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Prevalence of Cancer in Female Plastic Surgeons in the United States 美国女性整形外科医生的癌症患病率
Pub Date : 2015-03-29 DOI: 10.4172/2167-0420.1000229
Rana Sc, L. Chou, Tim Wang, Harris Ahs, S. Girod
Objective: Several female sub-populations of the healthcare industry, including radiologists, radiology technicians, and orthopedic surgeons, display an increased prevalence of breast cancer. Female plastic surgeons have a similar exposure to possible risk factors such as radiation exposure, late parturition, and overnight shifts. Therefore, this study aimed to evaluate the risk of breast cancer and overall cancer in female plastic surgeons. Methods: A two-page survey designed to collect data on respondent demographics, cancer incidence and exposure to social and occupational risk factors as identified in the current literature was mailed to 612 currently practicing female plastic surgeons identified by the American Society of Plastic Surgeons (ASPS). Prevalence rates for breast cancer and cancer in general were calculated. Only melanoma and internal cancers that were diagnosed within 15 years of the survey date were included, enabling us to compare the results with data from the National Institute’s Surveillance Epidemiology and End Results (SEER 11) Program. Standardized prevalence ratios (SPR), confidence intervals, and exact p-values were calculated. Results: Fourteen of the 352 respondents had been diagnosed with cancer, including three breast cancer cases, within 15 years preceeding the survey. These numbers are not signficantly lower than the expected prediction of 16 cancer and six breast cancer cases, based on the sex and race-specific prevalences in the general U.S. population. SPRs were 0.89 [95%CI: 0.49 to 1.5] for all cancers and 0.54 [95%CI: 0.11, 1.57] for breast cancer. Conclusion: Despite similarities to subpopulations with increased breast and overall cancer prevalence, the subpopulation of female plastic surgeons had no evdience of excess cancers compared to age and race-adjusted women in the general US population.
目的:医疗保健行业的几个女性亚群,包括放射科医生、放射技术人员和骨科医生,显示出乳腺癌的患病率增加。女性整形外科医生也有类似的可能风险因素,如辐射暴露、晚产和夜班。因此,这项研究旨在评估女性整形外科医生患乳腺癌和整体癌症的风险。方法:一份两页的调查,旨在收集调查对象的人口统计数据,癌症发病率和暴露于当前文献中确定的社会和职业风险因素,邮寄给612名美国整形外科学会(ASPS)确定的在职女性整形外科医生。计算了乳腺癌和一般癌症的患病率。只有在调查日期后15年内诊断出的黑色素瘤和内部癌症被包括在内,使我们能够将结果与国家研究所监测流行病学和最终结果(SEER 11)计划的数据进行比较。计算标准化患病率比(SPR)、置信区间和精确p值。结果:352名受访者中有14人在调查前的15年内被诊断患有癌症,其中包括3例乳腺癌病例。这些数字并没有明显低于预期的16例癌症和6例乳腺癌的预测,这是基于美国普通人群中特定性别和种族的患病率。所有癌症的SPRs为0.89 [95%CI: 0.49至1.5],乳腺癌的SPRs为0.54 [95%CI: 0.11, 1.57]。结论:尽管与乳腺癌和整体癌症患病率增加的亚群相似,但与美国普通人群中年龄和种族调整后的女性相比,女性整形外科医生亚群没有证据表明癌症发生率过高。
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引用次数: 4
Case Report of Uterocutaneous Fistula 子宫皮瘘1例报告
Pub Date : 2015-03-25 DOI: 10.4172/2167-0420.1000231
V. Vellanki, Sajana Gogineni, Jahnavi, S. Kanakamedala
Abstract Uterocutaneous fistula, although not exceptional, is a very rare clinical entity. It occurs most often after uterine or pelvic surgery. We report a case of Uterocutaneous fistula which was formed following lower segment caesarean section. MRI was helpful in the diagnosis and was treated successfully with hysterectomy. This report aims to remind practicing clinicians about this rare complication of caesarean section and discuss our experience with its management.
