1
|
Jouanny C, Abhyankar P, Maxwell M. A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms. BMC Womens Health 2024; 24:217. [PMID: 38570870 PMCID: PMC10993589 DOI: 10.1186/s12905-024-03063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing. AIM To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention. METHODS Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings. RESULTS 86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators. CONCLUSIONS Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7). SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021256956.
Collapse
Affiliation(s)
- Clare Jouanny
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland.
| | - Purva Abhyankar
- Department of Psychology, University of Stirling, Stirling, Scotland
| | - Margaret Maxwell
- The Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
| |
Collapse
|
2
|
Li J, Zhao X, Li J, Liu Y, Li T. Pelvic organ prolapse after delivery: effects on sexual function, quality of life, and psychological health. J Sex Med 2023; 20:1384-1390. [PMID: 37814537 DOI: 10.1093/jsxmed/qdad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Living with pelvic organ prolapse (POP) after delivery negatively impacted women's daily living and was detrimental to their psychological health. AIM The purpose of the present study was to explore the effects of POP after delivery on women's sexual function, quality of life (QoL), and psychological health within the first year following delivery. METHODS A cross-sectional study was conducted with 640 female participants at obstetric clinic in 2 hospitals in Shenzhen, China. OUTCOMES All women completed following questionnaires: short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on sexual function, Pelvic Floor Distress Inventory-20 (PFDI-20) on well-being and QoL, Symptom Checklist-90-Revised (SCL-90-R) on psychological health, and International Consultation on Incontinence Questionnaire Short Form. RESULTS Women with symptomatic POP (N = 250) had higher mean scores (P < .05) than those without symptoms (N = 390) in PISQ-12, PFDI-20, and SCL-90-R domains. In the symptomatic POP group (N = 250), the sexually dysfunctional group (N = 137) had significantly higher mean scores (P < .001) than the sexually functional group (N = 113) in PISQ-12, PFDI-20, and SCL-90-R domains. Women with POP duration ≥6 months (N = 132) had significantly higher mean scores (P < .001) than women with POP duration <6 months (N = 118) in PISQ-12, PFDI-20, and SCL-90-R domains. The multiple linear regression model of PISQ-12 showed that constipation history, regular pelvic floor muscle training, parity, and symptomatic POP were independently correlated with the questionnaire score (P < .05). CLINICAL IMPLICATIONS The significantly pervasive nature of POP often leads to the neglect of a substantial percentage of sexual problems and related emotional suffering, emphasizing the critical importance of raising awareness about this issue among clinicians and the general public. STRENGTHS AND LIMITATIONS The current study brought attention to significant aspects of postpartum POP; the findings suggest issues concerning POP occurrences and their impacts on sexual function, QoL, and psychological health. Primary constraints are linked to the utilization of self-report assessments. CONCLUSION The current study reveals a robust correlation between POP in postpartum women and compromised sexual function, QoL, and psychological health.
Collapse
Affiliation(s)
- Jie Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Xiaoling Zhao
- Department of Reproductive Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Juanhua Li
- Obstetrics Department, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou 518041, China
| | - Yuanwen Liu
- Obstetrics Department, Bao'an District Maternal and Child Health Care Hospital, Shenzhen 518102, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
| |
Collapse
|
3
|
Siyoum M, Teklesilasie W, Alelgn Y, Astatkie A. Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: a systematic review and narrative synthesis. BMC Womens Health 2023; 23:222. [PMID: 37138299 PMCID: PMC10157925 DOI: 10.1186/s12905-023-02367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/16/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) affects women's quality of life in various aspects. However, evidence on the healthcare-seeking behavior of women with POP is limited. Therefore, this review aimed to identify and synthesize the existing evidence on the healthcare-seeking behavior among women with POP. METHODS This systematic review and narrative synthesis of the literature on healthcare-seeking behavior among women with POP was conducted from 20 June to 07 July 2022. The electronic databases PubMed, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus and Directory of Open Access Journal, and Google Scholar were searched for relevant literature published from 1996 to April 2022. The retrieved evidence was synthesized using a narrative synthesis approach. The characteristics of included studies and the level of healthcare-seeking behavior were summarized in a table and texts. Error bar was used to show the variability across different studies. RESULTS A total of 966 articles were retrieved of which only eight studies with 23,501 women (2,683 women with pelvic organ prolapse) were included in the synthesis. The level of healthcare-seeking behavior ranges from 21.3% in Pakistan to 73.4% in California, USA. The studies were conducted in four different populations, used both secondary and primary data, and were conducted in six different countries. The error bar shows variation in healthcare-seeking behavior. CONCLUSIONS The level of health-care seeking behavior among women with POP is low in low-income countries. There is substantial variability in the characteristics of the reviewed studies. We recommend a large-scale and robust study which will help to better understand the healthcare-seeking behavior among women with POP.
