OBJECTIVE: To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological wellbeing and surgical outcome measurements. DESIGN: A prospective, open, randomised multicentre trial. SETTING: Seven hospitals and one private clinic in the south-east of Sweden. POPULATION: Two-hundred women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH). METHODS: Four different psychometric tests were used to measure general wellbeing, depression and anxiety preoperatively, and at 6 and 12 months postoperatively. Statistical analysis of variance and covariance were used. MAIN OUTCOME MEASURES: Effects of operating method on psychological wellbeing postoperatively. Analysis of demographic, clinical and surgical data, including peri- and postoperative complications and complaints at follow up. RESULTS: No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological wellbeing at 6 and 12 months postoperatively, compared with preoperatively. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications, nor serum concentration of sex hormones, were associated with general psychological wellbeing 12 months after the operation. CONCLUSIONS: General psychological wellbeing is equally improved after both SH and TH within 12 months of the operation, and does not seem to be associated with the occurrence of peroperative complications or serum concentration of sex hormones.
Thirty-eight women undergoing augmentation mammaplasty, consecutively operated on at the Department of Plastic and Reconstructive Surgery, Malmö, Sweden, were studied preoperatively regarding medical history, personality, psychosocial and psychiatric characteristics. Thirty-six of these patients were interviewed one year postoperatively. Thirty-three age-matched women operated on with minor surgical out-patient procedures were used as a contrast group. The mammaplasty patients generally came from insecure homes with conflicts between parents and unsatisfactory emotional relations to both parents. Their educational as well as income level was significantly lower than the contrast group and they were socially isolated. Their sexual adaptation seemed to have been hampered by their sensitivity reactions towards their breasts but nonetheless most of them lived in stable heterosexual relations. Generally the augmentation mammaplasty patients were not psychiatrically abnormal apart from the negative evaluation of their physical attractiveness. The great majority of the women, 86%, were satisfied with the results of surgery. Postoperatively the patients changed their style of dressing, extended their leisure time activities and social contacts, improved their sexual life and relations to their spouse. Postoperative increase of nervous symptoms was reported by 39% of the patients, but about as many patients, 36%, reported decreased nervous symptoms. Difficulties in accepting the surgical result, sexual dysfunctions and negative mental reactions proved to be associated with specific personality characteristics. Various factors have previously been proposed as being usable in the prediction of adverse reactions after augmentation mammaplasty. None of these factors, however, proved in this study to correlate with postoperative maladaptation. A need for increased methodological stringency in predictor studies is indicated.
OBJECTIVES: A patient with newly diagnosed localized prostate cancer can choose from an array of therapies. A patient's willingness to trade life for freedom from therapy-induced long-term symptoms is poorly investigated. METHODS: In October 2002, we attempted to collect information from the 591 men who had been diagnosed and registered with prostate cancer in 1999 in Stockholm County. In a postal questionnaire, men were asked to balance absence or presence of certain therapy-induced long-term symptoms against varying lengths of survival gain as a consequence of the therapy. RESULTS: Information was provided by 511 (86%) of the 591 men. A large majority of the men participating in this study ended up in one of two extreme categories: either they accepted the therapy-induced symptom to gain survival or they did not. For fecal leakage, 78% of the men chose one of two extreme categories compared with 74% for urinary leakage, 71% for tender enlarged breasts, 73% for erectile dysfunction, and 78% for restricted diet. Thirty-seven percent of the men in the study were willing to accept fecal leakage if there was only the slightest chance to gain survival, comparing percentages for urinary leakage, tender enlarged breasts, restricted diet, and erectile dysfunction and were 48%, 53%, 55%, and 64%, respectively. CONCLUSION: Willingness to accept therapy-induced long-term symptoms to avoid a shortened survival due to prostate cancer varies dramatically among men with localized prostate cancer and a large majority of men are in one of two extreme categories. Among symptoms, long-term fecal leakage was the one fewest men were willing to accept to gain survival.
Many commentaries about men's health practices and masculinities indicate that men do not typically engage with self-health or acknowledge illness, let alone openly discuss their health concerns with other men. Prostate cancer support groups (PCSGs) appear to run contrary to such ideals, yet the factors that influence men's attendance and engagement at group meetings are poorly understood. As part of a larger PCSG study, we noticed that humor was central to many group interactions and this prompted us to examine the connections between humor, health, and masculinities.
A qualitative ethnographic design was used to direct fieldwork and conduct participant observations at the meetings of 16 PCSGs in British Columbia, Canada. Individual semi-structured interviews were completed with 54 men who attended PCSGs to better understand their perceptions about the use of humor at group meetings.
Four themes, disarming stoicism, marking the boundaries, rekindling and reformulating men's sexuality, and when humor goes south were drawn from the analyses. Overall, humor was used to promote inclusiveness, mark the boundaries for providing and receiving mutual help, and develop masculine group norms around men's sexuality. Although there were many benefits to humor there were also some instances when well-intended banter caused discomfort for attendees.
The importance of group leadership was central to preserving the benefits of humor, and the specificities of how humor is used at PCSGs may provide direction for clinical practice and the design of future community-based men's health promotion programs.
