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"value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: leprosy patients may face the effects of stigma and different forms of discrimination , such as rejection , abuse , divorce , or loss of employment , leading to reduced self - esteem and loss of respect from their communities . interpersonal relationships , social status , mobility , and dignity suffer and may cause anxiety , depression , emotional stress , isolation , and suicide or attempted suicide . multiple studies found women to be more affected by leprosy and its stigma than men . often , the social and psychological complications due to leprosy remain even after the medical treatment is finished . the psychosocial consequences a person has to bear after being diagnosed by leprosy are often heavier than the physical consequences that may occur . an important example of a social complication of leprosy is the effect of leprosy on marital relationships . a qualitative study on the psychological needs of men and women with leprosy in south africa found that one - third of leprosy patients had been abandoned by their spouses . she states that it is clear that in maithili and nepali culture , it is undesirable to marry someone who has been or is affected by leprosy and the prevalence of visual signs of leprosy is important [ this time in ] affecting the opinion of prospective partners in arranged marriages . adhikari and colleagues , who did a cross - sectional study in nepal among community members unaffected by leprosy , found that 48 % of the community members thought that people affected by leprosy would encounter marital problems . however , not much is known about the nature of the effects of leprosy on ongoing marriages and even less is known about the effects on sexual relationships and perceptions of sexuality and reproductive health . in nepal , as in most cultures in the global south , marriage is considered very important . definitions of marriage may vary among nepal 's 60 ethnic groups . according to lamichhane and colleagues , however , overallwomen are expected to play a subordinate , submissive , and more conservative gender role in marital relationships especially in rural areas . in particular in rural areas , early marriage is quite common . even though there is a slow shift from arranged marriages to love marriages , arranged marriages are still predominant in nepal and individual choices are subordinate to relationships and agreements between families . in case of arranged marriages , especially when they happen at a young age , premarital romantic relationships often do not happen . for the majority of nepali women , the onset of sexual activity occurs within marriage . closely linked to the common practice of arranged marriages , marriage in nepal occurs at a rather young age , with a median age at first marriage of 16.5 years for women born in the late 1970s . sexuality is closely linked to marriage and has long been avoided as a study topic because of the taboo associated with discussing sexuality . for this reason , , no research has been done on the effects of leprosy on sexual relationships and perceptions of sexual health . however , a number of studies have investigated the effects of disability on sexual relationships . for people with a disability , sexuality is often not recognized as a legitimate form of pleasure and an expression of love . mccabe and taleporos , who studied predominantly people with a spinal cord injury , cerebral palsy , and acquired brain injury , found that having a physical disability leads to increased negative feelings , including a belief of being less sexually attractive than people without a disability and the feeling that people with a disability are limited in expressing their sexuality . the latter are generally less satisfied with their romantic relationships than their able - bodied peers . people with a disability are sometimes viewed as asexual . it is often inaccurately thought that people with disabilities lack the desire , ability , and capacity to be sexually active . according to nosek and colleagues , having a mobility - related disability limits the opportunity for sexual activity . they state that women with disabilities reported significantly lower levels of sexual activity , sexual response , and satisfaction with their sex lives . a lack of privacy , dependence on others for care , and inaccessibility to homes and meeting places also make it more difficult for people with a disability to maintain sexual relationships . leprosy is one of the neglected tropical diseases endemic in the country . in 2014 , 3,046 new cases were registered . in addition to those currently on treatment , many thousands of people live with residual leprosy - related disabilities , many of which are aggravated by social stigma which is still very strong . the scanty evidence that is available indicates that leprosy may severely affect relationships , to the extent that even divorce is not uncommon in marriages in which one spouse develops leprosy . given the fear of contagion that surrounds leprosy , it is likely that divorce is only the tip of the iceberg and that many problems in marital and sexual relationships go unnoticed . this study aimed to investigate the experiences of women affected by leprosy regarding marital life and sexuality , comparing these to the experiences of women with other physical disabilities and to those of able - bodied women in south - east nepal . this study focused on women , because women are often more severely affected by leprosy and its stigma than men . this study used a cross - sectional , nonrandom survey design with a qualitative approach . three groups of people were included in the study : women affected by leprosy , with and without visible impairments.non - leprosy - affected women with visible impairments.able - bodied , healthy women.the first group consisted of women who had completed their leprosy treatment and women who still received treatment . of the women who had a disability resulting from leprosy , the disabilities were graded using the grading system of the who , which grades impairments in eyes , hands , and feet . each hand , foot , and eye ( left and right ) is assessed and graded on its own . either the maximum grade or the sum of the six grades is used as indicator of the severity of impairment . in this study , the women affected by leprosy had to have at least a grade 1 impairment . both women with grade 1 and women with grade 2 impairments were included , to explore both problems resulting from physical appearance and problems resulting from the diagnosis of leprosy itself . women affected by leprosy , with and without visible impairments . non - leprosy - affected women with visible impairments . included were women with an impairment obvious to the community based on appearance and / or those with limited functioning . examples of visible physical impairments