Collapse
Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yitateku Alelgn
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
4
|
Elbiss HM, Abu-Zidan FM. Postpartum urinary incontinence of nulliparous women: A prospective cohort study. Medicine (Baltimore) 2023; 102:e33171. [PMID: 36862880 PMCID: PMC9981355 DOI: 10.1097/md.0000000000033171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Postpartum urinary incontinence affects women's quality of life. It is associated with different risk factors during pregnancy and childbirth. We evaluated the persistence of postpartum urinary incontinence and associated risk factors among recently delivered nulliparous women with incontinence during pregnancy. This was a prospective cohort study, which followed up all nulliparous women recruited antenatally from 2012 to 2014 in Al-Ain Hospital, Al-Ain, United Arab Emirates, who developed urinary incontinence for the first time during pregnancy. Three months after giving birth they were interviewed face-to-face, using a structured and pre-tested questionnaire, and divided into 2 groups: those who had urinary incontinence and those without it. Risk factors were compared between the 2 groups. Of the 101 participants interviewed, postpartum urinary incontinence continued in 14 (13.7%) while 87 (86.3%) recovered from it. The comparative analysis did not show any statistically significant difference between the 2 groups for sociodemographic risk factors nor for antenatal risk factors. Childbirth-related risk factors were also not statistically significant. Recovery from incontinence during pregnancy in nulliparous women was over 85% as postpartum urinary incontinence affected only a small proportion at 3 months following delivery. Expectant management is advised instead of invasive interventions in these patients.
Collapse
Affiliation(s)
- Hassan M. Elbiss
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, United Arab Emirates University, AL-Ain, United Arab Emirates
- *Correspondence: Hassan M. Elbiss, Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, P O Box 17666, AL-Ain, United Arab Emirates (e-mail: )
| | - Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, AL-Ain, United Arab Emirates
| |
Collapse
|
5
|
Byamugisha J, Justus B, Kakaire O, Haddy N, Susan O, Korn A, Mukasa DC, Haruna M, Godfrey A, Alison EA. Characteristics and outcomes of patients with pelvic organ prolapse: an analysis of data from Mulago National Referral Hospital from 2007-2016. Afr Health Sci 2023; 23:410-416. [PMID: 37545968 PMCID: PMC10398439 DOI: 10.4314/ahs.v23i1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016. METHODS The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14. RESULTS The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition. CONCLUSIONS Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.
Collapse
Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barageine Justus
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nalubwama Haddy
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Obore Susan
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco
| | | | - Mwanje Haruna
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Alia Godfrey
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - El Ayadi Alison
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco
| |
Collapse
|
6
|
Elbiss HM, Osman N, Abu-Zidan FM. Risk factors for urinary incontinence during pregnancy among nulliparous women in the United Arab Emirates. Medicine (Baltimore) 2023; 102:e32738. [PMID: 36705358 PMCID: PMC9876023 DOI: 10.1097/md.0000000000032738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Urinary incontinence (UI), which affects the quality of life, is associated with different risk factors during pregnancy. We aimed to study the risk factors related to UI during pregnancy among nulliparous women in the UAE. This is a prospective descriptive survey, which included all nulliparous women after the first 24 weeks' gestation from 2012 to 2014 in a teaching hospital in the UAE. Participants were interviewed face-to-face, using a structured and pre-tested questionnaire and divided into 2 groups: those with UI and those without it. Factors which were statistically significant (P < .05) between the 2 groups were entered into an logistic regression backward logistic regression model to define the factors predicting UI. Five hundred one participants were interviewed. UI occurred in 106/501 (21.2%). The 2-sample comparison analysis showed that urinary tract infection (UTI) (47.2% vs 34.4%, P = .018) and its number of attacks (P = .007), chronic cough (28.3% vs 13.9%, P < .001) and chronic constipation (34.9% vs 19%, P < .001) were statistically significant between those who had UI and those who did not. The logistic regression backward logistic regression model showed that the risk factors which predicted UI were chronic constipation (P = .003), chronic cough (P = .008), and the number of UTI attacks (P = .036). UI affects one-fifth of nulliparous women in the UAE. Chronic cough, constipation, and repeated UTI infection, significantly increase the odds of UI during pregnancy. Addressing these risk factors may reduce the risk of UI.
