ABSTRACT
During the pandemic, assisted reproductive treatments suffered from major disruptions in their terms due to the restrictions imposed. The objective of this study is to evaluate the level of anxiety of women whose treatments were either suspended or delayed. METHODS: Descriptive cross-sectional study conducted between April and May 2020. The State-Trait Anxiety Inventory was applied by telephone in a Spanish adapted version. The research also included social, personal, and work aspects which may be involved in the challenging situation. RESULTS: A total of 115 patients participated in the study (73.7%). Women showed a mean in trait anxiety of 17.79 (SD = 8.80) and a mean in state anxiety of 19.95 (SD = 9.08). Neither the type of treatment nor the time of infertility were predictors of trait anxiety or state anxiety. Greater age pressure and more worry were associated to greater trait and state anxiety (p < 0.001). The most common emotional reactions to discontinuation of fertility treatments were sadness and anxiety. CONCLUSIONS: Discontinuation of fertility treatments due to confinement restrictions had a negative impact on the mental health of women who were following a process of assisted reproduction treatment, increasing their levels of emotional distress and anxiety.
ABSTRACT
Introduction: Migration to Western countries is associated with social and health challenges that are difficult to manage. Female genital mutilation (FGM) is a harmful practice that still occurs in the 21st century. According to the World Health Organization, FGM is a ritual procedure involving the partial or total removal of the external female genitalia for non-therapeutic reasons. Objectives: (I) To explore the experiences of women residing in the Canary Islands, in Spain, who had suffered FGM, and their assessment of the healthcare received. (II) To explore the perspectives of healthcare professionals who had attended to these cases, care pathways, and prevention. Methods: A qualitative study, phenomenologically oriented based on a pragmatic perspective, was conducted. We conducted open in-person interviews, and written documents were sent via email for data collection. Purposeful and snowball sampling methods were used to select women who had undergone FGM and healthcare providers who had attended to such patients. Nine participants were recruited, five health professionals and four women. Although the sample size was not very large, the data had enough depth and richness to meet the goals of the study. The data were analyzed using the thematic analysis technique. Results: Six main themes emerged, including the "meaning of FGM," "health consequences," "benefits of treatments," "knowledge about FGM," "experiences of professionals and with professionals," and "recommendations of professionals in improving care." Conclusions: Professionals and women identified the lack of training to address this problem, and both parties perceived FGM as a negative practice. The women lack knowledge about the relationship between some health problems they suffer and FGM, which poses a challenge for accurate diagnosis and treatment. Therefore, professionals need to know in detail all health conditions related to FGM to diagnose and treat these women more accurately. When affected women arrive in Western countries and receive correct information on the consequences of FGM, they are more likely to reject this practice. The identification of cases of FGM in women born in the Canary Islands urges the need to develop strategies to avoid such situations.
ABSTRACT
OBJECTIVE: Female genital mutilation is present in 31 countries, affecting 200 million women and girls. Due to migratory movements, cases have been described in western countries which receive part of this immigration. Spain gets an important migratory flow from countries at risk, and the Canary Islands represents an important route of entry. The main goal of this study was to evaluate the knowledge, attitudes and practices about FGM among health professionals in the island of Tenerife. METHODS: A cross-sectional descriptive study about the level of knowledge, attitudes and practices among health professionals in the Island of Tenerife was conducted based on an online questionnaire. Gynaecologists, family doctors, paediatricians, nurses, midwives and social workers were included in the study. Frequency and percentage were calculated to describe the nominal variables and mean ± standard deviation for the quantitative variables. For the statistical treatment of the data, the R software was used. RESULTS: 142 questionnaires were analysed. A total of 19.7% of the professionals surveyed responded that they had found a case during their professional practice, 19% claimed to have received training, 26.8% correctly recognized the typology and 15.5% the countries of prevalence. Only 6.3% claimed to know a specific protocol for action. CONCLUSIONS: There are cases of FGM in the Island of Tenerife. In general, the respondents show a lack of knowledge about the practice, its typology, the countries where it takes place, or the reasons why it is carried out. Specific training on the subject increased the rate of case detection and the knowledge of the practice.