include people with neurological impairments requiring mobility aids and people with severe burn scars . both women with congenital impairments and women who acquired an impairment later in lifeable - bodied , healthy women were interviewed , to try and distinguish issues resulting from cultural practices , and lack of knowledge or awareness , from those caused by disability or leprosy . in total , 10 women affected by leprosy , 10 women with a visible physical impairment , and 10 able - bodied women were included . of the women affected by leprosy , 6 had a grade 1 impairment and 4 had a grade 2 impairment . all participants lived in the eastern terai region of nepal , in jhapa , morang , saptari , or sunsari districts . if women indicated a need for support or counselling , they were referred to the biratnagar leprosy referral centre . because we wanted to interview women with specific characteristics , participants were selected using purposive sampling . all women included in the study had to be married and had to be between the ages of 18 and 50 . excluded were women with a mental illness that interfered with their ability to undergo an in - depth interview , widowed women , and women whose husbands did not know they have or have had leprosy . the participants were contacted through the netherlands leprosy relief ( nlr ) network in the eastern development region of nepal and through local health posts . local health posts in the study area were visited to check whether there were leprosy - affected women that met the inclusion criteria . both the women with disabilities and the able - bodied women were selected based on their similarity to the leprosy - affected women , mainly in age and living area . participants underwent in - depth interviews about their marital and sexual relationship by means of semistructured interviews . the interview guide used consisted of four themes : sense of self , marital relationship , knowledge and awareness of sexual and reproductive health , and sexual relationship . the interview guide was developed based on a literature review and on discussions with leprosy specialists . some questions were translated multiple times using different interpreters , to ensure that the meaning of the original english version was retained . taking into account the sensitivity of the topic , participants were interviewed by a local , married female interpreter in their home , or at a private , safe space near their home . the interpreter had several years of experience working for nlr in the area of research . the interpreter had experience with and knowledge of working with people affected by leprosy and qualitative data collection . prior to the pilot interviews , the interpreter received an interview training of several days in which she did role plays and was provided with feedback by the researcher . the researcher herself was not present during the interviews to prevent discomfort on the side of the interviewee . the recordings were translated , transcribed , and analysed using open coding and content analysis . the interviews were transcribed in english by the interpreter and discussed with the researcher to help put issues in perspective and context . the software programmeopen , inductive coding was done in maxqda , where similar phrases with recurring themes were coded . all codes with supporting quotes were then clustered together in different tables , ordered by subquestion to get an overview of responses and to identify connection between codes and themes . prior to the in - depth interviews , participants were fully informed about the nature and objective of the study and of confidentiality of the data . written consent for participation in the studythe mean age was 35 years for the women affected by leprosy ( range : 2250 years ) , 36 for the women with physical impairments ( range : 2450 years ) , and 36 for the control group ( range : 2450 years ) . assessment of impairments using the who 's grading system for disabilities resulting from leprosy classified six women as grade 1 and four as grade 2 . three women still received treatment for leprosy , whereas seven women were released from treatment . all the women ( n = 30 ) who participated in this study were still with their husbands . ethnicity was categorized into four groups : ( i ) brahmin / chettri , ( ii ) dalit , ( iii ) tribal , and ( iv ) other . the majority of women were hindu ( n = 26 ) and lived in rural areas ( n = 21 ) . love marriages occurred mostly among the women with physical disabilities , with five women having a love marriage . except for one participant who had upper back problems , all participants with a visible physical disability had impairments related to their feet and legs , observable in walking . except for three women , three women , one in each group , were visibly pregnant at the time of the interviews . more than half of the women ( n = 17 ) indicated they did not work outside the home . no demographic data was collected about the husbands of the women included in the study . for five women affected by leprosy , all contacts , husband , neighbours , and relatives , knew they had leprosy , for two , only the husband knew , and for three , only a few people who were very close knew they were affected by leprosy . four out of ten women did not seem to know the real cause of their disease . one woman told us , before there were problems , i did not give them [ family ] food which i had taken . my husband is afraid that it transmits through respiration , so he does not want to tongue kiss for seven months . ( woman affected by leprosy , age 22 ) in the quotes presented , women mostly referred to their situation after contracting leprosy . before there were problems , i did not give them [ family ] food which i had taken . ( woman affected by leprosy , age 33 ) my husband is afraid that it transmits through respiration , so he does not want to tongue kiss for seven months . ( woman affected by leprosy , age 22 ) most of the thirty women who were interviewed ( n = 26/30 ) indicated that being married is important in their community and to themselves also . sexual relationship , an important part of marriage , seemed to be of mixed importance . six women from the control group indicated that sex is an important part of their relationship . for the women with a disability , five women considered it important , five did not . except for two women , all women indicated that sex is important to their husbands . some women ( n = 4/30 ) thought that their opinion on whether sex is important is not really of importance . according to them , what they think is important does not always matter . they are supposed to be ready whenever their husbands are ready , as the following quotes illustrate : yes , it is also important for me , but our importance has no value . ( woman affected by leprosy , age 26 ) it is not necessary how important it is for us because whenever our husband is ready we