axillary lymph nodes (ALNs) after complete axillary lymph node dissection (ALND) in comparison to the preoperative status were evaluated using lymphoscintigraphy performed preoperatively and 1-6 weeks after surgery in 30 women with a new diagnosis of unilateral, invasive breast carcinoma. Analysis of lymphoscintigrams revealed that ALNs after surgery were present in 26 of 30 examined women. In comparison to preoperative status, they were visualized in the same location (12 women), in the same and additionally in different locations (9 women), or only in different locations (4 women). No lymph nodes were visualized in one woman and lymphocoele were in 4 women. Thus, after ALND, a variable number of axillary lymph nodes remain and were visualized on lymphoscintigraphy in the majority of women. The classical ALND, therefore, does not allow complete dissection and removal of axillary nodes with total disruption of axillary lymphatic pathways, accounting in part for the variable incidence and severity of lymphedema after the procedure.

  19. Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. (United States)

    Słowik, Agnieszka J; Jabłoński, Marcin Jacek; Michałowska-Kaczmarczyk, Anna M; Jach, Robert


    Both because of the large number of women undergoing surgery and a high cure rates, psychological rehabilitation of the consequences of breast cancer and side effects of their treatment is a major challenge of modern psychooncology. Aim. The study analyzed the quality of life in women with breast cancer, with particular emphasis on indicators of sexual satisfaction, future perspectives and body image, depending on the method of surgery. The study included 42 women aged 35-70 years, 3 months after surgery due to early breast cancer, treated with adjuvant chemotherapy. The following research tools were used in the study: two EORTC questionnaires: QLQ-C30, BR23, and sexual function questionnaire: PL-FSFI. There was no significant difference in the overall quality of life, depending on the type of surgery. The greatest local complaints were reported by patients after breast conserving surgery (BCT) with axillary lymphadenectomy. A higher level of cognitive functioning but a greater severity of systemic side effects was found in women undergoing mastectomy compared to BCT-patients. Women who underwent surgery of the right breast reported increased problems in sexual functioning (p = 0.034). Multiple regression analysis showed a positive correlation of the emotional functioning variable with the assessment of future perspectives (p = 0.01) and body image (p = 0.007). The type of surgical technique does not affect the overall quality of life and sexual satisfaction. Problems with memory and attention do not correlate directly with the side effects, and as such require an independent diagnostics. Women undergoing treatment of the dominant-side breast should be the candidates for sexology consultation. There is a risk of disturbances in the body image and in the assessment of future perspectives in patients with emotional disorders observed within 3 months after surgery.

  20. Timing of surgery with regard to the menstrual cycle in women with primary breast cancer. (United States)

    Badwe, R A; Mittra, I; Havaldar, R


    There is sufficient evidence to support both the hormonal influence on the outcome of breast cancer surgery and the SDA hypothesis. The SDA model produces a paradigm shift in the understanding of the natural history of breast cancer. It offers opportunities to try modifying a tumor's biological potential for metastasis (e.g., by tamoxifen, progesterone, antiprotease, or angiostatin) in the neoadjuvant setting. It continues to support the beneficial effects of detection and surgery early in the natural history of disease. It would be worthwhile to plan a trial comparing standard practice (unplanned surgery as the patient enrolls) with surgery during the luteal phase of the menstrual cycle in premenopausal women. Another possibility, based on studies of circulating progesterone, would be to compare primary progesterone treatment (for 4 to 10 days before surgery) with standard practice. Such a trial of primary progesterone is already under way, conducted by the Indian Breast Group. More than 200 patients have enrolled so far. The details of the trial are available from Clinical Research Secretariat, Tata Memorial Centre, Parel, Mumbai, India (e mail:

  1. A Qualitative Study of Breast Reconstruction Decision-Making among Asian Immigrant Women Living in the United States. (United States)

    Fu, Rose; Chang, Michelle Milee; Chen, Margaret; Rohde, Christine Hsu


    Despite research supporting improved psychosocial well-being, quality of life, and survival for patients undergoing postmastectomy breast reconstruction, Asian patients remain one-fifth as likely as Caucasians to choose reconstruction. This study investigates cultural factors, values, and perceptions held by Asian women that might impact breast reconstruction rates. The authors conducted semistructured interviews of immigrant East Asian women treated for breast cancer in the New York metropolitan area, investigating social structure, culture, attitudes toward surgery, and body image. Three investigators independently coded transcribed interviews, and then collectively evaluated them through axial coding of recurring themes. Thirty-five immigrant East Asian women who underwent surgical treatment for breast cancer were interviewed. Emerging themes include functionality, age, perceptions of plastic surgery, inconvenience, community/family, fear of implants, language, and information. Patients spoke about breasts as a function of their roles as a wife or mother, eliminating the need for breasts when these roles were fulfilled. Many addressed the fear of multiple operations. Quality and quantity of information, and communication with practitioners, impacted perceptions about treatment. Reconstructive surgery was often viewed as cosmetic. Community and family played a significant role in decision-making. Asian women are statistically less likely than Caucasians to pursue breast reconstruction. This is the first study to investigate culture-specific perceptions of breast reconstruction. Results from this study can be used to improve cultural competency in addressing patient concerns. Improving access to information regarding treatment options and surgical outcomes may improve informed decision-making among immigrant Asian women.

  2. Consultations for women's health problems: factors influencing women's choice of sex of general practitioner.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Bakker, D.H. de; Bensing, J.M.


    AIM. This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD. Data from the Dutch

  3. Factors influencing career choice after initial training in surgery.

    LENUS (Irish Health Repository)

    McHugh, Seamus


    INTRODUCTION: Irish general surgery faces a recruitment crisis with only 87 of 145 (60%) basic surgical training (BST) places filled in 2009. We assessed basic surgical trainees to identify objective, and potentially modifiable, factors that influence ultimate recruitment into a general surgical career. METHODS: Candidates commencing BST training during a 5-year period between 2004 and 2008 were included in a quantitative study. In addition a total of 2,536 candidates, representing all those who commenced surgical training in Ireland since 1960 were identified through the Royal College of Surgeons in Ireland (RCSI) database and invited to complete an online survey. Statistical analysis was performed using SPSS version 15, with p < 0.05 considered significant. RESULTS: During the 5-year quantitative study period there were 381 BST trainees. Gender was a significant predictor of career choice with women more likely to ultimately choose a nonsurgical career after initial surgical training (p = 0.049). Passing surgical membership examinations (MRCS) also was predictive of remaining in surgery (p = 0.005). Training region was not a significant predictor of ultimate career choice. There were 418 survey respondents. The influence of role models was most commonly cited as influencing candidates in choosing to commence surgical training. Candidates who rated "academic opportunity" (p = 0.023) and "intellectual challenge" (p = 0.047) as factors that influenced their decision to commence surgical training were more likely to ultimately continue their careers in a surgical speciality. CONCLUSIONS: This study describes the career pathway of surgical trainees and confirms the importance of academic achievement in discriminating between candidates applying for surgical training schemes.

  4. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice

    Directory of Open Access Journals (Sweden)

    Abdulrasheed Ibrahim


    Full Text Available Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important. Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students.

  5. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice (United States)

    Ibrahim, Abdulrasheed; Asuku, Malachy E


    Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students. PMID:27013852

  6. The Efficacy of Assisted Reproduction in Women with Inflammatory Bowel Disease and the Impact of Surgery

    DEFF Research Database (Denmark)

    Friedman, S; Larsen, Pia Veldt; Fedder, Jens


    BACKGROUND: In this study, we analyze the chance of a live birth and the impact of inflammatory bowel disease surgery in women with Crohn's disease (CD) or ulcerative colitis (UC) who have undergone assisted reproductive technology (ART) treatments. METHODS: This is a nationwide cohort study based...

  7. The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. (United States)

    Abelson, Jonathan S; Chartrand, Genevieve; Moo, Tracy-Ann; Moore, Maureen; Yeo, Heather


    There have been many efforts to increase the number of women surgeons. We provide an update of women surgeon representation along the pathway to surgical academia. Data was extracted from Association of American Medical Colleges FACTS and Faculty Administrative Management Online User System as well as GME annual reports starting in 1994 until the last year available for each. The proportion of graduating women medical students has increased on average .5% per year from 1994 to 2014. Women general surgery trainees have more than doubled in number over the same period but represented 38.3% of all general surgery trainees in 2014. Women Full Professors increased on average .3% from 1994 to 2015 but still make up less than 10% of all Full Professors. Despite improvements over the past 20 years, there are still large gender gaps in surgery for trainees and academic leadership. At the current rate of increase, women Full Professors will not achieve gender parity until in 2136. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery

    Directory of Open Access Journals (Sweden)

    Jones Kim D


    Full Text Available Abstract Background Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. Methods A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11 and widespread pain (n = 12. Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI, Short Form McGill Pain Questionnaire (MPQ-SF, disease impact (Fibromyalgia Impact Questionnaire (FIQ, Functional Assessment of Cancer Therapy-Breast (FACT-B, health status (Medical Outcomes Short Form (SF-36 and quality of life (Quality of Life Scale (QOLS were gathered. Results There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance. Conclusion This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.

  9. The Cesarean Decision Survey (United States)

    Puia, Denise M.


    A descriptive study design was used to describe the decision of women having a cesarean surgery. The Cesarean Birth Decision Survey was used to collect data from 101 postpartum women who underwent a cesarean. Most of the surgeries were to primipara women who reported doctor recommendation and increased safety for the baby as the main reasons for the cesarean. Those women who had repeat cesarean surgery all cited their previous cesarean as the main reason for the current surgery. Women’s knowledge of cesarean surgery needs to be assessed early in pregnancy so that appropriate education may be provided. Accurate and ongoing information may decrease the number of women choosing a cesarean surgery. PMID:24868134

  10. Is aortic lymphadenectomy indicated in locally advanced cervical cancer after neoadjuvant chemotherapy followed by radical surgery? A retrospective study on 261 women. (United States)

    Martinelli, F; Signorelli, M; Bogani, G; Ditto, A; Chiappa, V; Perotto, S; Scaffa, C; Lorusso, D; Raspagliesi, F


    The aim of this study was to estimate the rate of aortic lymph nodes (LN) metastases/recurrences among patients affected by locally advanced stage cancer patients (LACC), treated with neoadjuvant chemotherapy (NACT) and radical surgery. Retrospective evaluation of consecutive 261 patients affected by LACC (stage IB2-IIB), treated with NACT followed by radical surgery at National Cancer Institute, Milan, Italy, between 1990 and 2011. Stage at presentation included stage IB2, IIA and IIB in 100 (38.3%), 50 (19.2%) and 111 (42.5%) patients, respectively. Squamous cell carcinoma accounted for more than 80%, followed by adenocarcinoma or adenosquamous cancers (20%). Overall, 56 women (21.5%) had LN metastases. Four out of 83 women (5%) who underwent both pelvic and aortic LN dissection had aortic LN metastases, and all women had concomitant pelvic and aortic LN metastases. Only one woman out of 178 (0.5%) who underwent pelvic lymphadenectomy only, had an aortic LN recurrence. Overall 2% of women (5/261) had aortic LN metastases/recurrence. Our data suggest that aortic lymphadenectomy at the time of surgery is not routinely indicated in LACC after NACT, but should reserved in case of bulky LN in both pelvic and/or aortic area. The risk of isolated aortic LN relapse is negligible. Further prospective studies are warranted. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  11. Different cycle ergometer outcomes in severely obese men and women without documented cardiopulmonary morbidities before bariatric surgery

    NARCIS (Netherlands)

    Dolfing, JG; Dubois, EF; Wolffenbuttel, BHR; ten Hoor-Aukema, NM; Schweitzer, DH

    Study objectives: The number of severely obese patients undergoing bariatric surgery is increasing. No incremental cycle ergometer data are available in this category of patients. The current study was undertaken to provide information and to compare outcomes between severely obese men and women

  12. Innovations in Bariatric Surgery. (United States)

    Zhu, Catherine; Pryor, Aurora D


    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  13. [Surgery as specialization for female physicians: Results from course evaluations and alumni studies at MHH]. (United States)

    Paulmann, V; Fischer, V; Dudzinska, A; Pabst, R


    There is a lack of young surgeons in Germany. In order to provide a successful learning environment in medical education and to attract more physicians, training concepts need to be regularly controlled. Evaluation results compiled over several years from the Hanover Medical School (MHH) were analyzed for gender-related differences. In addition to overall satisfaction with practical training items were included that consider aspects of interaction between students and instructors. Furthermore, alumni studies provided data on the postgraduate specialty choice made by MHH students. Surgical training is integrated into medical education as block training periods of various durations. Against the background of an increased percentage of women in medicine this article analyzed whether surgery is evaluated differently between female and male medical students with respect to their experiences in clinical teaching. Evaluations of clinical training in surgery demonstrated that female and male medical students do not differ substantially with respect to the teaching quality; however, young female physicians choose surgery as a professional option less frequently than men. A systematic review of clinical training evaluations is crucial to identify weaknesses of current curricula. More empirical data from other faculties can induce discussions about the attractiveness of surgery as a profession.

  14. The Impact of Midurethral Sling Surgery on Sexual Activity and Function in Women With Stress Urinary Incontinence

    NARCIS (Netherlands)

    Mengerink, Bianca B.; van Leijsen, Sanne A. L.; Vierhout, Mark E.; IntHout, Joanna; Mol, Ben W. J.; Milani, Alfredo L.; Roovers, Jan-Paul W. R.; van Eijndhoven, Hugo W. F.; van der Vaart, Carl H.; van Gestel, Iris; Hartog, Francis E.; Heesakkers, John F. A.; Kluivers, Kirsten B.


    Introduction: Stress urinary incontinence has a negative impact on sexual function. Aim: To assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. Methods: This is a secondary analysis of the Value of Urodynamics Prior to Stress

  15. Influences on decision making among primiparous women choosing elective caesarean section in the absence of medical indications: findings from a qualitative investigation. (United States)

    Kornelsen, Jude; Hutton, Eileen; Munro, Sarah


    Patient-initiated elective Caesarean section (PIECS) is increasingly prevalent and is emerging as an urgent issue for individual maternity practitioners, hospitals, and policy makers, as well as for maternity patients. This qualitative study sought to explore women's experiences of the decision-making process leading to elective operative delivery without medical indication. We conducted 17 exploratory qualitative in-depth interviews with primiparous women who had undergone a patient-initiated elective Caesarean section in the absence of any medical indication. The study took place in five hospitals (three urban, two semi-rural) in British Columbia. The findings revealed three themes within the process of women deciding to have a Caesarean section: the reasons for their decision, the qualities of the decision-making process, and the social context in which the decision was made. The factors that influenced a patient-initiated request for delivery by Caesarean section in participants in this study were diverse, culturally dependent, and reflective of varying degrees of emotional and evidence-based influences. PIECS is a rare but socially significant phenomenon. The a priori decision making of some women choosing PIECS does not follow the usual diagnosis-intervention trajectory, and the care provider may have to work in reverse to ensure that the patient fully understands the risks and benefits of her decision subsequent to the decision having been made, while still ensuring patient autonomy. Results from this study provide a context for a woman's request for an elective Caesarean section without medical indication, which may contribute to a more efficacious informed consent process.

  16. Pregnancy and the Plastic Surgery Resident. (United States)

    Garza, Rebecca M; Weston, Jane S; Furnas, Heather J


    Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

  17. HPV genotype distribution in older Danish women undergoing surgery due to cervical cancer

    DEFF Research Database (Denmark)

    Hammer, Anne; Mejlgaard, Else; Gravitt, Patti


    INTRODUCTION: The prevalence of human papillomavirus (HPV)16/18 in cervical cancer may decrease with age. This study aimed to describe the HPV genotype distribution in Danish women aged 55 years or older with cervical cancer. MATERIAL AND METHODS: In this cross-sectional study we identified 153...... cases of cervical cancer diagnosed at Aarhus University Hospital, Denmark (1990-2012) and Copenhagen University Hospital Herlev, Denmark (2007-2012). All women had surgery to treat the disease. HPV genotyping was performed on cervical cancer tissue using the INNO LiPA HPV genotyping extra (Fujirebio......, Belgium) at the Department of Pathology, Aarhus University Hospital, Denmark. The main outcome was to estimate the age-specific prevalence of high-risk HPV genotypes included in the bivalent, the quadrivalent, and the nonavalent vaccine. RESULTS: Of 121 cases of cervical cancer included in this study, 113...

  18. Womens' preference in Down syndrome screening

    NARCIS (Netherlands)

    de Graaf, IM; Tijmstra, T; Bleker, O.P.; van Lith, JMM

    Objective To determine the knowledge of pregnant women about prenatal tests. and what tests they would choose if offered. Also, the preference of pregnant women for second-trimester or first-trimester screening was assessed. Patients and methods Pregnant women receiving antenatal care in a

  19. Women's reflections and actions regarding working after breast cancer surgery - a focus group study. (United States)

    Nilsson, M I; Olsson, M; Wennman-Larsen, A; Petersson, L-M; Alexanderson, K


    To better understand processes affecting return to work (RTW) after breast cancer, more knowledge from the perspective of sickness absentees is warranted. Still, research based on women's own reasoning and actions in RTW is very scarce. This study aims to elucidate how women with breast cancer reflect and act on work-related issues. Thematic analyses of data from four focus group interviews with 23 women who had had breast cancer surgery in the previous 3-13 months were carried out. The five following themes of reflections regarding RTW were identified: 'health and functioning', 'self-esteem/integrity', 'value of work', 'relationships at work', and 'social circumstances'. These reflections were associated with the three identified themes of actions taken by the women: 'to work or to be sickness absent', 'to adjust work according to own needs or not', and 'to disclose or to hide one's cancer'. There was a distinct difference between women who experienced work as a source of well-being and those who needed a respite from work. This study adds knowledge to the process of RTW after breast cancer and focuses on factors that lead the women to an active role in this process. We point to the interplay between women's own preferences, perceived competence, outer opportunities, and the actions each woman take with regard to RTW, which need to be recognized by all stakeholders involved. Furthermore, it continues to be essential to address the specific issue of disclosure in the workplace because this may be distressing for women. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Rectal surgery for endometriosis--should we be aggressive? (United States)

    Varol, Nesrin; Maher, Peter; Healey, Martin; Woods, Rod; Wood, Carl; Hill, David; Lolatgis, Nick; Tsaltas, Jim


    To assess the outcome of aggressive but conservative laparoscopic surgery in the treatment of severe endometriosis involving the rectum. Retrospective study (Canadian Task Force classification III). Endosurgery unit of a tertiary referral center. One hundred sixty-nine women. Laparoscopy or laparotomy. The procedure was completed successfully laparoscopically in 145 (86%) and by laparotomy in 24 women (14%). The rate of preoperative symptoms was higher in 25 women who underwent bowel resection compared with those who had other bowel surgery. In addition to bowel surgery, excision of uterosacral ligaments, adhesiolysis, excision of endometrioma, and oophorectomy were the four most commonly performed procedures. At 35-month follow-up 61 patients (36%) required further surgery for pain. The average time between primary and repeat surgery was 16 months. This second operation was performed by laparoscopy in over three-fourths of the women. Overall recurrent endometriosis was found in 26 patients (15%). Overall morbidity associated with all surgery was 12.4%. Surgery for endometriosis of the cul-de-sac and bowel involves some of the most difficult dissections encountered, but it can be accomplished successfully with the low postoperative morbidity typical of laparoscopy.

  1. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

    Directory of Open Access Journals (Sweden)

    Nicole Szell, DO


    Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

  2. Ten-year results of the treatment of early-stage breast carcinoma in elderly women using breast-conserving surgery and definitive breast irradiation

    International Nuclear Information System (INIS)

    Solin, Lawrence J.; Schultz, Delray J.; Fowble, Barbara L.


    Purpose: The optimal management of breast cancer in elderly women is not well established. Therefore, the present study was undertaken to evaluate the outcome of breast cancer in elderly women treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 558 women age ≥ 50 years treated with breast-conserving surgery and definitive breast irradiation for Stages I-II invasive carcinoma of the breast. Of the 558 total women, there were 173 elderly women age ≥ 65 years and a comparison group of 385 women age 50-64 years. Treatment for all women included complete gross excision of the primary tumor, pathologic axillary lymph node staging, and definitive breast irradiation. Adjuvant systemic chemotherapy was used in 18% (102 out of 558) of the overall group. Adjuvant tamoxifen was used in 17% (94 out of 558) of the overall group. The median follow-up after treatment was 6.2 years (mean = 6.4 years; range 0.1-15.4 years). Results: Elderly patients age ≥ 65 years and patients age 50-64 years were both found to have tumors with adverse prognostic features, including clinical T2 lesions (43 vs. 34%, respectively; p = 0.055), estrogen receptor negativity (9 vs. 16%, respectively; p = 0.13), and progesterone receptor negativity (17 vs. 21%, respectively; p = 0.50). Pathologic axillary lymph node staging showed that 24% of the elderly women were node positive, including 8% with four or more positive nodes, which was not different from women age 50-64 years (p = 0.23). There was no difference between the two age groups for the rate of deaths from breast cancer at 10 years (13 vs. 13%, respectively; p = 0.71). However, there was a significant difference between the two age groups for the rate of deaths from intercurrent disease at 10 years (11 vs. 2%, respectively; p = 0.0006). There were no differences between the two age groups for the 10-year rates of overall survival (77 vs. 85%, respectively; p = 0

  3. Why do younger women have higher breast cancer recurrence rates after breast-conserving surgery?

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Matsuda, Masakazu; Miyayama, Haruhiko; Okazaki, Shinji; Kai, Chiharu; Ozaki, N.


    Preventing breast cancer recurrence after breast-conserving surgery is an important issue. The main factors contributing to such recurrence are positive margins, absence of radiotherapy and young age. To investigate the clinical significance of age in breast-conserving surgery, we examined the relationship between clinicopathological findings or outcome and age, especially young age. The cases were divided into three groups by age; 35 years old or less, 36-50y.o. and 51y.o. or higher. Between April 1989 and March 2003, 743 patients were treated with breast-conserving surgery. There were 49 patients aged 35 years old or less (6.6%). Younger age significantly correlated with positive surgical margin, lymph node metastases, higher proliferative activity, negative estrogen receptor (ER) or progesterone receptor (PgR), larger tumor size, and shorter nipple-tumor distances. Although younger patients had a higher recurrence rate irrespective of radiotherapy, margin status had an impact on recurrence rate. Thus, the reason young age was a significant factor for breast recurrence after breast-conserving surgery was that young patients frequently had numerous risk factors such as positive margin, higher proliferative activity, positive nodes, negative ER/PgR and larger tumor. However, negative surgical margins could reduce recurrence rates even in young women. These results suggest that more suitable criteria and strategies may be needed for young patients with breast cancer. (author)

  4. Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery. (United States)

    López-Gómez, Juan José; Izaola-Jáuregui, Olatz; Torres-Torres, Beatriz; Gómez-Hoyos, Emilia; Castro Lozano, María Ángeles; Ortolá-Buigues, Ana; Martín Ferrero, Miguel Ángel; De Luis-Román, Daniel Antonio


    Knee osteoarthritis is a disease with a high prevalence in our environment, especially in women. Weight loss can improve the quality of life of these patients before surgery. To evaluate the effect of a meal-replacement diet on weight loss, body composition, and the improvement of the quality of life in obese women with knee osteoarthritis pending surgery. One branch intervention study was performed over three months on 81 women with a body mass index greater than 30 kg/m2 with knee osteoarthritis before surgery. Patients received a hyperproteic meal-replacement diet with two bottles of an oral nutrition supplement in lunch and dinner (1,035 kcal). Anthropometric parameters, and body composition were measured. The quality of life was assessed by WOMAC and SF-36 test. The mean age of the patients was 62.23 (8.50) years. The percentage of weight loss was 8.23% (4.04). An improvement in the SF-36 total score was observed (basal: 49.35 [20.41], three months: 58.71 [17.07], p diet, there is a significant decrease in weight and fat mass with a relative increase of the latter. There is an improvement in the quality of life according to SF-36 and WOMAC. There is an independent relationship between weight loss and SF-36 improvement.

  5. Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon. (United States)

    Ettner, Randi; Ettner, Frederic; White, Tonya


    Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient-provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures. Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making. Results: The results generally confirm previous findings regarding how patients select providers. Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

  6. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad


    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

  7. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice. (United States)

    Ibrahim, Abdulrasheed; Asuku, Malachy E


    Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P work-life balance in selecting plastic surgery compared to male medical students.

  8. Modeling the intention to choose natural vaginal delivery: using reasoned action and social cognitive theories. (United States)

    Kanani, Safieh; Allahverdipour, Hamid; AsghariJafarabadi, Mohammad


    The Behavioral Intention Model is one of the best and most widely models used regarding attitude of behavioral of pregnancy and decrease the rate of cesarean section (CS) among pregnant women, except effect of attitude and subjective norms on behavioral intention. Two variables of self-efficacy, and outcome expectation, relate to individual's behavior in an upcoming situation, and both of them are important at the development of behavior. The purpose of the present study was to develop a model to explain women's inten-tion to choose natural vaginal delivery (NVD). The variables of self-efficacy and outcome expectations, derived from Bandura's Social Cognitive Theory, and Behavioral Intention Model constructs were used to define the model. The study was descriptive and cross-sectional in nature and took place in Pars Abad, Iran in 2014. The non-probability sample consisted of 200 pregnant women who voluntarily participated in the study and provided the data. SPSS 21 and MPLUS 6.8 were employed to analyze the data. Self-efficacy, outcome expectations, and attitude toward NVD were associated with intention to choose the NVD. The study findings may play a role in designing educational interventions aimed at influencing the NVD and improving childbirth programs.

  9. Reproductive Endocrinology: Pregnancy and fertility after bariatric surgery. (United States)

    Ginsburg, Elizabeth S


    Increases in rates of bariatric surgery are staggering, and many obese individuals who undergo such procedures are women of reproductive age. So, how does the surgery affect women's fertility and pregnancy outcomes thereafter? A new systemic review aimed to find out.

  10. Designing innovative retractors and devices to facilitate mitral valve repair surgery


    Okamoto, Kazuma; Yozu, Ryohei


    Various devices have been developed to facilitate mitral valve surgery, including those that improve mitral valve exposure and assist surgeons with associated procedures. Choosing appropriate supporting devices when performing minimally invasive mitral valve surgery (MIMVS) through a minithoracotomy with endoscopic assistance is critical. Depending on the surgeon’s preference, trans-thoracic or trans-working-port left atrial retractors can be utilized. Although the trans-thoracic retractors p...

  11. Myocardial infarction among women with early-stage breast cancer treated with conservative surgery and breast irradiation

    International Nuclear Information System (INIS)

    Rutqvist, Lars E.; Liedberg, Anette; Hammar, Niklas; Dalberg, Kristina


    Purpose: To assess the possible impact of the irradiation on the risk of acute myocardial infarction among breast cancer patients treated with conservative surgery and postoperative radiation therapy. Methods and Materials: The incidence of and mortality from acute myocardial infarction was assessed in a group of 684 women with early-stage breast cancer diagnosed during 1976-1987 who had been treated with breast conserving surgery plus postoperative radiation therapy given with tangential photon fields. In 94% of the patients the total dose was between 48-52 Gy given with 2 Gy daily fractions 5 days per week for a total treatment period of about 4 (1(2)) - 5 (1(2)) weeks. In 88% of the patients the target volume included the breast parenchyma alone. In the remaining patients regional nodal areas were also irradiated. A concurrent group of 4,996 breast cancer patients treated with mastectomy without postoperative radiation therapy was used as a reference. Results: After a median follow-up of 9 years (range: 5-16 years) 12 conservatively treated patients (1.8%) had developed an acute myocardial infarction and 5 (0.7%) had died due to this disease. The age-adjusted relative hazard of acute myocardial infarction for the conservative group vs. the mastectomy group was 0.6 (95% C.I.: 0.4-1.2) and for death due to this disease 0.4 (0.2-1.1). The incidence of acute myocardial infarction among the conservatively treated women was similar irrespective of tumor laterality. Conclusions: There was no indication of an increased risk of acute myocardial infarction with the radiation therapy among the women treated with conservative surgery. However, due to the small number of events the study could not exclude the possibility that cardiac problems may arise in some patients with left-sided cancers who have their heart located anteriorly in the mediastinum. Individual, three-dimensional dose planning represents one method to identify such patients and is basic to technical changes

  12. Leaving surgical training: some of the reasons are in surgery. (United States)

    Forel, Deanne; Vandepeer, Meegan; Duncan, Joanna; Tivey, David R; Tobin, Stephen A


    In 2014, the Royal Australasian College of Surgeons identified, through internal analysis, a considerable attrition rate within its Surgical Education and Training programme. Within the attrition cohort, choosing to leave accounted for the majority. Women were significantly over-represented. It was considered important to study these 'leavers' if possible. An external group with medical education expertise were engaged to do this, a report that is now published and titled 'A study exploring the reasons for and experiences of leaving surgical training'. During this time, the Royal Australasian College of Surgeons came under serious external review, leading to the development of the Action Plan on Discrimination, Bullying and Sexual Harassment in the Practice of Surgery, known as the Building Respect, Improving Patient Safety (BRIPS) action plan. The 'Leaving Training Report', which involved nearly one-half of all voluntary 'leavers', identified three major themes that were pertinent to leaving surgical training. Of these, one was about surgery itself: the complexity, the technical, decision-making and lifestyle demands, the emotional aspects of dealing with seriously sick patients and the personal toll of all of this. This narrative literature review investigates these aspects of surgical education from the trainees' perspective. © 2018 Royal Australasian College of Surgeons.

  13. "Everything you need to know": how women's magazines structure prenatal diagnosis for women over 35.

    NARCIS (Netherlands)

    Beaulieu, A; Lippman, A


    The use of biomedical testing and genetic counselling is usually framed as something an individual woman chooses, with little consideration given to the context in which women make these choices. In order to understand something of the context in which women (35 and over) undergo prenatal diagnostic

  14. Prepare now to counsel patients on RU486. Women speak about the abortion pill. (United States)


    The advantages of RU-486 to most women who are educated about it are obvious, but the experience can be both empowering and traumatic because they are essentially performing the abortion on themselves. A research organization in Los Angeles initiated eight focus groups with 73 sexually active women ages 18-34 in Los Angeles, Portland, and New York City to find out about the acceptability of this new abortifacient. 63% of the participants had heard about it but were not quite sure about what it was. After the counseling sessions they were given the option of choosing a method of abortion. 38% chose RU-486 (mainly to avoid surgery and anesthesia), 34% chose vacuum aspiration, and 26% remained undecided. Some providers of family planning predict that RU-486 would be preferred because of the avoidance of surgical abortion and the comfort of doing the procedure in their own homes. At an abortion clinic in Paris, France, only a few women would not choose RU-486 because of the emotional impact of seeing the expelled conceptus. Others were relieved to realize that the expelled embryo was only a mass of cells not a baby. Seeing the expelled embryo could, in fact, prevent pregnancies in the future, because surgical abortions, in which tissues taken are not seen, are often easier to forget. More information will be forthcoming about this procedure from a US study initiated by the Population Council at 12 sites involving 2100 women. The trials will be finished by mid-1995 and approval of the Food and Drug Administration will be expected in time for marketing in 1996.

  15. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass. (United States)

    Stentebjerg, Louise Laage; Andersen, Lise Lotte Torvin; Renault, Kristina; Støving, René Klinkby; Jensen, Dorte Møller


    To compare perinatal and pregnancy outcomes including adherence to the Institute of Medicine's (IOM) recommendations for gestational weight gain (GWG) in pregnant women with conception surgery. Women in the late group had a significantly higher risk of requiring CS or receiving intravenous iron supplementation compared to the early group (57% versus 30%, p = 0.03 and 29% versus 7%, p = 0.02, respectively). Early conception was not significantly associated with insufficient GWG, preterm delivery or birthweight. Among 54 women with information on GWG, only 13 (24%) had an appropriate GWG. The majority of pregnant women with gastric bypass did not fulfill guidelines for GWG; however, this study could not support the recommendation to postpone pregnancy.

  16. Keys to career satisfaction: insights from a survey of women pediatric surgeons. (United States)

    Caniano, Donna A; Sonnino, Roberta E; Paolo, Anthony M


    Declining interest in the field of surgery is attributed to lifestyle issues, more women per class, high debt, and long residency. To maintain surgery as a premier career choice, female students must find surgery to be professionally and personally rewarding. A 35-item questionnaire was mailed to 95 women pediatric surgeons (WPS), assessing multiple professional and personal factors. Responses were entered into a confidential database and analyzed by chi2 or t tests. Seventy-nine percent of surveys were returned; practice was identified as academic (60%) and private (40%). Respondents were grouped by age: A, less than 44 years (41%); B, 45 to 54 years (37%); and C, greater than 55 years (22%). For academic WPS, 81% are on timeline for promotion. Insufficient protected time was a significant obstacle for a successful academic career in groups A and B (P =.001). Clinical load, on-call responsibilities, lack of mentorship, and departmental support were major obstacles in all groups (P =.05). Seventy-three percent of WPS in private practice were satisfied with their role in practice management; poor practice conditions were cited as the most frequent reason for job relocation. Sixty-one percent of WPS are married, and 46% are raising children. WPS had statistically significant more responsibilities for child care and household tasks in comparison with their partners. Eighty-three percent report career satisfaction but desire more time with family and for personal interests. Part-time and flexible work schedules were identified as attractive ways to achieve career-family balance. Eighty-four percent believe that quality-of-life issues are the dominant reason that fewer medical students choose surgical fields. WPS express career satisfaction but share the concerns of their female colleagues in other surgical disciplines. Quality of life is viewed as central to career choice for the current generation of medical students; female role models are key to recruiting women

  17. Sexual satisfaction following bariatric surgery: A prospective exploratory study. (United States)

    Ferrer-Márquez, Manuel; Pomares-Callejón, María Ángeles; Fernández-Agis, Inmaculada; Belda-Lozano, Ricardo; Vidaña-Márquez, Elisabet; Soriano-Maldonado, Alberto


    Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m 2 ), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Choosing to Participate: Revised Edition (United States)

    Goldstein, Phyllis; Strom, Adam


    "Choosing to Participate" focuses on civic choices--the decisions people make about themselves and others in their community, nation, and world. The choices people make, both large and small, may not seem important at the time, but little by little they shape them as individuals and responsible global citizens. "Choosing to…

  19. Choosing Beauty

    NARCIS (Netherlands)

    Friederich, Simon


    Reasoning that takes into account self-locating evidence in apparently plausible ways sometimes yields the startling conclusion that rational credences are such as if agents had bizarre causal powers. The present paper introduces a novel version of the Sleeping Beauty problem-Choosing Beauty-for



    Followell, Janet


    Obesity has reached epidemic proportion in the United States. Results of diet, exercise regimens, and/or medications are discouraging for most individuals; therefore, bariatric surgery is on the rise. Patients undergoing bariatric surgery are overwhelmingly female. There is a plethora of research regarding improvement of co-morbidities, but little focus has been placed on the impact of bariatric surgery on positive as well as negative psychosocial outcomes. The purposes of t...

  1. Why don't girls choose technological studies? Adolescents' stereotypes and attitudes towards studies related to medicine or engineering. (United States)

    López-Sáez, Mercedes; Puertas, Susana; Sáinz, Milagros


    Gender differences in choice of studies emerge already in adolescence. Two studies with adolescents are presented, the goal of which is to explore the influence of gender by assessing males and females who choose studies related to Medicine or Engineering. Study 1, correlational (N = 330, mean age 15.9, 56.7% girls), shows that girls who choose technology are more poorly appraised than girls who choose other studies. Study 2 (N = 130; mean age 16.77, 56.2% girls), experimental, measures implicit attitudes (using the IAT) towards males and females from Medicine and Engineering. Implicit attitudes are more favorable towards women if they are studying Medicine and towards men if they study Engineering. The results are analyzed with relation to the percentages of boys and girls in the different fields of study.

  2. Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies. (United States)

    Lönnerfors, Celine; Bossmar, Thomas; Persson, Jan


    To evaluate the incidence and possible predictors associated with port-site metastases following robotic surgery. Prospective study. University Hospital. Women with gynecological cancer. The occurrence of port-site metastases in the first 475 women undergoing robotic surgery for gynecological cancer was reviewed. Rate of port-site metastases. A port-site metastasis was detected in nine of 475 women (1.9%). Eight women had either an unexpected locally advanced disease or lymph-node metastases at the time of surgery. All nine women received postoperative adjuvant therapy. Women with ≥ stage III endometrial cancer and women with node positive cervical cancer had a significantly higher risk of developing a port-site metastasis, as did women with high-risk histology endometrial cancer. Port-site metastases were four times more likely to occur in a specimen-retrieval port. One (0.2%) isolated port-site metastasis was detected. The median time to occurrence of a port-site metastasis was 6 months (range 2-19 months). Six of the nine women (67%) have died and their median time of survival from recurrence was 4 months (range 2-16 months). In women with gynecological cancer, the incidence of port-site metastases following robotic surgery was 1.9%. High-risk histology and/or advanced stage of disease at surgery seem to be contributing factors. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. The Influence of Repeat Surgery and Residual Disease on Recurrence After Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Bodilsen, Anne; Bjerre, Karsten; Offersen, Birgitte V


    BACKGROUND: A significant proportion of women who have breast-conserving surgery (BCS) subsequently undergo re-excision or proceed to mastectomy. This study aimed to identify factors associated with residual disease after repeat surgery and to determine their effect on ipsilateral breast tumor re...