OBJETIVO: La mutilación genital femenina está presente en 31 países, afectando a 200 millones de mujeres y niñas. Debido a los movimientos migratorios se han descrito casos en los países occidentales receptores de esta inmigración. España recibe un importante flujo migratorio procedente de países de riesgo, siendo las Islas Canarias una importante vía de entrada. El objetivo principal de este estudio fue evaluar los conocimientos, las actitudes y las prácticas sobre la MGF entre los profesionales de la salud en la isla de Tenerife. METODOS: Se realizó un estudio descriptivo transversal acerca del nivel de conocimientos, actitudes y prácticas entre los profesionales sanitarios en la Isla de Tenerife a través de la difusión de una encuesta online. Se incluyeron en el estudio: ginecólogos, médicos de familia, pediatras, personal de enfermería, matronas y trabajadores sociales. Se calculó frecuencia y porcentaje para describir las variables nominales y media ± desviación típica para las variables cuantitativas. Para el tratamiento estadístico de los datos, se empleó el software R. RESULTADOS: Se analizaron 142 cuestionarios. Un 19,7 % de los profesionales encuestados respondió que había encontrado algún caso durante su práctica profesional, un 19% afirmó haber recibido formación, un 26,8% reconoció correctamente la tipología y un 15,5 % los países de prevalencia. Sólo el 6,3% afirmó conocer algún protocolo específico de actuación. CONCLUSIONES: Existen casos de MGF en la Isla de Tenerife. En general, los encuestados muestran una falta de conocimiento sobre la práctica, su tipología, los países donde se realiza o las razones por las que se lleva a cabo. La formación específica sobre la materia aumentó la tasa de detección de casos y el conocimiento sobre la práctica.
Subject(s)
Circumcision, Female , Health Knowledge, Attitudes, Practice , Health Personnel , Cross-Sectional Studies , Female , Health Personnel/psychology , Humans , Spain , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To assess the safety, satisfaction and economic impact of total laparoscopic hysterectomy with bilateral salpingooophorectomy performed as an outpatient procedure on transsexual patients. MATERIAL AND METHODS: Retrospective cohort study conducted in a tertiary university hospital, between 2015-2018. Epidemiological data, intraoperative and postoperative complications and surgical results were collected. Pain score, general state of health and satisfaction levels were assessed on a phone survey. Cost savings were calculated taking as a reference the average cost of stay. RESULTS: 49 patients were recruited. Admission was required in two cases (4.1%). The rate of intraoperative complications was 6.1% (3/49) and there were no major complications. Six patients (12.2%) attended the emergency services but no admission were required. 97.6% (41/42) of patients was regarded their general state of health as good or excellent and the average pain score was 2.20 according to the Visual Analogue Scale. Calculated cost savings based on the outpatient procedure were €45,705.62. CONCLUSIONS: The performance of total laparoscopic hysterectomy with bilateral salpingo-oophorectomy as an outpatient procedure on transsexual patients presents minor complications, a low rate of readmission and emergency visits, high patient satisfaction levels and low pain scores, with reduced costs
OBJETIVO: evaluar la seguridad, satisfacción y el impacto económico de la histerectomía total laparoscópica con salpingo-oforectomía bilateral realizada como un procedimiento ambulatorio en pacientes transexuales. MATERIAL Y MÉTODOS: estudio de cohort restrospectivo realizado en un hospital universitario de tercer nivel, entre 2015-2018. Se recogieron datos epidemiológicos, complicaciones intraoperatorias y postoperatorias y resultados quirúrgicos. La puntuación de nivel de dolor, el estado general de salud y los niveles de satisfacción se evaluaron mediante encuesta telefónica. El ahorro económico se calculó tomando como referencia el coste por estancia hospitalaria. RESULTADOS: se recogieron 49 pacientes. El ingreso hospitalario fue necesario en dos casos (4,1%). La tasa de complicaciones intraoperatorias fue del 6,1% (3/49) y no hubo complicaciones mayores. Seis pacientes (12,2%) acudieron al servicio de urgencias, pero no precisaron ingreso. El 97,6% (41/42) de los pacientes consideraron su estado de salud general como bueno o excelente y la puntuación promedio de dolor fue de 2,20 según la escala visual analógica. El ahorro de los costes calculados basados en el procedimiento ambulatorio fue de 45.705,62€. CONCLUSIONES: la histerectomía total laparoscópica con salpingo-ooforectomía bilateral como procedimiento ambulatorio en pacientes transexuales presenta complicaciones menores, una baja tasa de reingresos y consultas al servicio de urgencias, altos niveles de satisfacción del paciente y bajos niveles de dolor postquirúrgico, con un ahorro económico añadido
Subject(s)
Humans , Female , Young Adult , Adult , Laparoscopy/methods , Patient Satisfaction , Hysterectomy/methods , Transsexualism/surgery , Retrospective Studies , Cohort Studies , Pain, PostoperativeABSTRACT
OBJECTIVE: To understand the process of sexual reassignment from the perspective of people who undergo this procedure; to know how their body image influences their day to day life and the impact on their sexuality, and to learn from transgender male experiences in order to guide the health care teams involved, so that they can provide care in a more adjusted way to actual needs. METHOD: Qualitative study with a total of 7 male transsexuals over 18 years of age, undergoing at least one surgery intervention for sexual reassignment, using data collection techniques such as individual, semi structured, open, audio recorded interviews and writing of reflective diaries. RESULTS: Decision making to undergo surgery to change their body image and sexual identity is complex. Factors influencing this decision are related to: the need to accept their own body, the experience with hormonal treatments, the relationship with the family and social context and with the partner, management of their own fears, the organization of health care services, the relationship and communication with the health care professionals, and the economic aspects. CONCLUSIONS: Both professionals and health services should consider and delve into the topic with the goal to understand the meaning of sex reassignment procedures to ensure better care for transsexualism.