should be ready . ( woman affected by leprosy , age 50 ) it is not so important for me because of my condition , but i used to be ready for my husband and i do not mind , after all he is my husband . ( woman with physical disability , age 48 ) most women ( n = 24/30 ) did not receive sexual education in school or through a health post , or at least not before marriage . only six women said they received sexual education in school , mostly mentioning grade eight , nine , or ten . all of the women who mentioned they had had sexual education had received higher or secondary education . other women mentioned they received some form of sexual education through the health post or from a neighbour or relative . many women ( n = 15 ) mentioned receiving sexual education through tv or radio . yes , it is also important for me , but our importance has no value . ( woman affected by leprosy , age 26 ) it is not necessary how important it is for us because whenever our husband is ready we should be ready . ( woman affected by leprosy , age 50 ) it is not so important for me because of my condition , but i used to be ready for my husband and i do not mind , after all he is my husband . ( woman with physical disability , age 48 ) several factors may influence the marital relationship of the women interviewed . factors reported to have a positive effect on their marital relationship were love , harmony , and understanding each other , money or property , and sex . two women said : i think sex is the ultimate factor for a couple to stay happy . ( woman with physical disability , age 43 ) the most important is trust , love and understanding ( woman affected by leprosy , age 32 ) factors reported to have a negative influence on marriage are the ( alcohol ) drinking habit of the husband , a negative attitude of family members or others towards the woman , misunderstanding between husband and wife , and an unsupportive husband . furthermore , two women with leprosy indicated that they felt that people were more distant since they knew they are affected by leprosy . my sister in law was very rude , she used to come to the house as she was married and tell unnecessary things to my husband . ( woman from control group , age 32 ) when i was diagnosed with leprosy i felt that my husband 's behaviour had changed , he did not share anything with me and he pretended to be busy with work . ( woman affected by leprosy , age 33 ) before there were problems , when my father and mother - in - law knew about my disease , they hesitated to talk to me and come near me . ( woman affected by leprosy , age 33 ) however , the alcohol problem of the husband , if present , seemed to be the biggest problem . this was mentioned by all three groups , but was most frequently experienced by the women affected by leprosy . of these women , three women were in the control group , four women had a disability , and five women were affected by leprosy . i used to stay with my father and mother in law in their house . my sister in law was very rude , she used to come to the house as she was married and tell unnecessary things to my husband . ( woman from control group , age 32 ) when i was diagnosed with leprosy i felt that my husband 's behaviour had changed , he did not share anything with me and he pretended to be busy with work . ( woman affected by leprosy , age 33 ) before there were problems , when my father and mother - in - law knew about my disease , they hesitated to talk to me and come near me . ( woman affected by leprosy , age 33 ) when asked about the possibility of the husband of someone with either a disability or leprosy marrying and taking on a second wife , six women said they had never heard of this , 17 women said they had heard of this but had not experienced this themselves , four women indicated that only certain types of people do this , and two women affected by leprosy said they had experienced this themselves . the husband of one of these women had taken a second wife , because of her leprosy . another husband sent his wife away to her parents ' house and then had several affairs . some women with a disability pointed out the difference between men and women when it comes to remaining faithful to their marriage . one woman said , about taking on a second wife , if the husband has a disability then they marry a common woman or if he becomes disabled after marriage , then his wife stays with him , but if the woman is disabled then she can not marry a common man and if she becomes disabled then the husband brings another wife .... ( woman with physical disability , age 32 ) i feel that , if the problem that my husband has had had happened to me , my husband would have brought a second wife . but i am a woman so i can not do so and i love him . ( woman with physical disability , age 32 ) if the husband has a disability then they marry a common woman or if he becomes disabled after marriage , then his wife stays with him , but if the woman is disabled then she can not marry a common man and if she becomes disabled then the husband brings another wife .... ( woman with physical disability , age 32 ) i feel that , if the problem that my husband has had had happened to me , my husband would have brought a second wife . but i am a woman so i can not do so and i love him . ( woman with physical disability , age 32 ) there are positive and negative factors that influence the sexual relationship of women . factors that may have a positive influence include loving each other and being emotionally engaged , understanding each other , obeying the husband and / or giving priority to him , and the husband not drinking alcohol . two women said , if sexual intercourse is a mutual understanding then we can get pleasure . ( woman from control group , age 32 ) love helps for the good sexual relationship with my husband . ( woman affected by leprosy , age 35 ) if sexual intercourse is a mutual understanding then we can get pleasure . ( woman from control group , age 32 ) love helps for the good sexual relationship with my husband . ( woman affected by leprosy , age 35 ) factors that may have a negative influence on the sexual relationship of married women include the alcohol problem of the husband , being forced by the husband to have sex , disagreeing with the husband , and reduced interest in having sex on the side of the wife . only 11 women indicated not having any sexual problems . the husband drinking alcohol and , with thati feel so irritated but what can i do , we think of our husband as god and we should obey him . ( woman affected by leprosy , age 26 ) about being sexually abused , two women said , when i do not want to have sexual intercourse , my husband forces me . i used to earn money , bring food for you all but you do not want [ to have sex ] , then get out of the house ! ( woman affected by leprosy , age 32 ) he never asks about my health and forces me to have intercourse . ( woman with physical disability , age 33 ) of the