  4. Changes in Global Transcriptional Profiling of Women Following Obesity Surgery Bypass. (United States)

    Pinhel, Marcela Augusta de Souza; Noronha, Natalia Yumi; Nicoletti, Carolina Ferreira; de Oliveira, Bruno Affonso Parente; Cortes-Oliveira, Cristiana; Pinhanelli, Vitor Caressato; Salgado Junior, Wilson; Machry, Ana Julia; da Silva Junior, Wilson Araújo; Souza, Dorotéia Rossi Silva; Marchini, Júlio Sérgio; Nonino, Carla Barbosa


    Differential gene expression in peripheral blood mononuclear cells (PBMCs) after Roux-en-Y gastric bypass (RYGB) is poorly characterized. Markers of these processes may provide a deeper understanding of the mechanisms that underlie these events. The main goal of this study was to identify changes in PBMC gene expression in women with obesity before and 6 months after RYGB-induced weight loss. The ribonucleic acid (RNA) of PBMCs from 13 obese women was analyzed before and 6 months after RYGB; the RNA of PBMCs from nine healthy women served as control. The gene expression levels were determined by microarray analysis. Significant differences in gene expression were validated by real-time quantitative polymerase chain reaction (RT-qPCR). Microarray analysis for comparison of the pre- and postoperative periods showed that 1366 genes were differentially expressed genes (DEGs). The main pathways were related to gene transcription; lipid, energy, and glycide metabolism; inflammatory and immunological response; cell differentiation; oxidative stress regulation; response to endogenous and exogenous stimuli; substrate oxidation; mTOR signaling pathway; interferon signaling; mitogen-activated protein kinases (MAPK), cAMP response element binding protein (CREB1), heat shock factor 1 (HSF1), and sterol regulatory element binding protein 1c (SREBP-1c) gene expression; adipocyte differentiation; and methylation. Six months after bariatric surgery and significant weight loss, many molecular pathways involved in obesity and metabolic diseases change. These findings are an important tool to identify potential targets for therapeutic intervention and clinical practice of nutritional genomics in obesity.

  5. General surgery graduates may be ill prepared to enter rural or community surgical practice. (United States)

    Gillman, Lawrence M; Vergis, Ashley


    Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Pregnancy and bariatric surgery. (United States)

    Mahawar, Kamal K


    A large number of women experience pregnancy after bariatric surgery. The purpose of this review was to understand the evidence base in this area to come up with practical, evidence-based recommendations. We examined PubMed for all published articles on pregnancy in patients who have previously undergone a bariatric surgery. There is an increasing body of evidence pointing towards a beneficial effect of weight loss induced by bariatric surgery on female and male fertility prompting calls for recognition of infertility as a qualifying co-morbidity for patients between the Body Mass Index of 35.0 kg/m2 and 40.0 kg/m2. Women in childbearing age group should be routinely offered contraceptive advice after bariatric surgery and advised to avoid pregnancy until their weight has stabilized. Until more focused studies are available, the advice to wait for 12 months or 2 months after the weight loss has stabilized, whichever is latter, seems reasonable. Patients should be advised to seek clearance from their bariatric teams prior to conception and looked after by a multi-disciplinary team of women health professionals, bariatric surgeons, and dietitians during pregnancy. The main objective of care is to ensure adequate nutritional state to allow for a satisfactory weight gain and fetal growth. There is a relative lack of studies and complete lack of Level 1 evidence to inform practice in this area. This review summarizes current literature and makes a number of practical suggestions for routine care of these women while we develop evidence to better inform future practice.

  7. Female plastic surgery patients prefer mirror-reversed photographs of themselves: A prospective study. (United States)

    de Runz, Antoine; Boccara, David; Chaouat, Marc; Locatelli, Katia; Bertheuil, Nicolas; Claudot, Frédérique; Bekara, Farid; Mimoun, Maurice


    The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p < 0.001, binomial (214, 156, 0.5)); 73% of the patients preferred the mirror-reversed photographs. The proportions of patients who preferred the mirror-reversed photograph differed significantly (p = 0.047) between Groups 1 (84%) and 2 (70%). Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. III. Copyright © 2015 British Association of Plastic

  8. All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer. (United States)

    Melamed, Alexander; Rizzo, Anthony E; Nitecki, Roni; Gockley, Allison A; Bregar, Amy J; Schorge, John O; Del Carmen, Marcela G; Rauh-Hain, J Alejandro


    To compare all-cause mortality between women who underwent fertility-sparing surgery with those who underwent conventional surgery for stage I ovarian cancer. In a cohort study using the National Cancer Database, we identified women younger than 40 years diagnosed with stage IA and unilateral IC epithelial ovarian cancer between 2004 and 2012. Fertility-sparing surgery was defined as conservation of one ovary and the uterus. The primary outcome was time from diagnosis to death. We used propensity score methods to assemble a cohort of women who underwent fertility-sparing or conventional surgery but were otherwise similar on observed covariates and conducted survival analyses using the Kaplan-Meier method and Cox proportional hazard models. We identified 1,726 women with stage IA and unilateral IC epithelial ovarian cancer of whom 825 (47.8%) underwent fertility-sparing surgery. Fertility-sparing surgery was associated with younger age, residence in the northeastern and western United States, and serous or mucinous histology (Pfertility-sparing surgery and 37 deaths among propensity-matched women who underwent conventional surgery after a median follow-up of 63 months. Fertility-sparing surgery was not associated with hazard of death (hazard ratio 0.80, 95% confidence interval [CI] 0.49-1.29, P=.36). The probability of survival 10 years after diagnosis was 88.5% (95% CI 82.4-92.6) in the fertility-sparing group and 88.9% (95% CI 84.9-92.0) in the conventional surgery group. In patients with high-risk features such as clear cell histology, grade 3, or stage IC, 10-year survival was 80.5% (95% CI 68.5-88.3) among women who underwent fertility-sparing surgery and 83.4% (95% 76.0-88.7) among those who had conventional surgery (hazard ratio 0.86, 95% CI 0.49-1.53, P=.61). Compared with conventional surgery, fertility-sparing surgery was not associated with increased risk of death in young women with stage I epithelial ovarian cancer.

  9. Breast cancer biomarkers predict weight loss after gastric bypass surgery

    Directory of Open Access Journals (Sweden)

    Sauter Edward R


    Full Text Available Abstract Background Obesity has long been associated with postmenopausal breast cancer risk and more recently with premenopausal breast cancer risk. We previously observed that nipple aspirate fluid (n levels of prostate specific antigen (PSA were associated with obesity. Serum (s levels of adiponectin are lower in women with higher body mass index (BMI and with breast cancer. We conducted a prospective study of obese women who underwent gastric bypass surgery to determine: 1 change in n- and s-adiponectin and nPSA after surgery and 2 if biomarker change is related to change in BMI. Samples (30-s, 28-n and BMI were obtained from women 0, 3, 6 and 12 months after surgery. Findings There was a significant increase after surgery in pre- but not postmenopausal women at all time points in s-adiponectin and at 3 and 6 months in n-adiponectin. Low n-PSA and high s-adiponectin values were highly correlated with decrease in BMI from baseline. Conclusions Adiponectin increases locally in the breast and systemically in premenopausal women after gastric bypass. s-adiponectin in pre- and nPSA in postmenopausal women correlated with greater weight loss. This study provides preliminary evidence for biologic markers to predict weight loss after gastric bypass surgery.

  10. Mortality and suicide among Danish women with cosmetic breast implants

    DEFF Research Database (Denmark)

    Jacobsen, Poul Harboe; Hölmich, Lisbet R; McLaughlin, Joseph K


    disorders as measured by admission to a psychiatric hospital among women seeking cosmetic surgery. METHODS: Cohort study of 2761 women who underwent cosmetic breast implant surgery at private clinics of plastic surgery or public hospitals, 7071 women who underwent breast reduction surgery at public.......7-5.2). Women who underwent breast reduction exhibited low SMRs for death overall (0.7; 95% CI, 0.7-0.8) and several specific causes, including breast cancer (0.4; 95% CI, 0.2-0.6), whereas death from suicide was moderately above expectation (SMR, 1.6; 95% CI, 1.0-2.5). The prevalence of psychiatric admission...... prior to cosmetic surgery was higher among women who underwent cosmetic breast implant surgery (8.0%; 95% CI, 7.0%-9.0%) than among women who underwent breast reduction (4.7%; 95% CI, 4.2%-5.2%) or other cosmetic procedures (5.5%; 95% CI, 4.5%-6.7%). When compared with all control groups, women...

  11. Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility

    Directory of Open Access Journals (Sweden)

    James Butterworth


    Full Text Available Background. Polycystic ovary syndrome (PCOS is the commonest cause of female infertility. Visceral obesity and insulin resistance are key pathophysiological mechanisms behind PCOS. Women suffering from this syndrome and infertility often seek bariatric surgery hoping that they would be able to conceive postoperatively. Objective. At present, there is no consensus on the role of bariatric surgery in the management of PCOS-associated infertility within the medical community, making it difficult to give specific advice to these women, so a review of the literature was necessary. Results. A detailed review of the literature was performed. Only 6 manuscripts were relevant and contained quantitative data. They demonstrated that bariatric surgery results in postoperative conception rates varying from 33% to 100%. Surgery is also associated with amelioration of menstrual irregularities, hormonal abnormalities, and hirsutism that are associated with PCOS. These studies were retrospective and only had a small number of participants with infertility. Conclusions. Bariatric surgery has been shown to conclusively improve life expectancy, quality of life, and comorbidities like type 2 diabetes and obstructive sleep apnea. However, further research is required to identify whether weight loss surgery results in significant improvement in fertility of women with PCOS and to investigate which operation has the best results.

  12. The preoperative reaction and decision-making process regarding colostomy surgery among Chinese rectal cancer patients. (United States)

    Zhang, Jun-E; Wong, Frances Kam Yuet; Zheng, Mei-Chun


    Patients with rectal cancer have issues in adjusting to their permanent colostomy after surgery, and support is required to help them resume normal life. However, few studies have explored the experience and factors that affect a patient's decision-making and maladjustment prior to colostomy surgery. The aim of this study was to explore the experience of rectal cancer patients who have to undergo colostomy surgery. A descriptive, qualitative design was used. We studied a purposive sample of 18 patients who had received a diagnosis of primary rectal cancer and were expecting permanent colostomy surgery. The thematic analysis approach was used to analyze the data collected using semi-structured, open-ended questions. The overriding theme that emerged was 'stoma dilemma: a hard decision-making process'. From this main theme, three themes were derived: the resistance stage, the hesitation stage, and the acquiescence stage. It is hard for preoperative rectal patients to choose to undergo stoma surgery or a sphincter-saving operation. From the initial stage of definitive diagnosis to the final consent to stoma surgery, most patients experience the resistance and hesitation stages before reaching the acquiescence stage. Arriving at a decision is a process that nurses can facilitate by eliminating unnecessary misunderstanding surrounding colostomy surgery and by fully respecting patients' right to choose at the various stages. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Fertility sparing surgery in young women affected by endometrial stromal sarcoma: an oncologic dilemma or a reliable option? review of literature starting from a peculiar case

    Directory of Open Access Journals (Sweden)

    Noventa M


    Full Text Available Marco Noventa, Salvatore Gizzo, Lorena Conte, Angela Dalla Toffola, Pietro Litta, Carlo Saccardi Department of Woman and Child Health, University of Padua, Padua, Italy Background: Endometrial stromal sarcoma (ESS is a term used to define a rare neoplasm that accounts for approximately 0.2%–1% of all uterine malignancies; it is, however, implicated in an estimated 10%–15% of those malignancies with a mesenchymal component. Recent evidence suggests that while the preservation of the ovaries may be considered appropriate in premenopausal women, hysterectomy and bilateral salpingo-oophorectomy remains the recommended treatment in postmenopausal women. Currently, only a few case series reporting the treatment of ESS in young women with a desire to preserve fertility and thus subjected to a fertility-sparing surgery are available in the literature. Case presentation: We report a peculiar case of early stage ESS treated by laparoscopic fertility-sparing surgery and a strict follow-up program (every 3 months of imaging and clinical evaluation. The patient remained disease free 1 year after primary treatment. Three months after completing oncological follow-up, the patient conceived spontaneously and is, to date, pregnant at 11 weeks of gestation without evidence of recurrent disease or obstetric complications. Conclusion: Based on our case report and in accordance with the data available, we suggest that in young patients affected by early stage ESS who wish to preserve reproductive function, fertility-sparing surgery could represent a valid option, though strict oncological follow-up remains mandatory. Keywords: young women, laparoscopic surgery, pregnancy, neoplasia, surgical management, follow up, disease recurrence

  14. Highlights on recurrence after surgery for cervical cancer

    DEFF Research Database (Denmark)

    Fuglsang, Katrine

    Objective After surgery due to cervical cancer women are offered to attend a follow-up program 10 times during five years with the purpose for early diagnosis of recurrence. The aim of this study is to evaluate the follow-up program, which has remained unchanged for 20 years even though reminding...... and concerning women, who we consider healthy after surgery. Methods A retrospective longitudinal study of women attending follow-up program after surgery due to cervical cancer at the Department of Gynecology and Obstetrics, Aarhus University Hospital. 524 patients were identified from 1996 to 2011...... with the diagnosis of cervical cancer combined with a surgical procedure. From the national pathological database and patient files information was extracted. Information was stored in Epidata. Associations were calculated using stratified analysis and logistic regression. Results 133(25%) women of 524 needed...

  15. The publication gender gap in US academic surgery. (United States)

    Mueller, Claudia; Wright, Robert; Girod, Sabine


    Terms such as "glass ceiling" and "sticky floor" are still commonly used to describe women's role in academic surgery. Despite continued efforts to address disparities between men and women in the field, gender inequalities persist. In this investigation we highlight gender differences in published surgical literature by both quantity and impact. Websites for departments of surgery of three academic centers were reviewed to assess the bibliometrics of publications by gender over a two-week period. A one-way ANOVA showed a significantly higher H-index for men than women (p > .05). Further, one-way ANOVA showed significantly more articles published by men than women (p = .019). These differences are most dramatic at the rank of associate professor where the H-index for men is three times that of the women. The rank of full professor showed men had double the number of articles published. These findings align with the previous research that shows a disparity between males and females as they climb the academic ladder. Conducting and publishing research is a vital part of advancement in academic medicine. This study suggests that publication productivity may be a factor that hinders women from advancing within surgery compared to men. Continuing to explore and identify reasons for this gender difference in academic surgery may highlight ways to address the imbalance.

  16. Whey Protein Supplementation Enhances Body Fat and Weight Loss in Women Long After Bariatric Surgery: a Randomized Controlled Trial. (United States)

    Lopes Gomes, Daniela; Moehlecke, Milene; Lopes da Silva, Fernanda Bassan; Dutra, Eliane Said; D'Agord Schaan, Beatriz; Baiocchi de Carvalho, Kenia Mara


    The ideal nutritional approach for weight regain after bariatric surgery remains unclear. The objective of this study is to assess the effect of whey protein supplementation on weight loss and body composition of women who regained weight 24 or more months after bariatric surgery. This is a 16-week open-label, parallel-group, randomized controlled trial of women who regained at least 5 % of their lowest postoperative weight after a Roux-en-Y gastric bypass (RYGB). A total of 34 participants were treated with hypocaloric diet and randomized (1:1) to receive or not supplementation with whey protein, 0.5 g/kg of the ideal body weight. The primary outcomes were changes in body weight, fat free mass (FFM), and fat mass (FM), evaluated by tetrapolar bioelectrical impedance analysis (BIA). Secondary outcomes included resting energy expenditure, blood glucose, lipids, adiponectin, interleukin 6 (IL-6), and cholecystokinin levels. Statistical analyses included generalized estimating equations adjusted for age and physical activity. Fifteen patients in each group were evaluated: mean age was 45 ± 11 years, body mass index (BMI) was 35.7 ± 5.2 kg/m 2 , and time since surgery was 69 ± 23 months. Protein intake during follow-up increased by approximately 75 % in the intervention group (p = 0.01). The intervention group presented more body weight loss (1.86 kg, p = 0.017), accounted for FM loss (2.78, p = 0.021) and no change in FFM, as compared to controls (gain of 0.42 kg of body weight and 0.6 kg of FM). No differences in secondary outcomes were observed between groups. Whey protein supplementation promoted body weight and FM loss in women with long-term weight regain following RYGB.

  17. Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery. (United States)

    Novelli, Isabelle Romero; Fonseca, Laís Gomes; Gomes, Daniela Lopes; Dutra, Eliane Said; Baiocchi de Carvalho, Kênia Mara


    Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome. This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old)  ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL. The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = -0.286; P = 0.033), regardless of age, educational attainment, and postoperative time. The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The use of breast conserving surgery: linking insurance claims with tumor registry data

    International Nuclear Information System (INIS)

    Maskarinec, Gertraud; Dhakal, Sanjaya; Yamashiro, Gladys; Issell, Brian F


    The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer. Breast cancer cases registered in the Hawaii Tumor Registry (HTR) from 1995 to 1998 were linked with insurance claims from a local health plan. We identified 722 breast cancer cases with stage I and II disease. Surgical treatment patterns and comorbidities were identified using diagnostic and procedural codes in the claims data. The HTR database provided information on demographics and disease characteristics. We used logistic regression to assess determinants of BCS vs. mastectomy. The linked data set represented 32.8% of all early stage breast cancer cases recorded in the HTR during the study period. Due to the nature of the health plan, 79% of the cases were younger than 65 years. Women with early stage breast cancer living on Oahu were 70% more likely to receive BCS than women living on the outer islands. In the univariate analysis, older age at diagnosis, lower tumor stage, smaller tumor size, and well-differentiated tumor grade were related to receiving BCS. Ethnicity, comorbidity count, menopausal and marital status were not associated with treatment type. In addition to developing solutions that facilitate access to radiation facilities for breast cancer patients residing in remote locations, future qualitative research may help to elucidate how women and oncologists choose between BCS and mastectomy

  19. Maternal and perinatal outcomes after bariatric surgery: a case control study. (United States)

    de Alencar Costa, Laura Arrais Sydrião; Araujo Júnior, Edward; de Lucena Feitosa, Francisco Edson; Dos Santos, Andréa Cavalcante; Moura Júnior, Luiz Gonzaga; Costa Carvalho, Francisco Herlânio


    To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

  20. Surgery Should Complement Endocrine Therapy for Elderly Postmenopausal Women with Hormone Receptor-Positive Early-Stage Breast Cancer

    Directory of Open Access Journals (Sweden)

    Olivier Nguyen


    Full Text Available Introduction. Endocrine therapy (ET is an integral part of breast cancer (BC treatment with surgical resection remaining the cornerstone of curative treatment. The objective of this study is to compare the survival of elderly postmenopausal women with hormone receptor-positive early-stage BC treated with ET alone, without radiation or chemotherapy, versus ET plus surgery. Materials and Methods. This is a retrospective study based on a prospective database. The medical records of postmenopausal BC patients referred to the surgical oncology service of two hospitals during an 8-year period were reviewed. All patients were to receive ET for a minimum of four months before undergoing any surgery. Results. Fifty-one patients were included and divided in two groups, ET alone and ET plus surgery. At last follow-up in exclusive ET patients (n=28, 39% had stable disease or complete response, 22% had progressive disease, of which 18% died of breast cancer, and 39% died of other causes. In surgical patients (n=23, 78% were disease-free, 9% died of recurrent breast cancer, and 13% died of other causes. Conclusions. These results suggest that surgical resection is beneficial in this group and should be considered, even for patients previously deemed ineligible for surgery.

  1. The erasure of gender in academic surgery: a qualitative study. (United States)

    Webster, Fiona; Rice, Kathleen; Christian, Jennifer; Seemann, Natashia; Baxter, Nancy; Moulton, Carol-Anne; Cil, Tulin


    The number of women in surgery has steadily increased, yet their numbers in academic surgery positions and in high-ranking leadership roles remain low. To create strategies to address and improve this problem, it is essential to examine how gender plays into the advancement of a woman's career in academic surgery. Focus group (1) and one-on-one qualitative interviews (8) were conducted with women academic surgeons from various subspecialties in a large university setting. Interviews examined women surgeons' accounts of their experiences as women in surgery. Audio-recorded data were transcribed verbatim and coded thematically. NVivo10 software was used for cross-referencing of data and categorization of data into themes. Focus group data suggested that gender discrimination was pervasive in academic surgery. However, in interviews, most interviewees strongly disavowed the possibility that their gender had any bearing on their professional lives. These surgeons attempted to distance themselves from the possibility of discrimination by suggesting that differences in men and women surgeons' experiences are due to personality issues and personal choices. However, their narratives highlighted deep contradiction; they both affirmed and denied the relevance of gender for their experience as surgeons. As overt acts of discrimination become less acceptable in society, it does not necessarily disappear but rather manifests itself in covert forms. By disavowing and distancing themselves from discrimination, these women exposed the degree to which these issues continue to be pervasive in surgery. Women surgeons' ability to both identify and resist discrimination was hobbled by narratives of individualism, gender equality, and normative ideas of gender difference. Copyright © 2016. Published by Elsevier Inc.

  2. Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: a transversal and retrospective study. (United States)

    Fukushima, Kassandra Ferreira Pessoa; Carmo, Luana Aroucha; Borinelli, Adriana Carvalho; Ferreira, Caroline Wanderley Souto


    Breast cancer is the most common malignancy among women. Surgical treatment is an essential part of therapy, which still includes chemotherapy, radiotherapy and hormone therapy. The increase in early cancer detection and less aggressive treatment has made longer survival rates possible for women with this neoplasia. Morbidities after treatment have subsequently aroused particular interest in the scientific community in order to minimize their effects and provide increased quality-of-life for these patients. The present study aimed at investigating one of these morbidities: axillary web syndrome, which occurs after axillary surgical management. From December 2011 to September 2012, according to the inclusion and exclusion criteria, 97 patients, who had been surgically treated for breast cancer, were enrolled, interviewed, and submitted to a specific physical exam. An investigation of the axillary cords, characteristic of this syndrome, was performed in all patients. The axillary web syndrome was diagnosed in 28.86% of the women. Higher risk of triggering the syndrome has been associated with younger age (21.7%), longer time between first treatment and data collection (29.3%), greater number of resected lymph nodes (149.7%) and surgical management medical teams (113.2%). One can conclude that axillary web syndrome was associated with younger age, greater time elapsed since surgery, surgical management of medical staff and number of resected lymph nodes. Further studies are needed to review prior-to-surgery and post-operative follow-up, to properly assess the effects of surgery in the axilla on homeostatic balance, not only in the ipsilateral upper limb, but also assess their compensatory consequences throughout the body.

  3. Colorectal endometriosis-associated infertility: should surgery precede ART? (United States)

    Bendifallah, Sofiane; Roman, Horace; Mathieu d'Argent, Emmanuelle; Touleimat, Salma; Cohen, Jonathan; Darai, Emile; Ballester, Marcos


    To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility. Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis. University referral centers. A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy. First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis. After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated. After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL. First-line surgery may be a good option for women with colorectal endometriosis-associated infertility. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Cardiometabolic health among gastric bypass surgery patients with polycystic ovarian syndrome. (United States)

    Gomez-Meade, Carley A; Lopez-Mitnik, Gabriela; Messiah, Sarah E; Arheart, Kristopher L; Carrillo, Adriana; de la Cruz-Muñoz, Nestor


    To examine the effect of gastric bypass surgery on cardiometabolic health among women with polycystic ovarian syndrome (PCOS). Retrospective medical chart review identified women (n = 389) with PCOS who underwent Roux-en-Y gastric bypass surgery from 2001-2009 in one surgical practice. Separate repeated measures linear mixed models were fit using the MIXED procedure to assess mean change in cardiometabolic disease risk factors from before to 1-year after surgery and were evaluated by ethnicity [Hispanic, non-Hispanic black (NHB) and white (NHW)]. The majority of the sample was Hispanic (66%, 25% NHB, 9% NHW). Mean body mass index significantly improved 1 year post-surgery for all ethnic groups (45.5 to 35.5 kg/m(2) for Hispanics, 46.8 to 37.7 kg/m(2) for NHB and 45.7 to 36.7 kg/m(2) for NHW, P cardiometabolic outcomes adjusted for age and type of surgery before and 1 year after surgery showed no statistical difference between the three groups for any outcome. Cardiometabolic disease risk improvements vary by ethnicity and obesity may impact glucose tolerance and liver function changes more in Hispanic women with PCOS vs non-Hispanic women.

  5. Women Physicists Speak Again (United States)

    Ivie, Rachel; Guo, Stacy


    More than 1350 women physicists from more than 70 countries responded to a survey designed to identify issues important to women in physics. Women physicists had many areas of concern, notably discrimination and career/family balance. However, they also had many successes in physics. The majority would choose physics again and felt that they had progressed in their careers at least as quickly as their colleagues. Many spoke eloquently about their love of physics, the support they had received from others, and about their own determination and hard work.

  6. Urethral sensation following reconstructive pelvic surgery. (United States)

    Abernethy, M G; Davis, C; Lowenstein, L; Mueller, E R; Brubaker, L; Kenton, K


    Most urethral neuromuscular function data focus on efferent rather than afferent innervation. We aimed to determine if changes exist in urethral afferent nerve function before and after reconstructive pelvic surgery (RPS). Secondarily, we compared afferent urethral innervation in women with and without stress urinary incontinence undergoing RPS. Participants underwent current perception threshold (CPT) and urethral anal reflex (UAR) testing prior to surgery and again post-operatively. Wilcoxon signed ranked test and Spearman's correlations were used and all tests were two-sided. p = 0.05 was considered to indicate statistical significance. Urethral CPT thresholds increased significantly after RPS, consistent with decreased urethral afferent function. Pre-operative urethral CPT thresholds at 5 and 250 Hz were lower in SUI women (10 [IQR 5-29], 40 [32-750]) compared with continent women (63 [14-99], 73 [51-109]; p = 0.45, p = 0.020), signifying increased urethral sensation or easier activation of urethral afferents in SUI women. Reconstructive pelvic surgery is associated with a short-term deleterious impact on urethral afferent function, as demonstrated by the higher levels of stimuli required to activate urethral afferent nerves (decreased urethral sensation) immediately after RPS. Women with SUI required lower levels of stimuli to activate urethral afferent nerves prior to RPS, although UAR latencies were similar regardless of concomitant SUI.

  7. A combination of subcuticular sutures and a drain for skin closure reduces wound complications in obese women undergoing surgery using vertical incisions. (United States)

    Inotsume-Kojima, Y; Uchida, T; Abe, M; Doi, T; Kanayama, N


    Obesity is a risk factor for surgical site or wound complications in women undergoing surgery involving vertical incisions. Several investigators have reported the efficacy of subcutaneous drains in minimising the complication rate but there is no consensus on using these for surgery in obese patients. In 2006, the Scottish Surveillance of Healthcare Associated Infection Programme showed that using subcuticular sutures rather than staples to close incisions significantly reduced the risk of surgical site infection. Before January 2008 (group 1; N = 40), wound complications occurred in some obese patients in our hospital after obstetric and gynaecological surgery when only staples were used for skin closure. In January 2008 (group 2; N = 31), we changed the method of skin closure for obese patients [body mass index (BMI) > 28 kg/m(2)] and we now use a subcutaneous drain with four channels along the running tube and subcuticular sutures with interrupted, buried 4-0 polydioxanone sutures. The aim of this study was to assess the effects of these interventions for skin closure in obese women. The general characteristics (age, weight and BMI) were similar between the two groups. There were no wound complications in group 2. In group 1, wound disruptions and a seroma occurred in five (12.5%) and one (2.5%) patients, respectively. The wound complication rate in group 2 was significantly lower than that in group 1 (P = 0.0319). Thus, new materials and techniques for skin closure can reduce the wound complication rate in obese women. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. "I don't want to take chances.": A qualitative exploration of surgical decision making in young breast cancer survivors. (United States)

    Rosenberg, Shoshana M; Greaney, Mary L; Patenaude, Andrea F; Sepucha, Karen R; Meyer, Meghan E; Partridge, Ann H


    Young women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM), despite its limited medical benefit for most women. The purpose of this study was to better understand this choice through a qualitative exploration of surgical decision-making in young survivors, including how issues particular to younger women affected their decision and the post-surgical experience. Women age ≤ 40 years with stage 0 to III breast cancer, 1 to 3 years from diagnosis who had undergone breast cancer surgery were recruited to participate. Four focus groups were conducted: 2 with women who had bilateral mastectomy and 2 with women who kept their contralateral breast. Focus groups were recorded and transcribed with identifiers removed. Emergent themes were identified by thematic content analysis using NVivo 11. Of the 20 participants, median age at diagnosis was 37 years. Emergent themes were categorized into the following domains: (1) emotions/feelings surrounding surgery/decision about surgery; (2) factors affecting the decision; (3) communication and interaction with the healthcare team; (4) impact on post-surgical life and recovery; and (5) support needs. Young women who chose CPM often were concerned about a future breast event, despite this low risk, suggesting some gain peace of mind by choosing CPM. Young survivors also had many physical and emotional concerns after surgery for which they did not always feel prepared. Informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short and longer-term physical and emotional effects after surgery. Copyright © 2018 John Wiley & Sons, Ltd.

  9. Choosing Wood Burning Appliances (United States)

    Information to assist consumers in choosing a wood burning appliance, including types of appliances, the differences between certified and non-certified appliances, and alternative wood heating options.

  10. Archives | Women in Science | Initiatives | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    Women scientists share their experiences of choosing Science for their study and career ... News on Women's Day Conference by DST in Science journal; Dr. Maria ... of 52, after a valiant battle with cancer, today on 29th March 2016 in Delhi.

  11. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  12. Educational Vouchers: Freedom to Choose?


    Reel, Jordan; Block, Walter E.


    Milton Friedman is famous for his book title: “Free to Choose.” He also favors educational vouchers, which denies the freedom to choose to people who do not wish to subsidize the education of other people’s children. Thus, he is guilty of a logical contradiction. Why is it important to assess whether Friedman’s views on educational vouchers are logically consistent with his widespread reputation as an advocate of free enterprise, and, thus, freedom to chose? It is important to assess all figu...

  13. Personality characteristics in surgery seeking and non-surgery seeking obese individuals compared to non-obese controls

    DEFF Research Database (Denmark)

    Stenbæk, Dea S; Hjordt, Liv V; Haahr, Mette E


    It is currently unknown what makes some obese individuals opt for bariatric surgery whereas others choose not to. The aim of this study was to examine whether personality characteristics differed between obese individuals signed up for Roux-en-Y gastric bypass (RYGB) (N=30) and obese individuals...... groups did not differ in terms of personality. The Neuroticism domain and possibly the Extraversion domain may therefore be worthwhile to consider in future studies investigating the outcome of bariatric surgery....... not seeking RYGB (N=30) compared to non-obese controls (N=30). All participants completed the NEO Personality Inventory-Revised. The obese RYGB group displayed higher levels of Neuroticism and borderline lower levels of Extraversion compared to the obese non-RYGB and the non-obese group, while the two latter...

  14. The effect of education given before surgery on self-esteem and body image in women undergoing hysterectomy. (United States)

    Yaman, Şengül; Ayaz, Sultan


    To evaluate the effect of information provided before surgery on the self-esteem and body image of women undergoing hysterectomy. The study had a semi-experimental design with pre-post tests. A total of 60 women were included in the study and divided into two groups, the intervention group (n=30) and control group (n=30). A questionnaire, the Rosenberg self-esteem scale, and the body image scale were used to collect data. The pre- and post-test body image scores were similar in the intervention group patients, but the post-test scores were significantly higher in the control group (pself-esteem scores were again similar in the intervention group, but the post-test scores were significantly lower in the control group (pbody image and consequently self-esteem.

  15. Prevalence and risk of depressive symptoms 3-4 months post-surgery in a nationwide cohort study of Danish women treated for early stage breast-cancer

    DEFF Research Database (Denmark)

    Christensen, Søren; Zachariae, Robert; Jensen, Anders Bonde


    surgery for breast cancer, and to identify clinical risk factors while adjusting for pre-cancer sociodemographic factors, comorbidity, and psychiatric history. PATIENTS AND METHODS: The study cohort consists of 4917 Danish women, aged 18-70 years, receiving standardized treatment for early stage invasive...... breast cancer during the 2 1/2 year study period. Of these, 3343 women (68%) participated in a questionnaire study 12-16 weeks following surgery. Depressive symptoms (Beck's Depression Inventory II) and health-related behaviors were assessed by questionnaire. The Danish Breast Cancer Cooperative Group...... prognostic information. Physical functioning, smoking, alcohol use, and BMI were also independently associated with depressive symptoms. CONCLUSION: Risk factors for depressive symptoms were primarily restricted to pre-cancer conditions rather than disease-specific conditions. Special attention should...

  16. Effects of a Physical Activity Program on Cardiorespiratory Fitness and Pulmonary Function in Obese Women after Bariatric Surgery: a Pilot Study. (United States)

    Onofre, Tatiana; Carlos, Renata; Oliver, Nicole; Felismino, Amanda; Fialho, Davi; Corte, Renata; da Silva, Eliane Pereira; Godoy, Eudes; Bruno, Selma


    In severely obese individuals, reducing body weight induced by bariatric surgery is able to promote a reduction in comorbidities and improve respiratory symptoms. However, cardiorespiratory fitness (CRF) reflected by peak oxygen uptake (VO 2peak ) may not improve in individuals who remain sedentary post-surgery. The objective of this study was to evaluate the effects of a physical training program on CRF and pulmonary function in obese women after bariatric surgery, and to compare them to a control group. Twelve obese female candidates for bariatric surgery were evaluated in the preoperative, 3 months postoperative (3MPO), and 6 months postoperative (6MPO) periods through anthropometry, spirometry, and cardiopulmonary exercise testing (CPX). In the 3MPO period, patients were divided into control group (CG, n = 6) and intervention group (IG, n = 6). CG received only general guidelines while IG underwent a structured and supervised physical training program involving aerobic and resistance exercises, lasting 12 weeks. All patients had a significant reduction in anthropometric measurements and an increase in lung function after surgery, with no difference between groups. However, only IG presented a significant increase (p bariatric surgery could promote a significant increase in CRF only in the trained group, yet also showing that bariatric surgery alone caused an improvement in the lung function of both groups.

  17. Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye. (United States)

    Grosso, Andrea; Ceruti, Piero; Scarpa, Giuseppe; Giardini, Franco; Marchini, Giorgio; Aragona, Emanuela; Bert, Fabrizio; Bandello, Francesco; Siliquini, Roberta


    One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.

  18. To Choose or Not to Choose Science

    DEFF Research Database (Denmark)

    Holmegaard, Henriette Tolstrup; Madsen, Lene Møller; Ulriksen, Lars


    In the literature, there is a general concern that a less number of students choose to study science, technology, engineering or mathematics (STEM). This paper presents results from a Danish longitudinal study which examines students’ choice of whether or not to continue studying STEM after upper......-secondary school. In particular, this study focuses on students who held an STEM subject as one of their favourite subjects at secondary educational level, but who chose not to study STEM at the tertiary level. This paper explores how students’ perceptions of STEM relate to their identity work. The data used...

  19. Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia. (United States)

    Gjerde, Janne L; Rortveit, Guri; Adefris, Mulat; Belayneh, Tadesse; Blystad, Astrid


    Women living in resource constrained settings often have limited knowledge of and access to surgical treatment for pelvic organ prolapse. Additionally, little is known about experiences during recovery periods or about the reintegration process for women who do gain access to medical services, including surgery. This study aimed to explore women's experiences related to recovery and reintegration after free surgical treatment for pelvic organ prolapse in a resource-constrained setting. The study had a qualitative design and used in-depth interviews in the data collection with a purposive sample of 25 participants, including 12 women with pelvic organ prolapse. Recruitment took place at the University of Gondar Hospital, Ethiopia, where women with pelvic organ prolapse had been admitted for free surgical treatment. In-depth interviews were carried out with women at the hospital prior to surgery and in their homes 5-9 months following surgery. Interviews were also conducted with health-care providers (8), representatives from relevant organizations (3), and health authorities (2). The fieldwork was carried out in close collaboration with a local female interpreter. The majority of the women experienced a transformation after prolapse surgery. They went from a life dominated by fear of disclosure, discrimination, and divorce due to what was perceived as a shameful and strongly prohibitive condition both physically and socially, to a life of gradually regained physical health and reintegration into a social life. The strong mobilization of family-networks for most of the women facilitated work-related help and social support during the immediate post-surgery period as well as on a long-term basis. The women with less extensive social networks expressed greater challenges, and some struggled to meet their basic needs. All the women openly disclosed their health condition after surgery, and several actively engaged in creating awareness about the condition. Free surgical

  20. The Effect of Education to Reduce Depression Rate in Women With a History of Tubal Ligation Surgery

    Directory of Open Access Journals (Sweden)

    Maryam Etefagh


    Full Text Available Introduction: Mental disorders such as depression are the most common complications after tubal ligation surgery. The aim of this study was to determine the effect of training to reduce depression rate in woman who had undergone tubectomy. Materials and Methods: This quasi-experimental study was performed on 80 women (40 in each of the control and intervention groups who had undergone tubectomy in Kaboudar-Ahang Health Centers. The participants completed a self-administered questionnaire containing demographic characteristics and General Health Questionnaire (GHQ-28.The educational plan set was performed during four educational sessions face-to-face and in-group for the individuals. The data was gathered before and two months after the training in the two groups. Data was analyzed by Pearson correlation test, independent T-test and ANCOVA using SPSS-18 software. Results: Educational Program had an impact to reduce depression rate in women in the intervention group, which was statically meaningful (p< 0.05. The mean score of depression was 29.85 before the training and 15.23 after it. Depression was associated with literacy and job status. More educated women had a lower rate of depression and depression in unemployed women was also higher. Conclusion: Result of the present study demonstrated the importance of education to improve mental health in women with a history of tubectomy.

