Ninety six women, average age 47, who had a hysterectomy between October 1997 and June 1999 were initially interviewed in hospital and followed up for four months after discharge. The findings of the study indicate that adequate support was needed in early recovery period and discharge programs should take into consideration the needs of women with small children and those who have no onsite home support. Strategies used by the women to assist convalescence included support from family and friends but little in the way of health professional or community support. The majority of women returned to normal activities by four months. Communication between women and health professionals was also considered by the women to be important following discharge, especially in terms of information and reassurance about their progress during recovery. / Master of Science (Hons) (Health)

Thesis (M. H. Sc.)--Victoria University (Melbourne, Vic.), 2008. / Includes bibliographical references.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

In the United States, hysterectomy is one of the most commonly performed operations for women that is not related with pregnancy. However, not enough attention has been paid to how women's exposure to the surgery differs according to their social characteristics as well attitudinal/behavioral factors. Using cohort data from the National Longitudinal Surveys of Mature Women, this study investigated two aspects: (1) the association between socioeconomic status and hysterectomy and (2) the impact of women's attitudinal/behavioral characteristics on hysterectomy. With Cox proportional hazards analyses, this study found that women's exposure to hysterectomy significantly differs according to their social and attitudinal standings. Social characteristics that were found to be statistically significant risk factors of hysterectomy include women's eduction, employment status, and marital status. Among additional and behavioral factors, women's locus of control and number of children were identified as statistically significant risk factors. These findings may be used to enhance consumer awareness of hysterectomy and aid in policy reconstruction.

The purpose of this thesis is to explore the methodological and empirical issues relating to the economic evaluation of minimal access surgery (MAS). Given the likely increase in the utilisation of economic analysis in this area, it is crucial to explore whether the methods of economic evaluation have limitations in the face of the particular characteristics of MAS. The comparison of abdominal hysterectomy (AH) and transcervical endometrial resection (TCRE), for the treatment of menorrhagia, is used as a vehicle to develop methods in relation to MAS. Having reviewed the literature and issues relating to the economic analysis of this group of technologies, the empirical starting point of the thesis is the assessment of the limitations of economic evaluations alongside clinical trials, using a trial comparing AH and TCRE. Three major areas of weakness are identified, and alternative ways of addressing these weaknesses are explored in the remainder of the thesis. The first area of methodological development relates to the measure of benefit used in economic evaluation of MAS. In this clinical context, it is argued that the trade-offs that exist between MAS and conventional surgery, in terms of process characteristics and outcomes, should result in an important role for patients' preferences in the construction of a benefit measure. A cost-utility analysis using the standard quality-adjusted life year (GALY) is undertaken, using trial data augmented with valuation data from a further study. The lack of consistency between individual preferences and standard QALYs suggests a major weakness with this measure of benefit. The strengths and weaknesses of an alternative measure of benefit in cost-utility analysis - the ex ante healthy years equivalent (HYE) - are assessed based on a further valuation study. It is shown that it is feasible to elicit ex ante HYEs from patients and that this measure of benefit exhibits some consistency with other expressions of patients' preferences. However, the HYE is likely to impose a greater measurement burden than the standard QALY. The second area of methodological development in the thesis is the analysis of the generalisability of trial-based economic evaluation, given the limitations that often exist with the external validity of trials. A framework is developed within which trial and observational data can be synthesised. This facilitates the use of sensitivity analysis to explore the robustness of base-case (trial-generated) results to alternative sources of data, which may be more representative of routine practice. The third area of methodological development stems from the importance of patients' preferences in relation to MAS. This element relates to the use of methods to model and to evaluate management strategies which use patients' preferences to determine treatment allocation. It is concluded that preference-based decision making has the potential to be cost effective in relation to TCRE and AH, and MAS applications more generally. The thesis demonstrates the importance of continued development in the detailed methods of economic evaluation.