Collapse
Affiliation(s)
- Hassan M Elbiss
- Department of Obstetrics and Gyanecology, College of Medicine and Health Sciences United Arab Emirates University, Al-Ain, UAE
- * Correspondence: Hassan Elbiss, Department of Obstetrics and Gynaecology, College of Medicine, and Health Sciences, Al-Ain 17666, United Arab Emirates (e-mail: )
| | - Nawal Osman
- Department of Obstetrics and Gyanecology, College of Medicine and Health Sciences United Arab Emirates University, Al-Ain, UAE
| | - Fikri M. Abu-Zidan
- The Research Office, College of Medicine, and Health Sciences United Arab Emirates University, Al-Ain, UAE
| |
Collapse
|
7
|
Dora BT, Kassa ZY, Hadra N, Tsigie BB, Esayas HL. Determinants of pelvic organ prolapse at public hospitals in Hawassa city, Southern Ethiopia, 2020: unmatched case control study. BMC Womens Health 2022; 22:301. [PMID: 35858912 PMCID: PMC9301820 DOI: 10.1186/s12905-022-01890-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Even though the Pelvic organ prolapse (POP) is outstanding gynecologic problem, most private and asymptomatic nature of the illness makes it the “hidden epidemic.” The aim of this study was to identify the determinants of POP.
Methods
Facility based unmatched case control study was conducted from June 15 to September 10, 2020. All cases diagnosed with POP were enrolled in the study by using consecutive random sampling method by assuming that patient flow by itself is random until the required sample size was obtained. Then 1:2 cases to control ratio was applied. A structured interviewer-administered questionnaire and chart review for type and degree of prolapse was used. Epi-data was used for data entry and SPSS were used for analysis. Chi square test and binary and multivariable logistic regression analysis was employed. Multicollinearity was checked.
Result
On multivariate logistic regression, heavy usual work load(AOR = 2.3, CI(1.066–4.951), number of pregnancy ≥ 5(AOR = 3.911, CI(1.108–13.802), birth space of < 2 years(AOR = 2.88, CI(1.146–7.232), history of fundal pressure (AOR = 5.312, CI(2.366–11.927) and history of induced labor (AOR = 4.436, CI(2.07–9.505) were significantly associated with POP with P value < 0.05 and 95% CI after adjusting for potential confounders.
Conclusion
Heavy usual work load, having pregnancy greater than five, short birth space, history of induced labor, and history of fundal pressure are independent predictors of pelvic organ prolapse. Hence the responsible body and obstetric care providers should counsel the women about child spacing, minimizing heavy usual work load and effect of multigravidity on POP. Incorporation of health education on those risk factors related to POP on antenatal and postnatal care should be considered. The obstetric care providers also avoid fundal pressure and labor induction without clear indication and favorability, and the hospital officials set a law to ban fundal pressure during labor.