子宫皮瘘,虽然不例外,是一个非常罕见的临床实体。它最常见于子宫或盆腔手术后。我们报告一例子宫皮瘘形成后,下段剖宫产。MRI有助于诊断,并成功治疗子宫切除术。本报告旨在提醒临床医师注意这种罕见的剖宫产并发症,并讨论我们的处理经验。
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引用次数: 4
Promoting Tobacco Cessation in a Community-Based Women's Health Centre. 在社区妇女保健中心促进戒烟。
Pub Date : 2015-03-01 Epub Date: 2015-02-25 DOI: 10.4172/2167-0420.1000225
Annamaria Masucci Twarozek, Thomas Eggert, Zachary G Puca, Nefertiti DuPont, Deborah O Erwin, Chester H Fox, Martin C Mahoney

Objective: This report assesses the impact of a series of education sessions delivered to office staff on the delivery of smoking cessation services among patients seeking care at a community-based women's health center.

Methods: A quasi-experimental design was used to examine the delivery of smoking cessation services to patients in a medical office before and after office staff attended a series of 3 educational sessions intended to increase their knowledge and self-efficacy to address cessation. Delivery of smoking cessation services was documented through a systematic review of medical records using a structured abstraction form.

Results: While nearly all smokers (93%) were asked about smoking status at their last office visit, few smokers at baseline or follow-up were assessed for interest in setting a quit date or offered pharmacotherapy. Referrals to the smokers quit line increased from <1% at baseline to 8% at follow-up (p<0.001) and "any assistance" also showed a modest but significant increase (<1% baseline, 9% follow-up, p<0.001).

Conclusion: This evaluation failed to identify clinical meaningful changes in the delivery of smoking cessation services in this women's health office before and after completion of a series of educational interventions for office staff. It is anticipated that the implementation of patient centered medical homes, and EMR systems, will help to enhance the delivery of smoking cessation services to women seeking medical care.

目的:本报告评估向办公室工作人员提供的一系列教育课程对在社区妇女保健中心寻求治疗的患者提供戒烟服务的影响。方法:采用准实验设计,在诊所工作人员参加一系列旨在提高戒烟知识和自我效能的3次教育课程之前和之后,检查向患者提供戒烟服务的情况。通过使用结构化抽象表格对医疗记录进行系统审查,记录了戒烟服务的提供情况。结果:虽然几乎所有吸烟者(93%)在最后一次就诊时被问及吸烟状况,但很少有吸烟者在基线或随访时被评估是否有兴趣设定戒烟日期或接受药物治疗。结论:该评估未能确定在完成对办公室工作人员的一系列教育干预之前和之后,该妇女健康办公室提供的戒烟服务有临床意义的变化。预计以病人为中心的医疗之家和电子病历系统的实施将有助于加强向寻求医疗保健的妇女提供戒烟服务。
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引用次数: 4
The Contagious Head and Neck Cancer: The Role of Human PapillomavirusHPV 传染性头颈癌:人乳头瘤病毒的作用
Pub Date : 2015-02-25 DOI: 10.4172/2167-0420.1000226
B. Hoffman-Ruddy, Sarah Miller, E. Silverman, Lewis, H. Ho
Summary Squamous cell cancer of the head and neck (HNSCC) is an evolving area of clinical and research focus with a rising prevalence of the disease in the female population. Some human papillomavirus (HPV) types act as carcinogens that contribute to the development of HNSCC. The purpose of this article is to discuss the role of HPV in the rise of HNSCC in women, with a focus on shifting clinical practice guidelines.
