Delay in diagnosis of muscle disorders depends on the subspecialty of the initially consulted physician

<p>Abstract</p> <p>Background</p> <p>New therapeutic strategies in muscular dystrophies will make a difference in prognosis only if they are begun early in the course of the disease. Therefore, we investigated factors that influence the time to diagnosis in muscle dystrophy patients.</p> <p>Methods</p> <p>A sample of 101 patients (mean age 49 years; range 19-80; 44% women) with diagnosed muscle dystrophies from neurological practices and the neuromuscular specialty clinic in Berlin, Germany, was invited to participate. Time from first consultation to diagnosis, subspecialty of physician, and sociodemographic data were assessed with self-report questionnaires. The association between time to diagnosis and potential predictors (subspecialty of initially consulted physician, diagnoses, gender, and age at onset) was modeled with linear regression analysis.</p> <p>Results</p> <p>The mean time span between first health-care contact and diagnosis was 4.3 years (median 1). The diagnostic delay was significantly longer if patients were initially seen by a non-neurological specialist compared to a general practitioner (5.2 vs. 3.5 years, p = 0.047). Other factors that were independently associated with diagnostic delay were female gender and inherited muscle disease.</p> <p>Conclusion</p> <p>Action to improve clinical awareness of muscle diseases in non-neurological specialists is needed.</p

Knowledge, Perceptions and Information about Hormone Therapy (HT) among Menopausal Women: A Systematic Review and Meta-Synthesis

BACKGROUND: The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial. METHOD/RESULTS: We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients. CONCLUSIONS: Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers

Die geburtshilfliche Betreuung von Frauen mit Fluchterfahrung - Perspektiven geburtshilflicher Akteur*innen

Background: The number of refugees has increased worldwide. Pregnant refugee women are considered a vulnerable group, as they experience physical exertion and psychological burden while fleeing their home countries pregnant. Moreover, pregnancy and the postpartum period require specialised care to enable the transition to motherhood without complications.Aim: The aim of this project is to analyse maternal healthcare services for refugee women and asylumseeking women from the perspective of maternal healthcare professionals (MHCP) in Germany.Methods: An interview study was conducted. MHCP with experience in caring for refugee women were recruited for the study. Semi-structured interviews were conducted and analysed according to the standards employed in qualitative thematic analysis.Results: MHCPs face different barriers when providing maternal healthcare to refugee women, e.g. in the field as well as when it comes to ethical principles and ideals. Due to a lack of resources (e.g. translators, time) and other conditions, they react by adjusting their professional practices towards refugee women, including employing modified or reduced general maternal healthcare practices.Discussion: The identification of challenges and opportunities in maternal healthcare for refugee women can help improve maternal healthcare and, in turn, maternal health. Research findings in the context of refugee care can help further the development of new approaches in maternal healthcare.Hintergrund: Die Anzahl der Menschen mit Fluchterfahrung nimmt weltweit zu. Schwangere mit Fluchterfahrung gelten als vulnerable Subpopulation, da sie parallel zur Schwangerschaft auf der Flucht körperlichen und psychischen Belastungen ausgesetzt sind. Die Phase des Mutterwerdens erfordert eine spezielle Betreuung, um einen komplikationslosen Übergang in die Mutterschaft zu ermöglichen. Ziel: Das Ziel dieses Projekts ist es, die geburtshilfliche Versorgung von Frauen mit Fluchterfahrung aus der Perspektive geburtshilflicher Akteur*innen zu analysieren. Methoden: Wir haben eine qualitative Studie mit geburtshilflichen Akteur*innen (GA) mit Erfahrung in der Betreuung von Frauen mit Fluchterfahrung durchgeführt. Halbstrukturierte Interviews wurden nach den Standards der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse: GA stehen in ihrer beruflichen Praxis vor Herausforderungen in der Betreuung von Frauen mit Fluchterfahrung z. B. in Bezug auf ihre ethischen Grundsätze und Ideale. Aufgrund mangelnder Ressourcen (z. B. Sprachmittlung, Zeit) und anderer Bedingungen reagieren sie mit Anpassungen in ihrem Handeln, die die Modifizierung, Aufrechterhaltung und Reduzierung der allgemeinen Praktiken umfassen. Diskussion: Die Identifizierung von Herausforderungen und Chancen in der geburtshilflichen Betreuung von Frauen mit Fluchterfahrung kann dazu beitragen, die Gesundheitsversorgung von Müttern und damit die Gesundheit von Müttern zu verbessern. Die Ergebnisse geben Anlass, Versorgungsansätze weiter zu entwickeln