  1. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Lagro-Janssen, A.; Fischer, K.; Berghmans, L.C.; Vaart, C.H. van der


    INTRODUCTION AND HYPOTHESIS: To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. METHODS: This was a cohort study including women with moderate to severe stress incontinence who were

  2. The use of contraception for patients after bariatric surgery. (United States)

    Ostrowska, Lucyna; Lech, Medard; Stefańska, Ewa; Jastrzębska-Mierzyńska, Marta; Smarkusz, Joanna


    Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.

  3. [Severe vaginal discharge following rectal surgery

    NARCIS (Netherlands)

    Burg, L.C.; Bremers, A.J.A.; Heesakkers, J.P.; Kluivers, K.B.


    BACKGROUND: Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on

  4. Trastuzumab Benefits Women with Locally Advanced or Inflammatory (United States)

    Women treated with trastuzumab (Herceptin) and chemotherapy before surgery and trastuzumab again after surgery had a reduced risk of the disease recurring or progressing compared with women who received pre-surgical chemotherapy but no trastuzumab, accord

  5. Perceived gender-based barriers to careers in academic surgery. (United States)

    Cochran, Amalia; Hauschild, Tricia; Elder, William B; Neumayer, Leigh A; Brasel, Karen J; Crandall, Marie L


    Women represent roughly 50% of US medical students and one third of US surgery residents. Within academic surgery departments, however, women are disproportionately underrepresented, particularly at senior levels. The aim of this study was to test the hypothesis that female surgeons perceive different barriers to academic careers relative to their male colleagues. A modified version of the Career Barriers Inventory-Revised was administered to senior surgical residents and early-career surgical faculty members at 8 academic medical centers using an online survey tool. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences on the basis of gender. Respondents included 70 women (44 residents, 26 faculty members) and 84 men (41 residents, 43 faculty members). Women anticipated or perceived active discrimination in the form of being treated differently and experiencing negative comments about their sex, findings that differed notably from those for male counterparts. Sex-based negative attitudes inhibited the career aspirations of female surgeons. The presence of overt and implicit bias resulted in a sense that sex is a barrier to female surgeons' career development in academic surgery. No differences were observed between male and female respondents with regard to career preparation or structural barriers. Female academic surgeons experience challenges that are perceived to differ from their male counterparts. Women who participated in this study reported feeling excluded from the dominant culture in departments of surgery. This study may help guide transformative initiatives within academic surgery departments. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Personal, professional and financial satisfaction among American women urologists

    Directory of Open Access Journals (Sweden)

    Ciara S. Marley


    Full Text Available PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5% of female medical students enter the surgical subspecialties compared to nearly 20% of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69% who responded, 86.8% (211 reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81% (198 said that they would remain in medicine and 91.4% (222 would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006. CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.


    Directory of Open Access Journals (Sweden)

    Muntean Andreea


    Full Text Available The entrepreneurship is widely considered as a solution for economic problems. The number of young people who start a new business is in increasing. The students’ motivation for choosing entrepreneurship is the research purpose of this paper. A survey developed in Alba Iulia, on a number of 100 students’ points out the relevant motivation why young people choose entrepreneurial alternative. The results showed that most of the actual students would choose to be entrepreneurs because they want to improve their life standards, to explore new business opportunities and to have a social status. In conclusion, the teachers, the governmental authorities and all the others interested in stimulating the entrepreneurial motivation should their words and actions affect potential entrepreneurs’ perceptions of entrepreneurial feasibility and net desirability.

  8. Choosing to coose: reasons and expectations regarding marriage

    Directory of Open Access Journals (Sweden)

    Alessandra Alves Macedo


    Full Text Available The choice of the partner in adult life is considered one of the only choices that is made with freedom, however, loaded with social, personal, family expectations and also motivated by subjective aspects (ANTON, 2002. This paper seeks to describe how in the process of choosing the spouse, family aspects are directly or indirectly involved. A semi-structured interview was conducted to seven women in their first year of marriage. Data were analyzed according to Content Analysis. Three categories were chosen: Family of Origin; Marriage; and Religion. The participants have a vision of how their choice was made, with free choice, yet they were influenced by the beliefs and values of the families of origin. In their first year of marriage, they demonstrate good experience in marriage, and have built a relationship based on dialogues, despite the "sayings and no sayings" of the family of origin and society.

  9. External breast prostheses. A survey of their use by women after mastectomy. (United States)

    Tanner, R; Abraham, S F; Llewellyn-Jones, D


    Women who have had a mastectomy for breast cancer have to cope with two major problems: first, that they have cancer, and second, that they have lost their physical appearance. The provision of an appropriate prosthesis can reduce the sense of disfigurement. If women were to obtain the full psychological benefit of wearing a breast prosthesis, they need to be informed about the available breast forms, have an opportunity to choose between them, and to be satisfied with their choice. In this study of 49 women, only 44% had had the opportunity to choose a prosthesis, 28% were dissatisfied with their prostheses, and 17% were still using temporary prostheses.

  10. Relationship between cosmetic surgery and psychological variables

    Directory of Open Access Journals (Sweden)

    Reyhaneh souri


    Full Text Available Objective: The main aim of this paper is to examine the relationship between cosmetic surgery and psychological variables such as self-esteem and marital satisfaction along with its components in Iran. Methods: The study had an ex-post facto, pre-post-test design. Using purposive sampling method, a total of 30 married women, who had referred for cosmetic surgery to clinics in Tehran, were incorporated during a six-month period. Data collection instruments included Enrich Marital Satisfaction Scale and Coopersmith Self-Esteem Inventory. The obtained data were analyzed using inferential statistics (analysis of variance for repeated measures, related sample test, and Pearson correlation coefficient. Results: According to the results of this study, some components of marital satisfaction (such as marital relations, financial management, leisure, and sex and self-esteem of women before and after cosmetic surgery is statistically significant also there is a relationship betwean marital satisfaction and self-esteem, as self-esteem increases, marital satisfaction rises too. Conclusion: Performance of such surgeries always presents risks, and advice should be sought before making any decision about the surgery.

  11. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik


    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  12. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Lagro-Janssen, A. L. M.; Fischer, K.; Berghmans, L. C. M.; van der Vaart, C. H.

    To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a

  13. Between hope and fear: patient's expectations prior to pelvic organ prolapse surgery

    NARCIS (Netherlands)

    Lawndy, S.S.S.; Withagen, M.I.J.; Kluivers, K.B.; Vierhout, M.E.


    INTRODUCTION AND HYPOTHESIS: The aim of our study was to analyse the patient's expectations (fears and goals (hopes)) in women who are scheduled for pelvic organ prolapse (POP) surgery. METHODS: All consecutive women awaiting surgery for POP in a tertiary urogynaecological centre were included. A

  14. Lack of insurance and parity influence choice between long-acting reversible contraception and sterilization in women postpregnancy. (United States)

    Baldwin, Maureen K; Rodriguez, Maria I; Edelman, Alison B


    Disparities in postpregnancy contraception utilization exist, with low-income women disproportionately undergoing sterilization. We assessed the impact of increased intrauterine device (IUD) availability on rates of female sterilization. Hospital billing records were used to identify women with an IUD placement or sterilization within 1 year of a pregnancy at a university hospital between Oct 2005 and Jun 2007. Demographic data were compared between women receiving either an IUD or sterilization. There were 365 sterilizations and 223 IUD placements during the study period. IUD placements doubled over the study period from 6% to 12% of all deliveries, while sterilizations remained stable at 11% (pwomen with either public or private insurance who had financial access to both sterilization (n=253) and IUD (n=223). Women receiving sterilization were slightly older (mean age 31 years versus 30 years, p=.03), of higher parity (median three versus two, pwomen who received IUD. Approximately 45% of women delivering in Oregon in 2007 were publicly insured (2010 Maternal and Child Health Update: States Make Progress Towards Improving Systems of Care. National Governor's Association, Table 6. Available at, accessed Nov 2011). After adjusting for age, parity and type of delivery, women choosing sterilization were more likely to have public insurance than women choosing IUD (odds ratio 8.4, 95% confidence interval 4.7-14.9, pWomen choosing sterilization are more likely to have public insurance than women choosing IUD and may represent a continued trend toward nonreversible contraception among women of lower socioeconomic status despite available long-acting reversible methods. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Female sexuality and consent in public discourse: James Burt's "love surgery". (United States)

    Rodriguez, Sarah B


    Beginning in the mid-1960s, gynecologist and obstetrician James Burt developed what he called "love surgery" on unknowing women after they gave birth. It was, he later told them, a modification of episiotomy repair. In the mid-1970s, Burt began promoting love surgery as an elective sexual enhancement surgery and women came to his clinic in hopes of a surgically-enabled better sex life. But though Burt now offered love surgery, he continued to perform it on patients who did not come to him for it through the late 1980s. Over the course of more than two decades, discourse on love surgery occurred twice nationally. In the late 1970s, feminists and sex therapists attacked love surgery as altering a woman's body for male sexual pleasure. Though Burt never hid his continued use of love surgery on women who had not elected for it, the public discourse at this time focused on love surgery as a reflection of larger cultural ideas about female sexuality. In the late 1980s, when Burt's love surgery again appeared in the national media, the issue of informed consent, largely absent from the discourse about love surgery in the late 1970s, moved to the center. Though significant activity happened within the local medical and legal communities beginning in the mid-1970s regarding Burt and his practice of love surgery, my interest here is on these two periods when the discourse regarding love surgery, female sexuality, and informed consent occurred within a national frame.

  16. Breast conservation surgery versus total mastectomy among women with localized breast cancer in Soweto, South Africa (United States)

    Dietz, Donald; Rosenbaum, Evan; Murugan, Nivashni; Chih, Ming Tsai; Ayeni, Oluwatosin; Dickens, Caroline; Crew, Katherine


    Purpose Breast conserving surgery (BCS) has become the preferred surgical option for the management of patients with nonmetastatic breast cancer in high-income countries. However, little is known about the distribution and determinants of BCS in low-and middle-income countries, especially those with high HIV prevalence. Methods We compared demographic and clinical characteristics of female patients who received BCS and those who received total mastectomy (TM) for nonmetastatic invasive carcinoma of the breast in Soweto, South Africa, 2009–2011. We also developed a multivariable logistic regression model of predictors of type of surgery. Results Of 445 patients, 354 (80%) underwent TM and 91 (20%) BCS. Of 373 patients screened for HIV, 59 (15.8%) tested positive. Eighty-two of 294 patients with stage I/II disease (28%), but just 9 of 151 (6%) with stage III disease had BCS (p<0.001). All women who received BCS (except for seven who received completion mastectomy within 6 weeks of BCS) and 235 (66.4%) women who received TM were referred for radiation therapy (RT). In our multivariable analysis, age group 50–59 years (OR = 2.28, 95% CI = 1.1–4.8) and ≥70 years (OR = 9.55, 95% CI = 2.9–31.2) vs. age group <40 years, stage at diagnosis (stage II (OR = 3.79, 95% CI = 1.6–8.2) and stage III (OR = 27.8, 95% CI = 9.0–78.8) vs. stage 1, HIV (HIV positive (OR = 3.19, 95% CI = 1.3–7.9) vs. HIV negative) and HER2-enriched subtype (OR = 3.50, 95% CI = 1.2–10.1) vs. triple negative were independently associated with TM. Conclusion TM was more common than BCS among patients with nonmetastatic breast cancer in Soweto, not only among patients with locally advanced disease at diagnosis, but also among women with stage I and II disease. PMID:28797046

  17. Women in computer science: An interpretative phenomenological analysis exploring common factors contributing to women's selection and persistence in computer science as an academic major (United States)

    Thackeray, Lynn Roy

    The purpose of this study is to understand the meaning that women make of the social and cultural factors that influence their reasons for entering and remaining in study of computer science. The twenty-first century presents many new challenges in career development and workforce choices for both men and women. Information technology has become the driving force behind many areas of the economy. As this trend continues, it has become essential that U.S. citizens need to pursue a career in technologies, including the computing sciences. Although computer science is a very lucrative profession, many Americans, especially women, are not choosing it as a profession. Recent studies have shown no significant differences in math, technical and science competency between men and women. Therefore, other factors, such as social, cultural, and environmental influences seem to affect women's decisions in choosing an area of study and career choices. A phenomenological method of qualitative research was used in this study, based on interviews of seven female students who are currently enrolled in a post-secondary computer science program. Their narratives provided meaning into the social and cultural environments that contribute to their persistence in their technical studies, as well as identifying barriers and challenges that are faced by female students who choose to study computer science. It is hoped that the data collected from this study may provide recommendations for the recruiting, retention and support for women in computer science departments of U.S. colleges and universities, and thereby increase the numbers of women computer scientists in industry. Keywords: gender access, self-efficacy, culture, stereotypes, computer education, diversity.

  18. The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes. (United States)

    Tan, Orkun; Carr, Bruce R


    Obesity-related infertility is one of the most common problems of reproductive-age obese women who desire childbearing. The various types of bariatric surgeries have proved effective in controlling excessive weight gain, improving fertility, and preventing certain maternal and fetal complications in these women. This article summarizes the current evidence regarding the impact of bariatric surgery on obesity-related infertility and in vitro fertilization (IVF) outcomes. We have also attempted to draw conclusions about maternal and fetal risks and the benefits of bariatric surgery. Laparoscopic adjustable gastric banding and Roux-en-Y procedures are the two most commonly performed bariatric surgeries. Bariatric surgery was believed to improve menstrual irregularity and increase ovulation rate in anovulatory obese women, which lead to increased pregnancy rates. Although there are data in the literature suggesting the improvement of both the ovulatory function and the spontaneous pregnancy rates in obese women who lost weight after bariatric surgery, most of these are case-control studies with a small number of patients. The data are insufficient to determine an ideal time interval for pregnancy after bariatric surgery; however, the general consensus is that pregnancy should be delayed 12 to 18 months after bariatric surgery to avoid nutritional deficiencies. Few data exist regarding IVF success rates in women who have undergone bariatric surgery. One pairwise study discussed five patients who underwent bariatric surgery followed by IVF that resulted in three term pregnancies in three patients after the first IVF cycle. Many studies reported reductions in obesity-related pregnancy complications such as gestational diabetes and hypertensive disorders after bariatric surgery. Although data are inconsistent, some studies reported increased rate of preterm delivery and small for gestational age infants after bariatric surgery. Pregnancies after bariatric surgery may be

  19. Women's motivation to become dentists in Brazil. (United States)

    Kfouri, Maria G; Moyses, Samuel J; Moyses, Simone Tetu


    There has been a marked increase of women in dentistry in Brazil and in many countries around the world. The behavioral mechanisms behind the choice of career differ between men and women, and the inclination to care for others is thought by some to be more present in women than it is in men. This article discusses the reasons that lead women to choose dentistry as a profession in Brazil and the impact of feminization on the current and future profile of the profession, based on the ethics of care. The authors' review of the relevant literature published between 2000 and 2011, primarily in Brazil, suggests that whereas men have tended to choose dentistry as a good business opportunity, women have tended to base their decision on relations with other people and the flexibility of practicing the profession. Many women dentists have been found to decide to work fewer hours, report more interruptions in their activities, and have less preference to work in private practice than men dentists. In the view of service users and dental auxiliaries in Brazil, women dentists invest more time in their patients and communicate in a more pleasant, sensitive, and friendly manner. The conclusion suggests that characteristics often associated with women can affect the dental profession in Brazil by introducing greater concern with the promotion of health and other people's well-being in contrast to traditional dentistry based on curative procedures.

  20. Consideration of Cosmetic Surgery As Part of Women’s Benefit-Provisioning Mate Retention Strategy

    Directory of Open Access Journals (Sweden)

    Mohammad Atari


    Full Text Available Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women’s consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective.

  1. Consideration of Cosmetic Surgery As Part of Women’s Benefit-Provisioning Mate Retention Strategy (United States)

    Atari, Mohammad; Barbaro, Nicole; Sela, Yael; Shackelford, Todd K.; Chegeni, Razieh


    Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women’s consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women) in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective. PMID:28855884

  2. Current interest in careers in surgery and cardiothoracic surgery from the millennial generation. (United States)

    Ghannam, Michael; Zhao, Lili; Reddy, Rishindra M


    Interest in cardiothoracic surgery (CTS) as a career has decreased over the past decade. Anecdotal evidence suggests that many surgeons develop an interest in CTS before medical school and even before college. This study evaluates the interest of high-school students at a magnet high school, with regard to careers in medicine, in surgery, and in CTS. A survey assessing career interests and values was conducted among junior and senior high-school students. Students were given a 1-hour presentation by a cardiothoracic (CT) surgeon on the postgraduate training process and then completed a postpresentation survey. A magnet math and science high school, the Kalamazoo Area Mathematics and Science Center. Of 128 students, 117 (91% response rate) completed the survey. Overall, 38% of students reported having a high interest in medicine; of this group, 58% reported a high interest in surgery and 36% reported having a high interest in CTS. Men were more likely than women were to have a high interest in surgery and CTS (p < 0.001). Students with at least 1 family member as a physician vs those without were more likely to be interested in medicine, surgery, and CTS and also have a higher level of concern for postgraduation debt (p < 0.01). Women were more likely than men were to have a high level of concern about postgraduation debt (p = 0.018). After a presentation by a CT surgeon, students showed no changes in interest in medicine careers but did report an increased level of knowledge about the process of becoming a CT surgeon, going from 31% to 72%. There exists a large interest in both surgery and CTS at the high-school level, but there may be a need for more active outreach to maintain and foster their interest in surgery and CTS through undergraduate and medical school. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. "What motivates her": motivations for considering labial reduction surgery as recounted on women’s online communities and surgeons’ websites

    NARCIS (Netherlands)

    Zwier, S.


    Introduction Increasing numbers of women are seeking labial reduction surgery. We studied the motivations for considering labial reduction surgery as recounted on women's online communities and surgery provider's websites. Aims The study analyzed motivations for considering labial reduction surgery

  4. Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

  5. Depo-Provera (depot medroxyprogesterone acetate) use after bariatric surgery. (United States)

    Lam, Clarissa; Murthy, Amitasrigowri S


    In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m 2 and 29.9 kg/m 2 ) or obese (body mass index >30 kg/m 2 ). In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA) and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE). The obesity-associated increase in VTE should be mitigated by surgically induced weight loss. The concurrent use of DMPA in the post bariatric surgical period should not further increase the risk of VTE.

  6. Breast magnetic resonance imaging for surveillance of women with a personal history of breast cancer: outcomes stratified by interval between definitive surgery and surveillance MR imaging. (United States)

    Park, Vivian Youngjean; Kim, Eun-Kyung; Kim, Min Jung; Moon, Hee Jung; Yoon, Jung Hyun


    Women with a personal history of breast cancer are at increased risk of future breast cancer events, and may benefit from supplemental screening methods that could enhance early detection of subclinical disease. However, current literature on breast magnetic resonance (MR) imaging surveillance is limited. We investigated outcomes of surveillance breast magnetic resonance (MR) imaging in women with a personal history of breast cancer. We reviewed 1053 consecutive breast MR examinations that were performed for surveillance in 1044 women (median age, 53 years; range, 20-85 years) previously treated for breast cancer between August 2014 and February 2016. All patients had previously received supplemental surveillance with ultrasound. Cancer detection rate (CDR), abnormal interpretation rate and characteristics of MR-detected cancers were assessed, including extramammary cancers. We also calculated the PPV 1 , PPV 3 , sensitivity and specificity for MR-detected intramammary lesions. Performance statistics were stratified by interval following initial surgery. The CDR for MR-detected cancers was 6.7 per 1000 examinations (7 of 1053) and was 3.8 per 1000 examinations (4 of 1053) for intramammary cancers. The overall abnormal interpretation rate was 8.0%, and the abnormal interpretation rate for intramammary lesions was 7.2%. The PPV 1 , PPV 3 , sensitivity and specificity for intramammary lesions was 5.3% (4 of 76), 15.8% (3 of 19), 75.0% (3 of 4) and 98.3% (1031 of 1049), respectively. For MR examinations performed ≤36 months after surgery, the overall CDR was 1.4 per 1000 examinations. For MR examinations performed > 36 months after surgery, the overall CDR was 17.4 per 1000 examinations. Surveillance breast MR imaging may be considered in women with a history of breast cancer, considering the low abnormal interpretation rate and its high specificity. However, the cancer detection rate was low and implementation may be more effective after more than 3

  7. Pregnancy after bariatric surgery: the effect of time-to-conception on pregnancy outcomes. (United States)

    Yau, Patricia O; Parikh, Manish; Saunders, John K; Chui, Patricia; Zablocki, Tara; Welcome, Akuezunkpa Ude


    At our medical center, female patients who have undergone bariatric surgery are advised to defer pregnancy for 2 years after surgery to avoid the following complications and their potential consequences for the fetus: inadequate gestational weight gain, inadequate postsurgical weight loss, hyperemesis gravidarum, nutritional deficiencies, gestational diabetes, and gestational hypertension. To examine the effect of time from surgery to conception on pregnancy course and outcomes in bariatric patients. University. We identified 73 pregnancies in 54 women who became pregnant after undergoing bariatric surgery. Surgery to conception interval was compared between pregnancies that were carried to delivery and 8 pregnancies that resulted in spontaneous abortion. Of 41 pregnancies that were carried to delivery, 26 occurred in women who had undergone surgery less than 2 years before conception, and 15 occurred in women who had undergone surgery greater than 2 years before conception. Gestational age at delivery, number of neonatal intensive care unit admissions, gestational weight gain, hyperemesis gravidarum, nutritional deficiencies, gestational diabetes, and gestational hypertension during pregnancy were compared for the 2 groups. Eight patients who had spontaneous abortion had a significantly shorter time from surgery to conception. There were no significant differences between our 2 groups in rates of preterm deliveries, neonatal intensive care unit admission, gestational weight gain, hyperemesis, nutritional deficiencies, gestational diabetes, or gestational hypertension. Becoming pregnant within the first 2 years after bariatric surgery appears to have no effect on pregnancy course and outcomes. Women who miscarried had a significantly lower mean surgery to conception interval. These results fail to show an increased rate of pregnancy complications during the first 2 years after bariatric surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by

  8. How traumatic is breast cancer? Posttraumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer

    DEFF Research Database (Denmark)

    O'Connor, Maja; Christensen, Søren; Jensen, Anders Bonde


    for primary breast cancer. Methods: Sixty-eight percent of all Danish women receiving surgery for primary breast cancer between October 2001 to March 2004 completed a questionnaire 3 months post-surgery (n=3343), which included the Impact of Event Scale (IES). Ninety-four percent of the disease-free women......The literature shows considerable between-study variation in the prevalence of Post-traumatic Stress Symptoms (PTSS) among women with breast cancer. Our aim was therefore to explore the prevalence of and risk factors for cancer-related PTSS in a nationwide inception cohort of women treated...... physical and mental illness, axillary lymph node involvement (>3), and reduced physical functioning at 3 months. Conclusion: The results confirm that receiving a breast cancer diagnosis can be a significant traumatic experience, and that many women experience persistent cancer-related PTSS. Low social...

  9. Textual Analysis of General Surgery Residency Personal Statements: Topics and Gender Differences. (United States)

    Ostapenko, Laura; Schonhardt-Bailey, Cheryl; Sublette, Jessica Walling; Smink, Douglas S; Osman, Nora Y


    Applicants to US general surgery residency training programs submit standardized applications. Applicants use the personal statement to express their individual rationale for a career in surgery. Our research explores common topics and gender differences within the personal statements of general surgery applicants. We analyzed the electronic residency application service personal statements of 578 applicants (containing 3,82,405 words) from Liaison Committee on Medical Education-accredited medical schools to a single ACGME-accredited general surgery program using an automated textual analysis program to identify common topics and gender differences. Using a recursive algorithm, the program identified common words and clusters, grouping them into topic classes, which are internally validated. We identified and labeled 8 statistically significant topic classes through independent review: "my story," "the art of surgery," "clinical vignettes," "why I love surgery," "residency program characteristics," "working as a team," "academics and research," and "global health and policy." Although some classes were common to all applications, we also identified gender-specific differences. Notably, women were significantly more likely than men to be represented within the class of "working as a team." (p differences between the statements of men and women. Women were more likely to discuss surgery as a team endeavor while men were more likely to focus on the details of their surgical experiences. Our work mirrors what has been found in social psychology research on gender-based differences in how men and women communicate their career goals and aspirations in other competitive professional situations. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Arguments for and against a career in surgery: a qualitative analysis. (United States)

    Businger, Adrian; Villiger, Peter; Sommer, Christoph; Furrer, Markus


    To evaluate arguments given by board-certified surgeons in Switzerland for and against a career in surgery. Currently, the surgical profession in most Western countries is experiencing a labor shortage because of a declining interest in a surgical career among new graduates, a changed public opinion of medicine and its representatives, and as a consequence of the increasing influence of health economists and politicians on the professional independence of surgeons. Reports that focus primarily on the reasons that board-certified surgeons remain within the surgical profession are rare. Surgeons were asked to answer 2 questions concerning arguments for and against a career in surgery. Of 749 surgeons the arguments of 334 (44.6%) were analyzed using Mayring's content analysis. The surgeons were also asked whether they would choose medicine as a career path again. The 334 participating surgeons provided 790 statements for and 981 statements against a career in surgery. Fifty-nine surgeons (17.7%) would not choose medicine as a career again. Mayring's content analysis of the statements yielded 10 categories with arguments both for and against a career in surgery. "Personal Experience in Daily Professional Life" (18.7%) was the top-ranked category in favor of a career in surgery, and "Specific Training Conditions" (20%) was the top-ranked category against the choice of such a career. Ordinal logistic regression showed that the category "Personal Experience in Daily Professional Life" (OR, 2.39; 95%CI, 1.13-5.07) was independently associated with again studying medicine, and the category "Work-life Balance" (OR, 0.37; 95%CI, 0.20-0.70) was associated with not studying medicine again. This qualitative study revealed unfavorable working conditions and regulations as surgeons' main complaints. It is concluded that new organizational frameworks and professional perspectives are required to retain qualified and motivated surgeons in the surgical profession.

  11. Factors Influencing Japanese Women to Choose Two-Year Colleges in Japan (United States)

    Anzai, Shinobu; Paik, Chie Matsuzawa


    Two-year colleges in Japan have traditionally absorbed the major portion of female college entrants due to long-held gender stereotypes. Recently, Japanese women began to explore selfhood outside the traditional realm of marriage and motherhood. However, two-year colleges in Japan today continue to enroll mostly female students and few male…

  12. Does pregnancy influence long-term results of bariatric surgery? (United States)

    Quyên Pham, Thu; Pigeyre, Marie; Caiazzo, Robert; Verkindt, Hélène; Deruelle, Philippe; Pattou, François


    Bariatric surgery is performed mostly on obese women of reproductive age. Many authors have studied pregnancy outcomes after bariatric surgery. Only a small number of studies have analyzed the impact of maternity on the results of bariatric surgery. To study the effect of pregnancy on long-term outcomes of bariatric surgery. Lille University Hospital. A retrospective study was conducted on 591 women aged 18 to 42 years who had undergone laparoscopic adjustable gastric band (LAGB) surgery or laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery between 1996 and 2012. A comparison of the results after a 5-year follow-up was performed between patients who became pregnant after their bariatric surgery (pregnant group, n = 84) and postoperative nonpregnant women (nonpregnant group, n = 507). At the 5-year visit, 84.8% patients were seen. The preoperative body mass index (BMI) was the same in the 2 groups (pregnant group: 47.8±6.9 kg/m(2); nonpregnant group: 47.5±7.2 kg/m(2); P = .755). The percentage of excess weight loss (%EWL) was lower in the pregnant group at 2 years (pregnant group = 45.9±24.6%; nonpregnant group = 56.9±28.6%, P = .002) but was similar at 5 years (47.7±27.7% versus 49.9±28.9%, P = .644). The decrease in co-morbidities was similar after 5 years. The gestational weight gain (GWG) was higher when the band was deflated during pregnancy (GWG =+12.7±10.5 kg) compared to the band without fluid removal (GWG =+4.9±7 kg) or laparoscopic Roux-en-Y gastric bypass (GWG =+4.4±1.1 kg) (Pbariatric surgery slows down postoperative weight loss but does not affect weight results at 5-year follow-up. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients (United States)

    Mahony, David


    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  14. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B


    .001), excessive weight loss in men, and younger age in women (p vitamin B12 increased from before surgery to 24 months after surgery (p Vitamin D increased from baseline to month 24 in both...... months after surgery. Daily supplement of 800 mg calcium, 800 U vitamin D, a multivitamin, and a vitamin B12 injection (1 mg) every third month was recommended. In subjects with low ferritin and decreasing hemoglobin levels, oral, or intravenous iron was administered. RESULTS: Hemoglobin concentration...... sexes (p vitamin D was sufficient. Iron substitution did not prevent anemia, which especially affected premenopausal women. More attention should...

  15. Digging up Classroom Dollars on DonorsChoose (United States)

    Curriculum Review, 2006


    Back in 2000, Charles Best was teaching at Wings Academy, an alternative high school in the Bronx, when he got the idea for a Web site where teachers could solicit donations for class projects. With help from his students, soon was born. Last year, the site won's Nonprofit Innovation Award. So far, DonorsChoose has…

  16. Carcinoma of the urethra in women

    International Nuclear Information System (INIS)

    Grigsby, Perry W.


    Purpose: This analysis was performed to evaluate the influence of clinical and treatment factors on local tumor control, survival, and complications for women with urethral carcinoma. Methods and Materials: The records of 44 women with carcinoma of the urethra were reviewed. Their age ranged from 37 to 89 years (mean, 67 years). Mean follow-up time was 8.25 years. The stages of disease were T1 in eight, T2 in five, T3 in 22, and T4 in nine. Treatment was with surgery in 7, radiotherapy in 25, and combined surgery and radiotherapy in 12. Results: The 5-year overall survival was 42% and the 5-year cause-specific survival was 40%. At the time of last follow-up, 11 women were alive and 33 were dead. Recurrence of tumor occurred in 27 women and was the cause of death for 23. Recurrence was local in 8, local and distant in 15, and distant in 4. Severe complications occurred in nine women (20%). The severe complication rate was 29% (2 of 7) for women treated with surgery, 24% (6 of 25) for women treated with radiotherapy, and 8% (1 of 12) for women treated with surgery and radiotherapy. A multivariate analysis was performed to evaluate the interaction of tumor size, histology, and location, and lymph node status. This analysis indicated that tumor size and histology were independent prognostic factors for survival and local tumor control. Adenocarcinoma occurred in 13 women, and none of them were alive at 5 years. Only 1 of 10 women with tumors greater than 4 cm was alive at 5 years. Conclusions: The most significant clinical factors affecting prognosis were tumor size and histology. Tumor location was not an independent prognostic variable. None of the women with adenocarcinoma, and only one woman with a tumor greater than 4 cm was alive at 5 years, irrespective of modality of treatment. Aggressive treatment resulted in a high complication rate

  17. [Severe vaginal discharge following rectal surgery]. (United States)

    Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B


    Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

  18. Sociosexuality predicts women's preferences for symmetry in men's faces. (United States)

    Quist, Michelle C; Watkins, Christopher D; Smith, Finlay G; Little, Anthony C; Debruine, Lisa M; Jones, Benedict C


    Although men displaying cues of good physical condition possess traits that are desirable in a mate (e.g., good health), these men are also more likely to possess antisocial characteristics that are undesirable in a long-term partner (e.g., aggression and tendency to infidelity). How women resolve this trade-off between the costs and benefits associated with choosing a mate in good physical condition may lead to strategic variation in women's mate preferences. Because the costs of choosing a mate with antisocial personality characteristics are greater in long- than short-term relationships, women's sociosexuality (i.e., the extent to which they are interested in uncommitted sexual relationships) may predict individual differences in their mate preferences. Here we investigated variation in 99 heterosexual women's preferences for facial symmetry, a characteristic that is thought to be an important cue of physical condition. Symmetry preferences were assessed using pairs of symmetrized and original (i.e., relatively asymmetric) versions of 10 male and 10 female faces. Analyses showed that women's sociosexuality, and their sociosexual attitude in particular, predicted their preferences for symmetry in men's, but not women's, faces; women who reported being more interested in short-term, uncommitted relationships demonstrated stronger attraction to symmetric men. Our findings present new evidence for potentially adaptive variation in women's symmetry preferences that is consistent with trade-off theories of attraction.

  19. Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence. (United States)

    Edmunds, Laurel D; Ovseiko, Pavel V; Shepperd, Sasha; Greenhalgh, Trisha; Frith, Peggy; Roberts, Nia W; Pololi, Linda H; Buchan, Alastair M


    Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for women's choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals' career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The effect of education given before surgery on self-esteem and body image in women undergoing hysterectomy

    Directory of Open Access Journals (Sweden)

    Şengül Yaman


    Full Text Available Objective: To evaluate the effect of information provided before surgery on the self-esteem and body image of women undergoing hysterectomy. Materials and Methods: The study had a semi-experimental design with pre-post tests. A total of 60 women were included in the study and divided into two groups, the intervention group (n=30 and control group (n=30. A questionnaire, the Rosenberg self-esteem scale, and the body image scale were used to collect data. Results: The pre- and post-test body image scores were similar in the intervention group patients, but the post-test scores were significantly higher in the control group (p<0.05. The pre- and post-test self-esteem scores were again similar in the intervention group, but the post-test scores were significantly lower in the control group (p<0.05. Conclusion: This study revealed that health education given to patients prior to hysterectomy protects body image and consequently self-esteem.

  1. Persuading Iranian Women toward Normal Vaginal Delivery: Using Pictorial Perception of the Labour Process

    Directory of Open Access Journals (Sweden)

    Safieh Kananikandeh


    CONCLUSION: Pictorial education could be effective on the intention of women to choose natural vaginal delivery among pregnant women, and it can be used as an effective training technique for developing health literacy, enhancing self-efficacy and decision-making power of women in the delivery.

  2. Hearing Aids: How to Choose the Right One (United States)

    Hearing aids: How to choose the right one Many types of hearing aids exist. So which is best for you? Find out what to consider when choosing a hearing ... used to the device and decide if it's right for you. Have the dispenser put in writing ...

  3. Laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse after failed transvaginal polypropylene mesh surgery. (United States)

    Schmid, Corina; O'Rourke, Peter; Maher, Christopher


    A prospective case series to assess the safety and efficacy of laparoscopic sacrocolpopexy for the surgical management of recurrent pelvic organ prolapse (POP) after transvaginal polypropylene mesh prolapse surgery. Between January and December 2010, women with post-hysterectomy recurrent prolapse (≥ stage 2 POP-Q) after transvaginal polypropylene mesh prolapse surgery were included. Perioperative morbidity and short-term complications were recorded and evaluated. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification system (POP-Q), the validated, condition-specific Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I) at 12 months. All 16 women in this study had undergone surgery with trocar-guided transvaginal polypropylene mesh kits. In 75% the recurrent prolapse affected the compartment of prior mesh surgery with the anterior (81%) and apical (75%) compartment prolapse predominating. At a mean follow-up of 12 months, all women had resolution of awareness of prolapse, had transvaginal mesh surgery is feasible and safe. Further widespread evaluation is required.

  4. Mabel Lee and Louise Pound: The University of Nebraska's Battle Over Women's Intercollegiate Athletics

    National Research Council Canada - National Science Library

    Kristi, Lowenthal


    .... Pound flouted Victorian restraints and refused to enter the women's "separate sphere" of household duties, choosing instead to defeat both men and women at golf, tennis, cycling, and a variety of other sports...

  5. The Customer Cannot Choose

    NARCIS (Netherlands)

    A.C.D. Donkers (Bas)


    textabstractPeople can choose and they make many choices each and every day. However, most people are unaware of how strong their environment influences the choices they make. In his inaugural address, Bas Donkers highlights the impact of what people see (and what they don’t see), what people

  6. Choosing and Using Images in Environmental Science Education (United States)

    Muthersbaugh, Debbie Smick


    Although using images for teaching has been a common practice in science classrooms (Gordon & Pea, 1995) understanding the purpose or how to choose images has not typically been intentional. For this dissertation three separate studies relating to choosing and using images are prepared with environmental science in mind. Each of the studies…

  7. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida


    Medicine Database). Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester......OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA). RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351) days. The mean "fetal...

  8. Depo-Provera (depot medroxyprogesterone acetate use after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lam C


    Full Text Available Clarissa Lam,1 Amitasrigowri S Murthy2,3 1New York University School of Medicine, 2Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine, 3New York University Langone Medical Center, New York, NY, USA Abstract: In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2 or obese (body mass index >30 kg/m2. In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE. The

  9. Management of occult stress urinary incontinence with prolapse surgery. (United States)

    Al-Mandeel, H; Al-Badr, A


    Pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are two common health-related conditions, each affecting up to 50% women worldwide. Stress urinary incontinence only observed after the reduction of co-existent prolapse is called occult SUI (OSUI), and is found in up to 80% of women with advanced POP. Although there is no consensus on how to diagnose OSUI, there are several reported methods to better diagnose. Counseling symptomatically continent women with POP concerning the potential risk for developing SUI postoperatively cannot be overstated. Evidence suggests that positive OSUI in symptomatically continent women who are planning to have POP repair is associated with a high risk of POSUI, furthermore, adding continence procedure is found to reduce postoperative SUI. Therefore, adding continence surgery at the time of POP surgery in patients who are found to have OSUI preoperatively is advocated.