头颈部鳞状细胞癌(HNSCC)是一个不断发展的临床和研究重点领域,该疾病在女性人群中的患病率不断上升。一些人类乳头瘤病毒(HPV)类型作为致癌物质,有助于HNSCC的发展。本文的目的是讨论HPV在女性HNSCC上升中的作用,重点是改变临床实践指南。
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引用次数: 5
Epidemiology of Cardiac Disease during Pregnancy in Khartoum Hospital,Sudan 苏丹喀土穆医院妊娠期心脏病流行病学研究
Pub Date : 2015-02-25 DOI: 10.4172/2167-0420.1000227
K. Yassin, Elfil Amh, H. Hamid, S. Ak, A. AziemAAli
Data was collected prospectively during the period of May 2011-through December 2012 at Khartoum Teaching Hospital from 75 pregnant women with heart diseases to investigate the epidemiology of cardiac disease in pregnancy. Means and proportions were calculated using student and X2 test, respectively. Univariate and multivariate analyses were performed, confidence intervals of 95% were calculated and P<0.05 was considered significant. With regard to classification of the cardiac disease, 60%, 26.7% and 13.3% was rheumatic heart disease, congenital heart disease and other acquired heart disease respectively. Ten cases were ended with therapeutic and spontaneous miscarriage and 65 cases reached viability. The reported medical problems that complicated the pregnancy of our patients included: congestive heart failure (14/75, 18.6%), arrhythmias (6/75, 8%), pulmonary embolism (4/75, 5.3%) and pulmonary oedema (2/75, 2.6%). There were two cases of maternal mortality (2.7%). In this study maternal cardiac complication were more common among women with past medical history of cardiac complication (OR=1.0; CI=, 1.0-1.0; P =0.023), NYHA class III & IV at booking (OR=15.9; CI=, 2.8-38; P =0.000), mitral stenosis without other valvular lesion (OR=5.3; CI=, 1.0-25.1; P =0.021), cardiomyopathy (OR=10; CI=, 1.1-88.6; P =0.036) and those without preconception counselling (OR=2.4; CI=, 1.3-4.2; P =0.002). Cardiac surgery prior to pregnancy did not guarantee a complication-free course in subsequent pregnancies. Thus Rheumatic heart disease is the most dominant aetiology of heart disease during pregnancy in Sudan. Cardiac surgery prior to pregnancy is not a grantee for pregnancy free complication.
2011年5月至2012年12月期间,在喀土穆教学医院前瞻性地收集了75名患有心脏病的孕妇的数据,以调查妊娠期心脏病的流行病学。均值和比例分别采用student检验和X2检验计算。进行单因素和多因素分析,计算95%的置信区间,P<0.05为显著性。在心脏病的分类上,风湿性心脏病占60%,先天性心脏病占26.7%,其他获得性心脏病占13.3%。治疗性自然流产10例,存活65例。我们报告的导致患者妊娠的医疗问题包括:充血性心力衰竭(14/75,18.6%)、心律失常(6/75,8%)、肺栓塞(4/75,5.3%)和肺水肿(2/75,2.6%)。有2例产妇死亡(2.7%)。本研究中,母体心脏并发症在既往有心脏并发症病史的女性中更为常见(OR=1.0;CI = 1.0 - -1.0;P =0.023), NYHA III级和IV级预订(OR=15.9;CI = 2.8 -38;P =0.000),二尖瓣狭窄无其他瓣膜病变(OR=5.3;CI = 1.0 - -25.1;P =0.021),心肌病(OR=10;CI = 1.1 - -88.6;P =0.036)和未接受孕前咨询的患者(OR=2.4;CI = 1.3 - -4.2;P = 0.002)。妊娠前心脏手术并不能保证妊娠后无并发症。因此,风湿性心脏病是苏丹怀孕期间心脏病的最主要病因。妊娠前心脏手术不能保证妊娠无并发症。
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引用次数: 13
Integrated Care for Women, Mothers, Children and Newborns: Approaches and Models for Mental Health, Pediatric and Prenatal Care Settings 妇女、母亲、儿童和新生儿的综合护理:心理健康、儿科和产前护理设置的方法和模式
Pub Date : 2015-01-31 DOI: 10.4172/2167-0420.1000223
Emily C. Dossett, Erica Z. Shoemaker, Sarah E. Nasatir-Hilty, J. Daly, D. Hilty
“Integrated” behavioral health care most often refers to coordinated primary care and mental health care delivery at a co-located clinical site or psychiatric consultation service to a primary care clinical site. Women’s perinatal medical and mental health is an ideal target for integrated, patient-centered, and family-centered care. A three pronged approach is proposed to: 1) identify solutions for current barriers to mental health care delivery for pre- and postpartum women, 2) understand the relevance, steps toward and other thematic “how to” aspects of improving access to perinatal mental health services for the ongoing health of both mother and child, and 3) learn specifics of addressing maternal mental health, infant dyadic therapy, and enhanced parenting support. It borrows from the areas of stepped care, interdisciplinary teamwork, specific matching of treatments to disorders and stages of illness, and a range of individual, dyad, family and group treatments. These treatments are accessible, reduce stigmatization, and appropriate for dissemination using technology.
