Insufficient assessment of sexual dysfunction : A problem in gynecological practice

Background and Objective: Sexual health is an important part of a woman's life and well-being. Female sexual dysfunction is a complicated problem, it is often underestimated in the healthcare process, and its management is complex. Giving women the opportunity to talk about sexual problems is a fundamental part of healthcare and may improve their quality of life. The aim of this study was to find out patients' experience and attitudes toward the involvement of gynecologists addressing sexual issues, to disclose the main barriers to initiate a conversation, and to assess the prevalence of sexual disorders among patients in a gynecological clinic. Material and Methods: A questionnaire-based approach was used to survey 18- to 50-year-old voluntary patients in the gynecological clinic. The study population comprised 300 different gynecological (except oncologic) patients independently of reasons for being in the clinic. The duration of the study was 6 months. Results: Only one-third of the patients had ever been asked about their sexual life by a gynecologist, whilst the majority (80%) of the respondents reported they would like to be asked and discuss sexual issues. The patients mostly did not complain because of psychoemotional barriers, and shame was the main barrier for patients to talk about their problems. Sexual dysfunction was a frequent disorder among gynecological patients, reaching especially high levels in the arousal (46.41%) and lubrication (40.67%) domains. Conclusions: The assessment of sexual health is insufficient in gynecological care, and sexual history-taking and evaluation of sexual functions should be included in routine gynecological health assessments.publishersversionPeer reviewe

Oxidative stress parameters in Posttraumatic Stress Disorder risk group patients

Funding Information: The research is supported by European Social Foundation co-financing: Project for Doctoral students support, at Rîga Stradiòð University (No. 2009/0147/1DP/1.1.2.1.2/09/IPIA/ VIAA/009). The views expressed in this article are those of the authors and do not reflect the official policy or position of the Latvian government, Latvian National Armed Forces, Medical Support Centre of Latvian National Armed Forces or any of the institutions with which the authors are affiliated. The authors state no conflict of interest. All authors read and approved the final manuscript.Increased excitotoxity in response to stressors leads to oxidative stress (OS) due to accumulation of excess reactive oxygen/nitrogen species. Neuronal membrane phospholipids are especially susceptible to oxidative damage, which alters signal transduction mechanisms. The Contingent of International Operations (CIO) has been subjected to various extreme stressors that could cause Posttraumatic Stress Disorder (PTSD). Former studies suggest that heterogeneity due to gender, race, age, nutritional condition and variable deployment factors and stressors produce challenges in studying these processes. The research aim was to assess OS levels in the PTSD risk group in CIO. In a prospective study, 143 participants who were Latvian CIO, regular personnel, males, Europeans, average age of 27.4, with the same tasks during the mission, were examined two months before and immediately after a six-month Peace Support Mission (PSM) in Afghanistan. PCL-M questionnaire, valid Latvian language "Military" version was used for PTSD evaluation. Glutathione peroxidase (GPx), superoxide dismutase (SOD) and lipid peroxidation intensity and malondialdehyde (MDA) as OS indicators in blood were determined. Data were processed using SPSS 20.0. The MDA baseline was 2.5582 μM, which after PSM increased by 24.36% (3.1815 μM). The GPx baseline was 8061.98 U/L, which after PSM decreased by 9.35% (7308.31 U/L). The SOD baseline was 1449.20 U/gHB, which after PSM increased by 2.89% (1491.03 U/gHB). The PTSD symptom severity (total PCL-M score) baseline was 22.90 points, which after PSM increased by 14.45% (26.21 points). The PTSD Prevalence rate (PR) baseline was 0.0357, which after PSM increased by 147.06% (0.0882). We conclude that there is positive correlation between increase of OS, PTSD symptoms severity level, and PTSD PR in a group of patients with risk of PTSD - CIO. PTSD PR depends on MDA intensity and OS severity. OS and increased free radical level beyond excitotoxity, is a possible causal factor for clinical manifestation of PTSD.publishersversionPeer reviewe

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)