women facing sexual abuse , three women were in the control group , three women had a disability , and five were affected by leprosy . furthermore , three of the four women who had a leprosy - related grade 2 impairment were being sexually abused by their husbands . in addition , of the women who had a husband with an alcohol problem ( n = 12 ) , all but one faced sexual abuse by their husbands , as illustrated below : there were problems , he used to drink alcohol and come near me and force me to have sexual intercourse . ( woman affected by leprosy , age 41 ) when he drinks alcohol and comes i feel irritated and he forces me to have sexual intercourse with him . ( woman from control group , age 32 ) sexual abuse and alcohol abuse seemed to go hand - in - hand with violence . many ( n = 7/10 ) women were either beaten or threatened to be beaten if they do not obey . this also became clear when talking about what happens if they do not agree with their husbands : if i refuse him he scolds me and raises a hand on me . ( woman with physical disability , age 33 ) if the husband likes to have sex , then we have to give , if not he certainly beats me . ( woman from control group , age 50 ) i have to give him everything he wants even when i am not feeling well , because he gets angry if i refuse to give . he warns me that he 'll have sexual pleasure with another girl if i can not give pleasure . ( woman from control group , age 28 ) five women affected by leprosy , of whom three also faced sexual abuse , faced additional problems while receiving treatment or when they were first diagnosed . these problems disappeared later on and were not experienced at the time of the interviews . they included having no intercourse at all due to fear of transmission of the disease , experiencing more distance and sometimes sleeping in separate beds while taking medicine : at first when he knew that i was affected by leprosy he did not sleep with me . once he came to the biratnagar clinic with me , he asked the doctor about the sexual relationship . he was told that it does not transfer to him so he started having sexual intercourse with me again . ( woman affected by leprosy , age 32 ) one woman did not want to talk about the problems she had before , before i had very bad problems , but now there is no effect , i do not want to remember the past and talk about that . ( woman affected by leprosy , age 35 ) he has the bad habit of drinking alcohol . i feel so irritated but what can i do , we think of our husband as god and we should obey him . ( woman affected by leprosy , age 26 ) when i do not want to have sexual intercourse , my husband forces me . i used to earn money , bring food for you all but you do not want [ to have sex ] , then get out of the house ! sometimes he raised a hand on me . ( woman affected by leprosy , age 32 ) he never asks about my health and forces me to have intercourse . ( woman with physical disability , age 33 ) there were problems , he used to drink alcohol and come near me and force me to have sexual intercourse . ( woman affected by leprosy , age 41 ) when he drinks alcohol and comes i feel irritated and he forces me to have sexual intercourse with him . ( woman from control group , age 32 ) if i refuse him he scolds me and raises a hand on me . ( woman with physical disability , age 33 ) if the husband likes to have sex , then we have to give , if not he certainly beats me . ( woman from control group , age 50 ) i have to give him everything he wants even when i am not feeling well , because he gets angry if i refuse to give . he warns me that he 'll have sexual pleasure with another girl if i can not give pleasure . ( woman from control group , age 28 ) at first when he knew that i was affected by leprosy he did not sleep with me . once he came to the biratnagar clinic with me , he asked the doctor about the sexual relationship . he was told that it does not transfer to him so he started having sexual intercourse with me again . ( woman affected by leprosy , age 32 ) before i had very bad problems , but now there is no effect , i do not want to remember the past and talk about that . we found that many women experience marital problems and / or sexual abuse , regardless of their leprosy or disability status . in addition , we found clear indications that leprosy may influence the marital and sexual relationship of married women in various ways . this included significant problems during treatment , which is often a full year , such as having no intercourse at all due to fear of contagion , experiencing more distance from close others , and husband and wife sleeping in separate beds . other studies found stigma to have negative consequences for persons affected by leprosy , leading to discrimination , problems in interpersonal relationships , and problems with social status . women affected by leprosy seem to face most problems when first diagnosed or while receiving treatment . the above problems may have been caused or aggravated by the fact that almost half of the women did not seem to know the cause of their disease and how leprosy is transmitted . thilakavathi and colleagues , who conducted in - depth interviews with 72 leprosy - affected men and women , of whom 48 were married , found that a few participants did not sleep in the same room as their spouses , but they did not elaborate on this . they also found that most of their interviewees lacked basic knowledge on the transmission and cause of leprosy . this happened to two women with grade 2 impairments due to leprosy in our study . qualitative evidence suggests that women are more likely to be deserted by their spouses than men , but conclusive evidence is not yet available . research in south - east nepal found that , of the nine men and ten women interviewed , three husbands had left their leprosy - affected wife and one wife had left her leprosy - affected husband . a study in south africa showed that of 23 married subjects , 9 men and 7 women had been deserted by their marriage partners because of leprosy . we can not tell whether the frequency of divorce found by scott , which is much higher than in our study , is due to sampling error , bias in the samples , or actual cultural differences , since the present study was only designed to explore the impact of leprosy , not to determine the prevalence of marital problems or divorce due to leprosy . our findings indicate that divorce is only the tip of the iceberg of marital problems that may be due to leprosy or other causes . an important finding is the high frequency of alcohol abuse among the husbands of the participants . this occurred in all three groups and therefore points to a more structural phenomenon in society . a larger survey using randomsampling will have to confirm whether the greater frequency of alcohol abuse among the husbands of leprosy - affected women compared to the other women included in this study is real , or a result of sampling error . jhingan