“综合”行为卫生保健通常是指在同一地点的临床站点协调初级保健和精神卫生保健服务,或向初级保健临床站点提供精神病学咨询服务。妇女围产期医疗和心理健康是以患者为中心和以家庭为中心的综合护理的理想目标。提出了一个三管齐下的方法:1)确定目前为产前和产后妇女提供心理保健服务的障碍的解决方案;2)了解改善围产期心理健康服务的相关性、步骤和其他主题“如何”方面,以促进母亲和儿童的持续健康;3)了解解决产妇心理健康、婴儿二元治疗和加强育儿支持的具体问题。它借鉴了阶梯式护理、跨学科团队合作、针对疾病和疾病阶段的特定匹配治疗以及一系列个人、夫妻、家庭和团体治疗等领域。这些治疗方法是可获得的,可以减少污名化,并且适合利用技术进行传播。
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引用次数: 8
The Etiology, Treatment and Effective Prevention of Iron Deficiency and Iron Deficiency Anemia in Women and Young Children Worldwide: A Review 全球妇女和幼儿缺铁和缺铁性贫血的病因、治疗和有效预防综述
Pub Date : 2015-01-23 DOI: 10.4172/2167-0420.1000213
Gavin R. Armstrong, A. Summerlee
The current review identifies the root causes of the problem, assesses the clinical impact of iron deficiency and iron deficiency anemia with a specific focus on the condition in developing countries, and outlines the potential solutions to address the problem. Iron deficiency, the most common micronutrient deficiency in the world, results from an imbalance in the access and use of iron in the body. Although it is found in the developing and developed world, it predominantly affects women and children especially those living in poverty. The clinical effects of iron deficiency are profound: mild deficiency results in the loss of concentration in children – affecting their performance at school, and reduces work capacity in adults – affecting their ability to work a full week of work; more profound effects can seriously and permanently damage cognitive development and pose serious health issues in pregnancy and child birth. Despite substantial international efforts to address iron deficiency, the levels have continued to rise over the last decade. As we have the technology to solve this problem, the Copenhagen Consensus Centre (which meets every four years) has identified iron deficiency as the principal health challenge facing the world: the health and economic burden falling predominantly on women of reproductive age.
目前的审查确定了问题的根本原因,评估了缺铁和缺铁性贫血的临床影响,特别关注发展中国家的情况,并概述了解决问题的潜在解决方案。缺铁是世界上最常见的微量营养素缺乏症,其原因是体内铁的获取和利用不平衡。虽然它存在于发展中国家和发达国家,但它主要影响妇女和儿童,特别是生活贫困的妇女和儿童。缺铁的临床影响是深远的:轻度缺铁会导致儿童注意力不集中——影响他们在学校的表现,并降低成人的工作能力——影响他们一周工作的能力;更深刻的影响可能严重和永久地损害认知发育,并在怀孕和分娩时造成严重的健康问题。尽管国际上为解决缺铁问题做出了大量努力,但在过去十年中,缺铁水平仍在继续上升。由于我们拥有解决这一问题的技术,哥本哈根协商一致中心(每四年召开一次会议)已确定缺铁是世界面临的主要健康挑战:健康和经济负担主要落在育龄妇女身上。
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引用次数: 9
Maternal Factors Hindering Successful Breastfeeding in Al Ain City, United Arab Emirates 阿拉伯联合酋长国艾因市阻碍母乳喂养成功的产妇因素
Pub Date : 2015-01-10 DOI: 10.4172/2167-0420.1000220
Nida Hameed, H. Tatari, A. Shibli, H. Narchi
We aimed to study the maternal factors that may hinder successful breastfeeding in a prospective cohort study of a cohort of 269 mother-child pairs (under two years of age) who presented over a 3-month period to a primary healthcare facility in Al Ain city, United Arab Emirates. Explanatory data was collected from the mothers by a face-to-face questionnaire survey. The mean age of the children at enrolment was 7 months (median 6, range 1 to 24). Ninety-six infants (36%) had been exclusively breastfed, 31 (11.5%) exclusively formula fed while 142 (52.8%) had received mixed feeding. Exclusive breastfeeding was significantly less common (n=29, 30.2%) among employed women (p=0.008) compared to those exclusively formula fed (n=17, 54.8%) or mixed fed (n=68, 47.9%). There was a significant (p<0.05) downward trend in the proportion of exclusively breastfed and of mixed fed infants between firstborn infants (n=44, 45.8%) and their subsequent siblings (n=81, 57%). In the city of Al Ain, the main factors impeding breastfeeding were mothers’ employment and their lack of awareness of the benefits of breastfeeding. Enhancing the health education of the mothers is urgently needed.
