Kronik yaygın ağrılı kadınlarda ağrı ve yorgunluğu etkileyen faktörler

Amaç: Bu çalışma Kronik Yaygın Ağrı’lı (KYA) kadınlarda ağrı şiddeti ve genel yorgunlukla ilişkili faktörleri incelemek amacıyla yapıldı. Gereç ve yöntem: KYA’lı 104 hasta dahil edildi. Yaş ortalaması 40.28±10.82 yıldı. Hem ağrı şiddeti hem de genel yorgunluk görsel analog skalası kullanılarak değerlendirildi. Hastane Anksiyete ve Depresyon Ölçeği anksiyete ve depresyon bulgularını tanımlamak için kullanıldı. Üç farklı anket (boş zaman aktivitesi, iş ve evde fiziksel aktivite) fiziksel aktivite düzeylerini tanımlamak için kullanıldı. Sonuçlar: Anksiyete skoru ağrı eşiğini etkileyen en yaygın faktördü (p=0.003). Diğer taraftan, orta düzeydeki evdeki fiziksel aktivite (p=0.027), işteki fiziksel aktivite (p=0.008) ve anksiyete skoru (p=0.027) genel yorgunluğu etkileyen anlamlı faktörlerdi. Tartışma: Sonuçlarımız anksiyetenin KYA’lı kadınlarda ağrı ve genel yorgunluğu etkileyen en önemli faktör olduğunu göstermiştir. Bu sonuçlar ağrı, yorgunluk ve anksiyete özelliklerinin ayrıca değerlendirilmesinin gerekli olduğu düşüncesini desteklemektedir.Purpose: This study was conducted to investigate factors related to pain intensity and global fatigue in females with Chronic Widespread Pain (CWP). Material and methods: One hundred four patients with CWP were included. The mean age was 40.28±10.82 years. Both Pain intensity and global fatigue were assessed using a Visual Analogue Scale (VAS). The Hospital Anxiety and Depression Scale was used to describe anxiety and depression symptoms. Three different questionnaires (leisure time activity, and physical activity at home, at work) were used to determine physical activity levels. Dorsal regression was used to analyze the data. Results: The anxiety score was the most common factor affecting pain intensity (p=0.003). On the other hand, a moderate level of physical activity at home (p=0.027), physical activity level at work (p=0.008), and the anxiety score (p=0.027) were significant factors affecting global fatigue. Conclusion: Our results show that anxiety is the most important factor affecting both pain and global fatigue in women with CWP. These results also support the idea that the characteristics of pain, fatigue and anxiety should be evaluated separately

Doğurgan çağda kadınlarda görülen üriner inkontinansın sağlık, sosyal, seksüel ve yaşam kalitesi üzerine etkisinin incelenmesi