Made available in DSpace on 2014-06-11T19:32:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T20:43:25Z : No. of bitstreams: 1 nahas_eap_dr_botfm.pdf: 6317606 bytes, checksum: d18aba8a3d61898306fba9d219d3485a (MD5) / Avaliar a função ovariana, em mulheres no menacme submetidas à histerectomia total abdominal (HTA), por meio de parâmetros clínicos, endocrinológicos e ultra-sonográficos. Pacientes e Métodos: Estudou-se, prospectivamente, 61 mulheres, idade ≤ 40 anos, divididas em: G1, composto por 31 pacientes submetidas à HTA e, G2, por 30 mulheres normais. Critérios de inclusão: eumenorreicas, ovulatórias, não obesas ou fumantes, sem cirurgias prévias, sem uso de medicações ou de endocrionopatias, com FSH basal < 15 mIU/ml (duas ocasiões). Realizou-se dosagens de FSH, LH, estradiol (E2) e inibina B nos momentos basal, aos 2, 6 e 12 meses. O volume ovariano na ultra-sonografia (US), o Índice de Pulsatilidade (IP) das artérias ovarianas pela dopplervelocimetria e o Valor de Maturação (VM) na colpocitologia foram mensurados inicialmente e aos 6 e 12 meses. Resultados: Na comparação estatística inicial, os grupos foram homogêneos. Nas pacientes submetidas à histerectomia, aos 6 e 12 meses, ocorreu aumento do E2 e redução da inibina B (p<0,05), sem alterar FSH e LH. Ao US, observou-se aumento do volume ovariano e diminuição do IP ao doppler (p<0,05), quando confrontadas ao controle. Aos 12 meses ocorreu redução do Valor de Maturação (p<0,05) no G1. Ao final do estudo, apenas entre as pacientes histerectomizadas, encontrou-se que 12,9% (4/31) apresentaram FSH > 40 mIU/ml, estradiol < 20 pg/ml e inibina B < 5 ng/ml, compatíveis com falência ovariana. No grupo controle não alterou nenhum desses parâmetros. Conclusão: Nas pacientes submetidas à HTA ocorreu redução significativa da inibina B, sem alterações de FSH e LH. Houve aumento do volume ovariano e redução do índice de pulsatilidade, ao doppler. Esses resultados sugerem que, a histerectomia total abdominal acelere o declínio da função ovariana em mulheres no menacme. / To evaluate the ovarian function in women of reproductive age submitted to total abdominal hysterectomy, using endocrine and ultrasonographic parameters. Patients and Methods: A prospective study on 61 women, age ≤ 40 years, was distributed in two groups: G1, 31 patients submitted to hysterectomy and, G2, 30 normal women. Criteria of inclusion: women with normal ovarian function at baseline, without tobacco exposition, normal body weight, no history of medications use or hormonal diseases, with basal FSH <15mUI/ml. The dosages of FSH, LH, estradiol (E2) and inhibin B, and ultrasonography (US) measures of the ovarian volume, of the Pulsatility Index (PI) realized by the doppler of ovarian arteries and of the Maturation Value (MV) assessed by vaginal cytology were performed in 3 moments: baseline, 6 and 12 months. Results: At baseline the groups were homogeneous. In the patient hysterectomized group, with 6 and 12 months, it was observed increase of the E2, reduction of the inhibin B, increase of the volume of the ovaries and decrease of PI (p<0,05), without altering FSH and LH. And it was observed decrease of MV (p<0,05) in the G1. At the end of the study, among the patient hyterectomized, 12,9% (4/31) of them presented FSH > 40mUI/ml, estradiol < 20pg/ml e inhibin B < 5ng/ml, compatible with ovarian failure. While in the control group it was not observed alteration of any appraised parameter. Conclusion: The hysterectomized group of patients showed expressive reduction of the inhibin B, while changes of FSH and LH levels were not observed. Enlargement of the ovaries and decrease of PI ocurred also. These results evokes that total abdominal hysterectomy stimulate the deterioration of ovarian function in women of reproductive age.

No description available.

Sixteen women who had had hysterectomies and eighteen women who had had mastectomies were mailed the Oregon Sex Inventory to see if any significant differences in sexual behavior occurred before or after surgery. The mastectomy group showed a greater degree of change in their sexual behavior than the hysterectomy group. The mastectomy group reported a decrease in the importance of the breast during the sexual act after surgery and a decrease in their desire for intercourse after surgery. The hysterectomy group reported lowered sexual satisfaction after surgery. The changes reported in this study although relatively small are statistically significant. The sample, because of the high income and education level may reflect some bias. The questionnaires were randomly sent but the women in both groups who responded seem to represent a definite socio-economic class of our society. It is of interest to note that this is the first research study done on mastectomies that used a control group.

No description available.

Thesis (M.Sc. (Hons.)) -- University of Western Sydney, 2003. / "A thesis presented to the University of Western Sydney in fulfillment of the requirements for the degree of Master of Science (Hons) Health" Bibliography : leaves 109-118.