Subject(s)
Body Image/psychology , Sex Reassignment Surgery/psychology , Transgender Persons/psychology , Transsexualism/psychology , Adult , Decision Making , Female , Gender Identity , Humans , Interviews as Topic , Male , Middle Aged , Qualitative Research , Sex Reassignment Procedures/psychology , Young AdultABSTRACT
Objetivo. Entender el proceso de reasignación sexual desde la perspectiva de las personas que lo realizan, conocer cómo influye en su día a día su imagen corporal y el impacto en su sexualidad, y aprender de los varones transexuales para orientar a los equipos sanitarios implicados, de forma que puedan ofrecer una atención más ajustada a las necesidades reales. Método. Estudio cualitativo con un total de 7 varones transexuales mayores de 18 años, sometidos como mínimo a una intervención quirúrgica, utilizando como técnica de recogida de datos las entrevistas individuales, semiestructuradas, abiertas grabadas en audio y la redacción de diarios reflexivos. Resultados. El decidir someterse a una intervención con el fin de modificar la imagen corporal para ajustarla a su identidad de género es compleja. Los factores que influyen se relacionan con: la necesidad de aceptación de su propio cuerpo, la experiencia con los tratamientos hormonales, la relación con la familia y el entorno social y de pareja, el manejo de los propios miedos, la organización de los servicios sanitarios y la relación y comunicación con los profesionales sanitarios y aspectos económicos. Conclusiones. Tanto los profesionales como los servicios sanitarios deben tener en cuenta y profundizar en el tema de conocer el significado de las intervenciones de reasignación sexual para asegurar una mejor atención a la transexualidad
Objective. To understand the process of sexual reassignment from the perspective of people who undergo this procedure; to know how their body image influences their day to day life and the impact on their sexuality, and to learn from transgender male experiences in order to guide the health care teams involved, so that they can provide care in a more adjusted way to actual needs. Method. Qualitative study with a total of 7 male transsexuals over 18 years of age, undergoing at least one surgery intervention for sexual reassignment, using data collection techniques such as individual, semi structured, open, audio recorded interviews and writing of reflective diaries. Results. Decision making to undergo surgery to change their body image and sexual identity is complex. Factors influencing this decision are related to: the need to accept their own body, the experience with hormonal treatments, the relationship with the family and social context and with the partner, management of their own fears, the organization of health care services, the relationship and communication with the health care professionals, and the economic aspects. Conclusions. Both professionals and health services should consider and delve into the topic with the goal to understand the meaning of sex reassignment procedures to ensure better care for transsexualism
Subject(s)
Humans , Male , Transsexualism , Sex Reassignment Procedures/statistics & numerical data , Gender Identity , Body Image , Sex Reassignment Procedures/methods , Sex Reassignment Procedures/psychology , Qualitative Research , Mastectomy , HysterectomyABSTRACT
BACKGROUND: Since the 1990s recombinant human FSH (r-hFSH), such as Gonal-f® and Puregon®, have been in widespread use for fertility treatment [1]. More recently Bemfola®, biosimilar to r-hFSH, has been introduced with similar efficacy and safety to Gonal-f® [2], but delivered in a novel, innovative injector pen system (Reddot design award 2011). The Bemfola® pen (BP) is a single-use, disposable pen available in five different presentations (i.e., 75IU, 150IU, 225IU, 300IU and 450IU), each of which provides a range of doses that it can deliver. Non-compliance to hormonal treatment regimens might be a critical issue to reach therapeutic goals. The use of pens by patients is often limited by factors such as fear of injection, but can be also related to the device itself [3-6]. Therefore, easy-to-use devices may also positively influence physicians» hormonal prescribing habits and patient's compliance. Accordingly, this user acceptance study aimed to assess the use of the Bemfola® pen in a population of potential users with regard to the easiness and convenience of handling of the Bemfola® Pen in comparison to the Gonal-f® pen and Puregon® pen. Material and Methods