  10. Attachment and couple satisfaction as predictors of expressed emotion in women facing breast cancer and their partners in the immediate post-surgery period. (United States)

    Favez, Nicolas; Cairo Notari, Sarah; Antonini, Tania; Charvoz, Linda


    To investigate expressed emotion (EE) in couples facing breast cancer in the immediate post-surgery period. EE may be predictive of psychological disturbances that hinder both partners' capacities to cope with the stress of the disease. Severity of the disease, attachment tendencies, and couple satisfaction were tested as predictors of EE. The design was cross-sectional. Couples (N = 61) were interviewed 2 weeks after the women's breast surgery. Expressed emotion was assessed in women and in partners with the Five-Minute Speech Sample, with a focus on overt and covert criticisms. Self-reported EE, attachment tendencies, and couple satisfaction were assessed with questionnaires. Hierarchical regression analyses were performed to test the predictors and possible interactions between them. Both partners expressed overt and covert criticisms; women expressed more overt criticisms than did their partners. Cancer stage was inversely related to the number of overt criticisms in women and to the number of covert criticisms in partners. Regression analyses showed that in women, higher attachment anxiety and lower couple satisfaction were positive predictors of overt criticisms; in partners, a higher cancer stage was a negative predictor of overt and covert criticisms. Practitioners should pay attention to the couple relationship in breast cancer. EE is most likely to appear when the cancer stage is low, showing that even when the medical prognosis is optimal, relational and emotional disturbances may occur. Statement of contribution What is already known on this subject? The couple relationship is of paramount importance in breast cancer. Expressed emotion (EE) is related to negative individual and relational psychological outcomes in psychiatric and somatic diseases. Expressed emotion has not yet been studied in the context of breast cancer. What does this study add? Expressed emotion is present in breast cancer situations, especially when the cancer stage is low. There

  11. Between hope and fear: patient's expectations prior to pelvic organ prolapse surgery. (United States)

    Lawndy, Sameh S S; Withagen, Mariella I; Kluivers, Kirsten B; Vierhout, Mark E


    The aim of our study was to analyse the patient's expectations (fears and goals (hopes)) in women who are scheduled for pelvic organ prolapse (POP) surgery. All consecutive women awaiting surgery for POP in a tertiary urogynaecological centre were included. A short questionnaire with two open questions on goals and fears with regard to the operation was used. Ninety-six out of 111 distributed questionnaires (86%) were analysed. Goals and fears were categorized into five groups. De novo symptoms (63%), POP recurrence (34%) and surgical complications (29%) were the most important fears. Symptom release (96%), improved lifestyle (physical capabilities; 30%) and improved sexual life (18%) were important goals. A wide variety of expectations both positive and negative can be found in women before POP surgery and should be an integral part of preoperative counselling. Achieving the individual goals as based on expectations, positive (goals) and negative (fears), should be part of the POP surgery evaluation.

  12. Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective.

    Directory of Open Access Journals (Sweden)

    Margrit Löbner

    Full Text Available This study aims to investigate (1 motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2 how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation three months after disc surgery.The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation, follow-up interviews three months later (post-rehabilitation. Binary logistic regression and multiple linear regression analyses were applied.(1 Motives, motivations and expectations: Inpatient rehabilitation (IPR patients stated "less effort/stress" (40.9%, more "relaxation and recreation" (39.1% and greater "intensity of care and treatment" (37.0% regarding their setting preference, whereas outpatient rehabilitation (OPR patients indicated "family reasons" (45.3%, the wish for "staying in familiar environment" (35.9% as well as "job-related reasons" (11.7% as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p < .001, health (p < .05, coping (p < .001, retirement/job (p < .01, psychological burden (p < .05 and physical burden (p < .001 compared to OPR patients. (2 Associations with rehabilitation outcome: Besides other factors (e.g. age, gender and educational level rehabilitation-related motivations/expectations were significantly associated with rehabilitation outcome measures. For example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p < .01 three months after disc surgery. Less motivations/expectations to achieve improvements regarding "psychological burden" was linked to a better mental health status (p < .001 and a

  13. A systematic approach to developing a global surgery elective. (United States)

    Hoehn, Richard S; Davis, Bradley R; Huber, Nathan L; Edwards, Michael J; Lungu, Douglas; Logan, Jocelyn M


    Interest in global health has been increasing for years among American residents and medical students. Many residency programs have developed global health tracks or electives in response to this need. Our goal was to create a global surgery elective based on a synergistic partnership between our institution and a hospital in the developing world. We created a business plan and 1-year schedule for researching potential sites and completing a pilot rotation at our selected hospital. We administered a survey to general surgery residents at the University of Cincinnati and visited medical facilities in Sierra Leone, Cameroon, and Malawi. The survey was given to all general surgery residents. A resident and a faculty member executed the fact-finding trip as well as the pilot rotation. Our general surgery residents view an international elective as integral to residency training and would participate in such an elective. After investigating 6 hospitals in sub-Saharan Africa, we conducted a pilot rotation at our selected hospital and gained the necessary information to organize a curriculum. We will begin sending senior residents for 8-week rotations in the coming academic year. By systematically approaching the process of creating a global surgery elective, we were able to gain considerable insight into choosing a location and organizing the elective. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  14. Short convalescence after vaginal prolapse surgery

    DEFF Research Database (Denmark)

    Ottesen, Marianne; Sørensen, Mette; Kehlet, Henrik


    OBJECTIVE: Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996-98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999-2000 at a Danish University...... Hospital. METHODS: The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast-track setting using a multimodal rehabilitation model with well-defined recommendations...... exceeding 10 kg. Limiting factors were fatigue and pain. The 1-year subjective recurrence rate was 17%. CONCLUSION: Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1-3 weeks with a multimodal rehabilitation model...

  15. Nutrition in Pregnancy Following Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Christopher Slater


    Full Text Available The widespread use of bariatric surgery for the treatment of morbid obesity has led to a dramatic increase in the numbers of women who become pregnant post-surgery. This can present new challenges, including a higher risk of protein and calorie malnutrition and micronutrient deficiencies in pregnancy due to increased maternal and fetal demand. We undertook a focused, narrative review of the literature and present pragmatic recommendations. It is advisable to delay pregnancy for at least 12 months following bariatric surgery. Comprehensive pre-conception and antenatal care is essential to achieving the best outcomes. Nutrition in pregnancy following bariatric surgery requires specialist monitoring and management. A multidisciplinary approach to care is desirable with close monitoring for deficiencies at each trimester.

  16. Questionnaires for Measuring Refractive Surgery Outcomes. (United States)

    Kandel, Himal; Khadka, Jyoti; Lundström, Mats; Goggin, Michael; Pesudovs, Konrad


    To identify the questionnaires used to assess refractive surgery outcomes, assess the available questionnaires in regard to their psychometric properties, validity, and reliability, and evaluate the performance of the available questionnaires in measuring refractive surgery outcomes. An extensive literature search was done on PubMed, MEDLINE, Scopus, CINAHL, Cochrane, and Web of Science databases to identify articles that described or used at least one questionnaire to assess refractive surgery outcomes. The information on content quality, validity, reliability, responsiveness, and psychometric properties was extracted and analyzed based on an extensive set of quality criteria. Eighty-one articles describing 27 questionnaires (12 refractive error-specific, including 4 refractive surgery-specific, 7 vision-but-non-refractive, and 8 generic) were included in the review. Most articles (56, 69.1%) described refractive error-specific questionnaires. The Quality of Life Impact of Refractive Correction (QIRC), the Quality of Vision (QoV), and the Near Activity Visual Questionnaire (NAVQ) were originally constructed using Rasch analysis; others were developed using the Classical Test Theory. The National Eye Institute Refractive Quality of Life questionnaire was the most frequently used questionnaire, but it does not provide a valid measurement. The QoV, QIRC, and NAVQ are the three best existing questionnaires to assess visual symptoms, quality of life, and activity limitations, respectively. This review identified three superior quality questionnaires for measuring different aspects of quality of life in refractive surgery. Clinicians and researchers should choose a questionnaire based on the concept being measured with superior psychometric properties. [J Refract Surg. 2017;33(6):416-424.]. Copyright 2017, SLACK Incorporated.

  17. [Body modifications and sexual health : Impact of tattoos, body piercing and esthetic genital plastic surgery on the sexual health of women and men]. (United States)

    Stirn, Aglaja Valentina; Zannoni, Ronja


    The present paper addresses the psychological impact of body modifications (e.g. tattoos, body piercing and esthetic genital plastic surgery) on the sexual health of individuals and refers to past and present research insights. Body modifications are understood as invasive interventions on the human body, especially interventions on the human skin which result in (semi-)permanent changes. Tattoos and body piercing (in particular genital piercing) positively affect the sexual satisfaction and the sexual appeal of men and women but there is a controversial association with high risk sexual behavior. Moreover, this article focuses on esthetic genital plastic surgery based on the increasing interest and insights of the impact on female genital self-perception and sexual behavior.

  18. Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective. (United States)

    Löbner, Margrit; Stein, Janine; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans Jörg; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G


    This study aims to investigate (1) motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2) how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation) three months after disc surgery. The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation), follow-up interviews three months later (post-rehabilitation). Binary logistic regression and multiple linear regression analyses were applied. (1) Motives, motivations and expectations: Inpatient rehabilitation (IPR) patients stated "less effort/stress" (40.9%), more "relaxation and recreation" (39.1%) and greater "intensity of care and treatment" (37.0%) regarding their setting preference, whereas outpatient rehabilitation (OPR) patients indicated "family reasons" (45.3%), the wish for "staying in familiar environment" (35.9%) as well as "job-related reasons" (11.7%) as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p job (p example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p satisfaction with rehabilitation (OR = .806; p < .05). Rehabilitation-related motivations and expectations differed substantially between IPR and OPR patients before rehabilitation and were significantly associated with rehabilitation outcome. Taking motivational and expectation-related aspects into account may help to improve allocation procedures for different rehabilitation settings and may improve rehabilitation success.

  19. Adolescent girls' views on cosmetic surgery: A focus group study. (United States)

    Ashikali, Eleni-Marina; Dittmar, Helga; Ayers, Susan


    This study examined adolescent girls' views of cosmetic surgery. Seven focus groups were run with girls aged 15-18 years (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1) dissatisfaction with appearance, (2) acceptability of cosmetic surgery, (3) feelings about undergoing cosmetic surgery and (4) cosmetic surgery in the media. Results suggest the acceptability of cosmetic surgery varies according to the reasons for having it and that the media play an important role by normalising surgery and under-representing the risks associated with it. © The Author(s) 2014.

  20. Surgery and postoperative brachytherapy for treatment of small volume uterine cervix cancer: an alternative to the standard association of utero vaginal brachytherapy + surgery

    International Nuclear Information System (INIS)

    Gallocher, O.; Thomas, L.; Pigneux, J.; Stocke, E.; Bussieres, E.; Avril, A.; Floquet, A.


    Purpose. -Evaluate the results of the treatment of small uterine cervix cancer with the association of surgery and postoperative vaginal brachytherapy, without unfavourable prognostic factors. Patients and methods. -After radical hysterectomy with lymphadenectomy, 29 women (mean age: 44 years) with carcinoma < 25 mm (26 stage IB1, 3 IIA, mean size: 15 mm) were treated by post-operative prophylactic vaginal brachytherapy using low dose rate. Ovarian transposition was performed at the surgical time in 14 young women (mean age 35 years). Results. - The actuarial specific survival rates at 5 and 10 years were 100% and 90% respectively, with a mean follow-up 75 months. Only one local recurrence was observed. The rate of grade 1 post-operative complication was 7%. The conservation rate of the ovarian function was 85% for young women. Conclusion. -Treatment of small volume uterine cervix cancer using first surgery and post-operative vaginal brachytherapy is a reliable therapeutic option. The results in terms of specific survival and complications are the same with those after standard association of preoperative utero-vaginal brachytherapy and surgery. (authors)

  1. "Big eye" surgery: the ethics of medicalizing Asian features. (United States)

    Aquino, Yves Saint James


    The popularity of surgical modifications of race-typical features among Asian women has generated debates on the ethical implications of the practice. Focusing on blepharoplasty as a representative racial surgery, this article frames the ethical discussion by viewing Asian cosmetic surgery as an example of medicalization, which can be interpreted in two forms: treatment versus enhancement. In the treatment form, medicalization occurs by considering cosmetic surgery as remedy for pathologized Asian features; the pathologization usually occurs in reference to western features as the norm. In the enhancement form, medicalization occurs by using medical means to improve physical features to achieve a certain type of beauty or physical appearance. Each type of medicalization raises slightly different ethical concerns. The problem with treatment medicalization lies in the pathologization of Asian features, which is oppressive as it continues to reinforce racial norms of appearance and negative stereotypes. Enhancement medicalization is ethically problematic because cosmetic surgery tends to conflate beauty and health as medical goals of surgery, overemphasizing the value of appearance that can further displace women's control over their own bodies. I conclude that in both forms of medicalization, cosmetic surgery seems to narrowly frame a complex psychosocial issue involving physical appearance as a matter that can be simply solved through surgical means.

  2. Determinants of career choices among women and men medical students and interns. (United States)

    Redman, S; Saltman, D; Straton, J; Young, B; Paul, C


    Women continue to be poorly represented in medical specialties other than general practice. A cross-sectional design was used to explore the development of career plans as medical training progressed; men and women students were compared in their first (n = 316), final (n = 295) and intern (n = 292) years. Women at each stage of training were significantly more likely to choose general practice as the field in which they were most likely to practise. There was little evidence that these differences were influenced by experience during training: women were as likely to choose general practice in first year as in the intern year. The most important determinant of career choice appeared to be the flexibility of training and of practice of medicine: variables such as the opportunity for part-time training, flexible working hours and part-time practice were important determinants of career choice and were of more importance to women than to men. The study also found high rates of discrimination or harassment reported by women medical students and interns. The results indicate the need for continued debate about these issues within medicine and the development of more flexible styles of medical training and practice.

  3. The influence of liver and pancreas surgery on the thyroid function

    Directory of Open Access Journals (Sweden)

    Wojciechowska-Durczynska Katarzyna


    Full Text Available Abstract Background Nowadays, the increasing number of oncologic patients with liver or pancreatic tumours are subjected to surgical treatment, as it can provide a long-term survival or sometimes cure. As a result, numerous new clinical questions regarding metabolic disturbances in these patients have been arisen. Among others, the impact of the pancreas and liver surgery extent in relation to the thyroid function remains to be elucidated. Materials and methods The study comprised 51 patients (25 men and 26 women, mean age ± SD 61.6 ± 10.4 yrs, mean ± SD with pancreatic or liver tumours, qualified for abdominal operation. Serum levels of FT3, FT4 and TSH were measured on the day before (time “0” and on the 1st, 3rd and 5th day after surgery in two (2 subgroups reflecting the extent of surgery: twenty seven (27 patients (14 men and 13 women, mean age ± SD 61.5 ± 11.8 yrs after major surgery (Whipple’s surgery, right and left hemihepatectomy, segmentectomy of the liver, distal pancreatectomy, total duodenopancreatectomy and twenty four (24 patients (11 men and 13 women, mean age ± SD 61.8 ± 8.9 yrs after minor, palliative surgery (exploratory laparotomy, gastroenterostomy, triple by-pass, liver tumour embolization, hepaticojejunostomy. Additionally, the obtained results were analyzed in relation to the type of the disease (pancreatic surgery vs liver surgery. Results Mean serum FT3 level decreased significantly during the study in major and minor surgery subgroups (prd and 5th day after major surgery was lower in pancreatic tumour patients in comparison to liver tumour patients (p=0.002, p=0.032, respectively. Similarly, mean FT3 concentration on the 3rd day in minor surgery subgroup was lower in pancreatic tumour patients in comparison to liver tumour patients (p=0.015. Discussion Our findings have confirmed essential reduction of FT3 values after abdominal surgery, independently of surgery extent. Additionally, pancreatic tumour

  4. Value of freedom to choose encoded by the human brain (United States)

    Fujiwara, Juri; Usui, Nobuo; Park, Soyoung Q.; Williams, Tony; Iijima, Toshio; Taira, Masato; Tsutsui, Ken-Ichiro


    Humans and animals value the opportunity to choose by preferring alternatives that offer more rather than fewer choices. This preference for choice may arise not only from an increased probability of obtaining preferred outcomes but also from the freedom it provides. We used human neuroimaging to investigate the neural basis of the preference for choice as well as for the items that could be chosen. In each trial, participants chose between two options, a monetary amount option and a “choice option.” The latter consisted of a number that corresponded to the number of everyday items participants would subsequently be able to choose from. We found that the opportunity to choose from a larger number of items was equivalent to greater amounts of money, indicating that participants valued having more choice; moreover, participants varied in the degree to which they valued having the opportunity to choose, with some valuing it more than the increased probability of obtaining preferred items. Neural activations in the mid striatum increased with the value of the opportunity to choose. The same region also coded the value of the items. Conversely, activation in the dorsolateral striatum was not related to the value of the items but was elevated when participants were offered more choices, particularly in those participants who overvalued the opportunity to choose. These data suggest a functional dissociation of value representations within the striatum, with general representations in mid striatum and specific representations of the value of freedom provided by the opportunity to choose in dorsolateral striatum. PMID:23864380

  5. Women's career choices in chemistry: Motivations, perceptions, and a conceptual model (United States)

    Grunert, Megan L.

    Statistics showing the under-representation of women at all levels within the physical sciences abound, particularly at the graduate and faculty levels. Women chemists choosing an academic career tend to select teaching institutions over research institutions. This study examined women at the graduate and faculty levels through interviews and the construction of participant narratives to better understand why many women opt out of a career in academic research. Specific attention was paid to women's decision-making processes and what motivates women to choose careers, the rewards and challenges associated with different careers, and the perception of different careers contribute to their decisions. The participant narratives were analyzed on a cross-case basis and constructivist grounded theory was used to develop a model about women's decision-making regarding their careers. Additionally, preliminary work has suggested that graduate students have inaccurate perceptions of careers in academia. Interviews with faculty at teaching and research institutions provided a clearer picture of what each type of career entails. Career-choice motivators, rewards, and challenges were identified for each of the faculty groups. It was found that graduate student women have inaccurate perceptions of academic research careers, which affects how they make career decisions. A model of career choice shows interactions between motivation and perception that guide the career decision-making process. By better understanding these women and their motivations, changes can be made to foster inclusion and accommodation for women and other underrepresented groups in academic chemistry.

  6. Melting the Plastic Ceiling: Overcoming Obstacles to Foster Leadership in Women Plastic Surgeons. (United States)

    Silva, Amanda K; Preminger, Aviva; Slezak, Sheri; Phillips, Linda G; Johnson, Debra J


    The underrepresentation of women leaders in plastic surgery echoes a phenomenon throughout society. The importance of female leadership is presented, and barriers to gender equality in plastic surgery, both intrinsic and extrinsic, are discussed. Strategies for fostering women in leadership on an individual level and for the specialty of plastic surgery are presented.

  7. Free to choose. The Buddhist view. (United States)

    Gnanawimala, B


    This Buddhist view of family planning is presented by a lecturer at the Buddhist and Pali University in Colombo. Birth control was not mentioned in the earliest Buddhist teachings because there was no urgency for population control. Large families were honored, and the expectation was that as many children as possible should be produced. Buddha did not mention the merits of population increase. Buddha considered family size a personal family choice. Buddhist's disciples are expected to be celibate. Chastity is encouraged among men and women. The Dhammapada, a canonical work of Buddha, mentions not increasing population and teaches ways of keeping the mind free from lust. Reduction of births is recommended. Buddha placed importance on the right of human beings to exist and procreate peacefully. The right to life begins in the womb, and abortion is a violation of the rights of the unborn child. The formation of life is absolutely dependent upon a mother's physical fitness, sexual intercourse, and the arrival of "a being's dislocated transmigratory unit of fivefold energy (gandhabba)." Couples are free to choose a fetus from any energy body. Sterilization and the use of contraceptives, therefore, do not destroy life. Buddha commended abstinence, which is similar to chastity. The principle teachings of Buddha aim to end suffering. If procreation strains the ability of resources to support life, then procreation is against the basic principles of Buddha.

  8. Pregnancy after Bariatric Surgery: Obstetric and Perinatal Outcomes and the Growth and Development of Children. (United States)

    Dell'Agnolo, Cátia Millene; Cyr, Caroline; de Montigny, Francine; de Barros Carvalho, Maria Dalva; Pelloso, Sandra Marisa


    Several outcomes of pregnancy after bariatric surgery are currently being studied. This cross-sectional, retrospective study evaluated the obstetric and perinatal outcomes of pregnancies in 19 women who underwent bariatric surgery, as well as the growth and development of their children, in the Southern Brazil. Among these women, 11 children were born prior to surgery and 32 were born post-surgery. The mean time between the surgery and the first pregnancy was 42.96 months. Preterm newborns were more common among the pre-surgery childbirths. Regarding growth, normal weights were observed in 27.3 % of the children in the pre-surgery births and obesity was observed in 54.5 %. In contrast, normal weights were observed in 59.4 % of the children born during the postoperative period and obesity was observed in 31.2 %. The average excess weight that the women lost prior to pregnancy was 64.88. Speech delays were found in three male children evaluated using the Denver Developmental Screening Test II. A statistical association was found between the interval from the surgery to the pregnancy and the outcome of the questionable Denver II test results (p = 0.011). Except for the large index of low birth weight, it can be concluded that pregnancy after bariatric surgery is safe. The growth rate was found to be adequate in the children born after the surgery, with reduced obesity. Although changes in speech development were detected, no factors were supported an association with pregnancy after bariatric surgery.

  9. Women's anxiety about social and exercise settings. (United States)

    Walton, Vicki R; Finkenberg, Mel E


    This study involved a comparison of social physique anxiety, assessed through the application of a modified version of the Social Physique Anxiety Scale, with 28 women who were new members exercising at all-female facilities compared to 43 new female members exercising at coeducational facilities. Analyses indicated there were no significant differences in means between the groups. The scores of women attending all-female facilities were significantly more influenced by the sex of members when choosing a facility.

  10. Women in Otolaryngology. (United States)

    O'Connell Ferster, Ashley P; Hu, Amanda


    Advances in gender equality have been sought in the field of medicine for centuries, including the specialty of otolaryngology. Currently, about 14.5% of practicing otolaryngologists are women. Strides have been made to support equality by the American Academy of Otolaryngology-Head and Neck Surgery through the development of the Women in Otolaryngology Section in 2010, among other efforts. This article reviews the literature of women in otolaryngology, as well as current trends toward equality among otolaryngologists of all genders.

  11. Women in physics in Bangladesh (United States)

    Choudhury, Shamima K.


    Bangladesh has had a glorious physics tradition since the beginning of the last century, when the physicist S.N. Bose published a groundbreaking paper with Albert Einstein on Bose-Einstein statistics. However, women in Bangladesh traditionally have not been able to make their way in the realm of science in general and physics in particular. Since Bangladesh achieved independence in 1971, the situation has gradually changed and more and more women choose physics as an academic discipline. The percentage of women students in physics rose from 10% in 1970 to almost 30% in 2010. In recent years, women physicists have actively participated in many activities promoting science and technology, creating awareness among the public about the importance of physics education. The present status of women physicists in academic, research, and administrative programs in the government and private sectors in Bangladesh is reported. The greater inclusion of women scientists, particularly physicists, in policy-making roles on important issues of global and national interest is suggested.

  12. Discovering the Barriers to Rural Women in STEM (United States)

    Kreft Pearce, Jennifer; McCaslin, Sara; Morgan, Leann


    This study investigates the attitudes women and girls from the East Texas region have towards engineering and physics. We use an online survey and interviews to determine what influences women to choose their career paths. Surprisingly, we find that women have more positive attitudes about physics and engineering than their male counterparts. For the group of students interviewed, self assessment of ability, lack of role models, and confusion about work/life balance issues were some of the determining factors in their choice not to pursue a career in a STEM field.

  13. Psychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees. (United States)

    van Driel, C M G; Oosterwijk, J C; Meijers-Heijboer, E J; van Asperen, C J; Zeijlmans van Emmichoven, I A; de Vries, J; Mourits, M J E; Henneman, L; Timmermans, D R M; de Bock, G H


    Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM. A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM. Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12-3.08), high negative affect (OR = 2.52, 95%CI = 1.44-4.43), high cancer worry (OR = 1.65, 95%CI = 1.00-2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18-5.89), high risk-perception (OR = 1.85, 95%CI = 1.15-2.95) and having children (OR = 2.06, 95%CI = 1.21-3.50). Negative and positive affects play an important role in the intention for RRM. Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Women and the sciences. (United States)

    Marcantoni, Carmelita; Castellino, Santina; Cicchetti, Teresa; Rastelli, Stefania; Mallamaci, Francesca


    The education level of women has increased significantly in recent decades. However, although there is a continued positive trend overall, women remain underrepresented (or misrepresented?) in the main fields of science. In Europe the proportion of women in scientific research is growing faster than that of men, but women are more likely than men to choose education, arts and humanities, health and welfare. Moreover, of the total number of women graduating in all faculties (55%), the percentage of women graduating in medicine is 65%-68%, in Europe as in the United States. As far as nephrology is concerned, unpublished data from the Italian Society of Nephrology indicate that female nephrologists make up almost 30% of the total number in the age group between 40 and 55, and this proportion is even higher in the age group younger than 40 years. In comparison with the past, there are some hints that things are going to change, but the path is still a difficult one, much effort is needed and there is a long way ahead.

  15. Ghanaian Women's Perceptions of the Quality of Ready-to-Wear Garments (United States)

    Fianu, Docea A. G.; Aryee-Atta, Salome N. A.


    Women can choose among many options with regard to ready-to-wear (RTW) clothing; for example, they can purchase imported or domestically produced garments, or they can select custom-made or second-hand garments. In Ghana, women have traditionally preferred imported RTW garments to RTW garments produced within the country. In this study,…

  16. End-Users' Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa. (United States)

    Weinrib, Rachel; Minnis, Alexandra; Agot, Kawango; Ahmed, Khatija; Owino, Fred; Manenzhe, Kgahlisho; Cheng, Helen; van der Straten, Ariane


    A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women's health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users. The Trio Study was a mixed-methods study in women ages 18-30 that examined acceptability of three MPT delivery forms: oral tablets, injections, and vaginal ring. Approval ratings and stated choice among the products was collected at baseline. Factors influencing stated product choice were explored using multivariable multinomial logistic regression. The majority (62%) of women in Trio stated they would choose injections, 27% would choose tablets and 11% would choose the ring. Significant predictors of choice included past experience with similar contraceptive delivery forms, age, and citing frequency of use as important. Ring choice was higher for older (25-30) women than for younger (18-24) women (aRR = 3.1; p < 0.05). These results highlight the importance of familiarity in MPT product choice of potential for variations in MPT preference by age.

  17. Chances of employment in women and men after surgery of congenital heart disease: comparisons between patients and the general population. (United States)

    Geyer, Siegfried; Norozi, Kambiz; Buchhorn, Reiner; Wessel, Armin


    It was examined whether women and men (17-45 years) with operated congenital heart disease differ with respect to chances of employment. Patients were compared with the general population. Patients (n = 314) were classified by type of surgery (curative, reparative, palliative) as indicator of initial severity of disease. The second classification was performed according to a system proposed by the New York Heart Association in order to take reported impairments into account. Controls (n = 1165) consisted of a 10% random sample drawn from the German Socio-Economic Panel. Chances of full-time employment decreased as disease severity increased. Chances of part-time and minor employment were higher in patients than among controls. These general effects were because of male patients, while the employment patterns of women did not differ from the control group. Independent of patient status, women were more likely to have lower rates of full-time employment, and the rates of part-time and minor employment were higher. Long-term adaptation to impairments as a result of congenital heart disease differs between women and men with respect to employment status. While female patients do not differ from the general population, males may lower their engagement in paid work.

  18. How to choose a delegation for a peace conference?

    NARCIS (Netherlands)

    Can, Burak; Csóka, Péter; Ergin, Emre


    This paper analyzes how to choose a delegation, a committee to represent a society such as in a peace conference. We propose normative conditions and seek optimal, consistent, neutral and non-manipulable ways to choose a delegation. We show that a novel class of threshold rules are characterized by

  19. Perception versus reality: elucidating motivation and expectations of current fellowship council minimally invasive surgery fellows. (United States)

    Watkins, Jeffrey R; Pryor, Aurora D; Truitt, Michael S; Jeyarajah, D Rohan


    The aim of our study is to determine minimally invasive trainee motivation and expectations for their respective fellowship. Minimally Invasive Surgery (MIS) is one of the largest non-ACGME post-residency training pathways though little is known concerning the process of residents choosing MIS as a fellowship focus. As general surgery evolves, it is important to understand resident motivation in order to better prepare them for a surgical career. A survey invitation was sent to current trainees in the Minimally Invasive and related pathways through the Fellowship Council. The participants were asked to complete a web-based questionnaire detailing demographics, experiences preparing for fellowship, motivation in choosing an MIS fellowship, and expectations for surgical practice after fellowship. Sixty-seven MIS trainees responded to the survey out of 151 invitations (44%). The Fellowship Council website, mentors, and other fellows were cited as the most helpful source of information when applying for fellowship. Trainees were active in surgical societies as residents, with 78% having membership in the ACS and 60% in SAGES. When deciding to pursue MIS as a fellowship, the desire to increase laparoscopic training was the most important factor. The least important reasons cited were lack of laparoendoscopic training in residency and desire to learn robotic surgery. The majority of trainees believed their laparoscopic skill set was above that of their residency cohort (81%). The most desired post-fellowship employment model is hospital employee (46%) followed by private practice (27%). Most fellows plan on marketing themselves as MIS surgeons (90%) or General Surgeons (78%) when in practice. Residents who choose MIS as a fellowship have a strong exposure to laparoscopy and want to become specialists in their field. Mentors and surgical societies including ACS and SAGES play a vital role in preparing residents for fellowship and practice.

  20. Quality of life of women submitted to myocardial revascularization surgery in a public hospital - doi:10.5020/18061230.2010.p237

    Directory of Open Access Journals (Sweden)

    Rafaela Melo de Oliveira


    Full Text Available Objective: To analyze the sociodemografic profile, risck factors and the quality of life of women submitted to myocardial revascularization surgery. Methods: We conducted a qualitative study by applying a questionnaire on lifestyle and risk factors and an interview with four guiding questions to 15 revascularized inpatients of cardiology units of a referral public hospital and who had no manifestations of depression prior to surgery. Results: The patients profile showed that 9 (60% were Caucasian, 8 (54% had incomplete primary education, 4(27% were housewives, 9 (60% lived in urban area, 10 (67% were married, all had a family income lower than three minimum wages and 4(27% had only two kids. From the content analysis of the interviews, the following categories aroused: religiosity, disruption with everyday life, family and quality of life. Conclusion: We found out that the knowledge about the psychosocial structure of each patient helps in the treatment of the individual submitted to myocardial revascularization. By identifying the lifestyle and risk factors, women promote self-knowledge, which can avoid habits that lead to cardiovascular diseases. We suggest the development of strategies for prevention and health promotion involving the patients and their families so that there is an extension of hospital care at home and a better adaptation to the new condition.

  1. Pregnancy After Bariatric Surgery: National Survey of Obstetrician's Comfort, Knowledge, and Practice Patterns. (United States)

    Smid, Marcela C; Dotters-Katz, Sarah K; Mcelwain, Cora-Ann; Volckmann, Eric T; Schulkin, Jay; Stuebe, Alison M


    The objective of this study is to survey a nationally representative sample of obstetricians regarding comfort, knowledge, and practice patterns of caring for pregnant women after bariatric surgery. We conducted an online survey of US obstetricians and describe obstetrician's demographics, practice settings, and practice patterns. We assessed respondent's knowledge and recommended practices. We compared provider knowledge by years since completing residency, scope of practice (generalist or specialist), and practice setting (academic setting or other). Statistical significance was set at p < 0.05. A total of 106 completed the survey (response rate of 54%). Respondents had a median age of 47 and median 17 years in practice. Sixty-two percent were generalists. Nearly all of the respondents (94%) had some experience with caring for pregnant women after bariatric surgery and 83% reported feeling "very comfortable" (48%) or "somewhat comfortable" (35%) providing care for this population. Most (74%) were aware of increased risk of small for gestational age after surgery. Only 13% were able to correctly identify all recommended nutritional labs and 20% reported that they "did not know" which labs are recommended. There were no differences in comfort, experience, knowledge, and practice patterns by physician characteristics and practice settings. While most obstetricians are aware of perinatal risks after bariatric surgery, a substantial percentage of obstetricians are unaware of recommended practices regarding nutrition and nutritional monitoring. As bariatric surgery becomes increasingly prevalent among reproductive age women, educational interventions to increase obstetricians' knowledge of optimal care of pregnant women after bariatric surgery are urgently needed.

  2. A survey of how and why medical students and junior doctors choose a career in ENT surgery. (United States)

    Bhutta, M; Mandavia, R; Syed, I; Qureshi, A; Hettige, R; Wong, B Y W; Saeed, S; Cartledge, J


    To ascertain determinants of an interest in a career in ENT surgery through a survey of medical students and junior doctors. A survey was administered, comprising Likert scales, forced response and single option questions, and free text responses, at five different courses or events for those interested in a career in ENT. The survey had an 87 per cent response rate; respondents consisted of 43 applicants for national selection, 15 foundation doctors and 23 medical students. The most important factors that encourage ENT as a career included: the variety of operative procedures, work-life balance, inherent interest in this clinical area and inspirational senior role models. Exposure to ENT in undergraduate or post-graduate training is critical in deciding to pursue this specialty. It is important to promote those aspects of ENT surgery that attract people to it, and to argue for greater exposure to ENT during undergraduate and post-graduate training.

  3. The impact of cosmetic surgery media portrayals on body image and attitudes


    Ashikali, Eleni-Marina


    The cosmetic surgery industry has rapidly expanded and Professional Associations for surgery in the UK and USA have expressed concern over the ways in which surgery is portrayed in the media. This thesis aimed to investigate how different portrayals of cosmetic surgery in the media impact women and adolescent girls’ body image and attitudes towards surgery. Moreover, it examined a number of moderating variables which may affect responses to such media.\\ud The first three studies examined the ...

  4. The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women. (United States)

    Steel, A; Frawley, J; Sibbritt, D; Broom, A; Adams, J


    This manuscript presents a preliminary examination of the characteristics of women who choose intrapartum hypnosis for pain management. Cross-sectional analysis of 2445 women (31-36 years) from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), employing Fisher exact tests. Australia. Use of intrapartum hypnosis, or hypnobirthing, for pain management during labour and birth. Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (phypnotherapy for intrapartum pain management less commonly identified as feeling safer knowing that an obstetrician is providing their care (phypnotherapy for intrapartum pain management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Impaired postural stability after laparoscopic surgery

    DEFF Research Database (Denmark)

    Eskildsen, K Z; Staehr-Rye, A K; Rasmussen, L S


    . METHODS: We included 25 women undergoing outpatient gynaecological laparoscopic surgery in the study. Patients received standardised anaesthesia with propofol, remifentanil and rocuronium. Postural stability was assessed preoperatively, at 30 min after tracheal extubation, and at discharge from the post...

  6. Are women engineers in Lebanon prepared for the challenges of an engineering profession? (United States)

    Baytiyeh, Hoda


    This study investigates the status of women engineers in the Middle East, considering women engineers in Lebanon as a case study. The author investigated the following questions: What are the influences behind females' decisions to choose engineering as their major course of study? What are the motives behind this decision? What are the perceptions of females regarding the essential skills for a successful engineering career? An online survey consisting of Likert-scale items was completed by 327 female engineers who graduated from universities in Lebanon and now work in various locations around the world. A genuine interest in the field appeared to be the main influence in the participants' decisions to choose engineering profession. The potential for professional growth was the leading motivator for choosing engineering. Although participants reported that they possessed adequate theoretical knowledge and technical skills before graduation, in the actual practice of engineering, they noted weaknesses in creativity and innovation.

  7. Gender Authorship Trends of Plastic Surgery Research in the United States. (United States)

    Silvestre, Jason; Wu, Liza C; Lin, Ines C; Serletti, Joseph M


    An increasing number of women are entering the medical profession, but plastic surgery remains a male-dominated profession, especially within academia. As academic aspirations and advancement depend largely on research productivity, the authors assessed the number of articles authored by women published in the journal Plastic and Reconstructive Surgery. Original articles in Plastic and Reconstructive Surgery published during the years 1970, 1980, 1990, 2000, 2004, and 2014 were analyzed. First and senior authors with an M.D. degree and U.S. institutional affiliation were categorized by gender. Authorship trends were compared with those from other specialties. Findings were placed in the context of gender trends among plastic surgery residents in the United States. The percentage of female authors in Plastic and Reconstructive Surgery increased from 2.4 percent in 1970 to 13.3 percent in 2014. Over the same time period, the percentage of female plastic surgery residents increased from 2.6 percent to 32.5 percent. By 2014, there were more female first authors (19.1 percent) than senior authors (7.7 percent) (p < 0.001). As a field, plastic surgery had fewer female authors than other medical specialties including pediatrics, obstetrics and gynecology, general surgery, internal medicine, and radiation oncology (p < 0.05). The increase in representation of female authors in plastic surgery is encouraging but lags behind advances in other specialties. Understanding reasons for these trends may help improve gender equity in academic plastic surgery.