Collapse
|
8
|
Determinants of Pelvic Floor Disorders among Women Visiting the Gynecology Outpatient Department in Wolkite University Specialized Center, Wolkite, Ethiopia. Obstet Gynecol Int 2022; 2022:6949700. [PMID: 35996749 PMCID: PMC9392642 DOI: 10.1155/2022/6949700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pelvic floor disorders encompass a broad range of interrelated clinical conditions. Pelvic floor disorders are a common public health concern that affects the lives of millions of adult females. This disorder is expected to be more widespread and probably more severe among women in low-income countries. However, there is limited knowledge about pelvic floor disorders and their determinants among women in Ethiopia. Objective The purpose of the study was to assess the determinants of pelvic floor disorders among women who visited the gynecology outpatient service at the Wolkite University Specialized Hospital, Wolkite, Ethiopia, in 2021. Methods A cross-sectional hospital study was conducted on 275 randomly chosen women from June 1 to July 1, 2021. A systematic sampling technique was used when selecting the study subjects. The data were gathered using interviewer administered structured questionnaires. The data collected was entered in version 3.1 of EpiData, and version 23 of Statistical Package for Social Sciences was used for the analysis. The variables with a P-value <0.25 in the bivariate analysis were considered for a subsequently built multivariable model, and factors with P < 0.05 in the final model were statistically significant. The results were presented in an adjusted odds ratio with a 95% confidence interval. Result The prevalence of pelvic floor disorder was reported to be 17.8% with 9.3% of the women experiencing urinary incontinence, 8.9% experiencing pelvic organ prolapse, and 5.9% experiencing anal incontinence. Two hundred thirty-two (85.9%) were currently married, while 110 (40.7%) were housewives. Statistically, a significant association was found between age at first pregnancy (AOR = 5.193; 95% CI = 1.905–14.157), many vaginal deliveries (AOR = 15.858; 95% CI = 5.305–47.400), history of episiotomy (AOR = 7.508 95% CI = 1.556–36.224), and menopause (AOR = 7.665; 95% CI = 2.440–24.078) when analyzed with a multivariate logistic regression model. Conclusion In this study, age at first pregnancy, number of vaginal births, history of episiotomy, and menopause were independently associated with pelvic floor disorder. Therefore, educating women about the year of their first pregnancy, promoting family planning, and advice on the prevention of routine episiotomy by a health professional is recommended.
Collapse
|
9
|
Sirage N, Hailu D, Kahsay T, Amaje E. Determinants of pelvic organ prolapse among gynecologic patients attending public referral hospitals in Amhara region, Ethiopia, 2020: Institution-based unmatched case-control study design. SAGE Open Med 2022; 10:20503121221094182. [PMID: 35492885 PMCID: PMC9047810 DOI: 10.1177/20503121221094182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Pelvic organ prolapse is a common disorder, with up to 40% of women worldwide
having some form of anatomical prolapse, and it is a significant public
health problem in developing countries including Ethiopia. The prevalence of
pelvic organ prolapse in Ethiopia is 13% in Benchi Maji. This study is
designed to provide information about the determinants of pelvic organ
prolapse among gynecologic patients attending public referral hospitals in
the Amhara region, 2020. Method: Institution-based unmatched case-control study design was conducted from
March to June 2020 among randomly selected 348 mothers (116 cases and 232
controls). A convenient sampling technique was used to select cases, and
controls were selected by systematic random sampling technique. A pre-tested
and structured interviewer-administered questionnaire was used to collect
the data. Data were coded and entered into Epi data version 3.1 and then
exported to the Statistical Package for Social Science IBM version 25 for
analysis. Finally, adjusted odds ratio and 95% confidence intervals were
used to declare statistical significance. Result: The result showed that being unable to read and write (illiterate) (adjusted
odds ratio = 3.91; 95% confidence interval = 1.06–14.39), age of
women >= 40 (adjusted odds ratio = 2.91; 95% confidence
interval = 1.255–6.736), giving first birth before age of 20 (adjusted odds
ratio = 5.72; 95% confidence interval = 1.73–18.94), carrying heavy objects
(adjusted odds ratio = 2.296; 95% confidence interval = 1.102–4.785),
parity ⩾ 4 (adjusted odds ratio = 7.02; 95% confidence
interval = 1.16–42.45), and family history of pelvic organ prolapse
(adjusted odds ratio = 3.09; 95% confidence interval = 1.24–7.71) were
significantly associated with pelvic organ prolapse. Conclusion: This study concluded that being unable to read and write, age ⩾ 40,
multiparity, family history of pelvic organ prolapse, early childbirth, and
carrying heavy objects were the risk factors of pelvic organ prolapse.
Providing health education on planning the number of children, and the
impact of carrying heavy loads on pelvic organs, preventing early
childbirth, and encouraging women to pursue their education at least up to
primary school level is recommended.