Randomised and single-blind study with three-arm user test. The investigation was conducted in females who considered undergoing hormonal treatment for the first time (naïve) and who were considering to start an IVF or donor egg treatment cycle. A total of 10 centers from Spain participated in this investigation. This study of user acceptance included 460 females qualifying for potential patients considering a therapy with follicle stimulating hormone. Users received the three pens in a randomized, consecutive sequence, completed for each of the pen one questionnaire (same for all 3 pens) and thereafter completed a concluding questionnaire comparing the handling, convenience and indicating their preference among the 3 pens. No self-injections were performed and an application pad for injections was used. Results The Bemfola® pen showed the highest scorings and strong preferences in all pen features assessed and achieved the highest proportion of best choice compared to both the Gonal-f® and Puregon®. pen. Conclusions The results indicated significant preferences of women, who intended to undergo a hormonal treatment, for the Bemfola® pen compared to both the Puregon® pen and the Gonal-f® pen
ANTECEDENTES: Desde la década de los noventa, la hormona foliculoestimulante humana recombinante (hFSH-r) como Gonal-f® y Puregon®, se ha utilizado ampliamente en el tratamiento de la fertilidad [1]. Más recientemente se ha introducido Bemfola®, biosimilar de la hFSH-r con eficacia y seguridad similar a Gonal-f® [2], pero desarrollada con un innovador sistema de pluma inyectora (premio de diseño Reddot, 2011). Bemfola® es una pluma precargada desechable de un solo uso, disponible en cinco presentaciones diferentes (75 UI, 150 UI, 225 UI, 300 UI y 450 UI), cada una de las cuales proporciona un rango de dosis determinado. El no-cumplimiento de las pautas de tratamiento hormonal es un problema fundamental en la consecución de los objetivos terapéuticos. El uso de plumas por las pacientes se ve a menudo limitado por el miedo a la inyección e incluso relacionado con el propio dispositivo [3-6]. Por tanto, los dispositivos de fácil uso pueden influir positivamente tanto en los hábitos de prescripción de terapias hormonales de los médicos como en el cumplimiento del paciente. En consecuencia, el objetivo de este estudio consiste en evaluar el uso de Bemfola® en una población de usuarias potenciales con respecto a la facilidad, y conveniencia en su manejo en comparación con las plumas Gonal-f® y Puregon®. Material y Métodos Estudio aleatorizado y simple ciego de tres ramas de tratamiento. Esta investigación se llevó a cabo en mujeres sin tratamiento previo que estaban considerando bien iniciar un ciclo de FIV o bien ser donantes de ovocitos. En este estudio participaron 10 centros de fertilidad de España. Se incluyeron 460 mujeres cualificadas para ser «pacientes potenciales de terapia hormonal con hormona foliculoestimulante humana recombinante» Las usuarias recibieron las tres plumas (Bemfola®, Gonal-f® y Puregon®) en una secuencia aleatoria y consecutiva, y completaron un cuestionario idéntico por cada una de las plumas, y un cuestionario de conclusión con el fin de comparar el manejo, la comodidad y la preferencia de las tres plumas. En ningún caso se realizaron auto-inyecciones y en su lugar se utilizó una almohadilla de aplicación de inyecciones. Resultados La pluma Bemfola® mostró la mayor puntuación y elevadas preferencias en todas las características evaluadas, y alcanzó la mayor proporción de «mejor» opción en comparación con la pluma Gonal-f® y la pluma Puregon®. Conclusiones Los resultados mostraron preferencias significativas de mujeres que tenían la intención de someterse a un tratamiento hormonal, para la pluma Bemfola® en comparación con las plumas Gonal-f® y Puregon®
Subject(s)
Humans , Female , Ovulation Induction/methods , Fertilization in Vitro , Follicle Stimulating Hormone/administration & dosage , Insemination, Artificial, Heterologous , Donor Selection , Patient Satisfaction , Injections, SubcutaneousABSTRACT