我们的目的是研究可能阻碍母乳喂养成功的母体因素,在一项前瞻性队列研究中,对269对(两岁以下)在阿拉伯联合酋长国艾因市初级卫生保健机构就诊超过3个月的母婴进行队列研究。解释性数据采用面对面问卷调查的方式从母亲中收集。儿童入组时的平均年龄为7个月(中位数为6个月,范围为1至24个月)。96名婴儿(36%)采用纯母乳喂养,31名(11.5%)采用纯配方喂养,142名(52.8%)采用混合喂养。与纯配方奶喂养(n=17, 54.8%)或混合喂养(n=68, 47.9%)的女性相比,纯母乳喂养的比例(n=29, 30.2%)显著降低(p=0.008)。头生儿(n=44, 45.8%)及其后续兄弟姐妹(n=81, 57%)中纯母乳喂养和混合喂养婴儿的比例有显著(p<0.05)下降趋势。在Al Ain市,阻碍母乳喂养的主要因素是母亲的就业和她们对母乳喂养的好处缺乏认识。迫切需要加强对母亲的健康教育。
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引用次数: 5
The Association between Pregnancy-Related Discomforts and Pre-Pregnancy Body Mass Index in Japanese Women 日本女性妊娠相关不适与孕前体重指数的关系
Pub Date : 2015-01-09 DOI: 10.4172/2167-0420.1000222
S. Morino, M. Ishihara, S. Nishiguchi, N. Fukutani, Daiki Adachi, Y. Tashiro, T. Hotta, M. Yamada, M. Yamashita, T. Aoyama
Objective: To determine the association between pregnancy-related discomforts and pre-pregnancy body mass index in a longitudinal study. Methods: The study included 355 pregnant women (age, 31.1 ± 4.1 years). Participants were divided into three groups according to their pre-pregnancy body mass index: the low body mass index group, normal body mass index group, and high body mass index group. The occurrence of pregnancy-related discomforts during the second and third trimesters was investigated. Binomial logistic regression analysis was used to examine the association between pre-pregnancy body mass index and pregnancy-related discomforts experienced during the last two trimesters. Results: The occurrence of most pregnancy-related discomforts increased in the third trimester, while that of constipation and shoulder stiffness or headache decreased. Based on logistic regression analysis, pre-pregnancy body mass index was significantly associated with various discomforts. The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval = 2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29– 3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high body mass index group than in the normal body mass index group. The low body mass index group exhibited a significantly a higher occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester and constipation (2.28/1.08–4.82) during the third trimester than the normal body mass index group. Conclusion: The occurrence of discomforts decreased or increased during pregnancy. Furthermore, both prepregnancy high and low body mass index represent important risk factors for many pregnancy-related discomforts, compared with a pre-pregnancy normal body mass index.