Collapse
Affiliation(s)
- Nurye Sirage
- Department of Midwifery, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Desta Hailu
- Department of Maternal and Reproductive Health Nursing, School of Nursing, Mekelle University, Mekelle, Ethiopia
| | - Tensay Kahsay
- Department of Maternal and Reproductive Health Nursing, School of Nursing, Mekelle University, Mekelle, Ethiopia
| | - Elias Amaje
- Department of Public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| |
Collapse
|
10
|
Snyder K, Mollard E, Bargstadt-Wilson K, Peterson J. “We don’t talk about it enough”: Perceptions of pelvic health among postpartum women in rural communities. WOMEN'S HEALTH 2022; 18:17455057221122584. [PMID: 36148940 PMCID: PMC9510969 DOI: 10.1177/17455057221122584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: A descriptive qualitative study was conducted to explore perceptions and
experiences related to pelvic health in the postpartum period among a cohort
of women residing in communities with less than 50,000 residents. Methods: A semi-structured interview approach guided by the Theory of Planned Behavior
was used. Postpartum individuals (<6 months since childbirth) were
interviewed in the fall/winter of 2021–2022. Results: Specific to individuals’ attitudes toward pelvic health, women viewed Kegels
as an important component to improving pelvic health but had a negative
attitude toward their own pelvic health, often identifying their pelvic
floor as “weak.” The subjective norms influencing a woman’s perception were
typically, a positive influence by family/friends and the Internet, although
the Internet was viewed as an insufficient resource. Healthcare providers
were noted as an infrequent and ineffective resource for education and
support in the postpartum period. Finally, women’s perceived behavioral
control to manage their pelvic health was influenced by limited knowledge of
pelvic health and time, and a desire for more education from their primary
care provider and geographical barriers. Conclusion: Innovative strategies are needed to support postpartum women’s pelvic health
within rural communities. Primary care providers may benefit from the
development of “quick tips” by specialists, such as women’s health physical
therapists, to optimize pelvic health discussions with their postpartum
patients. Education interventions targeted toward postpartum women in rural
communities should focus on strategies that address the geographic barriers
identified while still providing individualized care. Options, such as
webinars, telehealth, and text message interventions, could be
considered.
Collapse
Affiliation(s)
- Kailey Snyder
- Physical Therapy Department, Creighton University, Omaha, NE, USA
| | - Elizabeth Mollard
- College of Nursing-Lincoln Divison, University Nebraska Medical Center, Lincoln, NE, USA
| | | | - Julie Peterson
- Physical Therapy Department, Creighton University, Omaha, NE, USA
| |
Collapse
|
11
|
Abstract
BACKGROUND Rectal prolapse has a diverse symptom profile that affects patients of all ages. OBJECTIVE We sought to identify bothersome symptoms and clinical presentation that motivated patients who have rectal prolapse to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms. DESIGN This study is a retrospective analysis of a prospectively maintained registry. SETTINGS This study was conducted at a tertiary referral academic center. PATIENTS Included were 129 consecutive women with full-thickness rectal prolapse. MAIN OUTCOME MEASURES The main outcomes measured were primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, and the 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age <65 vs age ≥65 years. RESULTS Cleveland Clinic/Wexner Fecal Incontinence score >9 was more common in older patients (87% vs 60%, p = 0.002). Obstructed Defecation Syndrome score >8 was more common in younger patients (57% vs 28%, p < 0.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p = 0.021) and bleeding (12% vs 2%, p = 0.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p = 0.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p = 0.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p = 0.056). On multivariable regression, increasing age, narcotic use, and nonprotracting prolapse at rest were associated with reporting pain as a primary concern. LIMITATIONS This was a single-center study with a small sample size. CONCLUSIONS Rectal prolapse-related bothersome symptoms and health care utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at http://links.lww.com/DCR/B492. PROLAPSO DE RECTO INFLUENCIA DE LA EDAD EN DIFERENCIAS VINCULADAS CON LA PRESENTACIÓN CLÍNICA Y LOS SÍNTOMAS MAS DESAGRADABLES: El prolapso de recto tiene una gran variedad de síntomas que afectan a pacientes con edades diferentes.Identificar los síntomas mas molestos y la presentación clínica que motivaron a los pacientes con un prolapso