A total of 678 women were interviewed about symptoms before as well as advantages and disadvantages after abdominal hysterectomy. Medical complications, side effects, days of hospitalization and some possible differences between supravaginal hysterectomy (SVH) and total hysterectomy (TH) were also investigated. TH had been performed in 79% and SVH in 21% of the women. Leiomyoma was the most frequent diagnosis (79%). Heavy menstrual bleeding and dysmenorrhea were the dominant symptoms before surgery. After the operation, 71% of the women had no subjective gynecological complaints. Relief from heavy bleeding and pain was considered the major advantage and as many as 29% of the women experienced no disadvantage at all with the operation. Regarding sexual life, 39% experienced intercourse as much improved or better and 40% as unchanged. An intraabdominal abscess was more often found postoperatively in patients operated with TH than with SVH but with this exception no objective finding favoured one method more than the other. When new, alternative treatments such as endometrial ablation and GnRH analogues are introduced and promoted they should be subjected to careful evaluation and compared with the therapeutic efficacy of hysterectomy.
PURPOSE: We compared subjective quality of life, well-being, urinary tract symptoms and distress in patients after radical cystectomy and orthotopic urinary reconstruction with those in a matched control population. MATERIALS AND METHODS: Included in this study were 101 consecutive recurrence-free patients who underwent radical cystectomy and orthotopic bladder substitution with an ileal urethral Kock neobladder at Herlev Hospital with a minimum followup of 1 year. A frequency matched control group comprising 147 individuals was selected from the same geographical region. Information was collected by an anonymous postal questionnaire and analyzed externally in Sweden. RESULTS: The prevalence of low or moderate psychological well-being (32% versus 36%) and subjective quality of life (30% versus 38%), and high or moderate anxiety (23% versus 18%) and depression (26% versus 37%) was similar in patients with an orthotopic neobladder and population controls. Patients with a neobladder felt as attractive as the control population. Of the operated men 94% had erectile dysfunction compared with 48% of controls. Daytime and nighttime urinary frequency was similar in patients and controls (3% and 3%, and 15% and 13%, respectively), while the prevalence of urinary leakage at least once monthly was higher in patients (18% versus 5%). Intermittent self-catheterization was performed by 26% of patients with a neobladder. Urinary tract infection (14% versus 6%) was more common and the prevalence of distressful bowel symptoms (14% versus 9%) was slightly more common in patients than in controls. CONCLUSIONS: Well-being and subjective quality of life in patients after radical cystectomy and orthotopic bladder substitution were similar to those in a matched control population.
This survey investigated how individuals with facial paralysis resulting from acoustic neuroma surgery manage self-care needs of daily living. Facial paralysis was defined to include damage from surgery to other cranial nerves located in the same area as the facial nerve. The 40 patients surveyed had surgery performed at the Neurosurgical Department, National Hospital of Norway, Oslo, during a four-year period. The instrument used was a questionnaire based on Orem's universal self-care requisites. Results showed that problems related to eating and drinking and certain physiological problems were accepted over time, while pain, eye problems, and hearing loss remained difficult for patients to cope with. Social and psychological problems related to the facial paralysis were ongoing for many patients and seemed to be mitigated by self-acceptance and acceptance by others.
Four epidemiologic studies have examined mortality among women with cosmetic silicone gel-filled breast implants and have found that risk of death from suicide is two- to threefold higher in this group than among women of comparable age in the general population. The authors review the literature on the psychological and psychiatric hypotheses concerning women undergoing plastic surgery, although these hypotheses do not specifically address the association with suicide. Epidemiologic research is urgently needed to evaluate whether this association is an artifact of a higher prevalence of underlying and unreported psychopathology and other risk factors for suicide among women receiving breast implants or whether implants have an actual causal role in the risk of suicide. Until such studies are completed, psychiatric consultation should be considered before breast augmentation, especially for patients perceived to be at high risk by the plastic surgeon.
Previous research has concentrated mainly on surgical aspects and postoperative complication rates after day surgery laparoscopic cholecystectomy (LC), and less on patients' experiences and nursing care aspects. A qualitative study was conducted aimed at investigating patients' experiences of LC in day surgery. Ten women and two men were interviewed. The material was coded, categorized and analysed using qualitative analysis. The findings demonstrate that individuals with gallstone disease experience limitations in their daily life and feelings of socially handicapped. Prior to surgery, the patients felt anxious and expressed a wish for tranquilizers, and to meet the surgeon responsible. At discharge after day surgery, amnesia was experienced and the respondents did not remember important information about the operation given by the surgeon. Experience of postoperative pain varied greatly. Several respondents had a relapse of pain on the third day lasting up to 1 week. The need for additional pain medication and a bloated feeling were reported. Some respondents reported nausea and vomiting, and most had questions about wound care. The need for additional telephone follow-up was mentioned, as was the fact that it was difficult to come home to small children. However, the great majority felt that returning home on the same day as the operation, was positive.
A prospective study of short- and long-term cosmetic outcome after reduction mammaplasty from three different perspectives: the patient, a department surgeon, and an independent private practitioner in plastic surgery.
Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it.
The material stems from a Danish quality assurance program in the public health care system. Nonparametric statistics and logistic regression were used to compare cosmetic outcomes and possible confounding.
Over 80 percent of the patients evaluated the short- and long-term cosmetic outcome as good or very good. The surgeons and especially the private practitioner were more critical. The evaluation of breast features also differs between patients and surgeons. The main issue for patients is symmetry. With time, patients and the private practitioner become more critical about the scars. Surgeons are most concerned about nipple bottoming out. Predictive factors for surgeons were the patient's age, body mass index, and postoperative complications. Evaluation by patients was, in addition to complications, influenced by the preoperative information given, confidence in the treatment, and the overall course on the ward.
Patients evaluate cosmetic outcome significantly more favorably than surgeons and especially the private practitioner. They are also concerned about different breast features. Decreased nipple sensation does not influence the patient's evaluation. Evaluation by the surgeons depends on more objective measures than does evaluation by the patients. One must not underestimate the importance of factors such as preoperative information about the surgery and complications, together with proper and qualified care.