Woman - Psychosomatic Gynaecology and Obstetrics最新文献

Mental health concerns, particularly depression and anxiety, are common among women of all ages. Because obstetrician/gynecologists (ob/gyns) often serve as a primary source of care for women, they are in a unique position to detect and target mental health symptoms early. In this context, we define ethics as the balance between one's competency in practice, and the need to treat patients with conditions outside of that competency. This paper discusses the ethical challenges that ob/gyns may face in identifying and treating mental health conditions due to lack of expertise, training, and experience. We also focus on the ethical considerations that favor interventions on the part of ob/gyns, and how improved training could help to resolve this ethical dilemma. In addition, the expansion of collaborative care networks may help to build continuity of care.

Objective

The aim of the study was to investigate the prevalence of adverse obstetric history in women who consult practice-based gynaecologists and examine distinctive characteristics of the affected women.

Study design

We screened 921 women and acquired standardized obstetric and psychological data of 585 participants.

Results

Twenty-six percent of the screened women exhibited an adverse obstetric history (pregnancy loss, medically indicated or voluntary abortion) that dated back an average of 19 years. No noticeable general psychological issues could be ascertained among the affected women (somatic symptoms, depression, stress). 28 percent of these women stated to be still under emotional distress because of the gynaecological impact. These women indicated dysfunctional attribution patterns, pronounced coping efforts, stronger, longer lasting symptoms of grief, posttraumatic stress and depression.

Conclusion

About one fourth of this gynaecological outpatient sample exhibited an adverse obstetric history. Although most of these women don’t show psychiatric symptoms of clinical relevance, gynaecologists should ask for backdating miscarriages and abortions and the extent of persistent psychological strain. This allows detecting those women who did not manage to handle this experience in a functional way. Support for a change in dysfunctional attribution and coping strategies as well as for a decrease in grief, posttraumatic symptoms and depression can be provided.

Patients with hypothyroidism can present a series of so-called residual symptoms which are said to be without physical pathology. These symptoms, however, affect negatively the well-being state of these patients. Currently there are no explanations for this situation.

Based on previous investigations done with thyroid disease patients we have carried out a clinical examination which is centered on musculoskeletal features together with a simple evaluation of psychological stressors (scaled 1–3). Laboratory diagnosis was focused on serum magnesium. This report includes the data from 166 women including 58 euthyroid controls (six males) and 108 patients with hypothyroidism (eight males).

The most common complaints seen in our patients included fatigue, being easily tired, concentration deficit, ankle instability, and gait insecurity, giving way of the ankle, muscle cramps in the shanks, visual disturbances, irritability, and vertigo sensation. Besides this symptomatology a great majority of the patients (89.5%) presented musculoskeletal alterations. The main finding was that of lateral tension which entails an eccentric muscle action of the affected lower extremity. Lateral tension was always accompanied by (forward) rotation of the hemi-pelvis of the affected side. Idiopathic moving toes were found to be independent of lateral tension. Stress scores in patients were higher in patients than in the control group. Serum magnesium levels were significantly lower in patients (0.87 ± 0.1 mmol/l vs. 0.92 ± 0.07 mmol/l, p = 0.041) and showed a trend toward an inverse correlation to the intensity of lateral tension as well as to the stress score. Patients having magnesium levels below 0.9 mmol/l received 3× 1.4 mmol daily of elemental magnesium in the form of 400 mg of magnesium citrate. In cases presenting stress scores of 2 or 3 a relaxation treatment procedure was included in the treatment. This treatment was extended to the use of acupuncture on points of the Triple Burner meridian. Treatment success was observed in 90% of cases, i.e. residual symptoms were no longer present and patients reported an improved feeling of well-being.

