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Patients' Perspectives on the Impact of Genital Psoriasis: A Qualitative Study.

ABSTRACT: INTRODUCTION:Plaque psoriasis is a chronic skin disease where genital involvement is relatively common. Yet health care providers do not routinely evaluate psoriasis patients for genital involvement and patients do not readily initiate discussion of it. METHODS:A qualitative study of 20 US patients with dermatologist-confirmed genital psoriasis (GenPs) and self-reported moderate-to-severe GenPs at screening was conducted to identify key GenPs symptoms and their impacts on health-related quality of life (HRQoL). RESULTS:Patients had a mean age of 45 years, 55% were female, and patients had high rates of current/recent moderate-to-severe overall (65%) and genital (70%) psoriasis. Patients reported the following GenPs symptoms: genital itch (100%), discomfort (100%), redness (95%), stinging/burning (95%), pain (85%), and scaling (75%). Genital itching (40%) and stinging/burning (40%) were the most bothersome symptoms. Impacts on sexual health included impaired sexual experience during sexual activity (80%), worsening of symptoms after sexual activity (80%), decreased frequency of sexual activity (80%), avoidance of sexual relationships (75%), and reduced sexual desire (55%). Negative effects on sexual experience encompassed physical effects such as mechanical friction, cracking, and pain as well as psychosocial effects such as embarrassment and feeling stigmatized. Males reported a higher burden of symptoms and sexual impacts. Other HRQoL impacts were on mood/emotion (95%), physical activities (70%), daily activities (60%), and relationships with friends and family (45%). These impacts significantly affected daily activities. Physical activities were affected by symptoms and flares, and increased sweat and friction worsened symptoms. Patients reported daily practices to control outcomes. CONCLUSION:The high level of reported symptoms and sexual and nonsexual impacts reflects the potential burden of moderate-to-severe GenPs. GenPs can impact many facets of HRQoL and providers should evaluate their patients for the presence of genital psoriasis and its impact on their quality of life. FUNDING:Eli Lilly and Company.

SUBMITTER: Cather JC

PROVIDER: S-EPMC5698203 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundFemale genital mutilation (FGM) is prevalent in Iraqi Kurdistan Region, but there is a lack of adequate knowledge about how the practice is perceived by the women population who are the direct victims of the practice. This study aimed to assess the knowledge, beliefs, and attitude of a sample of Kurdish women of FGM and identify the main enabling factors for performing this practice and the barriers to ending it.MethodsThis qualitative study was based on six focus groups involving a sample of 51 women. We used a topic guide to lead discussions, which included questions on women's perspectives of different aspects of FGM such as the reasons for practicing it, the positive and negative consequences, the continuation of the practice and tackling this problem in the community. Content analysis was used for the qualitative analysis of the data.ResultsThe women had poor knowledge about different aspects of FGM particularly concerning the procedure and the consequences. The mutilated participants revealed the devastating experience of the pain and the psychological effects they have experienced. Reducing sexual desire, having halal (permissible by Allah) hands, and religious requirement were the main reasons for practicing FGM. Reduction in women's sexual desire and the related social problems with the husband were the main problems identified to be associated with FGM. Most women did not support the continuation of FGM practice, but some women still think that FGM should be left to the people's preference. The participants identified raising people's awareness, active involvement of religious leaders in prevention efforts and the issuance and enforcement of legislation against FGM as the primary measures to reduce FGM practice.ConclusionPassing through FGM at childhood is an overwhelming experience with long-term effects for women. There is still a significant segment among the women population that do not oppose the continuations of FGM and need religious and scientific evidence against FGM. Some reasons for practicing FGM are deeply embedded in the culture and traditions, and there is a need for extensive efforts to raise the awareness of the population and change their thoughts and behavior about FGM.

Project description:ObjectiveTo describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America.DesignTwenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes.Setting25 centres across nine countries in Latin America.ParticipantsNephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience.ResultsWe identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics).ConclusionNephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.

Project description:BackgroundWith the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation.MethodsSemi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives.ResultsSix themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits.DiscussionThe findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care.Patient contributionsPatients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.

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Patients' Perspectives on the Impact of Genital Psoriasis: A Qualitative Study.

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