de recto a consultar por atención médica, caracterizar las diferencias de gravedad de los síntomas con relación a la edad y determinar los factores asociados con los síntomas mas molestos.Análisis retrospectivo de un registro prospectivo.Centro académico de referencia terciaria.Consecutivamente 129 mujeres que presentaban un prolapso rectal completo.Síntomas y molestias primarias, cuestionario de incontinencia fecal de la Cleveland Clinic / Wexner de 5 ítems, cuestionario de síndrome de defecación obstruida de 5 ítems. Los pacientes fueron categorizados en < 65 años versus ≥ 65 años.El puntaje de incontinencia fecal de la Cleveland Clinic / Wexner > 9 fue más común en pacientes mayores (87% vs 60%, p = 0.002). La puntuación del síndrome de defecación obstructiva > 8 fue más común en pacientes más jóvenes (57% vs 28%, p <0,001). Los pacientes mayores fueron más propensos que los pacientes jóvenes a informar síntomas y molestias de dolor (38% vs 19%, p = 0.021) y sangrado (12% vs 2%, p = 0.046). La mayoría de los pacientes informaron secresión de moco (mayores, 72% frente a más jóvenes, 66%, p = 0,54), pero sólo el 18% tuvo molestias, independientemente de la edad. Los pacientes mayores tenían una exteriorización de prolapso más grave que los pacientes jóvenes (en reposo, 33% frente a 11%; durante la actividad, 26% frente a 19%; solo con defecación, 40% frente a 64%, p = 0,006). Los pacientes mayores tenían más probabilidades de buscar atención médica dentro de los 6 meses posteriores al inicio del prolapso (29% frente a 11%, p = 0.056). Tras la regresión multivariable, el aumento de la edad, el uso de narcóticos y el prolapso no prolongado en reposo se asociaron con la notificación de dolor como queja principal.Centro único; tamaño de muestra pequeño.Los síntomas y molestias relacionadas con el prolapso rectal y la solicitud de atención médica difieren según la edad. Aunque el dolor rectal a menudo no se asocia comúnmente con el prolapso, incomoda a muchas pacientes y motiva a las mujeres mayores a someterse a un examen médico. Los cuestionarios funcionales con las respuestas de las pacientes pueden no reflejar las preocupaciones principales de éstos con respecto a los síntomas específicos y podrían requerir cuestionarios complementarios para así obtener prioridades individualizadas con relación a los síntomas identificados. Consulte Video Resumen en http://links.lww.com/DCR/B492. (Traducción-Dr. Xavier Delgadillo).
Collapse
|
12
|
Al-Hanawi MK, Mwale ML, Kamninga TM. The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia. Risk Manag Healthc Policy 2020; 13:595-607. [PMID: 32607027 PMCID: PMC7308143 DOI: 10.2147/rmhp.s257381] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Saudi Arabia's healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia. Materials and Methods The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods. Results The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups. Conclusion The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.
Collapse
Affiliation(s)
- Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Martin Limbikani Mwale
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tony Mwenda Kamninga
- Department of Economics, Faculty of Social and Health Sciences, Millennium University, Blantyre, Malawi
| |
Collapse
|
13
|
Moroni RM, Alves da Silva Lara L, Ferreira CHJ, de Mello Constantino M, Oliveira Brito LG. Assessment of Body Image, Sexual Function, and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire. J Sex Med 2020; 16:126-136. [PMID: 30621920 DOI: 10.1016/j.jsxm.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Women's sense of attractiveness and body image, and the impact of pelvic organ prolapse (POP) over these constructs, are likely influenced by social and cultural background. AIM To evaluate sexual function and body image in women with POP, to compare the sense of attractiveness between women with and without POP, and to translate the Body Image in the Pelvic Organ Prolapse (BIPOP) questionnaire into Brazilian Portuguese and validate it in this population. METHODS In this cross-sectional study of 105 Brazilian women with POP, we administered the BIPOP (scored from 1 to 5, with higher scores indicating worse body image), the Female Sexual Function Inventory (FSFI) (scored from 2 to 36, with higher scores indicating lower risk for sexual dysfunction), and the Attractiveness subscale of the Body Attitudes Scale questionnaire (BAQ) (scored from 5 to 35, with higher score indicating better body image). We also included 100 control women who completed the BAQ Attractiveness subscale questionnaire. MAIN OUTCOME MEASURE The main outcome measure included BIPOP, FSFI, and BAQ Attractiveness scores. RESULTS Mean BIPOP scores were 3.09 ± 1.08 in women with any POP, 3.05 ± 1.00 in those with lesser-stage POP (1 or 2), and 3.13 ± 1.15 in those with advanced-stage