  8. Guide to Choosing Stroke Rehabilitation Services (United States)

    National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you:  Re-learn basic skills such ...

  9. Disparities in breast cancer surgery delay: the lingering effect of race. (United States)

    Sheppard, Vanessa B; Oppong, Bridget A; Hampton, Regina; Snead, Felicia; Horton, Sara; Hirpa, Fikru; Brathwaite, Echo J; Makambi, Kepher; Onyewu, S; Boisvert, Marc; Willey, Shawna


    Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients. Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses. Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p interventions to address delay are needed.

  10. Chinese women's participation in fertility discussions. (United States)

    Li, L


    In an attempt to better understand the process through which the family planning (FP) programs and socioeconomic developments in China affect fertility, women's participation in fertility discussions with their husbands are examined as an intermediate factor in a study based on results of a random survey of 6654 ever-married women of reproductive age from 7 cities and 30 counties of Guangdong. First, it must be noted that Chinese couples do have individual choices (albeit quite limited ones) about their fertility; they can choose to follow or ignore government policy or they can choose to remain childless. The present study has 3 major hypotheses: 1) the more a woman is involved in fertility discussions with her husband, the fewer children she will have; 2) urban women with a higher educational status will be more likely to have such discussions; and 3) women who are contacted individually by FP personnel are more likely to be involved in fertility discussions. After a discussion of data collection and variables (number of living children, education of wife and husband, age at marriage, residence, living with parents, contacted by FP personnel, and discussion with husband), the results are presented in terms of zero-order correlation coefficients indicating their relationships. The bivariate analysis supported the hypotheses. Multiple regression analysis showed that age at marriage, education of wives and husbands, FP contacts, and participation in discussions remain significant fertility determinants (but the correlation between fertility and residence becomes trivial). A further regression model indicated that a woman's educational attainment is the most significant positive indication of their participation in fertility discussions. These results imply that as women's status continues to improve in China and the deeply-rooted patriarchal tradition loses hold, increased gender equity and education will influence a fertility decline. FP personnel could also

  11. Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders? (United States)

    Pomian, Andrzej; Majkusiak, Wojciech; Lisik, Wojciech; Tomasik, Paweł; Horosz, Edyta; Zwierzchowska, Aneta; Kociszewski, Jacek; Barcz, Ewa


    Obesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool. The present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12-18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria. Fifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m 2 after surgery (p betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

  12. Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon


    Pao-Ling Torng; Kuan-Hung Lin; Jing-Shiang Hwang; Hui-Shan Liu; I-Hui Chen; Chi-Ling Chen; Su-Cheng Huang


    Objectives: To assess the learning curve and safety of laparoendoscopic single-site (LESS) surgery of gynecological surgeries. Materials and methods: Sixty-three women who underwent LESS surgery by a single experienced laparoscopic surgeon from February 2011 to August 2011 were included. Commercialized single-incision laparoscopic surgery homemade ports were used, along with conventional straight instruments. The learning curve has been defined as the additional surgical time with respect ...

  13. Patient reported and anatomical outcomes after surgery for pelvic organ prolapse. (United States)

    El-Azab, Ahmed S; Abd-Elsayed, Alaa A; Imam, Hala M K


    Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP >or= stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Questionnaire. Internal consistency of added question was good (Cronbach alpha = 0.78). Test-retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%.

  14. Mathematical Modeling of the Consumption of Low Invasive Plastic Surgery Practices: The Case of Spain

    Directory of Open Access Journals (Sweden)

    E. De la Poza


    Full Text Available Plastic surgery practice grows continuously among the women in Western countries due to their body image dissatisfaction, aging anxiety, and an ideal body image propagated by the media. The consumption growth is so important that plastic surgery is becoming a normal practice among women, like any other cosmetic product, with the risk of suffering psychopathology disorders in the sense that plastic surgery could be employed as an instrument to recover personal self-esteem or even happiness. Plastic surgery practice depends on economic, demographic, and social contagion factors. In this paper, a mathematical epidemiological model to forecast female plastic surgery consumption in Spain is fully constructed. Overconsumer subpopulation is predicted and simulated. Robustness of the model versus uncertain parameters is studied throughout a sensitivity analysis.

  15. Prognosis of oesophageal adenocarcinoma and squamous cell carcinoma following surgery and no surgery in a nationwide Swedish cohort study (United States)

    Mattsson, Fredrik


    Objectives To assess the recent prognostic trends in oesophageal adenocarcinoma and oesophageal squamous cell carcinoma undergoing resectional surgery and no such surgery. Additionally, risk factors for death were assessed in each of these patient groups. Design Cohort study. Setting A population-based, nationwide study in Sweden. Participants All patients diagnosed with oesophageal adenocarcinoma and oesophageal squamous cell carcinoma in Sweden from 1 January 1990 to 31 December 2013, with follow-up until 14 May 2017. Outcome measures Observed and relative (to the background population) 1-year, 3-year and 5-year survivals were analysed using life table method. Multivariable Cox regression provided HR with 95% CI for risk factors of death. Results Among 3794 patients with oesophageal adenocarcinoma and 4631 with oesophageal squamous cell carcinoma, 82% and 63% were men, respectively. From 1990–1994 to 2010–2013, the relative 5-year survival increased from 12% to 15% for oesophageal adenocarcinoma and from 9% to 12% for oesophageal squamous cell carcinoma. The corresponding survival following surgery increased from 27% to 45% in oesophageal adenocarcinoma and from 24% to 43% in oesophageal squamous cell carcinoma. In patients not undergoing surgery, the survival increased from 3% to 4% for oesophageal adenocarcinoma and from 3% to 6% for oesophageal squamous cell carcinoma. Women with oesophageal squamous cell carcinoma had better prognosis than men both following surgery (HR 0.71, 95% CI 0.61 to 0.83) and no surgery (HR 0.86, 95% CI 0.81 to 0.93). Conclusions The prognosis has improved over calendar time both in oesophageal adenocarcinoma and oesophageal squamous cell carcinoma in Sweden that did and did not undergo surgery. Women appear to have better prognosis in oesophageal squamous cell carcinoma than men, independent of treatment. PMID:29748347

  16. Antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy: A decision-making algorithm. (United States)

    LaHood, Benjamin R; Andrew, Nicholas H; Goggin, Michael

    Cataract surgery is the most commonly performed surgical procedure in many developed countries. Postoperative endophthalmitis is a rare complication with potentially devastating visual outcomes. Currently, there is no global consensus regarding antibiotic prophylaxis in cataract surgery despite growing evidence of the benefits of prophylactic intracameral cefuroxime at the conclusion of surgery. The decision about which antibiotic regimen to use is further complicated in patients reporting penicillin allergy. Historic statistics suggesting crossreactivity of penicillins and cephalosporins have persisted into modern surgery. It is important for ophthalmologists to consider all available antibiotic options and have an up-to-date knowledge of antibiotic crossreactivity when faced with the dilemma of choosing appropriate antibiotic prophylaxis for patients undergoing cataract surgery with a history of penicillin allergy. Each option carries risks, and the choice may have medicolegal implications in the event of an adverse outcome. We assess the options for antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy and provide an algorithm to assist decision-making for individual patients. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  17. Skilled nursing and rehabilitation facilities - choosing (United States)

    ... gov/ency/patientinstructions/000436.htm Choosing a skilled nursing and rehabilitation facility To use the sharing features ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  18. How to choose a health plan (United States)

    ... patientinstructions/000861.htm How to choose a health plan To use the sharing features on this page, ... paperwork for tax purposes. How to Compare Health Plans Employers and government sites, such as the Marketplace , ...

  19. Career satisfaction of women in surgery: perceptions, factors, and strategies. (United States)

    Ahmadiyeh, Nasim; Cho, Nancy L; Kellogg, Katherine C; Lipsitz, Stuart R; Moore, Francis D; Ashley, Stanley W; Zinner, Michael J; Breen, Elizabeth M


    With the current and projected shortages of general surgeons, more attention is being paid to the increasing pool of women physicians. This study seeks to understand the variables leading to career satisfaction for women surgeons to better recruit, retain, and support them. Eighteen semi-structured interviews of 12 female and 6 male surgeons 2 to 12 years into practice were qualitatively analyzed and converted to coded, categorized data. Significance was derived by Fisher's exact test. Participants were recruited by snowball sampling. Our sample represents a highly satisfied group of female and male surgeons. Although both women and men describe with equal frequency having made career tradeoffs for personal and family time, and vice versa, women far more frequently than men cite reasons related to their personal time, predictable time, and family relationships as why they are currently satisfied with their career (34.1% versus 8.7%; p women most frequently cite social networks as a key to success (88% versus 12% by men; p men more frequently cite reasons related to training (29% versus 0% by women; p women; p men and women make tradeoffs of career for family and family for career, women's perception of satisfaction comes from viewing their surgical career within the broader context of their lives. Women might be attracted to a career that acknowledges and values the whole person beyond the surgeon, and could benefit from work infrastructures that enhance networking. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Predictors of mortality within 1 year after primary ovarian cancer surgery

    DEFF Research Database (Denmark)

    Sjøland, Mette Ørskov; Iachina, Maria; Sørensen, Rikke Guldberg


    System. PARTICIPANTS: 2654 women who underwent surgery due to a diagnosis of primary ovarian cancer. OUTCOME MEASURES: Overall survival and predictors of mortality within 0-180 and 181-360 days after the primary surgery. Examined predictors were age, preoperative American Society of Anesthesiologists...

  1. Repeat surgery after failed midurethral slings

    DEFF Research Database (Denmark)

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler


    INTRODUCTION AND HYPOTHESIS: The objective was to describe the choice of subsequent surgery after failure of synthetic midurethral slings (MUS) based on a nationwide background population. METHODS: We used the Danish National Patient Registry to identify women who had undergone first-time synthetic...

  2. Consumer preference not to choose: Methodological and policy implications

    International Nuclear Information System (INIS)

    Brennan, Timothy J.


    Residential consumers remain reluctant to choose new electricity suppliers. Even the most successful jurisdictions, four US states and other countries, have had to adopt extensive consumer education procedures that serve largely to confirm that choosing electricity suppliers is daunting. Electricity is not unique in this respect; numerous studies find that consumers are generally reluctant to switch brands, even when they are well-informed about product characteristics. If consumers prefer not to choose, opening regulated markets can reduce welfare, even for some consumers who do switch, as the incumbent can exploit this preference by raising price above the formerly regulated level. Policies to open markets might be successful even if limited to industrial and commercial customers, with residential prices based on those in nominally competitive wholesale markets

  3. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). (United States)

    Glazener, Cathryn Ma; Breeman, Suzanne; Elders, Andrew; Hemming, Christine; Cooper, Kevin G; Freeman, Robert M; Smith, Anthony Rb; Reid, Fiona; Hagen, Suzanne; Montgomery, Isobel; Kilonzo, Mary; Boyers, Dwayne; McDonald, Alison; McPherson, Gladys; MacLennan, Graeme; Norrie, John


    The use of transvaginal mesh and biological graft material in prolapse surgery is controversial and has led to a number of enquiries into their safety and efficacy. Existing trials of these augmentations are individually too small to be conclusive. We aimed to compare the outcomes of prolapse repair involving either synthetic mesh inlays or biological grafts against standard repair in women. We did two pragmatic, parallel-group, multicentre, randomised controlled trials for our study (PROSPECT [PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trials]) in 35 centres (a mix of secondary and tertiary referral hospitals) in the UK. We recruited women undergoing primary transvaginal anterior or posterior compartment prolapse surgery by 65 gynaecological surgeons in these centres. We randomly assigned participants by a remote web-based randomisation system to one of the two trials: comparing standard (native tissue) repair alone with standard repair augmented with either synthetic mesh (the mesh trial) or biological graft (the graft trial). We assigned women (1:1:1 or 1:1) within three strata: assigned to one of the three treatment options, comparison of standard repair with mesh, and comparison of standard repair with graft. Participants, ward staff, and outcome assessors were masked to randomisation where possible; masking was obviously not possible for the surgeon. Follow-up was for 2 years after the surgery; the primary outcomes, measured at 1 year and 2 years, were participant-reported prolapse symptoms (i.e. the Pelvic Organ Prolapse Symptom Score [POP-SS]) and condition-specific (ie, prolapse-related) quality-of-life scores, analysed in the modified intention-to-treat population. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN60695184. Between Jan 8, 2010, and Aug 30, 2013, we randomly allocated 1352 women to treatment, of whom 1348 were included in the analysis. 865 women were included in the mesh

  4. Physician peer group characteristics and timeliness of breast cancer surgery. (United States)

    Bachand, Jacqueline; Soulos, Pamela R; Herrin, Jeph; Pollack, Craig E; Xu, Xiao; Ma, Xiaomei; Gross, Cary P


    Little is known about how the structure of interdisciplinary groups of physicians affects the timeliness of breast cancer surgery their patients receive. We used social network methods to examine variation in surgical delay across physician peer groups and the association of this delay with group characteristics. We used linked Surveillance, Epidemiology, and End Results-Medicare data to construct physician peer groups based on shared breast cancer patients. We used hierarchical generalized linear models to examine the association of three group characteristics, patient racial composition, provider density (the ratio of potential vs. actual connections between physicians), and provider transitivity (clustering of providers within groups), with delayed surgery. The study sample included 8338 women with breast cancer in 157 physician peer groups. Surgical delay varied widely across physician peer groups (interquartile range 28.2-50.0%). For every 10% increase in the percentage of black patients in a peer group, there was a 41% increase in the odds of delayed surgery for women in that peer group regardless of a patient's own race [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73]. Women in physician peer groups with the highest provider density were less likely to receive delayed surgery than those in physician peer groups with the lowest provider density (OR 0.65, 95% CI 0.44-0.98). We did not find an association between provider transitivity and delayed surgery. The likelihood of surgical delay varied substantially across physician peer groups and was associated with provider density and patient racial composition.

  5. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

    Directory of Open Access Journals (Sweden)

    Jemimah Ride

    Full Text Available Perinatal depression and anxiety (PNDA are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  6. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment. (United States)

    Ride, Jemimah; Lancsar, Emily


    Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  7. Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective. (United States)

    Wu, Shu-Mei; Lee, Hui-Ling; Yeh, Mei-Yu; Che, Hui-Lian


    To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement. Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women. Qualitative, in-depth interview A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data. Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust. The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions. Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions. © 2014 John Wiley & Sons Ltd.

  8. Young women's attitudes towards, and experiences of, long-acting reversible contraceptives. (United States)

    Bracken, Jennifer; Graham, Cynthia A


    To identify factors involved in women's decisions to choose particular contraceptive methods and more specifically, incentives and disincentives to use three long-acting reversible contraceptive (LARC) methods: injectables, implants, and intrauterine devices/systems (IUDs/IUSs). A total of 502 women aged 18 to 30 completed a cross-sectional online questionnaire. The three most important factors in choosing a contraceptive method were: high efficacy at preventing pregnancy, protection against sexually transmitted infections, and non-interference with sexual intercourse. The most common incentives for LARC use were the high efficacy and long duration of action. Disincentives included the possibility of irregular bleeding and concerns about effects on fertility; fear of needles and pain was a particular disincentive for IUD/IUS use. Only 93 (18%) of the participants reported ever having used a LARC. Reported disincentives to LARC use (e.g., concern about effects on future fertility) indicated that many young women hold inaccurate beliefs about these methods. The relatively high proportions of women who held neutral attitudes about LARCs (21-40%, depending on the method) highlight the importance of education and contraceptive counselling to improve knowledge about the advantages of these methods.

  9. Clinical challenges in the management of vaginal prolapse

    Directory of Open Access Journals (Sweden)

    Siddiqui NY


    Full Text Available Nazema Y Siddiqui, Autumn L EdenfieldDivision of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USAAbstract: Pelvic organ prolapse is highly prevalent, and negatively affects a woman’s quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.Keywords: pelvic organ prolapse, vaginal prolapse, surgery, sacrocolpopexy, sacrospinous ligament fixation, transvaginal mesh, uterosacral ligament suspension

  10. Role of the superior colliculus in choosing mixed-strategy saccades. (United States)

    Thevarajah, Dhushan; Mikulić, Areh; Dorris, Michael C


    Game theory outlines optimal response strategies during mixed-strategy competitions. The neural processes involved in choosing individual strategic actions, however, remain poorly understood. Here, we tested whether the superior colliculus (SC), a brain region critical for generating sensory-guided saccades, is also involved in choosing saccades under strategic conditions. Monkeys were free to choose either of two saccade targets as they competed against a computer opponent during the mixed-strategy game "matching pennies." The accuracy with which presaccadic SC activity predicted upcoming choice gradually increased in the time leading up to the saccade. Probing the SC with suprathreshold stimulation demonstrated that these evolving signals were functionally involved in preparing strategic saccades. Finally, subthreshold stimulation of the SC increased the likelihood that contralateral saccades were selected. Together, our results suggest that motor regions of the brain play an active role in choosing strategic actions rather than passively executing those prespecified by upstream executive regions.

  11. An Assessment of Gender Differences in Plastic Surgery Patient Education and Information in the United States: Are We Neglecting Our Male Patients? (United States)

    Sinno, Sammy; Lam, Gretl; Brownstone, Nicholas D; Steinbrech, Douglas S


    The number of total cosmetic procedures performed yearly has increased by more than 274% between 1997 and 2014, according to the American Society for Aesthetic Plastic Surgery. However, the vast majority of plastic surgery procedures are still targeted toward women, with little attention toward men. This study sought to quantify the extent of gender discrepancies observed in online plastic surgery marketing in this country. For the 48 contiguous United States, a systematic Google (Mountain View, CA) search was performed for "[state] plastic surgeon." The first 10 solo or group practice websites in each state were analyzed for the gender of the first 10 images featured, presence of a male services section, and which procedures were offered to men. The results were statistically analyzed using SPSS Software (IBM Corporation, Armonk, NY). A total of 453 websites were analyzed, as 5 states did not have 10 unique solo or group practice websites. Of the 4239 images reviewed, 94.1% were of females, 5.0% were of males, and 0.9% were of a male and female together. A male services page was present in 22% of websites. The most common procedures marketed toward men were gynecomastia reduction (58%), liposuction (17%), blepharoplasty (13%), and facelift (10%). Less than 10% of all websites offered other procedures to males, with a total of 15 other aesthetic procedures identified. Many plastic surgeons choose to ignore or minimize male patients in their online marketing efforts. However, as the number of men seeking cosmetic procedures continues to grow, plastic surgeons will benefit from incorporating male patients into their practice model. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission:

  12. Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment. (United States)

    Geber, Selmo; Ferreira, Daniela Parreiras; Spyer Prates, Luis Felipe Víctor; Sales, Liana; Sampaio, Marcos


    Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients 35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, for infertile patients, non-surgical treatment might be a better option to avoid reduction of the ovarian response.

  13. Efficacious Cefazolin Prophylactic Dose for Morbidly Obese Women Undergoing Bariatric Surgery Based on Evidence from Subcutaneous Microdialysis and Populational Pharmacokinetic Modeling. (United States)

    Palma, Eduardo Celia; Meinhardt, Nelson Guardiola; Stein, Airton Tetelbom; Heineck, Isabela; Fischer, Maria Isabel; de Araújo, BibianaVerlindo; Dalla Costa, Teresa


    To determine the efficacious cefazolin prophylactic dose for bariatric surgery using free subcutaneous concentrations accessed by microdialysis after 2 g or 3 g i.v. bolus dosing to morbidly obese women and POPPK modeling. A POPPK model with variable plasma and subcutaneous tissue protein binding was developed to simultaneously describe plasma and tissue data sets. The outcomes was predicted for common surgical site infection (SSI) bacteria over 3, 4, 5 and 6 h periods postdose, as probability of target attainment (PTA) using Monte Carlo simulation. CFZ 2 g warrant up to 5 h SSI prophylaxis for bacteria with MICs ≤1 mg/L such as Escherichia coli and Staphylococcus aureus. For species such as Klebsiella pneumoniae, which present MIC distribution frequency of 2 mg/L, the maintenance of PTA ≥ 90% occurs with a 3 g dose for surgeries lasting up to 5 h, and 2 g dose provide an adequate response up to 4 h (PTA of 89%). Effectiveness of CFZ 2 g is similar to 3 g against bacteria with a MIC up to 2 mg/L, especially if the surgery does not last for more than 4 h.

  14. What to choose as radical local treatment for lung metastases from colo-rectal cancer: surgery or radiofrequency ablation?

    NARCIS (Netherlands)

    Schlijper, R.C.; Grutters, J.P.C.; Houben, R.; Dingemans, A.M.; Wildberger, J.E.; Raemdonck, D. Van; Cutsem, E. van; Haustermans, K.; Lammering, G.; Lambin, P.; Ruysscher, D. de


    BACKGROUND: Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT). METHODS: A systematic review included 27 studies

  15. Decision-making process of women carrying a BRCA1 or BRCA2 mutation who have chosen prophylactic mastectomy. (United States)

    McQuirter, Megan; Castiglia, Luisa Luciani; Loiselle, Carmen G; Wong, Nora


    To explore the decision-making process of women with a BRCA1 or BRCA2 gene mutation who have chosen to undergo prophylactic mastectomy. Cross-sectional, qualitative, descriptive design. Participants were recruited from an outpatient cancer prevention center in the oncology and medical genetics departments of a large university-affiliated hospital in Montreal, Quebec, Canada. 10 women carrying a BRCA1 or BRCA2 mutation; 8 previously had had a prophylactic mastectomy and 2 were scheduled for surgery at the time of study. Semistructured, in-depth interviews were conducted. Field notes were written and audiotapes were transcribed verbatim. The textual data were coded and analyzed. Decision-making process for prophylactic mastectomy. Two broad findings emerged. First, several intrapersonal and contextual factors interacted throughout the process to move women either closer to choosing a prophylactic mastectomy or further from the decision. Second, all women reported experiencing a "pivotal point," an emotionally charged event when the decision to have a prophylactic mastectomy became definitive. Pivotal points for patients included either receiving a positive result for a genetic mutation or a breast cancer diagnosis for herself or a family member in the context of positive mutation status. Decision making about prophylactic mastectomy was an affective and intuitive process incorporating contexts and their relations rather than a rational, straight-forward process of weighing pros and cons. Supportive interventions for women in this population should explicitly address the individual and the inter-relationships of contextual factors that shape decision making about prophylactic mastectomy while recognizing important affective components involved.

  16. [Body weight evolution and classification of body weight in relation to the results of bariatric surgery: roux-en-Y gastric bypass]. (United States)

    Novais, Patrícia Fátima Sousa; Rasera Junior, Irineu; Leite, Celso Vieira de Souza; Oliveira, Maria Rita Marques de


    The objective of this study was to assess the evolution and classification of body weight in relation to the results of bariatric surgery in women who underwent the procedure more than two years ago. A total of 141 women underwent banded Roux-en-Y gastric bypass (RYGB). The participants were divided according to the time elapsed since surgery and the percentage of excess weight lost (%EWL): 75. The women in the group with %EWL 75 (36.2%) ranged from normal to pre-obese and presented lower late weight gain than the women in the other groups. Weight evolution two or more years after surgery showed the expected reductions, with some individuals responding better to surgery than others. This shows that it is necessary to monitor, investigate and intervene to obtain the desired results.

  17. Analysis of maternal-fetal outcomes of valvular heart surgeries in

    Directory of Open Access Journals (Sweden)

    Alireza Yaghoubi


    Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

  18. [Plastic surgery application in artistic studies of breast cosmetic]. (United States)

    Fabié, A; Delay, E; Chavoin, J-P; Soulhiard, F; Seguin, P


    As, quest for beauty has always been an aim. There is a need to define the "ideal" beautifull breast with objective caracteristics, usable in plastic, reconstructive and aesthetic surgery. After, we have defined the necessary parameters usable in breast surgery. We realized an anthropomorphic study including 70 volunteer women and one molded model. Multiple pictures have been taken for each volunteer, that were evaluated and noted by five plastic surgeon, five doctors from other speciality, five women, five men. A twenty notation was used for this study. The main values for the ten women that obtained best notation (>or=14/20) were used in order to defined the ideal measures for surgery. Breast arrow and breast arrow over the trunck height were the most significant factors. According statistical studies, this fraction is about 0,387 (P=0,000969). The nice breast has a round shape and look like juvenile breast. Bra size, cup size, base, segments II and III, fraction II/III are not significant in our series of (non operated) natural breast. The ideal breast is in harmony and proportional to the trunck height, with the main fraction of breast arrow on the trunck height about 0,387 in our serie.

  19. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol. (United States)

    Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen


    Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

  20. MOMS: Obstetrical Outcomes and Risk Factors for Obstetrical Complications Following Prenatal Surgery (United States)

    JOHNSON, Mark P.; BENNETT, Kelly A.; RAND, Larry; BURROWS, Pamela K.; THOM, Elizabeth A.; HOWELL, Lori J.; FARRELL, Jody A.; DABROWIAK, Mary E.; BROCK, John W.; FARMER, Diana L.; ADZICK, N. Scott


    Background The Management of Myelomeningocele Study (MOMS) was a multi-center randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the Data and Safety Monitoring Committee and outcome data for 158 of the 183 randomized women published. Objective In this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair. Study Design Pregnancy outcomes were compared between the two surgery groups. For women who underwent prenatal surgery antecedent demographic, surgical and pregnancy complication risk factors were evaluated for the following outcomes: premature spontaneous membrane rupture on or before 34 weeks 0 days (PPROM), spontaneous membrane rupture at any gestational age (SROM), preterm delivery at 34 weeks 0 days or earlier (PTD) and non-intact hysterotomy (minimal uterine wall tissue between fetal membranes and uterine serosa, or partial or complete dehiscence at delivery) and chorioamniotic membrane separation. Risk factors were evaluated using chi-square and Wilcoxon tests and multivariable logistic regression. Results A total of 183 women were randomized: 91 to prenatal surgery and 92 to postnatal surgery groups. Analysis of the complete cohort confirmed initial findings: that prenatal surgery was associated with an increased risk for membrane separation, oligohydramnios, spontaneous membrane rupture, spontaneous onset of labor and earlier gestational age at birth. In multivariable logistic regression of the prenatal surgery group adjusting for clinical center, earlier gestational age at surgery and chorioamniotic membrane separation were associated with increased risk of SROM (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.01-2.22; OR 2.96, 95% CI 1.05-8.35, respectively). Oligohydramnios was associated with an increased risk

  1. Choose Privacy Week: Educate Your Students (and Yourself) about Privacy (United States)

    Adams, Helen R.


    The purpose of "Choose Privacy Week" is to encourage a national conversation to raise awareness of the growing threats to personal privacy online and in day-to-day life. The 2016 Choose Privacy Week theme is "respecting individuals' privacy," with an emphasis on minors' privacy. A plethora of issues relating to minors' privacy…

  2. Australian medical students and their choice of surgery as a career: a review. (United States)

    Grigg, Megan; Arora, Manit; Diwan, Ashish D


    Surgery is an emotionally, physically and mentally challenging profession, and medical students factor in many variables when choosing surgery as a career choice. The aim of this study is to review the available literature on the factors influencing Australian medical students' choice of surgery as their career. A search of EMBASE and MEDLINE with the search terms 'medical students' AND 'surgery'; 'medical students' AND 'career pathways'; 'medical students' AND 'career choices' was conducted. Additionally, Google Scholar and the reference list of some articles were canvassed for suitable areas of study. Lifestyle factors were the main reason influencing medical student's career choices. A balance between work, family and lifestyle was found to be important, and a surgical career choice was not always compatible with this. In particular, female students placed more importance on family and lifestyle factors when opting for non-surgical careers. Positive exposure and/or experiences in a surgical environment, perceived prestige and perceived financial reward were associated with surgical career choice. There is a need to better understand the factors influencing surgical and non-surgical career choice among Australian medical students, and develop appropriate interventions to promote surgery as a career. This article does not discuss personality traits of people who go into surgery. © 2013 Royal Australasian College of Surgeons.

  3. Fusion Surgery Required for Recurrent Pediatric Atlantoaxial Rotatory Fixation after Failure of Temporary Fixation with Instrumentation

    Directory of Open Access Journals (Sweden)

    Yoshiyuki Matsuyama


    Full Text Available In cases of chronic irreducible and recurrent unstable atlantoaxial rotatory fixation (AARF, closed reduction and its maintenance are often unsuccessful, requiring surgical treatment. The purpose of the present report is to describe a rare case of pediatric AARF that required multiple treatments. A 6-year-old boy was diagnosed as having type 2 AARF. After conservative treatment, the patient was treated with temporary fixation surgery (C1-C2 Magerl without a bone graft in consideration of motion preservation after screw removal. AARF recurred after the screw removal and required fusion surgery (Magerl–Brooks with an iliac bone graft. Ultimately, bone union was achieved and the screws were removed 11 months after the surgery. We recommend surgeons be cautious when choosing temporary fixation surgery for AARF in small children. Further investigation is needed to determine the optimal time before screw removal.

  4. Sport, how people choose it: A network analysis approach. (United States)

    Ferreri, Luca; Ivaldi, Marco; Daolio, Fabio; Giacobini, Mario; Rainoldi, Alberto; Tomassini, Marco


    In order to investigate the behaviour of athletes in choosing sports, we analyse data from part of the We-Sport database, a vertical social network that links athletes through sports. In particular, we explore connections between people sharing common sports and the role of age and gender by applying "network science" approaches and methods. The results show a disassortative tendency of athletes in choosing sports, a negative correlation between age and number of chosen sports and a positive correlation between age of connected athletes. Some interesting patterns of connection between age classes are depicted. In addition, we propose a method to classify sports, based on the analyses of the behaviour of people practising them. Thanks to this brand new classifications, we highlight the links of class of sports and their unexpected features. We emphasise some gender dependency affinity in choosing sport classes.

  5. [Staged transcranial and transsphenoidal surgery for giant pituitary adenomas: a retrospective study of 21 cases]. (United States)

    Liao, D Y; Liu, Z Y; Zhang, J; Ren, Q Q; Liu, X Y; Xu, J G


    Objective: To investigate the effect of the second-stage transcranial and transsphenoidal approach for giant pituitary tumors. Methods: A retrospective review of 21 patients, who had undergone the transcranial surgery and then transsphenoidal surgery for giant pituitary adenomas from 2012 to 2015 in the neurosurgery department of West China Hospital, was performed. Visual findings, endocrine presentation, complications, and tumor types were collected. All data were based on clinical feature, MRI, and follow-up. Results: Among the 21 cases, gross total resection of tumor was achieved in 7 of all patients, subtotal in 11, and partial in 3. No intracranial hemorrhage or death occurred postoperatively. Postoperative infectionoccurred in one patient and cerebrospinal fluid leakage occurred in 3 patients. Four patients recovered after treatment. Conclusion: According to the clinical feature and MRI, it is safe and effective to choose the transcranial surgery and then transsphenoidal surgery for specific giant pituitary adenomas, which can improve treatment effects and reduce postoperative complications.

  6. Definition of Success after Surgery for Female Stress Incontinence or Voiding Dysfunction: An Attempt at Standardization. (United States)

    Carmel, Maude E; Deng, Donna Y; Greenwell, Tamsin J; Zimmern, Philippe E


    There is currently no standardized definition of success for surgery for stress urinary incontinence (SUI) and voiding dysfunction (VD) in women. To review the use of outcome measures (OMs) and definitions of success in the literature on SUI and VD surgery in women in an attempt to provide recommendations for future publications. A PubMed search of all English language full-text articles on SUI and VD surgery in women published between 2010 and 2015 was performed. A list of randomized trials and prospective and retrospective studies was obtained. Specific objective and subjective OMs used to define success were reviewed. Some 95 articles met the inclusion criteria for SUI surgery outcomes. Most trials reported outcomes at 12 mo after surgery. The majority (n=48) reported their primary outcomes using both objective and subjective success measures, 24 defined success using subjective OMs alone, and 23 using objective OMs alone. The OMs most frequently used for objective success were a negative cough stress test (CST), a negative pad test, and the absence of retreatment for SUI. The definition of subjective success most often involved questionnaires. The questionnaires most frequently used were Patient Global Impression of Improvement (PGI-I), Urinary Distress Inventory (UDI)/UDI-6, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Medical Epidemiologic and Social Aspects of Aging (MESA). Only 11 studies on OMs used for VD surgery were published between 2010 and 2015. The two most common criteria used for success were measurement of postvoid residual urine (PVR) and subjective resolution of VD symptoms. There is great heterogeneity in the definition of success used after surgery for SUI or VD in women. For SUI surgery, we recommend use of the CST and a 1-h pad test for the definition of objective success, and of the UDI/UDI-6, Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ), ICIQ-SF, or PGI-I questionnaire for

  7. Impact of family and gender on career goals: results of a national survey of 4586 surgery residents. (United States)

    Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann


    To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

  8. [A predictive model for the quality of sexual life in hysterectomized women]. (United States)

    Urrutia, María Teresa; Araya, Alejandra; Rivera, Soledad; Viviani, Paola; Villarroel, Luis


    The effects of hysterectomy on sexuality has been extensively studied. To establish a model to predict the quality of sexual life in hysterectomized women, six months after surgery. Analytical, longitudinal and prospective study of 90 hysterectomized women aged 45+/-7 years. Two structured interviews at the time of surgery and six months later were carried out to determine the characteristics of sexuality and communication within the couple. In the two interviews, communication and the quality of sexual life were described as "good" in 72 and 77% of women, respectively (NS). The variables that had a 40% influence on the quality of sexual life sixth months after surgery, were oophorectomy status, the presence of orgasm, the characteristics of communication and the basal sexuality with the couple. The sexuality of the hysterectomized women will depend, on a great extent, of pre-surgical variables. Therefore, it is important to consider these variables for the education of hysterectomized women.

  9. Obesity in Women: Insights for the Clinician. (United States)

    Tauqeer, Zujaja; Gomez, Gricelda; Stanford, Fatima Cody


    As a leading cause of morbidity and mortality in the United States and worldwide, obesity is a disease that is frequently encountered in clinical practice today and requires a range of medical interventions. While obesity affects both men and women across all ages, multiple issues are particularly germane to women's health, particularly as obesity is more prevalent among women than men in the United States and obesity among women of reproductive health relates to the growing issue of childhood obesity. Discussed herein are the epidemiology and pathophysiology of obesity along with the impact of perinatal obesity on fetal programming. Guidance on screening and management of obesity through lifestyle intervention, pharmacologic therapy, and bariatric surgery, as well as avoidance of weight-promoting medications wherever possible, is elaborated. Particular attention is paid to the contribution of these modalities to weight loss as well as their impact on obesity-related comorbidities that affect a woman's overall health, such as type 2 diabetes and hypertension, and her reproductive and gynecologic health. With modest weight loss, women with obesity can achieve notable improvements in chronic medical conditions, fertility, pregnancy outcomes, and symptoms of pelvic floor disorders. Moreover, as children born to women after bariatric surgery-induced weight loss show improved metabolic outcomes, this demonstrates a role for maternal weight loss in reducing risk of development of metabolic disturbances in children. In light of the immense cost burden and mortality from obesity, it is important to emphasize the role of lifestyle intervention, pharmacologic management, and bariatric surgery for weight loss in clinical practice to mitigate the impact of obesity on women's health.

  10. Leadership in nursing: analysis of the process of choosing the heads. (United States)

    de Moura, Gisela Maria Schebella Souto; de Magalhaes, Ana Maria Müller; Dall'agnol, Clarice Maria; Juchem, Beatriz Cavalcanti; Marona, Daniela dos Santos


    The process of choosing heads can be strategic to achieve desired results in nursing care. This study presents an exploratory and descriptive research that aims to analyze the process of choosing heads for the ward, in the nursing area of a teaching hospital in Porto Alegre. Data was collected from registered nurses, technicians and nursing auxiliaries through a semi-structured interview technique and free choice of words. Three theme categories emerged from content analysis: process of choosing heads, managerial competences of the head-to-be and team articulation. Leadership was the word most frequently associated with the process of choosing heads. The consultation process for the choice of the leader also contributes to the success of the manager, as it makes the team members feel co-responsible for the results achieved and legitimizes the head-to-be in their group.

  11. The Information Needs of Women Who Have Undergone Breast Cancer Surgery in the West of Turkey. (United States)

    Findik, Ummu Yildiz


    This descriptive study aimed to evaluate the information needs of breast cancer patients who have undergone surgery, and the level to which those information needs are met in the west of Turkey. It was conducted in 55 women who had undergone surgical intervention between March 2013 and March 2014 in a university hospital in the west of Turkey. A personal information form and the Patient Information Needs Scale were used to gather data. Descriptive statistics, the Chi-square test, and the Wilcoxon signed-rank test were used to analyze the data. It was found that the information need of the patients (3.9 +/- 0.6) was near the "very important" level, and that this need was "somewhat met" (2.4 +/- 0.9). When the information needs of the patients and the level to which those needs were fulfilled were compared, the level of fulfillment was statistically significantly lower (p < 0.001). Among the different subscales evaluated, information relating to medication was the most needed, and the information needs pertaining to this subscale were met to a greater degree (p < 0.05) than the remaining subscales. The results showed that the information needs, primarily the medication-related information needs, of the patients were high, but that the level of meeting these needs was low. It should be considered important for patients who have undergone breast cancer surgery to be kept informed and provided with information regarding their medication.

