Revista da Associacao Medica Brasileira (1992)最新文献

Objective: Chronic edema in the lower extremities leads to significant negative effects on the quality of life, body image perception, satisfaction, self-confidence, and self-esteem of affected individuals. The aim of this study was to evaluate body image, quality of life, and related factors in patients with chronic lower extremity edema due to lymphedema and lipedema.

Methods: This cross-sectional study included 14 lymphedema and 12 lipedema patients receiving treatment at the lymphedema unit. Individuals aged 18-65 years with a confirmed diagnosis were enrolled; those with active infections, malignancies, or systemic diseases were excluded. Body image, dysfunctional thoughts about appearance, and quality of life were evaluated using the Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale. Circumference measurements of the lower extremities were taken before and after 20 sessions of manual lymphatic drainage therapy. Quantitative data were analyzed to compare the two groups and assess correlations between clinical and psychosocial parameters.

Results: No significant differences were observed between the lymphedema and lipedema groups in terms of age, body mass index, or pre-treatment Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale scores (p>0.05). After 20 sessions of manual lymphatic drainage therapy, both groups showed reductions in limb circumference measurements (p<0.05). Reductions in limb size were moderately associated with improvements in Body Cathexis Scale and Lymphedema Quality of Life scale scores (p<0.05). Post-treatment improvements in body image and quality of life scores were observed in both groups.

Conclusions: This study highlights that patients with lower extremity lymphedema and lipedema experience significant body image disturbances and reduced quality of life. Manual lymphatic drainage therapy improves limb circumference, body image, and quality of life.

Objective: The present research was conducted to determine the empathic skills and self-compassion of midwifery students entering clinical practice.

Methods: This study was designed as descriptive and cross-sectional. This study was performed with all midwifery students studying in the midwifery department of a public university and entering clinical practice between January 15 and March 15, 2024. The aim of this study was to reach the whole population (n=420) and 280 people constituted the sample (66.7%). The study data were collected face-to-face using the "Personal Information Form," "Empathic Tendency Scale," and "Self-Compassion Scale."

Results: Of the midwifery students participating in the study, 56.1% stated that they entered their department willingly, and 71.1% indicated that they were satisfied with the department they studied in. The mean score of midwifery students on the Empathic Tendency Scale was 142.25±18.74, and their mean score on the Self-Compassion Scale was 76.65±14.76. A statistically significant difference was identified between students' grade level and their empathic skills and self-compassion levels (p<0.05). Second-year students scored significantly higher in empathy (p<0.001), suggesting curricular influences. Despite moderate self-compassion, high self-criticism subscale scores may reflect cultural norms. Findings highlight the need for empathy-supportive training, particularly in later clinical years.

Conclusion: This study found that midwifery students entering clinical practice had moderate empathic skills and self-compassion and concluded that education affected empathic skills and self-compassion.

Objective: The aim of the study was to evaluate the role of body composition parameters measured via computed tomography before and after neoadjuvant chemoradiotherapy in predicting pathological response in patients with locally advanced rectal cancer.

Methods: Eighty-four patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative surgery were retrospectively analyzed. Computed tomography images obtained before and after neoadjuvant chemoradiotherapy were used to assess total adipose area, visceral adipose tissue, subcutaneous adipose tissue, adipose tissue density, psoas muscle area, psoas muscle density, and mesorectal adipose volume and density at the level of the L3 vertebra. Pathological response was determined using the Ryan Tumor Regression Grade system. Baseline values and percentage changes (Δ) during treatment were compared between response groups.

Results: Of the 84 patients, 31 (36.9%) showed a pathological response. There were no significant differences in demographic or clinical features between the groups. Among baseline body composition metrics, only psoas muscle density was significantly higher in the response group (p=0.015). Post-treatment analysis revealed a significant difference only in the percentage change in psoas muscle density (ΔPMD) (p=0.023). No other baseline or percentage change values for total adipose area, subcutaneous adipose tissue, visceral adipose tissue, mesorectal adipose volume, or psoas muscle area were significantly associated with pathological response (p>0.05).

Conclusion: In patients with locally advanced rectal cancer, neither abdominal adipose composition nor mesorectal adipose volume nor psoas muscle area was predictive of response to neoadjuvant chemoradiotherapy. However, psoas muscle density, a potential indicator of muscle quality, may serve as a promising biomarker for predicting pathological response based on both baseline value and treatment-induced changes.

Objective: The aim of the study was to research the effective factors on decision-making process to terminate or continue the pregnancy in trisomy 21.

Methods: A total of 103 patients who had a confirmed trisomy 21 diagnosis in a tertiary center were involved in this study. Demographic data, obstetric history, educational status, family income, and maternal employment were compared between termination of pregnancy and continuation of pregnancy (non-termination of pregnancy) groups. Also, possible effective factors on parents' decisions were evaluated by a questionnaire.