and colleagues looked at alcohol dependence in dharan , in eastern nepal , and found the prevalence of alcohol dependence to be 25.8 % . they found dependence to increase with age , peaking with 41 % in the age group 4554 , compared to 10.7 % in the 1524 age group . several studies found the risk of sexual abuse and violence towards women to increase when husbands are drunk or are alcoholics . these studies were also conducted in developing countries and highlight the important role of alcohol use in sexual abuse . the present study seems to confirm the relationship between alcohol abuse and sexual abuse : most of the women who had a husband with an alcohol problem experienced sexual abuse and all husbands who sexually abused their wives reportedly had an alcohol problem . we did not find any literature on the relationship between alcohol abuse and sexual abuse when the spouse has an impairment . sexual abuse by the husband occurred in all groups , but the frequency was higher among women affected by leprosy . another study assessed the occurrence of violence against young married women aged 1524 years in rural nepal . as many as 53 % reported having experienced some form of violence in their lifetime and 46 % reported experiencing sexual violence . no or little interspousal communication and low autonomy of women were associated with violence against women . other studies that investigated sexual violence against young married women found a similar prevalence ( 49 % ) . lamichhane and colleagues associated women 's lower status in family and society with violence against women , particularly young women in rural nepal . also pradhananga and shrestha and puri and colleagues stress the low status of women in nepal . deepak and colleagues , who looked at violence and sexual violence against persons with disabilities in india , found that 14 % of their 146 participants reported experiences of sexual violence during the previous 12 months . the presence of visible impairments among leprosy patients and its influence on acceptance by others have been highlighted by other studies . kopparty , who looked at coping strategies of 500 families who had a leprosy - affected family member with and without disfigurement , found that the proportion of families having patients with deformities facing problems was ten times higher ( 57 % ) than those having patients with no deformities ( 5.7 % ) . it is therefore not unlikely that women with visible impairments would experience more discrimination and abuse than leprosy - affected women without visible impairments . their position in society may be low , possibly aggravated by alcohol abuse of the husband . furthermore , puri and colleagues found that 8 out of 15 women who refused to have intercourse with their husbands were beaten . being beaten or threatened with violence when not obeying their husbands was also reported by women in the present study . our study showed that a husband often has power over his wife and that wives are expected to obey their husband or otherwise may be expected to be punished . feelings were often not shared , because women felt their feelings and desires were not valued . these findings fit with the description of prevailing attitudes towards women described by regmi and colleagues . they stated that , in nepal , unequal power relations and lack of autonomy characterise the situation of married young women in many settings , the autonomy of married young women is particularly constrained and gender norms stress male entitlement to sex , even if forced within marriage . certain social roles are expected , and most of the women 's roles revolve around the household . an important finding was that most women had not received sexual education , or at least not before marriage . the few women who had sexual education before marriage received this sometime between grades 8 and 10 in school . there are major gaps in receiving information , services , and skills on sexual and reproductive health issues . the government of nepal has introduced sexual and reproductive health education in public schools for grades six to ten and in university curricula from 1998 onwards . regmi and colleagues assert that , in reality , young people do not have good access to appropriate information on sexual and reproductive health issues . this fits with our finding that several women who were in their twenties and who had secondary education or more indicated that they did not receive sexual education , despite the fact that a sexual and reproductive health education programme had already been introduced when they were in school . the current findings show that knowledge about leprosy and the relation between leprosy and marriage and sexual health should be addressed preventively whenever someone is diagnosed with leprosy . if at all possible , the spouse and possibly the in - laws of any newly diagnosed married patient should be included in such counselling efforts . materials addressing these issues should be developed and should be made available for distribution in primary health centres and other health facilities where persons affected by leprosy are diagnosed and treated . however , it was evident in our study that within - marriage violence and sexual abuse of women , aggravated by alcohol abuse of the husband , occurred in all groups regardless of health or disability status . sexual and reproductive health , freedom from violence , and freedom from discrimination are fundamental human rights that were systematically violated in the lives of many of the women interviewed . therefore , interventions to improve sexual health and safety of married women should be designed , tested , and implemented as a matter of urgency . the first limitation is the nonrandom sampling and small study size , as mentioned above . this , together with the specific geographic location of the present study , means that the results of the study can not be generalized to the whole study population or beyond . if men would have been included also , a more complete insight of the impact of leprosy on marital and sexual relationships could have been given . translating the interviews from nepali to english may have introduced some mistakes or misinterpretations , since not all words could be translated literally . the current study indicates that leprosy may influence the marital and sexual relationship of women in nepal in several ways . additional research is needed to gain more insight in the underlying reasons . knowing more about the factors that influence marital and sexual relationship may help patients as well as health workers deal with marital and sexual problems and may enhance their ability to anticipate and prevent problems . it will also inform policy and interventions to reduce within - marriage sexual abuse and violence . raising awareness of health workers concerning the risk of marital problems following a diagnosis of leprosy is essential . simple