We hypothesize that magnesium deficit is facilitated by the presence of physical and psychological stressors. This condition has the potential to negatively influence the function of Complex V of oxidative phosphorylation which relies on magnesium-ATP. Reproductive processes, which have high energetic requirements in women, could thus be affected. The disappearance of the so-called psychosomatic symptoms after our therapeutic scheme brings a new light into this field of medicine and it stresses the importance of holistic handling. Understanding of body–mind interactions is explained by discussing thermodynamics, noesis, Salutogenesis and Resilience, and shamanism.

Introduction

In spite of rising caesarean section rates there is no better obstetric outcome but sustained problematic consequences for women and infants. This puts professionalism of obstetricians into question.

Hypothesis

It is assumed that current obstetric practice acts against better medical knowledge (Evidence-based Medicine) by misapplying the value concept of “autonomy”.

Method

By method of values clarification the vague and open context term of autonomy is critically examined and reduced to the concrete consequences of its (mis)application in obstetrics.

Findings

Evidence-based Medicine is not adhered to in the name of an unquestioned and vague autonomy concept.

Conclusion

Rational autonomy based on inquiry and integrated in a caring relationship between the parturient woman and her obstetrician (principled autonomy) calls for responsible professionalism (EBM). The critical expertise of obstetricians and midwives is highly relevant to enable pregnant women to make rational, informed, and consequentialist decisions in order to not being abandoned to individualised responsibility.

In medicine, the vast majority of conscientious objection (CO) is exercised within the reproductive healthcare field – particularly for abortion and contraception. Current laws and practices in various countries around CO in reproductive healthcare show that it is unworkable and frequently abused, with harmful impacts on women's healthcare and rights. CO in medicine is supposedly analogous to CO in the military, but in fact the two have little in common.

This paper argues that CO in reproductive health is not actually Conscientious Objection, but Dishonourable Disobedience (DD) to laws and ethical codes. Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers.

CO in reproductive healthcare should be dealt with like any other failure to perform one's professional duty, through enforcement and disciplinary measures. Counteracting institutional CO may require governmental or even international intervention.

Postpartum depression (PPD) is a major health problem that affects many women worldwide. In Egypt, PPD is neglected despite the expected high prevalence rate among women during the transition period after the Egyptian revolution. This research investigated the prevalence, risk factors, and interventions of postpartum depression in southern rural Egypt. Interviews were conducted with 57 participants recruited from public and private hospitals. Questionnaires and the Arabic version of the Edinburgh Postnatal Depression Scale were administered. The prevalence of PPD was found to be 73.7% and is associated with low income and age at childbirth. Most participants regarded screening mothers after childbirth for PPD as an effective way to detect and intervene in PPD; in comparison to, antidepressants that were regarded by most participants as ineffective. Furthermore, in an effort to assess the cultural-suitability of prescribing antidepressants for PPD in such communities, where high pregnancy rate is favored, we examined the biological influence of Sertraline, a widely prescribed antidepressant medication, on the FSH and LH gene expression and discussed its possible effects on fertility based on our results.

Aim

The aim of the present study was to examine whether physicians’ estimations of medical needs are influenced by the physicians’ own personal values.

Design and method

We used a vignette where a young female requests hymen restoration or virginity certificate due to honour-related threats. We asked whether or not the participating physicians would under certain circumstances be prepared to help the young females. We also asked what would happen to their own trust and what they estimated would happen to the general public's trust in healthcare if performing such operations or writing such certificates was generally accepted.

Results

The majority of those whose own trust would not be influenced [59.7% (95% CI 55.2–64.2)] were found among the respondents who stated that they were prepared to help the young females, as against those [13.5% (95% CI 10–16.5)] stating that they would help under no circumstances. We found an association between those whose own trust would decrease and those stating that they would help under no circumstances [OR 90 (95% CI 12.2–664.3)].

Conclusion

The results indicate that factual aspects are influenced by physicians’ own values. If factual aspects such as estimation of the patient's trustworthiness and medical needs are impregnated by physicians’ personal values, there is a risk of arbitrariness when deciding whether to help young females in distress. In order to avoid arbitrariness in decision-making we suggest that consensus in the area is developed.