POP (3 or 4). There were no significant differences in score according to prolapse staging (P = .71). FSFI scores were independently associated with BIPOP scores (β = -0.052; P = .02). The mean scores for the BAQ Attractiveness subscale was 17.01 ± 4.07 in women with POP and 16.97 ± 4.60 in those without POP (P = .93). Older age was the sole characteristic associated with being sexually inactive in women with POP; regarding sexual function, a better body image and higher attractiveness scores were independently associated with a higher FSFI score. As for the Portuguese validation of the BIPOP instrument, the adapted version maintained good internal consistency (α = 0.908), good reliability (intraclass correlation coefficient, 0.94), and adequate construct validity. CLINICAL IMPLICATIONS Women with POP may not relate sexual function or attractiveness to POP extension. An impaired body image is associated with worse perception of attractiveness and increased risk for sexual dysfunction. STRENGTH & LIMITATIONS As strengths, we used a specific genital body image scale, and this is first study of its kind among Brazilian women. As for weaknesses, we encountered low educational levels in the women with POP. CONCLUSION Among women with POP, the anatomic features of the prolapse do not seem to interfere with genital body image or with sexual function. In addition, the presence of POP was not associated with being sexually active or inactive. Moroni RM, da Silva Lara LA, Ferreira CHJ, et al. Assessment of Body Image, Sexual Function, and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire. J Sex Med 2019;16:126-136.
Collapse
Affiliation(s)
- Rafael M Moroni
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Department of Gynecology and Obstetrics, West Parana State University Medical School, Cascavel, Brazil
| | - Lucia Alves da Silva Lara
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristine Homsi J Ferreira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Gustavo Oliveira Brito
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
14
|
Czerniak E, Oberlander TF, Weimer K, Kossowsky J, Enck P. "Placebo by Proxy" and "Nocebo by Proxy" in Children: A Review of Parents' Role in Treatment Outcomes. Front Psychiatry 2020; 11:169. [PMID: 32218746 PMCID: PMC7078585 DOI: 10.3389/fpsyt.2020.00169] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/21/2020] [Indexed: 12/12/2022] Open
Abstract
The "placebo (effect) by proxy" (PbP) concept, introduced by Grelotti and Kaptchuk (1), describes a positive effect of a patient's treatment on persons in their surrounding such as family members or healthcare providers, who feel better because the patient is being treated. The PbP effect is a complex dynamic phenomenon which attempts to explain a change in treatment outcome arising from an interaction between a patient and an effect from proxies such as parents, caregivers, physicians or even the media. By extension the effect of the proxy can also have a negative or adverse effect whereby a proxy feels worse when a patient is treated, giving rise to the possibility of a "nocebo (effect) by proxy" (NbP), and by extension can influence a patient's treatment response. While this has yet to be systematically investigated, such an effect could occur when a proxy observes that a treatment is ineffective or is perceived as causing adverse effects leading the patient to experience side effects. In this narrative review, we take these definitions one step further to include the impact of PbP/NbP as they transform to affect the treatment outcome for the patient or child being treated, not just the people surrounding the individual being treated. Following a systematic search of literature on the subject using the Journal of Interdisciplinary Placebo Studies (JIPS) database (https://jips.online) and PubMed (NCBI) resulted in very few relevant studies, especially in children. The effect of PbP per se has been studied in parents and their children for temper tantrums, acupuncture for postoperative symptoms, as well as for neuroprotection in very preterm-born infants. This paper will review the PbP/NbP concepts, show evidence for its presence in children's treatment outcome and introduce clinical implications. We will also offer suggestions for future research to further our understanding of the role of the proxy in promoting or distracting from treatment benefit in children. Increasing an appreciation of the PbP and NbP phenomena and the role of the proxy in children's treatment should improve research study design and ultimately harness them to improve clinical child healthcare.
Collapse
Affiliation(s)
- Efrat Czerniak
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.,Department of Clinical Psychology & Psychotherapy, University of Basel, Basel, Switzerland
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| |
Collapse
|