educational materials with facts about leprosy , explaining the absence of risk of transmission once someoneis being treated , would help health workers discuss these very important issues with their patients , preferably together with their spouses . on a wider scale , interventions to improve sexual health and safety of married women should be implemented as a matter of urgency . implementation research should investigate the appropriate format and manner in which this can be done . a larger study with a random sampleis needed to determine the extent of the problems identified and the added risk of being leprosy - affected or having a disability . many women in our study experienced marital problems and / or sexual abuse , regardless of their leprosy or disability status . fundamental human rights such as the rights to sexual and reproductive health , freedom from violence , and freedom from discrimination are systematically violated in the lives of many of the women interviewed.women affected by leprosy faced additional problems , related to fear of the disease , negative attitudes , and discrimination on account of leprosy.knowledge on the cause and transmission of leprosy was still lacking among leprosy - affected women and their community members . appropriate preventive and educational measures should be designed and tested to address these issues.lastly , women appear to have insufficient access to sexual education , despite programmes on sexual health education in schools and elsewhere . many women in our study experienced marital problems and / or sexual abuse , regardless of their leprosy or disability status . fundamental human rights such as the rights to sexual and reproductive health , freedom from violence , and freedom from discrimination are systematically violated in the lives of many of the women interviewed . women affected by leprosy faced additional problems , related to fear of the disease , negative attitudes , and discrimination on account of leprosy . knowledge on the cause and transmission of leprosy was still lacking among leprosy - affected women and their community members . lastly , women appear to have insufficient access to sexual education , despite programmes on sexual health education in schools and elsewhere . this should be addressed by the appropriate authorities .\noutput:\n"
},
{
"from": "agent",
"value": "background . leprosy is one of the most stigmatized diseases known today . the stigma surrounding leprosy can be a major burden and affects many dimensions of a person 's life , including intimate relationships . we aimed to investigate the experiences of women affected by leprosy regarding marital life and sexuality , comparing these to the experiences of women with other physical disabilities and to those of able - bodied women in south - east nepal . methods . this study used a qualitative approach and a cross - sectional , nonrandom survey design . thirty women underwent in - depth interviews about their marital and sexual relationship by means of a semi - structured interview guide . these thirty women included ten women affected by leprosy , ten women with other physical disabilities , and ten able - bodied women living in south - east nepal . results . we found that many women faced violence and abuse in their marriages . however , women affected by leprosy appeared to face more problems with regard to their marital and sexual relationships than women with physical disabilities and able - bodied women . some of these related to the fear of leprosy . conclusions . further research is recommended to investigate the extent of this problem and ways to ameliorate the situation of the affected women . education and counselling at diagnosis may help prevent many of the problems reported ."
}
] | ***task***
the task is to summarize an input biomedical literature in six sentences
***input***
the input is a biomedical literature
***output***
the output is the summary of an input biomedical literature in six sentences
***documentation***
***examples***
input: leprosy patients may face the effects of stigma and different forms of discrimination , such as rejection , abuse , divorce , or loss of employment , leading to reduced self - esteem and loss of respect from their communities . interpersonal relationships , social status , mobility , and dignity suffer and may cause anxiety , depression , emotional stress , isolation , and suicide or attempted suicide . multiple studies found women to be more affected by leprosy and its stigma than men . often , the social and psychological complications due to leprosy remain even after the medical treatment is finished . the psychosocial consequences a person has to bear after being diagnosed by leprosy are often heavier than the physical consequences that may occur . an important example of a social complication of leprosy is the effect of leprosy on marital relationships . a qualitative study on the psychological needs of men and women with leprosy in south africa found that one - third of leprosy patients had been abandoned by their spouses . she states that it is clear that in maithili and nepali culture , it is undesirable to marry someone who has been or is affected by leprosy and the prevalence of visual signs of leprosy is important [ this time in ] affecting the opinion of prospective partners in arranged marriages . adhikari and colleagues , who did a cross - sectional study in nepal among community members unaffected by leprosy , found that 48 % of the community members thought that people affected by leprosy would encounter marital problems . however , not much is known about the nature of the effects of leprosy on ongoing marriages and even less is known about the effects on sexual relationships and perceptions of sexuality and reproductive health . in nepal , as in most cultures in the global south , marriage is considered very important . definitions of marriage may vary among nepal 's 60 ethnic groups . according to lamichhane and colleagues , however , overallwomen are expected to play a subordinate , submissive , and more conservative gender role in marital relationships especially in rural areas . in particular in rural areas , early marriage is quite common . even though there is a slow shift from arranged marriages to love marriages , arranged marriages are still predominant in nepal and individual choices are subordinate to relationships and agreements between families . in case of arranged marriages , especially when they happen at a young age , premarital romantic relationships often do not happen . for the majority of nepali women , the onset of sexual activity occurs within marriage . closely linked to the common practice of arranged marriages , marriage in nepal occurs at a rather young age , with a median age at first marriage of 16.5 years for women born in the late 1970s . sexuality is closely linked to marriage and has long been avoided as a study topic because of the taboo associated with