Üriner inkontinans yaşamı tehdit eden bir olay olmasa da kişilerin fiziksel ve sosyalyaşamlarını kısıtlamakta ve depresyona kadar varan emosyonel sorunların gelişmesine nedenolmaktadır. Bununla birlikte inkontinanslı hastaların günlük iş ve ev içi aktiviteleri, cinsel yaşamlarıda olumsuz yönde etkilenmektedir.Bu çalışma sosyal ve hijyenik bir problem haline gelen inkontinansın nedenlerini, budurumun sağlık, sosyal, seksüel ve yaşam kalitesi üzerine etkisini belirlemek amacıyla planlanmıştır.Denizli ilinde yaşayan yaşları 15- 49 yıl arasında olan toplam 160 inkontinanslı kadınrastgele örneklem yöntemiyle çalışma kapsamına alınmıştır.Çalışmaya alınan kadınların üriner inkontinans problemi dışında herhangi bir nörolojik vesistemik probleminin olmamasına ve menopoza girmemiş olmasına dikkat edilmiştir. Çalışmayaalınan olgular, Beck Depresyon Envanteri, Bayan Seksüel Fonksiyon İndeksi (FSFI), Kısa Form 36(SF 36) ve Notthingham Sağlık Profili anketleri kullanılarak değerlendirilmiştir. Çalışmamıza, yaş ortalaması 33,02±9,32 yıl ve VKİ ortalaması 26,86± 9,32 (kg/m2) olantoplam 160 inkontinanslı kadın rastgele örneklem yöntemiyle alınmıştır. Kadınların %38.8'inde stresüriner inkontinans, % 28.1'inde miks tip inkontinans ve %33.1'inde urge inkontinans görüldüğüsaptanmıştır. İnkontinanslı kadınların %25'inde cinsel fonksiyonlarının etkilendiği, Miks ürinerinkontinansı olan kadınlarda depresyon skoru daha yüksek olduğu ve inkontinans süresi arttıkçadepresyon skorunun yükseldiği, yaşam kalitelerinin olumsuz yönde etkilendiği tespit edilmiştir.Yaş, obstetrik öykü, geçirilmiş cerrahi operasyon, VKİ, sigara, kahve, alkol tüketimi ve ürinerenfeksiyon üriner inkontinansa neden olan risk faktörleridir. Üriner inkontinas süresi arttıkçakadınların sağlık, sosyal, seksüel ve yaşam kalitesi olumsuz yönde etkilenmektedir.Although urinary incontinence is not a life threathining event, its symptoms such as continousmoisture, irritation, discomfort from bad odour, and anxiety, cause some districtions in physical andsocial relationship and emotional problems especially depression. Besides, daily activities at home andjob area and sexual life may be negativelly effected.This study was planned in order to describe the causes of urinary incontinence which are asocial and hygienic problem and to show is effects on health status, social function, sexual life, andquality of life.One hundred-sixty women with urinary incontinence aged between 15-49 years living inDenizli were selected randomly. Women are in the menopausal period with neurologic or systemicproblems were excluded from the study.The Beck Depression Envantory was used to describe depressive symptoms among subjects.FSFI was used to evaluate sexual life. To investigate the quality of life the subjects, both Short Form-36 and Notthingham Health Profile were used.38.8 % of the women had a diagnosis of stress urinary incontinence, while 28.1% of them hadmixed type incontinence and 33.1% of the women had urge incontinence. 25% of the women who hadhad any type of incontinence reported that urinary incontinence effect negativelly their sexual life.Women with mixed urinary incontinence had a higher depressive symtopms compared to the others.At the same time, the increasing incontinence period was found as a factor which increases thedepression score. And also the increasing depression score affected the quality of life among subjects.Associate risk factors for urinary incontinence such as age, obstetric history, prior surgeries,BMI, smoking, coffee and alchol constupation, and urinary infection are essential. Any type of urinaryincontinence affects health status, social life, sexual life and quality of life in women of reproductiveage

Characterisation and Mechanical Modelling of Polyacrylonitrile-Based Nanocomposite Membranes Reinforced with Silica Nanoparticles

In this study, neat polyacrylonitrile (PAN) and fumed silica (FS)-doped PAN membranes (0.1, 0.5 and 1 wt% doped PAN/FS) are prepared using the phase inversion method and are characterised extensively. According to the Fourier Transform Infrared (FTIR) spectroscopy analysis, the addition of FS to the neat PAN membrane and the added amount changed the stresses in the membrane structure. The Scanning Electron Microscope (SEM) results show that the addition of FS increased the porosity of the membrane. The water content of all fabricated membranes varied between 50% and 88.8%, their porosity ranged between 62.1% and 90%, and the average pore size ranged between 20.1 and 21.8 nm. While the neat PAN membrane’s pure water flux is 299.8 L/m2 h, it increased by 26% with the addition of 0.5 wt% FS. Furthermore, thermal gravimetric analysis (TGA) and differential thermal analysis (DTA) techniques are used to investigate the membranes’ thermal properties. Finally, the mechanical characterisation of manufactured membranes is performed experimentally with tensile testing under dry and wet conditions. To be able to provide further explanation to the explored mechanics of the membranes, numerical methods, namely the finite element method and Mori–Tanaka mean-field homogenisation are performed. The mechanical characterisation results show that FS reinforcement increases the membrane rigidity and wet membranes exhibit more compliant behaviour compared to dry membranes

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research