ANTECEDENTES: Desde la década de los noventa, la hormona foliculoestimulante humana recombinante (hFSH-r) como Gonal-f® y Puregon®, se ha utilizado ampliamente en el tratamiento de la fertilidad [1]. Más recientemente se ha introducido Bemfola®, biosimilar de la hFSH-r con eficacia y seguridad similar a Gonal-f® [2], pero desarrollada con un innovador sistema de pluma inyectora (premio de diseño Reddot, 2011). Bemfola® es una pluma precargada desechable de un solo uso, disponible en cinco presentaciones diferentes (75 UI, 150 UI, 225 UI, 300 UI y 450 UI), cada una de las cuales proporciona un rango de dosis determinado. El no-cumplimiento de las pautas de tratamiento hormonal es un problema fundamental en la consecución de los objetivos terapéuticos. El uso de plumas por las pacientes se ve a menudo limitado por el miedo a la inyección e incluso relacionado con el propio dispositivo [3-6]. Por tanto, los dispositivos de fácil uso pueden influir positivamente tanto en los hábitos de prescripción de terapias hormonales de los médicos como en el cumplimiento del paciente. En consecuencia, el objetivo de este estudio consiste en evaluar el uso de Bemfola® en una población de usuarias potenciales con respecto a la facilidad, y conveniencia en su manejo en comparación con las plumas Gonal-f® y Puregon®. Material y MÉTODOS: Estudio aleatorizado y simple ciego de tres ramas de tratamiento. Esta investigación se llevó a cabo en mujeres sin tratamiento previo que estaban considerando bien iniciar un ciclo de FIV o bien ser donantes de ovocitos. En este estudio participaron 10 centros de fertilidad de España. Se incluyeron 460 mujeres cualificadas para ser «pacientes potenciales de terapia hormonal con hormona foliculoestimulante humana recombinante». Las usuarias recibieron las tres plumas (Bemfola®, Gonal-f® y Puregon®) en una secuencia aleatoria y consecutiva, y completaron un cuestionario idéntico por cada una de las plumas, y un cuestionario de conclusión con el fin de comparar el manejo, la comodidad y la preferencia de las tres plumas. En ningún caso se realizaron auto-inyecciones y en su lugar se utilizó una almohadilla de aplicación de inyecciones. RESULTADOS: La pluma Bemfola® mostró la mayor puntuación y elevadas preferencias en todas las características evaluadas, y alcanzó la mayor proporción de «mejor» opción en comparación con la pluma Gonal-f® y la pluma Puregon®. CONCLUSIONES: Los resultados mostraron preferencias significativas de mujeres que tenían la intención de someterse a un tratamiento hormonal, para la pluma Bemfola® en comparación con las plumas Gonal-f® y Puregon®
BACKGROUND: Since the 1990s recombinant human FSH (r-hFSH), such as Gonal-f® and Puregon®, have been in widespread use for fertility treatment [1]. More recently Bemfola® has been introduced with familiar efficacy and safety to Gonal-f® [2], but delivered in a novel, innovative injector pen system (Reddot design award 2011). The Bemfola® pen (BP) is a singleuse, disposable pen available in five different presentations (i.e., 75IU, 150IU, 225IU, 300IU and 450IU), each of which provides a range of doses that it can deliver. Non-compliance to hormonal treatment regimens might be a critical issue to reach therapeutic goals. The use of pens by patients is often limited by factors such as fear of injection, but can be also related to the device itself [3-6]. Therefore, easy-to-use devices may also positively influence physicians' hormonal prescribing habits and patient's compliance. Accordingly, this user acceptance study aimed to assess the use of the Bemfola® pen in a population of potential users with regard to the easiness and convenience of handling of the Bemfola® Pen in comparison to the Gonal-f® pen and Puregon® pen. Material and methods Randomised and single-blind study with three-arm user test. The investigation was conducted in females who considered undergoing hormonal treatment for the first time (naïve) and who were considering to start an IVF or donor egg treatment cycle. A total of two 10 centres from Spain participated in this investigation. This study of user acceptance included 460 females qualifying for potential patients considering a therapy with follicle stimulating hormone. Users received the three pens in a randomized, consecutive sequence, complete for each of the pen one questionnaire (same for all 3 pens) and thereafter complete a concluding questionnaire comparing the handling, convenience and indicating their preference among the 3 pens. No self-injections were performed and an application pad for injections was used. Results The Bemfola® pen showed the highest scorings and strong preferences in all pen features assessed and achieved the highest proportion of best choice compared to both, the Gonal-f® and Puregon® pen. Conclusions The results indicated significant preferences of women, who intended to undergo a hormonal treatment, for the Bemfola® pen compared to both the Puregon® pen and the Gonal-f® pen