discussing sexuality . for this reason , , no research has been done on the effects of leprosy on sexual relationships and perceptions of sexual health . however , a number of studies have investigated the effects of disability on sexual relationships . for people with a disability , sexuality is often not recognized as a legitimate form of pleasure and an expression of love . mccabe and taleporos , who studied predominantly people with a spinal cord injury , cerebral palsy , and acquired brain injury , found that having a physical disability leads to increased negative feelings , including a belief of being less sexually attractive than people without a disability and the feeling that people with a disability are limited in expressing their sexuality . the latter are generally less satisfied with their romantic relationships than their able - bodied peers . people with a disability are sometimes viewed as asexual . it is often inaccurately thought that people with disabilities lack the desire , ability , and capacity to be sexually active . according to nosek and colleagues , having a mobility - related disability limits the opportunity for sexual activity . they state that women with disabilities reported significantly lower levels of sexual activity , sexual response , and satisfaction with their sex lives . a lack of privacy , dependence on others for care , and inaccessibility to homes and meeting places also make it more difficult for people with a disability to maintain sexual relationships . leprosy is one of the neglected tropical diseases endemic in the country . in 2014 , 3,046 new cases were registered . in addition to those currently on treatment , many thousands of people live with residual leprosy - related disabilities , many of which are aggravated by social stigma which is still very strong . the scanty evidence that is available indicates that leprosy may severely affect relationships , to the extent that even divorce is not uncommon in marriages in which one spouse develops leprosy . given the fear of contagion that surrounds leprosy , it is likely that divorce is only the tip of the iceberg and that many problems in marital and sexual relationships go unnoticed . this study aimed to investigate the experiences of women affected by leprosy regarding marital life and sexuality , comparing these to the experiences of women with other physical disabilities and to those of able - bodied women in south - east nepal . this study focused on women , because women are often more severely affected by leprosy and its stigma than men . this study used a cross - sectional , nonrandom survey design with a qualitative approach . three groups of people were included in the study : women affected by leprosy , with and without visible impairments.non - leprosy - affected women with visible impairments.able - bodied , healthy women.the first group consisted of women who had completed their leprosy treatment and women who still received treatment . of the women who had a disability resulting from leprosy , the disabilities were graded using the grading system of the who , which grades impairments in eyes , hands , and feet . each hand , foot , and eye ( left and right ) is assessed and graded on its own . either the maximum grade or the sum of the six grades is used as indicator of the severity of impairment . in this study , the women affected by leprosy had to have at least a grade 1 impairment . both women with grade 1 and women with grade 2 impairments were included , to explore both problems resulting from physical appearance and problems resulting from the diagnosis of leprosy itself . women affected by leprosy , with and without visible impairments . non - leprosy - affected women with visible impairments . included were women with an impairment obvious to the community based on appearance and / or those with limited functioning . examples of visible physical impairments include people with neurological impairments requiring mobility aids and people with severe burn scars . both women with congenital impairments and women who acquired an impairment later in lifeable - bodied , healthy women were interviewed , to try and distinguish issues resulting from cultural practices , and lack of knowledge or awareness , from those caused by disability or leprosy . in total , 10 women affected by leprosy , 10 women with a visible physical impairment , and 10 able - bodied women were included . of the women affected by leprosy , 6 had a grade 1 impairment and 4 had a grade 2 impairment . all participants lived in the eastern terai region of nepal , in jhapa , morang , saptari , or sunsari districts . if women indicated a need for support or counselling , they were referred to the biratnagar leprosy referral centre . because we wanted to interview women with specific characteristics , participants were selected using purposive sampling . all women included in the study had to be married and had to be between the ages of 18 and 50 . excluded were women with a mental illness that interfered with their ability to undergo an in - depth interview , widowed women , and women whose husbands did not know they have or have had leprosy . the participants were contacted through the netherlands leprosy relief ( nlr ) network in the eastern development region of nepal and through local health posts . local health posts in the study area were visited to check whether there were leprosy - affected women that met the inclusion criteria . both the women with disabilities and the able - bodied women were selected based on their similarity to the leprosy - affected women , mainly in age and living area . participants underwent in - depth interviews about their marital and sexual relationship by means of semistructured interviews . the interview guide used consisted of four themes : sense of self , marital relationship , knowledge and awareness of sexual and reproductive health , and sexual relationship . the interview guide was developed based on a literature review and on discussions with leprosy specialists . some questions were translated multiple times using different interpreters , to ensure that the meaning of the original english version was retained . taking into account the sensitivity of the topic , participants were interviewed by a local , married female interpreter in their home , or at a private , safe space near their home . the interpreter had several years of experience working for nlr in the area of research . the interpreter had experience with and knowledge of working with people affected by leprosy and qualitative data collection . prior to the pilot interviews , the interpreter received an interview training of several days in which she did role plays and was provided with feedback by the researcher . the researcher herself was not present during the interviews to prevent discomfort on the side of the interviewee . the recordings were translated , transcribed , and analysed using open coding and