Results: Maternal age, number of miscarriages, number of living children, maternal and paternal educational status, family income, maternal working status, and detected fetal anomalies were not found to be effective on the decision-making process. Early diagnosis was correlated with a higher termination of pregnancy ratio. Psychological and economic factors, concerns of having less time and energy for other children, and career concerns were significantly effective in the termination of pregnancy group. While in the non-termination of pregnancy group, religious factors were the main concern.

Conclusion: Gestational age at diagnosis, psychological factors, economic status, and religious concerns seem to be the possible factors behind deciding termination of pregnancy in pregnancies with trisomy 21.

Objective: The aim of this study was to determine the effect of the Health Belief Model-based training provided to women via WhatsApp on their health beliefs about mammography, self-efficacy levels, and regular mammography behavior.

Methods: This randomized controlled experimental trial was conducted with 81 women (41 experimental and 40 control), aged 40-69 years, who were literate, able to use WhatsApp, and had no communication barriers, and had no history of breast cancer. Participants were recruited from a Cancer Early Diagnosis, Screening, and Education Center in eastern Turkey. The experimental group was sent training content via WhatsApp once a week for 7 weeks, individual counseling was provided, and the training video was shared in the last week. Data were collected using the "Questionnaire on Descriptive Characteristics," "Health Belief Model Scale for Breast Cancer Screening," and "Mammography Self-Efficacy Scale."

Results: The demographic characteristics of the two groups were similar (p>0.05). After the training, it was determined that women in the experimental group had significantly higher averages in all sub-dimensions of the Health Belief Model Scale for Breast Cancer Screening and Mammography Self-Efficacy Scale compared to the control group (p<0.05). It was also observed that 70% of the women in the experimental group underwent mammography after the training.

Conclusion: Health Belief Model-based education delivered via WhatsApp positively affected women's health beliefs and mammography behaviors, demonstrating the effectiveness of education delivered through digital platforms.

Objective: Endometrial hyperplasia is a precursor lesion that may progress to endometrial carcinoma, particularly in cases with atypia. Early and accurate diagnosis is essential for timely intervention. The aim of the study was to evaluate the diagnostic performance of shear wave elastography in differentiating normal endometrium, non-atypical hyperplasia, and atypical hyperplasia in premenopausal women with abnormal uterine bleeding.

Methods: This prospective study included 235 premenopausal women over 45 years of age with abnormal uterine bleeding. All patients underwent transvaginal ultrasonography and shear wave elastography using a Toshiba Aplio 500 system. Five regions of interest were placed within heterogeneous endometrial areas, and mean shear wave elastography (mean-SWE) and highest shear wave elastography (highest-SWE) values were recorded. Histopathological evaluation was performed via probe curettage, and patients were categorized into three groups: normal endometrium, non-atypical hyperplasia, and atypical hyperplasia. Receiver operating characteristic curve analysis and logistic regression were conducted.

Results: Mean-SWE and highest-SWE values were significantly higher in the hyperplasia groups compared to the normal endometrium group (p=0.021, p=0.001). Highest-SWE had the highest diagnostic accuracy (cut-off: 37.71 kPa, sensitivity: 85.9%, specificity: 48.0%). Logistic regression identified body mass index, uterine free fluid, mean-SWE, and highest-SWE as independent predictors of endometrial hyperplasia (p<0.05).

Conclusions: Shear wave elastography demonstrated significant potential as a non-invasive tool for diagnosing endometrial hyperplasia. Mean-SWE and highest-SWE were independent predictors, supporting shear wave elastography as a complementary method to transvaginal ultrasonography. Future research should optimize shear wave elastography protocols for gynecological assessments.

Objective: Urinary incontinence is more common in women than men; additionally, prevalence rises in elderly women. This study was conducted to compare the 10-year results of tension-free transvaginal tape and transobturator tape operations in terms of urinary incontinence and quality of life in women.

Methods: Women who underwent transvaginal tape and transobturator tape operations in the urogynecology department at Istanbul Kanuni Sultan Süleyman Training and Research Hospital between January and December 2013 were retrospectively screened. The Urogenital Distress Inventory-6 and King's Health Questionnaire were applied to volunteers who could be reached via phone between January 2023 and July 2023 to evaluate urinary incontinence and quality of life.

Results: Of the 117 volunteers who were included in the study, 28 underwent transvaginal tape and 89 underwent transobturator tape operations. A statistically significant difference in favor of transvaginal tape was found between the two groups in terms of relief from postoperative stress urinary incontinence and pelvic pain (p<0.05). When transvaginal tape and transobturator tape groups were compared according to Urogenital Distress Inventory-6 and King's Health Questionnaire, no statistically significant difference was found (p>0.05). Although it is not statistically significant, it can be thought that transvaginal tape is superior than transobturator tape in terms of quality of life, by patient satisfaction with minimal clinically important difference.

Conclusion: Although there is no long-term statistical difference in terms of quality of life between transvaginal tape and transobturator tape surgery, the transvaginal tape procedure was more successful in the long term, subjectively, in terms of stress urinary incontinence and postoperative pelvic pain among women.