  12. On norms and bodies: findings from field research on cosmetic surgery in Rio de Janeiro, Brazil. (United States)

    Dorneles de Andrade, Daniela


    Brazil has the second highest rate of cosmetic surgery worldwide, provided in a large number of public and private clinics and hospitals, especially in the southeast. This qualitative field research in Rio de Janeiro included participant observation and in-depth interviews with 18 women cosmetic surgery patients, 10 key informants (e.g. psychologists and sociologists) and 12 plastic surgeons. Fifteen of the women were either pre- or post-operative; three had not decided whether to have surgery. When asked about their motivations and expectations of the surgery, the majority of the women said they wanted to be "normal". Most of the surgeons said they acted as empathic companions from decision-making through surgery and beyond. Many of the key informants were critical of what was happening to medical ethics in relation to cosmetic surgery. With the growth in a consumer culture, they saw ethics in medicine becoming more bendable and subject to the "law" of the market. The cult of the body has become a mass phenomenon and taken on an important social dimension in a society where norms and images are broadcast widely by the media. The trend towards body-modification by cosmetic surgery at an early age is increasing dramatically. What demands critical thinking and further investigation are the consequences of cosmetic surgery for physical and mental health. Copyright 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  13. Safely re-integrating silicone breast implants into the plastic surgery practice. (United States)

    Gladfelter, Joanne


    In the early 1990s, it was reported that silicone breast implants were possibly responsible for serious damage to women's health. In January 1992, the Food and Drug Administration issued a voluntary breast implant moratorium and, in April, issued a ban on the use of silicone gel-filled implants for cosmetic breast augmentation. Since that time, silicone gel-filled breast implants have been available to women only for select cases: women seeking breast reconstruction or revision of an existing breast implant, women who have had breast cancer surgery, a severe injury to the breast, a birth defect that affects the breast, or a medical condition causing a severe breast deformity. Since the ban on the use of silicone gel-filled breast implants for cosmetic breast augmentation, numerous scientific studies have been conducted. To ensure patient safety, the American Board of Plastic Surgery believes that these scientific studies and the Food and Drug Administration's scrutiny of silicone gel-filled breast implants have been appropriate and necessary.

  14. Nurse-led rehabilitation after gynaecological cancer surgery

    DEFF Research Database (Denmark)

    Seibæk, Lene


      Abstract This article presents the preliminary results and experiences from an ongoing study aiming to: Develop and test a nurse-led multidisciplinary rehabilitation programme for women who undergo surgery for localised gynaecological cancers.Evaluate the effect of the programme prospectively o...

  15. Choosing wisely-where is the choice?

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available No abstract available. Article truncated at 150 words. A little over a year ago an editorial was posted in the Southwest Journal about the Choosing Wisely campaign from the American Board of Internal Medicine and Consumer Reports (1. You may remember that Choosing Wisely announced a list of procedures or treatments that patients should question (2. In the editorial we wondered why pulmonary organizations such as the American Thoracic Society (ATS and the American College of Chest Physicians authored none of the recommendations and offered 10 suggestions. We also openly questioned if the recommendations were intended to improve patient care or reduce costs, and thus improve the profits of third party carriers. We can now report that recommendations were announced at the recent ATS meeting in Philadelphia. Seven recommendations were made for critical care and seven for pulmonary disease. Five from the critical care list and five from the pulmonary list will eventually be chosen for inclusion in …

  16. Choosing High School Courses with Purpose (United States)

    Ayotte, Steve; Sevier, Sharon


    In choosing high school courses, students often seem to focus on everything except preparation for an intended major or career. They consider graduation requirements, weighted classes, easy classes...but rarely are these types of choices preparing students for postsecondary education. This article describes the "Career Companion Guide"…

  17. A Survey on Awareness about the Role of Anesthesia and Anesthesiologists among the Patients Undergoing Surgeries in a Tertiary Care Teaching Women and Children Hospital. (United States)

    Marulasiddappa, Vinay; Nethra, H N


    Although anesthesiology has grown tremendously and although anesthesiologists play a crucial role in the perioperative management of patients and also outside operating theater (OT) such as critical care, pain clinic, and labor analgesia, they do not get due recognition. We conducted a study to assess the awareness about the role of anesthesia and anesthesiologists among patients scheduled to undergo surgery in a Government Tertiary Care Teaching Women and Children Hospital. A prospective cross-sectional survey with a sample size of 100 patients. Patients scheduled to undergo elective surgery in the age group of 18-65 years with the American Society of Anesthesiologists (ASA) Grades 1 and 2, who are willing to participate and given written informed consent. Patients whose age 0.05) between those with previous surgery and those without previous surgery regarding their knowledge of anesthesiology and anesthesiologist. Ninety percent did not know the complications, types of anesthesia and 44% did not know that anesthesiologist is a doctor. Most of the participants were not aware of the role of anesthesia and anesthesiologists inside and outside OT. Although this could be attributed to their lower level of education, the fraternity of anesthesiologists has to educate patients and surgeons about the role of anesthesia.

  18. Breast cancer survival and season of surgery

    DEFF Research Database (Denmark)

    Teilum, Dorthe; Bjerre, Karsten D; Tjønneland, Anne M


    Background Vitamin D has been suggested to influence the incidence and prognosis of breast cancer, and studies have found better overall survival (OS) after diagnosis for breast cancer in summer-autumn, where the vitamin D level are expected to be highest. Objective To compare the prognostic...... outcome for early breast cancer patients operated at different seasons of the year. Design Open population-based cohort study. Setting Danish women operated 1978-2010. Cases 79 658 adjusted for age at surgery, period of surgery, tumour size, axillary lymph node status and hormone receptor status...

  19. How adolescents decide on bariatric surgery: an interpretative phenomenological analysis. (United States)

    Doyle, J; Colville, S; Brown, P; Christie, D


    The National Institute of Clinical Excellence states that bariatric surgery may be considered for adolescents with severe obesity in 'exceptional circumstances'. However, it is not clear what is deemed to be exceptional, and there is a lack of long-term outcomes data or research, which would inform patient selection. This is an in-depth qualitative study involving five adolescents who had previously undergone bariatric surgery (between 1 and 3 years postoperatively) and four who were being assessed for the treatment. All patients were from one tertiary NHS weight management service offering bariatric surgery to adolescents. Participants were interviewed to explore how young people decide whether bariatric surgery is an appropriate intervention for them. Of the nine adolescents recruited, four were male and five female, aged between 17 and 20 years at the time of interview. Participants who had already undergone surgery did so between the ages of 16 and 18. The data were analysed using interpretative phenomenological analysis, and key themes were identified, such as (i) wanting a different future, (ii) experiences of uncertainty, (iii) managing the dilemmas and (iv) surgery as the last resort. The findings suggest that young people are prepared to accept a surgical solution for obesity despite numerous dilemmas. Young people choose this intervention as a way of 'normalizing' when they perceive there is nothing better available. It is argued that these findings may have implications for the counselling of young people living with overweight and obesity and for government policy. © 2018 World Obesity Federation.

  20. Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery

    DEFF Research Database (Denmark)

    Hansen, Melissa V; Andersen, Lærke T; Madsen, Michael T


    Depression, anxiety and sleep disturbances are known problems in patients with breast cancer. The effect of melatonin as an antidepressant in humans with cancer has not been investigated. We investigated whether melatonin could lower the risk of depressive symptoms in women with breast cancer...... in a three-month period after surgery and assessed the effect of melatonin on subjective parameters: anxiety, sleep, general well-being, fatigue, pain and sleepiness. Randomized, double-blind, placebo-controlled trial undertaken from July 2011 to December 2012 at a department of breast surgery in Copenhagen......, Denmark. Women, 30-75 years, undergoing surgery for breast cancer and without signs of depression on Major Depression Inventory (MDI) were included 1 week before surgery and received 6 mg oral melatonin or placebo for 3 months. The primary outcome was the incidence of depressive symptoms measured by MDI...

  1. The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Moeller, Ann M


    , the women did not consider themselves surviving cancer patients but as cured. The women searched for information from various sources, for example, the Internet and the online patient chart, to prepare for surgery and to come to terms with the diagnosis. CONCLUSIONS: Although the women had confidence...... activity is needed. Individualized information about anatomical changes after surgery is warranted, preferably using anatomical drawings. Potentially, the women could benefit from attending a nursing clinic during the first postoperative months....

  2. Work situation and sickness absence in the initial period after breast cancer surgery. (United States)

    Petersson, Lena-Marie; Wennman-Larsen, Agneta; Nilsson, Marie; Olsson, Mariann; Alexanderson, Kristina


    Breast cancer is the most common cancer diagnosis in women, many of whom are of working age, and the five-year survival rate in Sweden is approaching 90%. Accordingly, aspects of working life and sickness absence are of increasing importance for breast cancer survivors and may have a long-term impact on health and quality of life of these women. The aim was to elucidate the work situation and sickness absence during the initial period after breast cancer surgery and to explore factors associated with sickness absence. This is a cross-sectional questionnaire study 4-6 weeks after breast cancer surgery of women aged 20-63 years, and living in Stockholm. A consecutive sample of 933 women were invited and 756 (81%) accepted to participate. Logistic regression analyses were computed to estimate crude and adjusted odds ratios for associations between sick leave and other variables. Most women (86%) were employed (including self-employed) at diagnosis, and 91% of those worked ≥75% of full-time. At time of survey, 56% were on sick leave, the majority for full-time. Low self-rated health, poorer health than before diagnosis, having a strenuous work posture, and younger age were associated with sick leave during the initial period after breast cancer surgery in both univariate and multivariate analyses. The results of this study is not fully consistent compared to previous studies in this field, often performed in later phases after breast cancer surgery or after other cancer diagnoses. Therefore our results indicate that knowledge is needed during all phases of the breast cancer trajectory to determine factors of importance regarding sick leave and their impact throughout the disease trajectory.

  3. Primary Surgery or Interval Debulking for Advanced Epithelial Ovarian Cancer

    DEFF Research Database (Denmark)

    Markauskas, Algirdas; Mogensen, Ole; dePont Christensen, René


    OBJECTIVE: The aim of the present study was to investigate the surgical complexity, the postoperative morbidity, and the survival of the women after primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for advanced epithelial ovarian cancer....... MATERIALS AND METHODS: We consecutively included all patients who underwent debulking surgery at our institution between January 2007 and December 2012 for stages IIIc and IV of epithelial ovarian cancer. RESULTS: Of the 332 patients included, 165 (49.7%) underwent PDS, and 167 (50.3%) had NACT...

  4. Choosing a New Telephone System for Your Medical Practice. (United States)

    Metherell, Brian


    E-mail may rule the world in other types of businesses, but for medical practices, the telephone remains the primary mode of communication with patients, specialists, and pharmacies. From making appointments to calling in prescriptions, telephones are essential to patient care. With technology changing very quickly and new capabilities coming into the medical practice, such as telemedicine and Skype, you need to know your options when choosing a new telephone system. The possibilities include on-site, cloud, and hybrid networked solutions. A wide variety of features and capabilities are available, from dozens of vendors. Of course, no matter what telephone solution you choose, you must meet regulatory compliance, particularly HIPAA, and Payment Card Industry Data Security Standard if you take credit cards. And it has to be affordable, reliable, and long lasting. This article explores what medical practices need to know when choosing a new business telephone system in order to find the right solutions for their businesses.

  5. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials

    DEFF Research Database (Denmark)

    Darby, S; McGale, P; Correa, C


    After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute...

  6. Does breast reconstruction impact the decision of patients to pursue cosmetic surgery? (United States)

    Hsu, Vivian M; Tahiri, Youssef; Wes, Ari M; Yan, Chen; Selber, Jesse C; Nelson, Jonas A; Kovach, Stephen J; Serletti, Joseph M; Wu, Liza C


    Breast reconstruction is an integral component of breast cancer treatment, often aiding in restoring a patient's sense of femininity. However, many patients choose to have subsequent cosmetic surgery. The purpose of this study is to investigate the reasons that motivate patients to have cosmetic surgery after breast reconstruction. The authors performed a retrospective study examining patients who had breast reconstruction and subsequent cosmetic surgery at the University of Pennsylvania Health System between January 2005 and June 2012. This cohort received a questionnaire assessing the influences and impact of their reconstructive and cosmetic procedures. A total of 1,214 patients had breast reconstruction, with 113 patients (9.3%) undergoing cosmetic surgery after reconstruction. Of 42 survey respondents, 35 had autologous breast reconstruction (83.3%). Fifty-two cosmetic procedures were performed in survey respondents, including liposuction (26.9%) and facelift (15.4%). The most common reason for pursuing cosmetic surgery was the desire to improve self-image (n = 26, 61.9%), with 29 (69.0%) patients feeling more self-conscious of appearance after reconstruction. Body image satisfaction was significantly higher after cosmetic surgery (P = 0.0081). Interestingly, a multivariate analysis revealed that patients who experienced an improvement in body image after breast reconstruction were more likely to experience a further improvement after a cosmetic procedure (P = 0.031, OR = 17.83). Patients who were interested in cosmetic surgery prior to reconstruction were also more likely to experience an improvement in body image after cosmetic surgery (P = 0.012, OR = 22.63). Cosmetic surgery may improve body image satisfaction of breast reconstruction patients and help to further meet their expectations.

  7. Prospective hospital-based survey of attitudes of Southern women toward surgical treatment of breast cancer. (United States)

    Wei, J P; Sherry, R M; Baisden, B L; Peckel, J; Lala, G


    Breast-conserving surgery is equivalent to total mastectomy in the treatment of breast cancer. The Southern part of the United States has a low rate of breast conservation. We surveyed 300 women: 100 hospital personnel, 100 cancer clinic patients, and 100 non-cancer clinic patients. The women were asked about their attitudes toward breast cancer, surgery preferences, and factors that might influence their decisions. One hundred eighty-nine chose mastectomy as the best operation, 106 women chose lumpectomy, and five women were undecided. There was no difference in mean age, racial distribution, education level, income level, percentage of women who considered themselves Southern women, concerns about breast cancer, recent mammograms, previous breast surgery, previous breast cancer treatment, or acquaintances with breast cancer between the mastectomy and the lumpectomy groups. Women interested in saving the breast were more likely to pick lumpectomy (35 vs. 84%, p = 0.001). A fear of cancer recurrence played a role in the decision (88 vs. 40%, p = 0.001). Fear of radiation therapy (76 vs. 57%, p = 0.002) and of the side effects (80 vs. 63%, p = 0.005) was a significant factor. The choice of surgery for breast cancer is an individual process between a woman and her surgeon. Attitudes and fears regarding cancer recurrence and radiation therapy may make women select mastectomy over lumpectomy.

  8. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery


    Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro


    Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery ...

  9. Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory. (United States)

    Dunn, Jennifer A; Hay-Smith, E Jean C; Whitehead, Lisa C; Keeling, Sally


    To explore, from the perspective of the person with tetraplegia, the issues that influenced decision making about upper limb surgery and develop a conceptual framework describing the decision making process. Purposive and theoretical sampling of 22 people with tetraplegia, followed by interviews. Ten people had upper limb surgery and 12 had not. Verbatim transcripts were analyzed with constructivist grounded theory. Participants responded to the offer of surgery in one of three ways: yes, let me have it; no thanks; or possibly. Many influences on the decision about surgery had a temporal element, such as hope for the cure or recovery from SCI, inadequate physical or social supports while rehabilitating, life roles and goals, and the avoidance of re-hospitalization. The conceptual framework illustrated that many participants entered a liminal state within which they required a stimulus to review their decision about upper limb surgery. Decision making is a temporal process, and for some the process was a prolonged and liminal one. Therefore, multiple offers for surgery are required to allow for changing thoughts and circumstances throughout an individual's lifetime. Flexibility with regard to timing for surgery and type of rehabilitation may increase the uptake, especially for women. • Multiple offers for upper limb surgery are required throughout an individual's lifetime to account for changing thoughts and priorities. • Identification of the type of support required (informational, emotional) may assist in decreasing the time taken to make the decision about surgery. • Flexibility in surgical and rehabilitation options, especially for women, may increase the uptake of surgery.

  10. Preoperative warfarin reversal for early hip fracture surgery. (United States)

    Moores, Thomas Steven; Beaven, Alastair; Cattell, Andrew Edwin; Baker, Charles; Roberts, Philip John


    To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery. Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk. The international normalised ratio (INR) of patients was checked on admission and 6 hours after administration of vitamin K; an INR of fracture surgery within 36 to 48 hours of admission improves morbidity and mortality.

  11. Oncoplastic breast surgery does not delay the onset of adjuvant chemotherapy

    DEFF Research Database (Denmark)

    Klit, Anders; Tvedskov, Tove Filtenborg; Kroman, Niels


    BACKGROUND: Only a few studies of limited size have examined whether oncoplastic breast surgery delays the onset of adjuvant chemotherapy as compared to conventional breast surgery. We investigated whether oncoplastic breast surgery causes a delay in the onset of adjuvant chemotherapy in comparison...... to lumpectomy and mastectomy. MATERIAL AND METHODS: The study is a population-based cohort study. Within the nationwide registry of the Danish Breast Cancer Group (DBCG), we identified 1798 patients who received adjuvant chemotherapy following mastectomy, lumpectomy or oncoplastic breast surgery for early...... and unilateral invasive breast cancer. Women treated with neoadjuvant chemotherapy were excluded. RESULTS: We found no significant difference between the three groups (mastectomy, lumpectomy, oncoplastic breast surgery) in the time from biopsy to surgery (mean time 17.9, 17.0 and 18.3 days, respectively...

  12. Fall risk and function in older women after gynecologic surgery. (United States)

    Miller, Karen L; Richter, Holly E; Graybill, Charles S; Neumayer, Leigh A


    To examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. Prospective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. Median age was 72 years (range 65-88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (pBalance performance and functional mobility at 1 week were significantly lower than baseline (pfall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  13. Women on professional society and journal editorial boards. (United States)

    Morton, Melinda J; Sonnad, Seema S


    Membership on a professional medical society or journal editorial board is a marker of influence and prestige for those in academic medicine. This study presents the first comprehensive quantification of women on these boards and the implications for women in medicine. The numbers of women and men on professional society and journal editorial boards across 28 specialties (March 2004) were counted. The number of women holding multiple roles on these boards and the number of women holding top leadership positions on these boards were counted, and these proportions were compared. Three-thousand-four-hundred-seventy-three individuals on 39 professional medical society boards and 54 journal editorial boards were included. Eighty-three percent (2,884) of board members were male. Men occupied > 80% of top leadership positions on these boards. Thirty-five of the 589 women in the study held multiple roles. Anesthesiology (p women on boards in comparison to the total women in the specialty. Internal medicine, plastic surgery, cardiology and general surgery had nearly equivalent proportions; in otolaryngology and family medicine, female board members slightly exceeded the proportion of women in the field. Women's representation on society and editorial boards does not always reflect their presence in medical specialties, and it is critically lacking in certain specialties. Efforts should be made to attain parity of women leaders on these boards. Further efforts should be made to eliminate barriers to women's leadership in medicine.

  14. Results of primary versus recurrent surgery to treat stress urinary incontinence in women

    NARCIS (Netherlands)

    van der Doelen, Maarten J; Withagen, Mariëlla I J; Vierhout, Mark E; Heesakkers, John P F A

    INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

  15. Results of primary versus recurrent surgery to treat stress urinary incontinence in women

    NARCIS (Netherlands)

    Doelen, M.J. van der; Withagen, M.I.J.; Vierhout, M.E.; Heesakkers, J.P.F.A.


    INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

  16. Costs of reproduction are reflected in women's faces: Post-menopausal women with fewer children are perceived as more attractive, healthier and younger than women with more children. (United States)

    Marcinkowska, Urszula M; Little, Anthony C; Galbarczyk, Andrzej; Nenko, Ilona; Klimek, Magdalena; Jasienska, Grazyna


    The costs associated with reproduction (i.e., gestation, lactation, childcare) have long-term negative consequences by elevating risk of disease and reducing lifespan. We tested the hypotheses that high parity, and thus high reproductive costs bear by women, is perceived by other people when they evaluate facial appearance of health, attractiveness and age of mothers. Using computer software we created average facial images based on real photographs of post-menopausal women with varying number of children; 3 parity categories were created (1-2, 4-5, and 7-9 children). Study participants (N = 571) were asked to choose the face they perceived as more attractive, younger and healthier via two-alternative forced choice questions asked in three randomized blocks. Women who had given birth to fewer children were judged both by men and women as more attractive, younger and healthier than women with more children. In each category the lowest scores were received by women from highest parity category (7-9 children). Mechanisms behind the observed variation in facial appearance are not known but higher levels of oxidative stress among women with high parity may explain their faster aging and lower attractiveness in older age. These results suggest that costs of reproduction might affect women's physical appearance. © 2017 Wiley Periodicals, Inc.

  17. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial. (United States)

    van der Ploeg, J Marinus; Oude Rengerink, Katrien; van der Steen, Annemarie; van Leeuwen, Jules H Schagen; van der Vaart, C Huub; Roovers, Jan-Paul W R


    We compared pelvic organ prolapse (POP) repair with and without midurethral sling (MUS) in women with occult stress urinary incontinence (SUI). This was a randomized trial conducted by a consortium of 13 teaching hospitals assessing a parallel cohort of continent women with symptomatic stage II or greater POP. Women with occult SUI were randomly assigned to vaginal prolapse repair with or without MUS. Women without occult SUI received POP surgery. Main outcomes were the absence of SUI at the 12-month follow-up based on the Urogenital Distress Inventory and the need for additional treatment for SUI. We evaluated 231 women, of whom 91 randomized as follows: 43 to POP surgery with and 47 without MUS. A greater number of women in the MUS group reported absence of SUI [86 % vs. 48 %; relative risk (RR) 1.79; 95 % confidence interval (CI) 1.29-2.48]. No women in the MUS group received additional treatment for postoperative SUI; six (13 %) in the control group had a secondary MUS. Women with occult SUI reported more urinary symptoms after POP surgery and more often underwent treatment for postoperative SUI than women without occult SUI. Women with occult SUI had a higher risk of reporting SUI after POP surgery compared with women without occult SUI. Adding a MUS to POP surgery reduced the risk of postoperative SUI and the need for its treatment in women with occult SUI. Of women with occult SUI undergoing POP-only surgery, 13 % needed additional MUS. We found no differences in global impression of improvement and quality of life.

  18. Choosing a Geothermal as an HVAC System. (United States)

    Lensenbigler, John D.


    Describes the process of selecting and installing geothermal water source heat pumps for new residence halls at Johnson Bible College in Knoxville, Tennessee, including choosing the type of geothermal design, contractors, and interior equipment, and cost and payback. (EV)

  19. Surgical site infections in women and their association with clinical conditions

    Directory of Open Access Journals (Sweden)

    Maria Zélia de Araújo Madeira


    Full Text Available Introduction Surgical site infections (SSIs can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth reflecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.

  20. How Older Female Spouses Cope with Partners’ Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Suzanne Marnocha


    Full Text Available This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.

  1. Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. (United States)

    Silver, Julie K; Slocum, Chloe S; Bank, Anna M; Bhatnagar, Saurabha; Blauwet, Cheri A; Poorman, Julie A; Villablanca, Amparo; Parangi, Sareh


    Membership in medical societies is associated with a number of benefits to members that may include professional education, opportunities to present research, scientific and/or leadership training, networking, and others. In this perspective article, the authors address the value that medical specialty society membership and inclusion have in the development of an academic physician's career and how underrepresentation of women may pose barriers to their career advancement. Because society membership itself is not likely sufficient to support the advancement of academic physicians, this report focuses on one key component of advancement that also can be used as a measure of inclusion in society activities-the representation of women physicians among recipients of recognition awards. Previous reports demonstrated underrepresentation of women physicians among recognition award recipients from 2 physical medicine and rehabilitation specialty organizations, including examples of zero or near-zero results. This report investigated whether zero or near-zero representation of women physicians among recognition award recipients from medical specialty societies extended beyond the field of physical medicine and rehabilitation. Examples of the underrepresentation of women physicians, as compared with their presence in the respective field, was found across a range of additional specialties, including dermatology, neurology, anesthesiology, orthopedic surgery, head and neck surgery, and plastic surgery. The authors propose a call for action across the entire spectrum of medical specialty societies to: (1) examine gender diversity and inclusion data through the lens of the organization's mission, values, and culture; (2) transparently report the results to members and other stakeholders including medical schools and academic medical centers; (3) investigate potential causes of less than proportionate representation of women; (4) implement strategies designed to improve

  2. Increased risk of breast cancer in women with false-positive test

    DEFF Research Database (Denmark)

    von Euler-Chelpin, My; Kuchiki, Megumi; Vejborg, Ilse


    of misclassification, i.e. women who were actually false-negatives instead of false-positives. METHOD: We used data from the Copenhagen Mammography Screening Programme, Denmark. The study population was the 295 women, out of 4743 recalled women from a total of 58,003 participants, with a false-positive test during...... the women with misclassified tests had been excluded, there was an excess risk of breast cancer of 27% (RR=1.27, 95% confidence interval (CI), 1.11-1.46) among the women with a false-positive test compared to women with only negative tests. Women with a false-positive test determined at assessment had...... an excess risk of 27%, while false-positives determined at surgery had an excess risk of 30%. CONCLUSIONS: The results indicate that the increased risk is not explained only by misclassification. The excess risk remains for false-positives determined at assessment as well as at surgery, which favours some...

  3. Alterations in fatty acid metabolism in response to obesity surgery combined with dietary counseling. (United States)

    Walle, P; Takkunen, M; Männistö, V; Vaittinen, M; Käkelä, P; Ågren, J; Schwab, U; Lindström, J; Tuomilehto, J; Uusitupa, M; Pihlajamäki, J


    The effects of obesity surgery on serum and adipose tissue fatty acid (FA) profile and FA metabolism may modify the risk of obesity-related diseases. We measured serum (n=122) and adipose tissue (n=24) FA composition and adipose tissue mRNA expression of genes regulating FA metabolism (n=100) in participants of the Kuopio Obesity Surgery Study (KOBS, age 47.2±8.7 years, BMI 44.6±6.0, 40 men, 82 women) before and one year after obesity surgery. As part of the surgery protocol, all the subjects were instructed to add sources of unsaturated fatty acids, such as rapeseed oil and fatty fish, into their diet. The results were compared with changes in serum FA composition in 122 subjects from the Finnish Diabetes Prevention study (DPS) (age 54.3±7.1 years, BMI 32.2±4.6, 28 men, 94 women). The proportion of saturated FAs decreased and the proportion of n-3 and n-6 FAs increased in serum triglycerides after obesity surgery (all Pobesity surgery in all lipid fractions (all Pobesity surgery and lifestyle intervention, except for the change in the absolute amounts of n-3 FAs between the two studies (P=0.044). Beneficial changes in serum and adipose tissue FAs after obesity surgery could be associated with changes in endogenous metabolism and diet.

  4. The immune response is affected for at least three weeks after extensive surgery for ovarian cancer

    DEFF Research Database (Denmark)

    Brøchner, Anne Craveiro; Mikkelsen, Søren; Hegelund, Iørn


    INTRODUCTION: The treatment of women with ovarian cancer in advanced stages consists of extensive surgery followed by chemotherapy initiated three weeks after surgery. In this study, selected immune parameters were investigated to elucidate when the immune system is normalised following the opera......INTRODUCTION: The treatment of women with ovarian cancer in advanced stages consists of extensive surgery followed by chemotherapy initiated three weeks after surgery. In this study, selected immune parameters were investigated to elucidate when the immune system is normalised following......, interleukin-10 and the activity and total frequency of natural killer cells were measured. RESULTS: Interleukin-6 and interleukin-10 were significantly elevated immediately after the operation and also after 21 days. The total population of natural killercells and the total activity were reduced. The total...

  5. Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

    NARCIS (Netherlands)

    Thys, S. D.; Roovers, J. P.; Geomini, P. M.; Bongers, M. Y.


    Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our

  6. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth


    the last decade without randomised controlled trials (RCTs) to prove superiority over other surgical alternatives. The purpose of the thesis was to explore and describe patient and health economic outcomes of RALH for women with endometrial cancer using different research approaches. The first study...... weeks earlier. The women were positive towards the robotic approach and felt recovered shortly after. They expressed uncertainty with the normal course of bleeding and bowel movement post-operatively as well as with the new anatomy. The third study was an economic evaluation; an activity-based costing...... to monitor relevant surgical and patient-reported outcomes as indications for robotic surgery may alter, experiences may develop and further technical advances may change robotic surgery for women with endometrial cancer in the future....

  7. Wood preservatives : choosing the right one (United States)

    Matt Humphries; Stan Lebow; David Moses


    If you are having trouble choosing the right wood preservative system for your application, you are not alone. Dozens of products are available, some older types have gone out of use, others may be completely inappropriate for your application. As designers, specifiers and builders, you need to understand key information to be able to navigate through all of these...

  8. Gender inequality in career advancement for females in Japanese academic surgery. (United States)

    Okoshi, Kae; Nomura, Kyoko; Fukami, Kayo; Tomizawa, Yasuko; Kobayashi, Katsutoshi; Kinoshita, Koichi; Sakai, Yoshiharu


    During the past three decades, the participation of women in medicine has increased from 10.6% (1986) to 19.7% (2012) in Japan. However, women continue to be underrepresented in the top tiers of academic medicine. We highlight gender inequality and discuss the difficulties faced by female surgeons in Japanese academic surgery. Using anonymous and aggregate employment data of medical doctors at Kyoto University Hospital from 2009 and 2013, and a commercially-published faculty roster in 2012-2013, we compared gender balance stratified by a professional and an academic rank. The numbers of total and female doctors who worked at Kyoto University Hospital were 656 and 132 (20.1%) in 2009 and 655 and 132 (20.2%) in 2013, respectively. Approximately half the men (n = 281) were in temporary track and the rest (n = 242) were in tenure track, but only one fifth of women (n = 24) were in tenure track compared to 108 women in temporary track (p < 0.0001) in 2013. There were three female associate professors in basic medicine (8.1%), two female professors in clinical non-surgical medicine (3.9%) and one female lecturer in clinical surgical medicine (2.3%) in 2012. Fewer female doctors were at senior positions and at tenure positions than male doctors at Kyoto University Hospital. There were no female associate and full professors in surgery. The status of faculty members indicates the gender differences in leadership opportunities in Japanese academic surgery.

  9. How Does the Patient React After Reading the Informed Consent Form of a Gynecological Surgery? A Qualitative Study. (United States)

    Amorim, Andrea Cristina; Santos, Luis Guilherme Teixeira Dos; Poli-Neto, Omero Benedicto; Brito, Luiz Gustavo Oliveira


     To analyze the reaction of women after reading the Informed Consent Form (ICF) before undergoing elective gynecological/urogynecological surgeries.  A qualitative study with 53 women was conducted between September 2014 and May 2015. The analysis of the content was conducted after a scripted interview was made in a reserved room and transcribed verbatim. We read the ICF once more in front of the patient, and then she was interviewed according to a script of questions about emotions and reactions that occurred about the procedure and her expectations about the intra- and postoperative period.  The women had a mean age of 52 years, they were multiparous, and most had only a few years of schooling (54.7%). The majority (60.4%) of them had undergone urogynecological surgeries. Hysterectomy and colpoperineoplasty were the most frequent procedures. Ten women had not undergone any previous abdominal surgery. Fear (34.6%) was the feeling that emerged most frequently from the interviews after reading the ICF, followed by indifference (30.8%) and resignation (13.5%). Nine women considered their reaction unexpected after reading the ICF. Three patients did not consider the information contained in the ICF to be sufficient, and 3 had questions about the surgery after reading the document.  Reading the ICF generates fear in most women; however, they believe this feeling did not interfere in their decision-making process. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION: Mid Urethral Slings is the main stay of therapy in the management of stress urinary incontinence in the female, w e evaluated the effect of TVT on sexual function in women who are from the rural backward districts of Rayalaseema districts of Andhra Pradesh. MATERIALS & METHODS: 30 Women with a mean age of 44 yrs with SUI were evaluated before TVT procedure and then every 3months for 1yr for sexual health using NSF - 9 questionnaire . RESULTS: The sexual function in all the domains including desire, frequency ar ousal , orgasm remained the same as before surgery in more than 80% pts. The satisfaction rate was better in pts who were leaking during sex before surgery in six out of ten patients. CONCLUSIONS: TVT surgery does not have any significant impact on sexual function Sexual function is not an important issue for the female beyond the age of 40 yrs in the perimenopau s e/ post menopause period

  11. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery. (United States)

    Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

    Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  12. 'Fat girls' and 'big guys': gendered meanings of weight loss surgery. (United States)

    Newhook, Julia Temple; Gregory, Deborah; Twells, Laurie


    Over 80% of weight loss surgery (WLS) patients are women, yet gender is overwhelmingly absent in WLS research. This article discusses the findings of 54 interviews with twenty-one women and six men waiting for WLS in Newfoundland and Labrador, Canada. We critically examine the ways that gender shapes the meaning of WLS in these narratives. We explore gendered meanings in participants' perspectives on their embodied experiences before surgery, social support as they decided to undergo the procedure, and their expectations for their lives after WLS. We draw on feminist theory to explain how these findings counter the dominant gender-neutral medical model of obesity. © 2015 Foundation for the Sociology of Health & Illness.

  13. Mirror, mirror on the wall: how women learn body dissatisfaction. (United States)

    Lev-Ari, Lilac; Baumgarten-Katz, Inbar; Zohar, Ada H


    Extensive research indicates that exposure to media as well as pressure and modeling by sociocultural agents, such as peers and family, are predictive of the development of body image dissatisfaction (BID). This influence is mediated by social comparison and internalization of the thin-ideal. In the current study we assessed comparisons between participants and other women with whom they were in close relationships, (e.g. mother, sister and close female friend), and hypothesized that these would influence women's BID and drive-to-thinness. 283 women between the ages of 18-42 (mean=25.04; SD=3.53) sampled through social networking completed an online self-report which included the original Figure Rating Scale, which yielded self-ideal disparity, as well as a modified version comparing self to mother, self to sister closest-in-age, and self to best friend and then were asked to directly compare themselves to these women. In addition they completed the EDI-2's drive-for-thinness and body dissatisfaction subscales, and reported on Body Mass Index (BMI). Results indicate that comparisons to mothers, sisters, and best friend, were all associated with self-ideal disparity. BMI only slightly mediated this effect. Comparison to sister and to best friend, but not to mother, influenced drive-for-thinness and body dissatisfaction. Positive correlations were found between direct and indirect comparisons to others. Comparison to best friend was the most influential on body ideal. We conclude that comparison to others in close proximity greatly influences women's body ideal and may have a formative role in the development of women's body dissatisfaction. While women cannot choose their mother and sister closest in age, they do choose their best friend; and it is interesting that the comparison to the best friend is so influential. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Risk of connective tissue disease and related disorders among women with breast implants: a nation-wide retrospective cohort study in Sweden.


    Nyrén, O.; Yin, L.; Josefsson, S.; McLaughlin, J. K.; Blot, W. J.; Engqvist, M.; Hakelius, L.; Boice, J. D.; Adami, H. O.


    OBJECTIVE: To examine the relation between connective tissue disease and related conditions and breast implants. DESIGN: Retrospective cohort study of all women in the Swedish national inpatient registry who underwent breast augmentation surgery with artificial implants during 1964-93, compared with women who underwent breast reduction surgery during the same period. SETTING: Sweden. SUBJECTS: 7442 women with implants for cosmetic reasons or for reconstruction after breast cancer surgery and ...

  15. Scheduling the Stork: Media Portrayals of Women's and Physicians' Reasons for Elective Cesarean Delivery. (United States)

    Campo-Engelstein, Lisa; Howland, Lauren E; Parker, Wendy M; Burcher, Paul


    Media interest in cesarean delivery has grown in recent years driven both by rising cesarean delivery rates and the decision by the American College of Obstetrics and Gynecology (ACOG) to permit elective cesarean (EC) delivery. A content analysis of United States newspaper and magazine articles from 2000 to 2013 (n = 131 articles) was completed to understand how the news media portrays ECs. The majority of articles (71.8%) emphasized reasons to support women having an EC, while 38.2 percent of the articles exhibited themes of physician support for ECs. Relatively few articles mentioned reasons against ECs either from the women's perspective (11.5%) or the practitioners' (3.8%). The most common themes given for women choosing ECs were convenience/scheduling (48.9%), avoidance of pain or fear of labor (29.8%), and physical harm to women from vaginal birth (17.6%). Doctors' perspectives were less prevalent in the media than women's perspectives, but when mentioned they were almost exclusively in support of ECs for reasons including avoiding malpractice (28.2%), avoiding physical harm to the woman or baby (16.8%), and timing/scheduling (14.5%). Media coverage suggests ECs are widely accepted by both women and doctors, with women choosing an EC mainly for convenience/scheduling and fear. However, 43 percent of doctors surveyed by ACOG said they were not willing to perform the procedure, and surveys report that mothers rarely request an EC. © 2015 Wiley Periodicals, Inc.

  16. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. (United States)

    Zhang, Mingjuan Lisa; Hirunyachote, Phenpan; Jampel, Henry


    Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (, (, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) ( We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014.We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to

  17. The effect of Ramadan fasting on serum leptin, neuropeptide Y and insulin in pregnant women


    Khoshdel, Abolfazl; Kheiri, Soleiman; Nasiri, Jafar; Tehran, Hoda Ahmari; Heidarian, Esfandiar


    Background: Many pregnant Muslim women choose to fast during Ramadan every year worldwide. This study aimed to examine the effect of Ramadan fasting on serum leptin, neuropeptide Y and insulin in pregnant women and find whether fasting during pregnancy could have a negative effect on the health of mothers and fetuses. Methods: This cross-sectional study was conducted on 39 healthy volunteer fasting pregnant women. Serum leptin, neuropeptide Y, insulin levels, body mass index and weight were m...