目的:通过一项纵向研究,确定妊娠相关不适与孕前体重指数之间的关系。方法:研究对象为355例孕妇(年龄31.1±4.1岁)。参与者根据孕前体重指数分为三组:低体重指数组、正常体重指数组和高体重指数组。调查妊娠中期和晚期不适的发生情况。采用二项logistic回归分析检验孕前体重指数与最后两个月妊娠相关不适之间的关系。结果:妊娠晚期大多数妊娠不适的发生率增加,而便秘、肩僵或头痛的发生率减少。经logistic回归分析,孕前体重指数与各种不适显著相关。髋关节或耻骨疼痛的发生(优势比-4.95 / 95%置信区间= 2.38/1.14)在怀孕中期,-3.67(2.00/1.09)和睡眠困难,手或手指僵硬-6.45(3.00/1.36),腿抽筋-3.98(2.29/1.32),腰痛(2.20/1.29 - 3.75),髋关节或耻骨疼痛-3.73(2.14/1.23),和肩膀僵硬或头痛在怀孕后期-3.82(2.01/1.06)明显高于高身体质量指数组比正常体重指数组。低体重指数组在妊娠中期出现肩僵硬或头痛(2.84/1.35-5.96),在妊娠晚期出现便秘(2.28/1.08-4.82)的发生率明显高于正常体重指数组。结论:妊娠期不适感的发生有所减少或增加。此外,与孕前正常体重指数相比,孕前高和低体重指数都是许多妊娠相关不适的重要危险因素。
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引用次数: 5
Ultrasonographic Appearance of the Uterine Endometrium in Sudanese Breast Cancer Women on Tamoxifen Therapy 他莫昔芬治疗的苏丹乳腺癌妇女子宫内膜超声表现
Pub Date : 2015-01-03 DOI: 10.4172/2167-0420.1000215
M. Hummeida, R. Salah, I. Hussien, G. Adam, A. Ali
Although the potential benefit of Tamoxifen treatment in breast cancer patients outweighs its risk; however, all patients receiving Tamoxifen should undergo regular gynecologic evaluations. To survey the endometrial abnormality (endometrial thicknesses of 8 mm and more) using Trans-vaginal Ultrasound (TVS), data was collected prospectively from 104 patients with histologically confirmed stage I or II breast carcinoma, on Tamoxifen therapy for at least 6 months duration at Radiation and Isotopes Centre in Khartoum (RICK), Sudan during the period of June 2013 through December 2013. Means and proportions were compared between those with normal and abnormal endometrial thickness using student and chi-square test, respectively. P < 0.05 was considered significant. The mean (SD) duration of Tamoxifen use was 22 months. Among the total patients 39 (37.5%), 29 (27.8%), 20 (19.3%) and 16 (15.4%) used Tamoxifen for < 24, 24-36, 36-48 and ≥ 48 months respectively. Normal TVS was observed in 45 patients and abnormal findings were reported in 59 patients. In this study abnormal endometrial thickness was noticed more among nulliparous (p ≤ 0.001), longer duration of Tamoxifen use (p ≤ 0.001), premenopausal status (p ≤ 0.001), smoking (p ≤ 0.024) and BMI (p ≤ 0.001). In Conclusion: Although the discussions about endometrial screening in patients receiving Tamoxifen are still controversial, our study revealed strong association between Tamoxifen therapy and endometrial abnormality.
尽管他莫昔芬治疗乳腺癌患者的潜在益处大于其风险;然而,所有接受他莫昔芬治疗的患者都应定期接受妇科检查。为了使用阴道超声(TVS)调查子宫内膜异常(子宫内膜厚度为8mm及以上),我们前瞻性地收集了2013年6月至2013年12月期间在苏丹喀土穆放射和同位素中心(RICK)接受他莫昔芬治疗至少6个月的104例组织学证实的I期或II期乳腺癌患者的数据。采用学生检验和卡方检验比较正常和异常子宫内膜厚度的平均值和比例。P < 0.05为差异有统计学意义。他莫昔芬使用的平均(SD)时间为22个月。使用他莫昔芬治疗< 24、24-36、36-48和≥48个月的患者分别为39例(37.5%)、29例(27.8%)、20例(19.3%)和16例(15.4%)。45例TVS正常,59例出现异常。在本研究中,未产者(p≤0.001)、使用他莫昔芬时间较长(p≤0.001)、绝经前状态(p≤0.001)、吸烟(p≤0.024)和BMI (p≤0.001)中子宫内膜厚度异常更为明显。结论:虽然关于他莫昔芬患者子宫内膜筛查的讨论仍存在争议,但我们的研究显示他莫昔芬治疗与子宫内膜异常有很强的相关性。
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引用次数: 4
期刊
Journal of Womens Health Care
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