  18. Investigation of Personality Traits between Infertile Women Submitted to Assisted Reproductive Technology or Surrogacy


    Najmeh Asgarini; Fariba Yazdkhasti; Mohammad Hossein Nasr Esfahani


    Background: Personality traits affect human relationships, social interactions, treatment procedures, and essentially all human activities. The purpose of this study is to investigate the personality traits -including sensation seeking, flexibility, and happiness - among a variety of infertile women who were apt to choose assisted reproductive technology (ART) or surrogacy. Materials and Methods: This is a cross-sectional study that was performed on 251 infertile women who v...

  19. Working women: the domestic labour market in Ireland, 1890-1914


    Bourke, Joanna


    Historians and economists generally (and prudently) choose narrowly to define "labor" as\\ud paid employment, ignoring the largest sector of work: unpaid\\ud work within the home. It is no longer sufficient to regard women\\ud who work in the home as "surplus" or "unproductive" workers.\\ud Rather, the movement of women out of the paid employment\\ud market and into the unpaid domestic market is linked to the\\ud increased value of labor within the home. Although certain shifts\\ud in the economy pu...

  20. Acting on One's Attitudes: The Role of a History of Choosing Situations. (United States)

    DeBono, Kenneth G.; Snyder, Mark


    Three investigations examined the contributions of a history of choosing attitudinally relevant situations to attitude-behavior relations. Results point to an interrelated set of mechanisms, such as behavior, by which situational choice is linked to attitude-behavior relations. By choosing attitudinally relevant situations, individuals increase…

  1. Research productivity and gender disparities: a look at academic plastic surgery. (United States)

    Paik, Angie M; Mady, Leila J; Villanueva, Nathaniel L; Goljo, Erden; Svider, Peter F; Ciminello, Frank; Eloy, Jean Anderson


    The h-index has utility in examining the contributions of faculty members by quantifying both the amount and the quality of research output and as such is a metric in approximating academic productivity. The objectives of this study were (1) to evaluate the relationship between h-index and academic rank in plastic surgery and (2) to describe the current gender representation in academic plastic surgery to assess whether there are any gender disparities in academic productivity. The h-index was used to evaluate the research contributions of plastic surgeons from academic departments in the United States. There were 426 (84%) men and 79 (16%) women in our sample. Those in higher academic ranks had higher h-index scores (p productivity between men and women in assistant and associate professor positions (6.4 vs 5.1, respectively; p = 0.04). The h-index is able to objectively and reliably quantify academic productivity in plastic surgery. We found that h-indices increased with higher academic rank, and men had overall higher scores than their female colleagues. Adoption of this metric as an adjunct to other objective and subjective measures by promotions committees may provide a more reliable measure of research relevance and academic productivity in academic plastic surgery. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Identification of Metabolomic Biomarkers for Endometrial Cancer and Its Recurrence after Surgery in Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Yannick Audet-Delage


    Full Text Available Endometrial cancer (EC is the most frequent gynecological cancer in developed countries. Most EC occurs after menopause and is diagnosed as endometrioid (type I carcinomas, which exhibit a favorable prognosis. In contrast, non-endometrioid (type II carcinomas such as serous tumors have a poor prognosis. Our goal was to identify novel blood-based markers associated with EC subtypes and recurrence after surgery in postmenopausal women. Using mass spectrometry-based untargeted metabolomics, we examined preoperative serum metabolites among control women (n = 18 and those with non-recurrent (NR and recurrent (R cases of type I endometrioid (n = 24 and type II serous (n = 12 carcinomas. R and NR cases were similar with respect to pathological characteristics, body mass index, and age. A total of 1,592 compounds were analyzed including 14 different lipid classes. When we compared EC cases with controls, 137 metabolites were significantly different. A combination of spermine and isovalerate resulted in an age-adjusted area under the receiver-operating characteristic curve (AUCadj of 0.914 (P < 0.001 for EC detection. The combination of 2-oleoylglycerol and TAG42:2-FA12:0 allowed the distinction of R cases from NR cases with an AUCadj of 0.901 (P < 0.001. Type I R cases were also characterized by much lower levels of bile acids and elevated concentrations of phosphorylated fibrinogen cleavage peptide, whereas type II R cases displayed higher levels of ceramides. The findings from our pilot study provide a detailed metabolomics study of EC and identify putative serum biomarkers for defining clinically relevant risk groups.

  3. Choosing the Right Fireplace or Fireplace Retrofit Device (United States)

    This page is about choosing a fireplace or fireplace retrofit device, including information on hang tags and a list of fireplaces and retrofits that have qualified under the voluntary fireplace program

  4. Effect of nurse case management on the treatment of older women with breast cancer. (United States)

    Goodwin, James S; Satish, Shiva; Anderson, Elizabeth T; Nattinger, Ann B; Freeman, Jean L


    To evaluate the effect of nurse case management on the treatment of older women with breast cancer. Randomized prospective trial. Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas. Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer. Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer. The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis. More women in the intervention group received breast-conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast-conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management. Nurse case management results in more appropriate management of older women with breast cancer.

  5. Evaluation of Patients’ Satisfaction after Class III Orthognathic Surgery (United States)

    Magro-Filho, Osvaldo; Oliveira, Derly Tescaro Narcizo; Martins, Lidia Pimenta; Salazar, Marcio; Medeiros, Rodrigo Antonio De; Santos, Daniela Micheline Dos


    Background Well-planned orthognathic surgery improves psychological health, aesthetics and function of patients. Aim The present study aimed to investigate patients’ satisfaction after orthognathic surgery by means of a satisfaction questionnaire before and after surgery. Materials and Methods A total of 29 patients was selected (17 women and 12 men), with a mean age of 28 years, randomly selected from a private clinic at Araçatuba – São Paulo by two investigators. Anamnesis and clinical examination were performed. Subjects with facial deformities submitted to orthodontic treatment before and after orthognathic surgery with a minimum post-surgery period of 6 months, answered a satisfaction questionnaire composed of 10 questions regarding dental and facial aesthetics. In this study, the maximum satisfaction score was 10. Results Regarding aesthetics, two satisfaction parameters were investigated: dental and facial. For all indices, the average satisfaction was up to score 7. Conclusion According to the results, it can be concluded that orthognathic surgery has been an effective treatment for dentofacial deformities, aesthetics and functional problems, what was verified by pre and postoperative questionnaire application. PMID:26557610

  6. Evaluation of Patients' Satisfaction after Class III Orthognathic Surgery. (United States)

    Magro-Filho, Osvaldo; Goiato, Marcelo Coelho; Oliveira, Derly Tescaro Narcizo; Martins, Lidia Pimenta; Salazar, Marcio; Medeiros, Rodrigo Antonio De; Santos, Daniela Micheline Dos


    Well-planned orthognathic surgery improves psychological health, aesthetics and function of patients. The present study aimed to investigate patients' satisfaction after orthognathic surgery by means of a satisfaction questionnaire before and after surgery. A total of 29 patients was selected (17 women and 12 men), with a mean age of 28 years, randomly selected from a private clinic at Araçatuba - São Paulo by two investigators. Anamnesis and clinical examination were performed. Subjects with facial deformities submitted to orthodontic treatment before and after orthognathic surgery with a minimum post-surgery period of 6 months, answered a satisfaction questionnaire composed of 10 questions regarding dental and facial aesthetics. In this study, the maximum satisfaction score was 10. Regarding aesthetics, two satisfaction parameters were investigated: dental and facial. For all indices, the average satisfaction was up to score 7. According to the results, it can be concluded that orthognathic surgery has been an effective treatment for dentofacial deformities, aesthetics and functional problems, what was verified by pre and postoperative questionnaire application.

  7. The Tear Osmolarity Changes After Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Banu Öncel


    Full Text Available Pur po se: To determine the tear osmolarity changes in patients who had undergone phacoemulsification surgery. Ma te ri al and Met hod: Tear osmolarity measurements were performed in 30 eyes of 30 patients who had undergone cataract surgery without any complication. Measurements were performed before surgery and consecutively at 1st month, 3rd month, and 6th month after the surgery. TearLab osmometer (TearLab Corporation, San Diego, CA, USA device was used for the measurements and paired ttest was used for statistical analysis. Re sults: The mean age of the patients was 72.3±3.7 (67-78 years. Thirteen patients were men and 17 patients were women. The mean osmolarity values were 305.8±6.5 mOsm/L before the surgery and 312.3±6.4 mOsm/L at 1st month, 307.5±5.1 mOsm/L at 3rd month and 305.1±5.7 at 6th month after the surgery. The difference between the values before surgery and at 1st month was found statistically significant (p=0.001. Dis cus si on: The tear osmolarity increases at the first month after surgery but decreases to the levels measured before surgery at the 3rd month. The increase at the first month may be due to the corneal incisions and medication used after the surgery. We think that we have to take into account this similarity increase in all cataract patients, especially in those who also have dry eye disease. (Turk J Ophthalmol 2012; 42: 35-7

  8. Maintaining women's oral health. (United States)

    McCann, A L; Bonci, L


    Women must adopt health-promoting strategies for both general health and the oral cavity, because the health of a woman's body and oral cavity are bidirectional. For general health-maintenance strategies, dental practitioners should actively advise women to minimize alcohol use, abstain from or cease smoking, stay physically active, and choose the right foods to nourish both the body and mind. For oral health-maintenance strategies, dental practitioners should advise women on how to prevent or control oral infections, particularly dental caries and periodontal diseases. Specifically, women need to know how to remove plaque from the teeth mechanically, use appropriate chemotherapeutic agents and dentifrices, use oral irrigation, and control halitosis. Dental practitioners also need to stress the importance of regular maintenance visits for disease prevention. Adolescent women are more prone to gingivitis and aphthous ulcers when they begin their menstrual cycles and need advice about cessation of tobacco use, mouth protection during athletic activities, cleaning orthodontic appliances, developing good dietary habits, and avoiding eating disorders. Women in early to middle adulthood may be pregnant or using oral contraceptives with concomitant changes in oral tissues. Dental practitioners need to advise them how to take care of the oral cavity during these changes and how to promote the health of their infants, including good nutrition. Older women experience the onset of menopause and increased vulnerability to osteoporosis. They may also experience xerostomia and burning mouth syndrome. Dental practitioners need to help women alleviate these symptoms and encourage them to continue good infection control and diet practices.

  9. No. 127-The Evaluation of Stress Incontinence Prior to Primary Surgery. (United States)

    Farrell, Scott A


    To provide clinical guidelines for the evaluation of women with stress urinary incontinence prior to primary anti-incontinence surgery. The modalities of evaluation range from basic pelvic examination through to the use of adjuncts including ultrasound and urodynamic testing. These guidelines provide a comprehensive approach to the preoperative evaluation of urinary incontinence to ensure that excessive evaluation is avoided without sacrificing diagnostic accuracy. Published opinions of experts, supplemented by evidence from clinical trials, where appropriate. The quality of the evidence is rated using the criteria described by the Canadian Task Force on the Periodic Health Examination. Comprehensive evaluation of women considering surgery to treat urinary incontinence is essential to rule out causes of incontinence that may not be amenable to surgical treatment. Simplifying the evaluation minimizes the discomfort and embarrassment potentially experienced by women. VALIDATION: These guidelines have been approved by the Urogynaecology Committee and the Executive and Council of The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

  10. Blame it on patriarchy: more sexist attitudes are associated with stronger consideration of cosmetic surgery for oneself and one's partner. (United States)

    Swami, Viren; Pietschnig, Jakob; Stewart, Natasha; Nader, Ingo W; Stieger, Stefan; Shannon, Samantha; Voracek, Martin


    In the present work, we examined associations between oppressive, sexist beliefs and consideration of cosmetic surgery for oneself and also endorsement of cosmetic surgery for one's romantic partner. A total of 554 German-speaking volunteers from the community, mainly in Austria, completed measures of consideration of cosmetic surgery and three measures of sexist attitudes, while a subset of participants in romantic relationships completed a measure of endorsement of cosmetic surgery for their partners along with the measures of sexism. Preliminary analyses showed that women and single respondents were more likely to consider having cosmetic surgery than men and committed respondents, respectively. Further analyses showed that consideration of cosmetic surgery for oneself was significantly associated with sexist attitudes, particularly hostile attitudes to women. In addition, among participants in a relationship, sexist attitudes were associated with endorsement of cosmetic surgery for one's partner. These results indicate that attitudes to cosmetic surgery for oneself and one's partner are shaped by gender-ideological belief systems in patriarchal societies. Possible implications for understanding the motivations for having cosmetic surgery, among both single respondents and couples, are discussed.

  11. Obesity-Associated Hypertension: the Upcoming Phenotype in African-American Women. (United States)

    Samson, Rohan; Qi, Andrea; Jaiswal, Abhishek; Le Jemtel, Thierry H; Oparil, Suzanne


    The present obesity epidemic particularly affects African-American women. Whether the obesity epidemic will alter the hypertension phenotype in African-American women is entertained. The prevalence of morbid obesity is steadily increasing in African-American women, who are prone to developing hypertension (HTN) even in the absence of obesity. The obesity-associated hypertension phenotype is characterized by marked sympathetic nervous system activation and resistance/refractoriness to antihypertensive therapy. Weight loss achieved through lifestyle interventions and pharmacotherapy has a modest and rarely sustained antihypertensive effect. In contrast, bariatric surgery has a sustained antihypertensive effect, as evidenced by normalization of hypertension or lessening of antihypertensive therapy. The prevalence of HTN and its obesity-associated phenotype is likely to increase in African-American women over the next decades. Obese African-American women may be increasingly referred for bariatric surgery when hypertension remains uncontrolled despite lifestyle interventions and pharmacological therapy for weight loss and blood pressure (BP) control.

  12. Sociocultural Influences On Undergraduate Women's Entry into a Computer Science Major (United States)

    Lyon, Louise Ann

    Computer science not only displays the pattern of underrepresentation of many other science, technology, engineering, and math (STEM) fields, but has actually experienced a decline in the number of women choosing the field over the past two decades. Broken out by gender and race, the picture becomes more nuanced, with the ratio of females to males receiving bachelor's degrees in computer science higher for non-White ethnic groups than for Whites. This dissertation explores the experiences of university women differing along the axis of race, class, and culture who are considering majoring in computer science in order to highlight how well-prepared women are persuaded that they belong (or not) in the field and how the confluence of social categories plays out in their decision. This study focuses on a university seminar entitled "Women in Computer Science and Engineering" open to women concurrently enrolled in introductory programming and uses an ethnographic approach including classroom participant observation, interviews with seminar students and instructors, observations of students in other classes, and interviews with parents of students. Three stand-alone but related articles explore various aspects of the experiences of women who participated in the study using Rom Harre's positioning theory as a theoretical framework. The first article uses data from twenty-two interviews to uncover how interactions with others and patterns in society position women in relation to a computer science major, and how these women have arrived at the point of considering the major despite messages that they do not belong. The second article more deeply explores the cases of three women who vary greatly along the axes of race, class, and culture in order to uncover pattern and interaction differences for women based on their ethnic background. The final article focuses on the attitudes and expectations of the mothers of three students of contrasting ethnicities and how reported

  13. Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery

    Directory of Open Access Journals (Sweden)

    João Simão de Melo-Neto

    Full Text Available ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92. The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

  14. Impact of obesity on secondary cytoreductive surgery and overall survival in women with recurrent ovarian cancer. (United States)

    Tran, Arthur-Quan; Cohen, Joshua G; Li, Andrew J


    Obesity may negatively influence tumor biology in women with epithelial ovarian cancers. To date, only body mass indices (BMI) determined at the time of diagnosis have correlated with clinical outcome. We hypothesized that obesity negatively affects survival throughout the disease course, and sought to determine the prognostic role of BMI at the time of secondary cytoreductive surgery (SCS) for recurrent ovarian cancer. We performed a review of patients undergoing SCS for recurrent epithelial ovarian or peritoneal cancer between 1997 and 2012. We retrospectively reviewed data which were analyzed using Fisher's exact test, Kaplan-Meier survival, and Cox regression analysis. BMI was defined according to the National Institutes of Health's categorizations. We identified 104 patients; 2 were underweight, 46 were of ideal body weight, 32 were overweight, and 24 were obese. Overall, 90 patients underwent optimal resection and BMI did not correlate with ability to perform optimal SCS (p=0.25). When examining BMI strata (underweight, ideal, overweight, and obese), we observed a statistical trend between increasing BMI and poor outcome; median survival was undetermined (greater than 50 months), 46 months, 38 months, and 34 months, respectively (p=0.04). In a multivariate analysis, BMI was an independent predictor of survival (p=0.02). In this cohort of women undergoing SCS for recurrent ovarian cancer, BMI significantly and independently correlated with overall survival. This observation suggests an effect of excess weight on tumor biology and/or response to treatment that is prevalent throughout the disease course. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Purtscher-like retinopathy associated with cerebro- or cardiovascular surgery. (United States)

    Oshida, Eiki; Machida, Shigeki; Nishimura, Tomoharu; Sakamoto, Masaki


    To report the findings in five patients of Purtscher-like retinopathy that developed after cerebro- or cardiovascular surgeries. Three women and two men with a mean age of 56.6 years were studied. They had had cerebro- or cardiovascular disease that was treated by major vascular surgery. Postoperatively, all of the patients developed multiple patches of retinal whitening in the area corresponding to the radial peripapillary capillaries in the posterior pole of the eye uni- or bilaterally. In two patients, the optic nerve head was involved which affected their vision severely. Hematological examinations showed hypercoagulable state after the surgeries. The retinal pathologies abated with time. These results indicate that major cardio- or cerebrovascular surgeries can cause Purtscher-like retinopathy. The hypercoagulable state and specific structures of the radial peripapillary capillaries may play a role in pathogenesis of this disease.

  16. Changes in Upper Airway Volume Following Orthognathic Surgery. (United States)

    Marcussen, Lillian; Stokbro, Kasper; Aagaard, Esben; Torkov, Peter; Thygesen, Torben


    Reduced volume of the internal skeletal dimensions of the face is 1 of the main causes of obstructive sleep apnea, and attention to patients' airways is necessary when planning orthognathic treatment. This study aims to describe changes in upper airway volume following virtually planned orthognathic surgery.A retrospective pilot study was designed with 30 randomly selected patients (10 men and 20 women, aged 23.1 ± 6.8 years, molar-relations: 15 neutral, 8 distal, and 7 mesial). Cone-beam computed tomography scans were performed before surgery and 1 week following surgery. The authors did total upper airway volume measurements and obtained 1-mm slices at vertical levels in the velo-, oro-, and hypopharynx and at the smallest visible cross-section.Measurements before and after surgery were compared using Student t test.After orthognathic surgery, the minimum cross-sectional area at the vertical level increased from 83 mm ± 33 before surgery to 102 mm ± 36 after surgery (P = 0.019). In patients with neutral and distal occlusions, the minimum cross-sectional slice volume increased in 87% but in only 57% with mesial occlusion.The present findings suggest that orthognathic surgery increases upper airway volume parameters, but a few patients have continued impairment of the airways following orthognathic surgery. Further studies are needed to confirm an individual surgical planning approach that potentially could bring the minimum cross sectional area out of the risk zone.

  17. Complement Receptors C5aR and C5L2 Are Associated with Metabolic Profile, Sex Hormones, and Liver Enzymes in Obese Women Pre- and Postbariatric Surgery

    Directory of Open Access Journals (Sweden)

    Reza Rezvani


    Full Text Available Objective. Obesity is associated with metabolic dysfunction with sex differences and chronic, low-grade inflammation. We proposed that hepatic expression of immune complement C3 related receptors (C3aR, C5aR, and C5L2 would be associated with pre- or postmenopausal status and metabolic profile in severely obese women. We hypothesized that C5L2/C5aR ratio, potentially influencing the ASP/C5L2 metabolic versus C5a/C5aR immune response, would predict metabolic profiles after weight loss surgery. Materials and Methods. Fasting plasma (hormone, lipid, and enzyme analysis and liver biopsies (RT-PCR gene expression were obtained from 91 women during surgery. Results. Hepatic C5L2 mRNA expression was elevated in pre- versus postmenopausal women (P<0.01 and correlated positively with circulating estradiol, estrone, ApoB, ApoA1, ApoA1/B, waist circumference, age, and LDL-C (all P<0.05. While plasma ASP was lower in pre- versus postmenopausal women (P<0.01, the hepatic C5L2/C5aR mRNA ratio was increased (P<0.001 and correlated positively with estrone (P<0.01 and estradiol (P<0.001 and negatively with circulating ApoB and liver enzymes ALT, AST, and GGT (all P<0.05. Over 12 months postoperatively, liver enzymes in low C5L2/C5aR mRNA ratio group remained higher (ALP and ALT, P<0.05, AST and GGT, P<0.001 2-way-ANOVA. Conclusion. C5L2-C5aR association with other mediators including estrogens may contribute to hepatic metabolic and inflammatory function.

  18. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

    DEFF Research Database (Denmark)

    Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove


    . A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were......Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...... (n.s.). Conclusions. In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment...

  19. Diagnostic value of mammography flowing plastic and reconstructive breast surgery

    International Nuclear Information System (INIS)

    Wardzynska, K.; Wesolowska, E.


    Breast cancer is the most frequent malignant neoplasm in women. Due to the growing knowledge and self- consciousness about the disease itself as well as regarding treatment options among breast cancer patients. Main indications for reconstruction after mastectomy include fear of both physical and psychological damage and, in a broader sense, the lack of contraindications for the procedure. Altogether, these factors are in fact directly responsible for the increase in the number of reconstructive procedures, which have become one of the important elements in breast cancer treatment. Year by year, the number of plastic surgery procedures has been growing. Assessment of the breast aimed at discerning the presence diminishing procedures. In women with prostheses implanted for cosmetic reasons, mamsaography provides an opportunity to correctly diagnose and confirm implant damage. Women who have undergonew such procedures should be screened mammographically in the same way as the rest of the female population is. The aim of this paper is to summarize the value of diagnostic mammagraphy after plastic and reconstructive surgery. (authors)

  20. Laparoscopic versus open surgery for adnexal tumor in pregnant women

    Directory of Open Access Journals (Sweden)

    Yu-Jin Koo


    Conclusion: Adnexal surgery during pregnancy could be performed in safety for both mother and fetus. The laparoscopic approach particularly offered more benefit than laparotomy in terms of surgical outcome and was shown to be as safe as laparotomy regarding obstetric complications such as miscarriage and preterm labor.

  1. Heterogeneity in barriers regarding the motivation, the opportunity and the ability to choose low-calorie snack foods and beverages: associations with real-life choices. (United States)

    Bos, Colin; van der Lans, Ivo A; van Rijnsoever, Frank J; van Trijp, Hans Cm


    Employing Rothschild's Motivation-Opportunity-Ability framework, the present study examines the extent to which heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. Furthermore, the study investigates which dominant barrier profiles can be discerned. Data were obtained from a survey about participants' motivation, opportunity and ability to choose low-calorie over high-calorie snacks and an FFQ that measured habitual consumption of snack foods and beverages. Data were analysed using R packages lavaan and NbClust, and IBM SPSS Statistics. A representative sample (n 1318) of the Dutch population based on gender (686 women), age and education level. For both snack foods and beverages, motivation to choose low-calorie over high-calorie snacks was associated strongest with proportions of low-calorie choices. The perceived ability and perceived opportunity were also associated with proportions of low-calorie choices, albeit to a lesser extent. Furthermore, three dominant profiles of barriers were identified: the no-barrier profile, the lack-of-opportunity profile and the lack-of-motivation profile. These profiles differed significantly on proportions of low-calorie snack choices, daily meal consumption and sociodemographic characteristics. Heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. By identifying and appreciating heterogeneity in barriers, the present study provides further incentives for the tailoring of intervention strategies.

  2. Remote cerebellar hemorrhage after lumbar spinal surgery

    International Nuclear Information System (INIS)

    Cevik, Belma; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet


    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  3. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene


    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... to provide immediate advice and support. CONCLUSION: The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS...

  4. Picking and Choosing the ‘Sovereign’Border

    DEFF Research Database (Denmark)

    Parker, Noel; Adler-Nissen, Rebecca


    We argue that the continued persistence of borders is an effect of their constitutive role for the many dimensions of a social particular. States cannot choose to have a border; but they can and do make choices amongst the materials available on the various planes of inscription for bordering. Fo...

  5. Effect of midurethral sling (transobturator tape surgery on female sexual function

    Directory of Open Access Journals (Sweden)

    Fredrick Paul


    Full Text Available Introduction: Transobturator tapes (TOT are frequently used in the management of female stress urinary incontinence (SUI. We evaluated the effect of TOT on sexual function in Indian women with stress urinary incontinence. Materials and Methods: 34 sexually active women (mean age 42.38 years with SUI were evaluated before TOT placement for sexual function using the NSF-9 sexual scoring system questionnaire. The evaluation was repeated at the 3 rd , 6 th and 12 th months post surgery and then yearly. Results: There was significant improvement in scores in all domains of sexual function post-surgery. The frequency improved in 24 (70.5% patients, lubricacy improved in 12 (57.1% patients, orgasm improved in 21 (67.1% patients, pain improved in 14 (70% patients and, in leaking patients, sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 26 (76.4% of the patients before surgery; of them, 21 (80% patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in one and two patients, respectively. Conclusions: The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI.

  6. Sex differences in verbal and nonverbal learning before and after temporal lobe epilepsy surgery. (United States)

    Berger, Justus; Oltmanns, Frank; Holtkamp, Martin; Bengner, Thomas


    Women outperform men in a host of episodic memory tasks, yet the neuroanatomical basis for this effect is unclear. It has been suggested that the anterior temporal lobe might be especially relevant for sex differences in memory. In the current study, we investigated whether temporal lobe epilepsy (TLE) has an influence on sex effects in learning and memory and whether women and men with TLE differ in their risk for memory deficits after epilepsy surgery. 177 patients (53 women and 41 men with left TLE, 42 women and 41 men with right TLE) were neuropsychologically tested before and one year after temporal lobe resection. We found that women with TLE had better verbal, but not figural, memory than men with TLE. The female advantage in verbal memory was not affected by temporal lobe resection. The same pattern of results was found in a more homogeneous subsample of 84 patients with only hippocampal sclerosis who were seizure-free after surgery. Our findings challenge the concept that the anterior temporal lobe plays a central role in the verbal memory advantage for women. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Genetic Diagnosis before Surgery has an Impact on Surgical Decision in BRCA Mutation Carriers with Breast Cancer. (United States)

    Park, Sungmin; Lee, Jeong Eon; Ryu, Jai Min; Kim, Issac; Bae, Soo Youn; Lee, Se Kyung; Yu, Jonghan; Kim, Seok Won; Nam, Seok Jin


    The first aim of our study was to evaluate surgical decision-making by BRCA mutation carriers with breast cancer based on the timing of knowledge of their BRCA mutation status. The second aim was to evaluate breast cancer outcome following surgical treatment. This was a retrospective study of 164 patients diagnosed with invasive breast cancer, tested for BRCA mutation, and treated with primary surgery between 2004 and 2015 at Samsung Medical Center in Seoul, Korea. We reviewed types of surgery and timing of the BRCA test result. We compared surgical decision- making of BRCA carriers with breast cancer based on the timing of knowledge of their BRCA mutation status. Only 15 (9.1%) patients knew their BRCA test results before their surgery, and 149 (90.9%) knew the results after surgery. In patients with unilateral cancer, there was a significant difference between groups whose BRCA mutation status known before surgery and groups whose BRCA status unknown before surgery regarding the choice of surgery (p = 0.017). No significant difference was observed across surgery types of risk of ipsilateral breast tumor recurrence (p = 0.765) and contralateral breast cancer (p = 0.69). Genetic diagnosis before surgery has an impact on surgical decision choosing unilateral mastectomy or bilateral mastectomy in BRCA mutation carriers with breast cancer. Knowledge about BRCA mutation status after initial surgery led to additional surgeries for patients with BCS. Thus, providing genetic counseling and genetic testing before surgical choice and developing treatment strategies for patients with a high risk of breast cancer are important.

  8. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study. (United States)

    Howes, Benjamin H L; Watson, David I; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R


    Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

  9. Who Decides? Tanzanian Women's Narratives on Educational Advancement and Agency (United States)

    Okkolin, Mari-Anne


    One of the critical issues deliberated amongst researchers on gender and education is that of choosing and decision-making. Often, the focus of analysis is framed through the concept of agency. In this paper, the analytical focus is on educational advancement and agency. The paper is based on narratives of 10 highly educated Tanzanian women.…

  10. Life Satisfaction in Women With Breast Cancer1

    Directory of Open Access Journals (Sweden)

    Solange Fonseca


    Full Text Available It is well known that breast cancer carries many psychosocial consequences. For a deeper understanding of this topic, this study aims to analyze the relationship between life satisfaction, meaning in life, optimism, body image and depression in 55 women with breast cancer, organized into two groups: mastectomized and submitted to conservative surgery. The variables were characterized based on the results from the Auto-Actualização-SentidoVida [Self-Actualization-Life Meaning] sub-scale, the Escala de Otimismo [Optimism scale], the Body Image Scale, the Hospital Anxiety and Depression Scale and the Escala de Satisfação com a Vida [Life satisfaction scale]. Meaning in life and optimism were positively correlated with life satisfaction. Higher depression and body image disturbance appeared associated with lower life satisfaction. Body image disturbance was higher in mastectomized women. It was concluded that women submitted to conservative surgery do not have more life satisfaction than mastectomized women, requiring equal attention in terms of preventing depression and promoting positive variables.

  11. Psychological characterisation of severely obese patients: pre- and post-bariatric surgery

    Directory of Open Access Journals (Sweden)

    André Ferreira


    Full Text Available Although psychological disorders are more prevalent among candidates for bariatric surgery than among non-obese populations, there is limited knowledge about the impact of this type of surgery on psychopathology. The main goal of this study was to characterize the evolution of psychopathological morbidity among obese patients after surgery. This was an observational longitudinal study. All patients submitted to bariatric surgery between March 2008 and June 2010, in a general hospital located in the south of Portugal were invited to participate. Psychological assessment was done through structured clinical interviews and administration of MCMI-III. Participants were assessed with the same protocol before and after surgery (minimum, 12 months after surgery. Overall, 20 patients (19 women were assessed. The most prevalent clinical syndromes (axis I before surgery were: anxiety (40%, dysthymia disorder (20%, somatoform disorder and delusional disorder (both 15%. After surgery, the most prevalent clinical syndromes were: anxiety (40%, bipolar disorder, dysthymia disorder, and delusional disorder (all with 15%. Before surgery, compulsive personality was the most prevalent personality disorder (15%. After surgery, the most prevalent ones were: histrionic personality, compulsive personality disorder, and paranoia (all with 10%. These findings may suggest that bariatric surgery per se is not enough as treatment for the remission of psychopathology among severe obese patients.

  12. How to Choose the Best Skin Care Products (United States)

    ... Skin Care Products How to Choose the Best Skin Care Products Looking for a quick fix to erase wrinkles, ... available, the beauty aisle can be overwhelming. Some skin care products are overpriced and make claims they can’t ...

  13. What women want in their sperm donor: A study of more than 1000 women's sperm donor selections. (United States)

    Whyte, Stephen; Torgler, Benno; Harrison, Keith L


    Reproductive medicine and commercial sperm banking have facilitated an evolutionary shift in how women are able to choose who fathers their offspring, by notionally expanding women's opportunity set beyond former constraints. This study analyses 1546 individual reservations of semen by women from a private Australian assisted reproductive health facility across a ten year period from 2006 to 2015. Using the time that each sample was available at the facility until reservation, we explore women's preference for particular male characteristics. We find that younger donors, and those who hold a higher formal education compared to those with no academic qualifications are more quickly selected for reservation by women. Both age and education as proxies for resources are at the centre of Parental Investment theory, and our findings further build on this standard evolutionary construct in relation to female mate preferences. Reproductive medicine not only provides women the opportunity to become a parent, where previously they would not have been able to, it also reveals that female preference for resources of their potential mate (sperm donor) remain, even when the notion of paternal investment becomes redundant. These findings build on behavioural science's understanding of large-scale decisions and human behaviour in reproductive medical settings. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

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    Louise Crovesy-de-Oliveira


    Full Text Available Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent Roux-en-Y gastric and carried evaluation anthropometric and dietetic. The dietary evaluate was compared with the daily consumption requirement and food pyramid for these patients.Results: forty women with 43.1 ± 9.96 years, obesity and very high risk for metabolic complications associate with obesity, and with acceptation of supplementation (95% participated this study. The majority of women consumed group’s foods “high-calorie foods, fats and sweets are energy-dense foods” and showed high intake of foods groups “grains and cereals” and “high-fiber, low-calorie foods”. Dietary intake was low-calorie (1342.50 ± 474.06 Kcal, adequate in protein (22.10 ± 6.94%, carbohydrate (50.74 ± 10.96%, lipid (26.14 ± 7.17%, saturated fatty acids (8.69 ± 2.74% and polyunsaturated fatty acids (8.93 ± 3.51% and low-monounsaturated fatty acids (4.13 ± 1.78% and fibers (17.02 ± 10.64 g.Conclusions: nutritional habits of women showed inadequacy, these results reinforce the importance of nutritional accompanying in the late postoperative bariatric surgery.

  15. Women's challenges with postpartum weight loss. (United States)

    Montgomery, Kristen S; Bushee, Tracy D; Phillips, Jennifer D; Kirkpatrick, Terrie; Catledge, Courtney; Braveboy, Kristin; O'Rourke, Carol; Patel, Neema; Prophet, Malshundria; Cooper, Anita; Mosley, Lori; Parker, Christie; Douglas, Gaye M


    This study was designed to examine women's experiences of weight loss during the postpartum period. Understanding women's positive and negative experiences can assist health care providers to successfully intervene in helping women lose weight following pregnancy and avoid long-term weight gain and obesity development. Phenomenology, according to Husserl's perspective. Private location of the women's choosing. Twenty-six women, who ranged in age from 25 to 35 years, and had given birth within the last 5 years, were interviewed regarding their experiences with postpartum weight loss. The majority of the sample was Caucasian. Interviews were transcribed and themes were identified from each of the interviews. Comparisons were made between interviews to identify common experiences between women. Data were analyzed according to the Giorgi method. The women in the study had a wide range of experiences. Themes that emerged from the interviews related to women's challenges with return to prepregnancy weight. These included: time and motivation issues, the need for support, and weight and other struggles. This study provides a look inside the lives of women faced with the reality of losing weight after childbirth. Losing weight after delivery is multi-faceted and influenced by many factors. Interventions to assist women with weight loss should target the challenges described in this paper. When effective strategies are developed, education can be done during pregnancy to prepare for the postpartum period. Ultimately, future research efforts can help us to eliminate pregnancy as a risk factor for obesity in women.

  16. Cloud Computing and the Power to Choose (United States)

    Bristow, Rob; Dodds, Ted; Northam, Richard; Plugge, Leo


    Some of the most significant changes in information technology are those that have given the individual user greater power to choose. The first of these changes was the development of the personal computer. The PC liberated the individual user from the limitations of the mainframe and minicomputers and from the rules and regulations of centralized…

  17. Psychosocial factors and mortality in women with early stage endometrial cancer. (United States)

    Telepak, Laura C; Jensen, Sally E; Dodd, Stacy M; Morgan, Linda S; Pereira, Deidre B


    Psychosocial factors have previously been linked with survival and mortality in cancer populations. Little evidence is available about the relationship between these factors and outcomes in gynaecologic cancer populations, particularly endometrial cancer, the fourth most common cancer among women. This study examined the relationship between several psychosocial factors prior to surgical resection and risk of all-cause mortality in women with endometrial cancer. The study utilized a non-experimental, longitudinal design. Participants were 87 women (Mage  = 60.69 years, SDage  = 9.12 years) who were diagnosed with T1N0-T3N2 endometrial cancer and subsequently underwent surgery. Participants provided psychosocial data immediately prior to surgery. Survival statuses 4-5 years post-diagnoses were abstracted via medical record review. Cox regression was employed for the survival analysis. Of the 87 women in this sample, 21 women died during the 4- to 5-year follow-up. Adjusting for age, presence of regional disease and medical comorbidity severity (known biomedical prognostic factors), greater use of an active coping style prior to surgery was significantly associated with a lower probability of all-cause mortality, hazard ratio (HR) = 0.78, p = .04. Life stress, depressive symptoms, use of self-distraction coping, receipt of emotional support and endometrial cancer quality of life prior to surgery were not significantly associated with all-cause mortality 4-5 years following diagnosis. Greater use of active coping prior to surgery for suspected endometrial cancer is associated with lower probability of all-cause mortality 4-5 years post-surgery. Future research should attempt to replicate these relationships in a larger and more representative sample and examine potential behavioural and neuroendocrine/immune mediators of this relationship. What is already known on this subject? Psychosocial factors have previously been linked with clinical outcomes in a

  18. Mate-Choice Copying in Single and Coupled Women: The Influence of Mate Acceptance and Mate Rejection Decisions of other Women

    Directory of Open Access Journals (Sweden)

    Yan Deng


    Full Text Available Studies of humans and non-human animals indicate that females tend to change the likelihood of choosing a potential mate based on the decisions of other females; this is known as mate-choice copying. In a sample of both single and coupled women, we examined the influence of other women's (model mate-choice decisions, including mate acceptance and mate rejection, on participants' attractiveness ratings of men (target and willingness of mate selection. We also examined whether different types of relationships between the target men and the model women affected mate-choice copying. We found that both the single and coupled women showed mate-choice copying, but their response patterns differed. The significant effects for single women were dependent on a decrease in attractiveness ratings when they perceived the models' mate rejection. However, the significant findings for coupled women relied on an increase in attractiveness ratings when they observed the models' mate acceptance. Furthermore, the relationship status between the target men and the model women affected the magnitude of mate-choice copying effects for the single women. Specifically, they showed less mate-choice copying when the targets and models were in a committed romantic relationship than when in a temporary relationship.

  19. Factors influencing Zimbabwean physiotherapy students in choosing physiotherapy as a career


    T. Mkondo; W. Mudzi; N. P. Mbambo


    People join professions for different reasons and the same applies to physiotherapists. The aim of the study was to identify the reasons for choosing physiotherapy as a career by Zimbabwean physiotherapy students. The study used a descriptive cross-sectional design where a questionnaire was administered to 60 students. Data were collected on the demographics of the students and also on their rating on the importance of 12 factors for their influence in them choosing physiotherapy as a career....

  20. Social Media and the Plastic Surgery Patient. (United States)

    Sorice, Sarah C; Li, Alexander Y; Gilstrap, Jarom; Canales, Francisco L; Furnas, Heather J


    Many plastic surgeons use social media as a marketing tool to attract and retain patients, but information about how patients use social media and their preferred types of plastic surgery posts have been lacking. To investigate patients' preferred social media networks and the type of posts they wished to see, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons by surveying 100 consecutive patients. The age of the patients averaged 44.4 years (range, 17 to 78 years). Facebook had the greatest patient use and engagement, with YouTube second in use, and Instagram second in number of engaged users. Over half used Pinterest, but with little daily engagement. Only one-fourth used Snapchat, but the percentage of users who were highly engaged was second only to Facebook. The least popular network was Twitter, with the fewest patient users and least engagement. Social media played a minor role compared with the practice's Web site in both influencing patients to choose the practice and providing information on the day of the appointment. Patients most wanted to see posts on a plastic surgeon's social media platform related to practice information, before-and-after photographs, and contests. Articles about plastic surgery held the least interest. Among five types of Web site content, patients expressed most interest in before-and-after photographs. This study is the first to articulate the plastic surgery patient perspective regarding social media. The findings aim to help plastic surgeons maximize their influence on their target audience.

  1. Choosing children: intergenerational justice? (United States)

    Doyal, Len; McLean, Sheila


    In this discussion, we argue that the concept of intergenerational justice, usually used in environmental matters, is applicable to reproductive decisions also. Additionally, we propose that this permits certain reproductive choices to be made prior to conception or during the pregnancy, and that these choices should not be confined to clinical concerns. In particular, we argue that consideration of the interests of future children should be viewed from the perspective of objective well-being. That being the case, decisions about the sex of future offspring can, in terms of intergenerational justice, be legitimate. We do not argue that every reproductive choice is legitimate; for example it would not be legitimate deliberately to choose characteristics that prevent future children from potentially successful participation in social life.

  2. A solution to gender inequity in surgery? Better caregiving policies


    Acai, Anita; Steyn, Chris; Reid, Susan E.; Sonnadara, Ranil R.


    Attitudes toward women in surgery appear to be shifting in a positive direction. Why, then, do women still represent only 27% of surgeons in Canada? The answer may, at least in part, lie in the field’s inability to adequately accommodate caregiving duties, which are still disproportionately “women’s responsibilities” in our society. Although most Canadian academic centres now have paid maternity leave policies for trainees and faculty, these do not necessarily apply to surgeons working in the...

  3. Self-reported causes of weight gain: among prebariatric surgery patients. (United States)

    Ferguson, Sarah; Al-Rehany, Layla; Tang, Cathy; Gougeon, Lorraine; Warwick, Katie; Madill, Janet


    Bariatric surgery is accepted by the medical community as the most effective treatment for obesity; however, weight regain after surgery remains common. Long-term weight loss and weight maintenance may be aided when dietitians who provide perioperative care understand the causes of weight gain leading to bariatric surgery. In this study, the most common causes for weight gain were examined among prebariatric surgery patients. A retrospective chart review was conducted for 160 patients enrolled in a bariatric surgery program. Data were collected for 20 variables: puberty, pregnancy, menopause, change in living environment, change in job/career, financial problems, quitting smoking, drug or alcohol use, medical condition, surgery, injury affecting mobility, chronic pain, dieting, others' influence over diet, abuse, mental health condition, stress, death of a loved one, divorce/end of a relationship, and other causes. Frequency distribution and chi-square tests were performed using SPSS. Sixty-three percent of participants selected stress as a cause of weight gain, while 56% selected dieting. Significant differences existed between women and men in the selection of dieting and change in living environment. This information may allow dietitians to better identify causes for weight gain leading to bariatric surgery, and to address these causes appropriately before and after surgery.

  4. Asian-Chinese patient perceptions of natural orifice transluminal endoscopic surgery cholecystectomy. (United States)

    Teoh, Anthony Yuen Bun; Ng, Enders Kwok Wai; Chock, Alana; Swanstrom, Lee; Varadarajulu, Shyam; Chiu, Philip Wai Yan


    Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown. This was a cross-sectional survey carried out in the surgical outpatient's clinic at the Prince of Wales Hospital between June and September 2011. Patients were provided with an information leaflet and asked to complete a questionnaire regarding their perceptions of and preferences for NOTES cholecystectomy. Female patients attending the clinic were given an additional questionnaire regarding attitudes towards transvaginal surgery. Two hundred patients were recruited to complete the questionnaire(s) and the male to female ratio was 1:1. One hundred and fourteen patients (57%) preferred to undergo NOTES cholecystectomy for cosmetic reasons (P=0.009). Oral and anal routes were both acceptable for NOTES accesses in males and females. Forty-one percent of the female patients would consider transvaginal NOTES. Of these patients, significantly more patients indicated that the reason for choosing transvaginal NOTES was to minimize the risk of hernia (P=0.016) and to reduce pain associated with the procedure (P=0.017). The risk of complications (84.5%) and the cost of the procedure (58%) were considered the most important aspects when choosing a surgical approach by Asian-Chinese patients. Asian-Chinese preferred NOTES mainly for cosmetic reasons. However, the transvaginal route was less acceptable to females. Significant differences in patient perception on NOTES were observed between Asian-Chinese and Western patients. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  5. Color waves : a simple heuristic for choosing false colors

    NARCIS (Netherlands)

    Overveld, van C.W.A.M.


    A simple heuristic is presented for choosing false colors for visualizing scalar functions on two-dimensional domains. The color scheme allows inspection of the function on several length scales simultanously.

  6. E-Cigarettes for Immediate Smoking Substitution in Women Diagnosed with Cervical Dysplasia and Associated Disorders

    Directory of Open Access Journals (Sweden)

    Shirley A. James


    Full Text Available The aim of this study was to determine if 31 women with cervical dysplasia and associated conditions exacerbated by smoking would be successful substituting cigarettes with their choice of either nicotine replacement therapy (NRT or electronic cigarettes (EC. Women received motivational interviewing and tried both NRT and ECs, choosing one method to use during a six-week intervention period. Daily cigarette consumption was measured at baseline, six, and 12 weeks, with differences analyzed by the Wilcoxon signed-rank test. Study analysis consisted only of women choosing to use ECs (29/31, as only two chose NRT. At the 12-week follow-up, the seven day point prevalence abstinence from smoking was 28.6%, and the median number of cigarettes smoked daily decreased from 18.5 to 5.5 (p < 0.0001. The median number of e-cigarette cartridges used dropped from 21 at the six-week follow-up to 12.5 at the 12-week follow-up. After initiating EC use, women at risk for cervical cancer were able to either quit smoking or reduce the number of cigarettes smoked per day. Although a controlled trial with a larger sample size is needed to confirm these initial results, this study suggests that using ECs during quit attempts may reduce cigarette consumption.

  7. Analysis of Practice Settings for Craniofacial Surgery Fellowship Graduates in North America. (United States)

    Silvestre, Jason; Runyan, Christopher; Taylor, Jesse A

    In North America, the number of craniofacial surgery fellowship graduates is increasing, yet an analysis of practice settings upon graduation is lacking. We characterize the practice types of recent graduates of craniofacial fellowship programs in the United States and Canada. A 6-year cohort of craniofacial fellows in the United States and Canada (2010-2016) were obtained from craniofacial programs recognized by the American Society of Craniofacial Surgery. Practice setting was determined at 1 and 3 years of postgraduation, and predictors of practice setting were determined. A total of 175 craniofacial surgeons were trained at 35 fellowship programs. At 1 year of postgraduation, 33.6% had an academic craniofacial position and 27.1% were in private practice (p = 0.361). A minority of graduates pursued additional fellowships (16.4%), nonacademic craniofacial positions (10.0%), academic noncraniofacial positions (5.7%), and international practices (7.1%). At 3 years of postgraduation, the percentage of graduates in academic craniofacial positions was unchanged (34.5% vs 33.6%, p = 0.790). The strongest predictors of future academic craniofacial practice were completing plastic surgery residency at a program with a craniofacial fellowship program (odds ratio = 6.78, p < 0.001) and completing an academic craniofacial fellowship program (odds ratio = 4.48, p = 0.020). A minority of craniofacial fellowship graduates practice academic craniofacial surgery. A strong academic craniofacial surgery background during residency and fellowship is associated with a future career in academic craniofacial surgery. These data may assist trainees choose training programs that align with career goals and educators select future academic surgeons. Copyright © 2017. Published by Elsevier Inc.

  8. Cancer risk among Danish women with cosmetic breast implants. (United States)

    Friis, Søren; Hölmich, Lisbet R; McLaughlin, Joseph K; Kjøller, Kim; Fryzek, Jon P; Henriksen, Trine F; Olsen, Jørgen H


    The available epidemiologic evidence does not support a carcinogenic effect of silicone breast implants on breast or other cancers. Data on cancer risk other than breast cancer are limited and few studies have assessed cancer risk beyond 10-15 years after breast implantation. We extended follow-up of our earlier cohort study of Danish women with cosmetic breast implants by 7 years, yielding 30 years of follow-up for women with longest implant duration. The study population consisted of women who underwent cosmetic breast implant surgery at private clinics of plastic surgery (n = 1,653) or public hospitals (n = 1,110), and a control group of women who attended private clinics for other plastic surgery (n = 1,736), between 1973-95. Cancer incidence through 2002 was ascertained using the Danish Cancer Registry. Risk evaluation was based on computation of standardized incidence ratios (SIR) and Cox proportional hazards models, adjusting for age, calendar period and reproductive history. We observed 163 cancers among women with breast implants compared to 136.7 expected based on general population rates (SIR = 1.2; 95% confidence interval [CI] = 1.0-1.4), during a mean follow-up period of 14.4 years (range = 0-30 years). Women with breast implants experienced a reduced risk of breast cancer (SIR = 0.7; 95% CI = 0.5-1.0), and an increased risk of non-melanoma skin cancer (SIR = 2.1; 95% CI = 1.5-2.7). Stratification by age at implantation, calendar year at implantation and time since implantation showed no clear trends, however, the statistical precision was limited in these analyses. When excluding non-melanoma skin cancer, the SIR for cancer overall was 1.0 (95% CI = 0.8-1.2). With respect to other site-specific cancers, no significantly increased or decreased SIR were observed. Similar results were found when directly comparing women who had implants at private clinics with women who attended private clinics for other plastic surgery, with rate ratios for cancer

  9. Trends in workforce diversity in vascular surgery programs in the United States. (United States)

    Kane, Katherine; Rosero, Eric B; Clagett, G Patrick; Adams-Huet, Beverley; Timaran, Carlos H


    U.S. black and Hispanic populations are growing at a steady pace. In contrast, the medical profession lacks the same minority growth and representation. Women are also under-represented in many surgical disciplines. The purpose of this study was to assess trends in the proportion of women, blacks, and Hispanics admitted to vascular surgery (VS) and related specialties, and to compare them with each other and with a surgical specialty, orthopedic surgery (OS), with a formal diversity initiative. Data on the fellowship pool of VS, interventional radiology (IR), and interventional cardiology (IC), as well as the resident pools of general surgery (GS) and orthopedic surgery (OS), were obtained from U.S. graduate medical education reports for 1999 through 2005. Cochrane-Armitage trend tests were used to assess trends in the proportion of females, blacks, and Hispanics in relation to the total physician workforce for each subspecialty. No significant trends in the proportion of females, blacks, or Hispanics accepted into VS and IC fellowship programs occurred during the study period. In contrast, IR, GS, and OS programs revealed significant trends for increasing proportions of at least one of the underrepresented study groups. In particular, OS, which has implemented a diversity awareness program, showed a positive trend in female and Hispanic trainees (P workforce diversity.

  10. HIV among women in developing countries. (United States)

    Decarlo, P


    In South Africa, a pregnant woman infected with HIV took zidovudine to protect her fetus, but the child later developed HIV because the woman was not told about breast milk transmission. Women in developing countries have been hit hard by the AIDS epidemic because social inequalities that make it impossible for them to negotiate for safer sex or even to choose their sexual partners. In most developing countries, the only treatment women have access to is the zidovudine that is available only during their participation in clinical trials on prenatal transmission. Activists have expressed concern over programs that attempt to save the lives of babies with no regard for their mothers or other women. Women with HIV need access to health care, to information, and to counselors who can help them make choices. Women must be able to assess whether to risk breast feeding or attempt costly bottle feeding, which may lead to higher levels of infant mortality from bacteria in contaminated water. Women must also be educated so that they can protect their sexual health. In some settings, the topics of sex and sexuality still must be introduced into public discourse. Strong prevention programs are reducing HIV-infection rates among young women in parts of Tanzania, among pregnant women and prostitutes in Dakar, among prostitutes in Thailand and Nepal, and among street children in Brazil. Effective programs must consider AIDS a social issue and address education, equality, and information access.

  11. [Dentistry students' reasons for choosing dentistry as a career in Damascus University]. (United States)

    Mashlah, A M


    This cross-sectional questionnaire survey assessed the motives for choosing dentist as a profession among dentistry students at Damascus University, Syrian Arab Republic. A total of 408 undergraduate students (233 males and 175 females) aged 18-23 years were selected randomly from students in the second, third and fourth years of dentistry study. They completed a questionnaire that enquired about their reasons for studying dentistry as well as their sociodemographic characteristics. The number of admissions in females had increased over the 3 years. Most parents of the students were university-educated. The main motivation for choosing dentistry was as a means to achieve personal goals, including getting a good job abroad, having financial independence, and attaining a good reputation. There were significant differences between the sexes with regard to the reasons for choosing dentistry.

  12. Secondary Genioplasties for the Treatment of Chin Deformities After Orthognathic Surgery in Asian Women: Defining the Aesthetic Importance of Managing the Chin Shape in Orthognathic Surgery. (United States)

    Lee, Sang Woo; Ahn, Seung Hyun; Myung, Yujin


    Achieving aesthetically favorable results in orthognathic surgery is equally as important as good postoperative occlusion and jaw function. Orthognathic surgery that only changes profile or proportion in the vertical dimension can often lead to patient's dissatisfaction and additional surgical revision. To achieve maximal aesthetic improvement and postoperative patient's satisfaction, the chin shape should be considered as important a component of orthognathic surgery as dental occlusion or jaw function. From April 2010 to January 2014, 82 female patients with aesthetic complaints after previous orthognathic surgery visited our clinic for reevaluation and management. Among those 82 patients, 54 patients who were dissatisfied with their lower facial shape from the frontal view underwent revision surgery with narrowing genioplasty and contouring of the lower border of the mandible. Facial shapes, when viewed from the front in all patients, became more slender and balanced postoperatively, and there was no need for additional surgical revisions in this series. There were no significant complications caused by our surgical revisions. Good aesthetic results were obtained after 54 secondary genioplasties for chin deformities after orthognathic surgery. These results suggest that surgeons should give more attention to managing chin shape when performing orthognathic surgery to meet the high aesthetic demands of patients and to avoid surgical revisions.

  13. Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence. (United States)

    Casteleijn, Fenne M; Zwolsman, Sandra E; Kowalik, Claudia R; Roovers, Jan-Paul P W R


    The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.

  14. Kurdish women's preference for mode of birth: a qualitative study. (United States)

    Shahoei, Roonak; Rezaei, Masomeh; Ranaei, Fariba; Khosravy, Farangis; Zaheri, Farzaneh


    Choosing between a normal delivery and Caesarean section is a matter of critical importance for a pregnant woman. The third trimester is the time for her to think about methods of delivery. The study aims to gain insight into Kurdish pregnant women's birth preference and their perception of factors influencing this choice. In this qualitative study, 22 pregnant Kurdish women were interviewed during the third trimester of their pregnancies. The setting for the study included three public health-care centres of Kurdistan University of Medical Sciences in Sanandaj, a centre of the Kurdistan province at the western part of Iran. Study participants were recruited from maternity units of health-care centres. A purposive sample was used initially and then theoretical sampling was used towards the end of the data analysis. Sample size was not predetermined but was determined when interviewing reached saturation, that is, when no new data emerged about categories. The sample size was restricted to 22, as no new data were generated after the 20th interview. The criteria required for inclusion in the study were being Kurdish women, being in the third trimester of pregnancy, no physical disability, no history of Caesarean section and interest in the study. A qualitative design was chosen, as it is particularly suited to studying complex phenomena or processes that are less understood. This study revealed that of the 22 participants, 18 preferred vaginal delivery and only four preferred Caesarean section. The reasons for choosing the vaginal delivery method were grouped into four categories: safety of baby, fear, previous experience and social support. This finding does not support the rate of Caesarean section among Kurdish women in Sanandaj. It might reflect the effect of other factors such as social, institutional, professional and quality of care on women's choice for delivery method. © 2013 Wiley Publishing Asia Pty Ltd.

  15. Association of 5-HT2C (rs3813929) and UCP3 (rs1800849) gene polymorphisms with type 2 diabetes in obese women candidates for bariatric surgery. (United States)

    Schnor, Noa Pereira Prada; Verlengia, Rozangela; Novais, Patrícia Fátima Sousa; Crisp, Alex Harley; Leite, Celso Vieira de Souza; Rasera-Junior, Irineu; Oliveira, Maria Rita Marques de


    Obesity can cause systemic arterial hypertension (SAH) and type 2 diabetes mellitus (DM2) factor that is also influenced by genetic variability. The present study aims to investigate the association between gene polymorphisms related with obesity on the prevalence of SAH and DM2 in the preoperative period and 1 year after Roux-en-Y gastric bypass surgery. In total, 351 obese women in a Brazilian cohort completed the study. The clinical diagnosis of SAH and DM2 was monitored from medical records. Twelve gene polymorphisms (rs26802; rs572169; rs7799039; rs1137101; rs3813929; rs659366; rs660339; rs1800849; rs7498665; rs35874116; rs9701796; and rs9939609) were determined using real-time polymerase chain reaction and TaqMan assay. In the preoperative period, prevalence of SAH and DM2 was 57% and 22%, respectively. One year postoperatively, 86.8% subjects had remission of DM2 and 99.5% had control of SAH. Subjects with T allele from the serotonin receptor gene (5-HT2C, rs3813929) had five times greater chance of DM2, and the CC genotype from uncoupling protein 3 gene (UCP3, rs1800849) had three times greater chance in the preoperative period. These findings indicate that polymorphisms rs3813929 and rs1800849 from 5-HT2C and UCP3 genes were related to DM2 prevalence among the Brazilian obese women candidates for bariatric surgery.

  16. French Medico-Administrative Data to Identify the Care Pathways of Women With Breast Cancer. (United States)

    Lefeuvre, Delphine; Le Bihan-Benjamin, Christine; Pauporté, Iris; Medioni, Jacques; Bousquet, Philippe-Jean


    Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. The study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. The French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): a mixed-methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing prior to surgery for stress urinary incontinence in women. (United States)

    Hilton, Paul; Armstrong, Natalie; Brennand, Catherine; Howel, Denise; Shen, Jing; Bryant, Andrew; Tincello, Douglas G; Lucas, Malcolm G; Buckley, Brian S; Chapple, Christopher R; Homer, Tara; Vale, Luke; McColl, Elaine


    The position of invasive urodynamic testing in the diagnostic pathway for urinary incontinence (UI) is unclear. Systematic reviews have called for further trials evaluating clinical utility, although a preliminary feasibility study was considered appropriate. To inform the decision whether or not to proceed to a definitive randomised trial of invasive urodynamic testing compared with clinical assessment with non-invasive tests, prior to surgery in women with stress UI (SUI) or stress predominant mixed UI (MUI). A mixed-methods study comprising a pragmatic multicentre randomised pilot trial; economic evaluation; survey of clinicians' views about invasive urodynamic testing; qualitative interviews with clinicians and trial participants. Urogynaecology, female urology and general gynaecology units in Newcastle, Leicester, Swansea, Sheffield, Northumberland, Gateshead and South Tees. Trial recruits were women with SUI or stress predominant MUI who were considering surgery after unsuccessful conservative treatment. Relevant clinicians completed two online surveys. Subsets of survey respondents and trial participants took part in separate qualitative interview studies. Pilot trial participants were randomised to undergo clinical assessment with non-invasive tests (control arm); or assessment as controls, plus invasive urodynamic testing (intervention arm). Confirmation that units can identify and recruit eligible women; acceptability of investigation strategies and data collection tools; acquisition of outcome data to determine the sample size for a definitive trial. The proposed primary outcome for the definitive trial was International Consultation on Incontinence Modular Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) (total score) 6 months after surgery or the start of non-surgical treatment; secondary outcomes included: ICIQ-FLUTS (subscales); ICIQ Urinary Incontinence Short Form; ICIQ Lower Urinary Tract Symptoms Quality of Life; Urogenital

  18. Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team

    DEFF Research Database (Denmark)

    Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik


    multidisciplinary team (MDT) decisions. Materials and Methods Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3...... classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA......-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV. Conclusions The COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre...

  19. Perceptions of gender equality, work environment, support and social issues for women doctors at a university hospital in Riyadh, Kingdom of Saudi Arabia.

    Directory of Open Access Journals (Sweden)

    Shehla Baqi

    Full Text Available The Kingdom of Saudi Arabia (KSA is an Islamic monarchy and was established in 1932. Saudi women first entered the medical field in 1975 and the country has since seen a steady increase in women pursuing medicine. However, there is limited data on gender related issues for women doctors practicing in Saudi Arabia. Therefore, our study objective was to assess the perception amongst peers regarding gender equality and social issues faced by women doctors in Saudi Arabia. An online anonymous cross-sectional survey was administered in English to doctors at King Khalid Hospital, affiliated to King Saud University, in Riyadh, between April and May of 2016. Of 1015 doctors, 304 (30% participated, of which 129 (42.4% were females and 231 (76% were Saudi nationals. The average age was 32.4 years (±SD: 8.7. The majority opined that there was no gender discrimination in salaries (73.7% p-value = 0.4, hospital benefits (62.2% p-value = 0.06 or entry into any field of Medicine/Pediatrics (68.4% p-value = 0.207. However, only a minority believed that there was no gender discrimination for entry into surgery (37.3% p-value = .091. A higher proportion of male doctors agreed that promotion opportunities are equal (66.3% vs 45.7%, p-value = 0.002. However, of 54 consultants, only 18 (33.3% were women. Over half of the women (52.3% reported that they never wear the face veil. Only a minority of male and female doctors (12.2% believed women doctors should wear the veil since they examine male patients. Fewer respondents believed that female doctors face harassment from male doctors (14.5% whereas 30.7% believed female doctors face harassment from male patients. More females, than males, agreed with the statement that female doctors are as committed to their careers as are males (92.2% vs 67.4%, p-value<0.0001. Of 304 participants, 210 (69.1% said that they would still choose to become a doctor with approximately equal proportions between males and females (68% vs

  20. Sex Effect on Obesity Indices and Metabolic Outcomes in Patients with Obese Obstructive Sleep Apnea and Type 2 Diabetes After Laparoscopic Roux-en-Y Gastric Bypass Surgery: a Preliminary Study. (United States)

    Xu, Huajun; Zhang, Pin; Han, Xiaodong; Yu, Haoyong; Di, Jianzhong; Zou, Jianyin; Wang, Yuyu; Qian, Yingjun; Tu, Yinfang; Bao, Yuqian; Yi, Hongliang; Guan, Jian; Yin, Shankai; Jia, Weiping


    Roux-en-Y gastric bypass (RYGB) surgery is an effective therapy for obstructive sleep apnea (OSA). However, little attention has been paid to the treatment goals systematically stratified by sex. The objective of this study was to assess how sex differences affect obesity indices and metabolic outcomes after RYGB surgery. A sleep questionnaire was conducted and medical histories were taken. Full-night polysomnography (PSG), anthropometric variables, and blood samples were collected. Thirty-five consecutive patients with OSA who underwent laparoscopic RYGB surgery were prospectively examined for at least 6 months were included in the study. Significant improvements (p obesity indices, and metabolic outcomes [except low-density lipoprotein in men and high-density lipoprotein (HDL) in women] were obtained in men and women with OSA. Men had higher baseline triglyceride (TG) (p women. However, only TG in men improved more than in women (p = 0.02). Sleep parameters, obesity indices, and metabolic outcomes after RYGB surgery were of similar magnitude in women and men with OSA. Alleviating sleep and obesity problems was correlated with metabolic outcomes in men and women.

  1. Predicting, preventing and managing persistent pain after breast cancer surgery:

    DEFF Research Database (Denmark)

    Schreiber, Kristin L; Kehlet, Henrik; Belfer, Inna


    Persistent pain after breast cancer surgery (PPBCS) is increasingly recognized as a potential problem facing a sizeable subset of the millions of women who undergo surgery as part of their treatment of breast cancer. Importantly, an increasing number of studies suggest that individual variation...... in psychosocial factors such as catastrophizing, anxiety, depression, somatization and sleep quality play an important role in shaping an individual's risk of developing PPBCS. This review presents evidence for the importance of these factors and puts them within the context of other surgical, medical...

  2. Women dentists: Changing the face of dentistry

    Directory of Open Access Journals (Sweden)

    Jammula Surya Prasanna


    Full Text Available It was only toward the close of the last century that women emancipated themselves from their former small territory of usefulness in a strictly domestic life, and pushing forward, proved themselves often the business equal to men and sometimes their superior. If was long before this progression, when a women in business or professional ranks was almost a curiosity. When women first entered the profession, they faced many obstacles. Mentors or faculty in the dental organizations majority were male restraining women by all means. In the beginning, men were resentful because they feel women are inferior. It took a long time for women to become a consistent presence in dental schools. In the beginning, dental schools used to admit one or two women each year, later the number increased slowly. Olden day′s women used to relieve not even the tooth ache but also used to relieve others fret also. But histories of dentistry were not acknowledged the talent of women whatsoever. The efforts and achievements of women punch the clock in the future dentistry. The current scenario has totally changed now. Nearly, half of all dental students′ are women and 25% of them are practicing dentists. Only 3% women dentists were there before the 1970s. [1] Women struggled to obtain a degree, to establish practices, and are respected as professionals. Some women choose this rewarding occupation as career followed by their family members. The population tally of chosen work upbringing has changed over time. This paper reports in a delineative way of the amelioration, staggering presence, and intendment of dentistry practicing by worldwide women.

  3. Choosing the Path of Leadership in Occupational Therapy

    Directory of Open Access Journals (Sweden)

    Clark Patrick Heard D.OT Reg. (Ont.


    Full Text Available Leadership is vital to the success and sustainability of any group, organization, or profession. Using a qualitative phenomenological methodology, consistent with interpretative phenomenological analysis, this study examines why occupational therapists choose the path of leadership. Data was collected through the completion of semistructured interviews with 10 occupational therapy leaders in Ontario, Canada. This collected data was transcribed verbatim and coded for themes by multiple coders. Several methods were employed to establish trustworthiness. Results identify that a desire to influence the profession or care delivery, a need for personal or career development, and a need for change motivate those occupational therapists who might choose the path of leadership. Recommendations for supporting new or developing leaders include a focus on linking occupational therapy practice and leadership theory at the curriculum and professional levels. Moreover, application of novel approaches to mentorship for new and developing leaders, such as supportive communities of practice, are also considered.

  4. Urethral pressure reflectometry in women with pelvic organ prolapse

    DEFF Research Database (Denmark)

    Khayyami, Yasmine; Lose, Gunnar; Klarskov, Niels


    at an abdominal pressure of 50 cmH2O (PO-Abd 50). UPR can help identify women with POP at risk of postoperative de novo SUI. The aim of this study was to investigate the reproducibility of UPR in women with POP. METHODS: Women with anterior or posterior vaginal wall prolapse were recruited for this prospective......INTRODUCTION AND HYPOTHESIS: The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure...... studies to help reveal urodynamic features predictive of postoperative de novo SUI in women with POP....

  5. Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis. (United States)

    Sebag, Frederic; Fortanier, Cécile; Ippolito, Guiseppe; Lagier, Aude; Auquier, Pascal; Henry, Jean-Francois


    The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG). Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n = 50) and an HS group (n = 50). All pre- and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each patient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test. There were 81 women and 19 men (mean age, 55 +/- 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P = NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P = NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P = .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P = NS). Mean operative cost per patient was 990 euro (SD, 191) in the TC group and 1,024 euro (SD, 143) in the HS group (P = NS). Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.

  6. A multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy

    International Nuclear Information System (INIS)

    Nozaki, Miwako; Kagami, Yoshikazu; Mitsumori, Michihide; Hiraoka, Masahiro


    The objective of this study was to investigate late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated radiation therapy in 24 hospitals. This is a prospective investigation into patients who have been followed for 3 years or more after the completion of radiation therapy. The women visited hospitals for routine medical follow-up between 1 March and 31 May 2008. All patients underwent interviews and visual/palpating examinations. Their clinical chart, past chest X-rays and laboratory findings were reviewed. Evaluation criteria for late adverse events and breast cosmetic outcome were based on the Common Terminology Criteria for Adverse Events v.3 and the European Organization for Research and Treatment of Cancer Global Cosmetic Rating System. Seven hundred and three women, including 448 treated with whole-breast irradiation and 255 treated with whole-breast and boost irradiation, were examined by radiation oncologists in 24 hospitals. The frequent adverse events were breast pain (Grade 1, 115; Grade 2, 2), breast fibrosis (Grade 1, 72; Grade 2, 8), chest wall pain (Grade 1, 67; Grade 2, 3), telangiectasia (Grade 1, 29; Grade 2, 5) and pneumonitis (Grade 1, 20; Grade 2, 6; Grade 3, 3). Adverse events of Grade 2 or 3 were found in 27 patients (3.8%); 3 presented with radiation pneumonitis of Grade 3. The percentage of patients with an excellent or good cosmetic outcome was 69.1%. In the first multicenter investigation for Japanese women after breast-conserving therapy, the evaluation of late adverse events and breast cosmetic outcome was similar to several other reports from clinical trials in North America and Europe. (author)

  7. Pregnancy and Parenthood among Surgery Residents: Results of the First Nationwide Survey of General Surgery Residency Program Directors. (United States)

    Sandler, Britt J; Tackett, John J; Longo, Walter E; Yoo, Peter S


    Although family and lifestyle are known to be important factors for medical students choosing a specialty, there is a lack of research about general surgery residency program policies regarding pregnancy and parenthood. Similarly, little is known about program director attitudes about these issues. We performed a cross-sectional survey of United States (US) general surgery residency program directors. Sixty-six respondents completed the survey: 70% male, 59% from university-based programs, and 76% between 40 and 59 years of age. Two-thirds (67%) reported having a maternity leave policy. Less than half (48%) reported having a leave policy for the non-childbearing parent (paternity leave). Leave duration was most frequently reported as 6 weeks for maternity leave (58%) and 1 week for paternity leave (45%). Thirty-eight percent of general surgery residency program directors (PDs) reported availability of on-site childcare, 58% reported availability of lactation facilities. Forty-six percent of university PDs said that the research years are the best time to have a child during residency; 52% of independent PDs said that no particular time during residency is best. Sixty-one percent of PDs reported that becoming a parent negatively affects female trainees' work, including placing an increased burden on fellow residents (33%). Respondents perceived children as decreasing female trainees' well-being more often than male trainees' (32% vs 9%, p leave, length of leave, as well as inconsistency in access to childcare and availability of spaces to express and store breast milk. Program directors perceived parenthood to affect the training and well-being of female residents more adversely than that of male residents. Copyright © 2016 American College of Surgeons. All rights reserved.

  8. Recurrence after surgery due to cervical cancer - An evaluation of the follow-up program

    DEFF Research Database (Denmark)

    Fuglsang, Katrine; Petersen, Lone Kjeld; Blaakær, Jan

    Objective During the last 20 years the follow-up program after surgical treatment for cervical cancer has remained unchanged. Surprisingly, little is communicated in relation to the follow-up program even though it has a huge impact on the life of the women and their relatives for five years....... The focus for this study is to evaluate the follow-up program in fulfilling the purpose for early diagnosis of recurrence while reminding and concerning women, who we consider healthy after surgery, 10 times during five years. Already politicians are focusing on the subject due to the socioeconomic...... consequences, but there is a need for a foundation prior to an adjustment of the follow-up program. Methods Design: retrospective study of a cohort of women attending follow-up program after surgery due to cervical cancer. Material: From the patient register at the Department of Gynaecology and Obstetrics...

  9. Can medicine be aesthetic? Disentangling beauty and health in elective surgeries. (United States)

    Edmonds, Alexander


    This article analyzes tensions between aesthetics and health in medicine. The blurring of distinctions between reconstructive and cosmetic procedures, and the linking of plastic surgery with other medical treatments, have added to the legitimacy of an emerging "aesthetic medicine." As cosmetic surgeries become linked to other medical procedures with perceived greater medical necessity, health and aesthetics become entangled. One consequence is that medical needs are magnified while perceptions of the risks of surgery are minimized. Drawing on ethnographic work on plastic surgery, as well as other studies of obstetrics and cosmetic surgery, I illustrate this entanglement of health and aesthetics within the field of women's reproductive health care in Brazil. I argue that while it would be difficult to wholly disentangle aesthetics and health, analysis of how risk-benefit calculations are made in clinical practice offers a useful critical strategy for illuminating ethical problems posed by aesthetic medicine. © 2013 by the American Anthropological Association.

  10. Women's preferences for sexual dimorphism in height depend on menstrual cycle phase and expected duration of relationship. (United States)

    Pawlowski, Boguslaw; Jasienska, Grazyna


    Human mate preferences are related to many morphological traits, such as female waist-to-hip ratio (WHR), body mass index (BMI), male height or facial symmetry. People also vary in preferences for sexual dimorphism in stature (SDS = male height/female height) between themselves and a potential partner. Here, we demonstrate that women adjust their preference for SDS not only in relation to their own height but also in relation to (1) the phase of menstrual cycle during which their preferences were studied and (2) the sexual strategy (short- versus long-term) they were asked to choose. Taller males (larger SDS) were preferred more often when women were in the follicular (i.e. fertile) phase of their menstrual cycle and when the partners were chosen for short-term relationships. These effects were independent of woman's height. The results show that women in a potentially fertile phase of their menstrual cycle and when choosing a partner who might be less likely to invest in children select genes of taller males.

  11. Impact of a Video Intervention for Rural Peruvian Women With Cervical Neoplasia Before Loop Excisional Procedures. (United States)

    Ferris, Daron G; Condorhuaman, Wendy Shulay Guevara; Waller, Jennifer; Lilienthal, Anneliese


    Indigenous Peruvian women have very high rates of cervical cancer. This study assessed the impact of an educational video on impoverished rural Peruvian women seeking loop excision surgery. Women completed baseline, postvideo and postsurgery questionnaires that assessed knowledge and attitudes about the procedure. Differences between groups were examined using repeated measures analysis of variance. Women who watched the video were significantly more calm (2.6, 2.6, and 2.3, respectively; P = 0.04), relaxed (2.5, 2.5, and 2.1, respectively; P = 0.02), and content (3.4, 3.4, and 2.4, respectively, P < 0.01) at postvideo and postsurgery assessments compared with mean results at the baseline assessment. The same women were also significantly more tense (2.5, 2.0, and 2.0, respectively; P = 0.01), upset (1.6, 1.1, and 1.1, respectively; P = 0.01), and worried (3.0, 2.0, and 2.0, respectively; P = 0.01) at baseline compared with postvideo and postsurgery results. Approximately 93% of women believed that other women scheduled to have loop excision surgery should also watch the video. Dissemination of culturally sensitive video information minimizes adverse emotional responses associated with loop excision procedures before surgery. Such an intervention quickly improves the psychological well-being of women eventually subjected to surgical management of cervical neoplasia.

  12. Cardiac surgery in the parturient. (United States)

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D


    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

  13. Women's Agency and Fertility: Recent Evidence from Egypt. (United States)

    Samari, Goleen


    Fertility reached a two decade high of 3.5 births per woman in Egypt in 2014. Lower status of women is associated with higher fertility. Majority of the studies on women's agency and fertility rely on individual level cross-sectional data from South Asia, which limits the understanding of variation among communities and the direction of the relationship between women's agency and fertility in other global contexts. This study examines the relationship between women's agency and fertility longitudinally and among communities in the most populous country in the Middle East - Egypt. For 3,795 ever married women 15 to 49 years old in the 2006 and 2012 Egyptian Labor Market Panel Survey, multilevel models are estimated for having given birth and number of births between 2006 and 2012. Contrary to expectation, women with more agency with greater participation in household decision-making and mobility are, in fact, more likely to have had a birth and have a greater total number of births. Only women with more egalitarian attitudes are associated with fewer births. Community membership explains 5% of the variation in fertility. Since social norms in Egypt favor a higher number of births and labor market participation among