content analysis . the interviews were transcribed in english by the interpreter and discussed with the researcher to help put issues in perspective and context . the software programmeopen , inductive coding was done in maxqda , where similar phrases with recurring themes were coded . all codes with supporting quotes were then clustered together in different tables , ordered by subquestion to get an overview of responses and to identify connection between codes and themes . prior to the in - depth interviews , participants were fully informed about the nature and objective of the study and of confidentiality of the data . written consent for participation in the studythe mean age was 35 years for the women affected by leprosy ( range : 2250 years ) , 36 for the women with physical impairments ( range : 2450 years ) , and 36 for the control group ( range : 2450 years ) . assessment of impairments using the who 's grading system for disabilities resulting from leprosy classified six women as grade 1 and four as grade 2 . three women still received treatment for leprosy , whereas seven women were released from treatment . all the women ( n = 30 ) who participated in this study were still with their husbands . ethnicity was categorized into four groups : ( i ) brahmin / chettri , ( ii ) dalit , ( iii ) tribal , and ( iv ) other . the majority of women were hindu ( n = 26 ) and lived in rural areas ( n = 21 ) . love marriages occurred mostly among the women with physical disabilities , with five women having a love marriage . except for one participant who had upper back problems , all participants with a visible physical disability had impairments related to their feet and legs , observable in walking . except for three women , three women , one in each group , were visibly pregnant at the time of the interviews . more than half of the women ( n = 17 ) indicated they did not work outside the home . no demographic data was collected about the husbands of the women included in the study . for five women affected by leprosy , all contacts , husband , neighbours , and relatives , knew they had leprosy , for two , only the husband knew , and for three , only a few people who were very close knew they were affected by leprosy . four out of ten women did not seem to know the real cause of their disease . one woman told us , before there were problems , i did not give them [ family ] food which i had taken . my husband is afraid that it transmits through respiration , so he does not want to tongue kiss for seven months . ( woman affected by leprosy , age 22 ) in the quotes presented , women mostly referred to their situation after contracting leprosy . before there were problems , i did not give them [ family ] food which i had taken . ( woman affected by leprosy , age 33 ) my husband is afraid that it transmits through respiration , so he does not want to tongue kiss for seven months . ( woman affected by leprosy , age 22 ) most of the thirty women who were interviewed ( n = 26/30 ) indicated that being married is important in their community and to themselves also . sexual relationship , an important part of marriage , seemed to be of mixed importance . six women from the control group indicated that sex is an important part of their relationship . for the women with a disability , five women considered it important , five did not . except for two women , all women indicated that sex is important to their husbands . some women ( n = 4/30 ) thought that their opinion on whether sex is important is not really of importance . according to them , what they think is important does not always matter . they are supposed to be ready whenever their husbands are ready , as the following quotes illustrate : yes , it is also important for me , but our importance has no value . ( woman affected by leprosy , age 26 ) it is not necessary how important it is for us because whenever our husband is ready we should be ready . ( woman affected by leprosy , age 50 ) it is not so important for me because of my condition , but i used to be ready for my husband and i do not mind , after all he is my husband . ( woman with physical disability , age 48 ) most women ( n = 24/30 ) did not receive sexual education in school or through a health post , or at least not before marriage . only six women said they received sexual education in school , mostly mentioning grade eight , nine , or ten . all of the women who mentioned they had had sexual education had received higher or secondary education . other women mentioned they received some form of sexual education through the health post or from a neighbour or relative . many women ( n = 15 ) mentioned receiving sexual education through tv or radio . yes , it is also important for me , but our importance has no value . ( woman affected by leprosy , age 26 ) it is not necessary how important it is for us because whenever our husband is ready we should be ready . ( woman affected by leprosy , age 50 ) it is not so important for me because of my condition , but i used to be ready for my husband and i do not mind , after all he is my husband . ( woman with physical disability , age 48 ) several factors may influence the marital relationship of the women interviewed . factors reported to have a positive effect on their marital relationship were love , harmony , and understanding each other , money or property , and sex . two women said : i think sex is the ultimate factor for a couple to stay happy . ( woman with physical disability , age 43 ) the most important is trust , love and understanding ( woman affected by leprosy , age 32 ) factors reported to have a negative influence on marriage are the ( alcohol ) drinking habit of the husband , a negative attitude of family members or others towards the woman , misunderstanding between husband and wife , and an unsupportive husband . furthermore , two women with leprosy indicated that they felt that people were more distant since they knew they are affected by leprosy . my sister in law was very rude , she used to come to the house as she was married and tell unnecessary things to my husband . ( woman from control group , age 32 ) when i was diagnosed with leprosy i felt that my husband 's behaviour had changed , he did not share anything with me and he pretended to be busy with work . ( woman affected by leprosy , age 33 ) before there were problems , when my father and mother - in - law knew about my disease , they hesitated to talk to me and come near me . ( woman affected by leprosy , age 33 ) however , the alcohol problem of the husband , if present , seemed to be the biggest problem . this was mentioned by all three groups , but was most frequently experienced by the women affected by leprosy . of these women , three women were in the control group , four women had a disability , and five women were affected by leprosy . i used to stay with my father and mother in law in their house . my sister in law was very rude , she used to come to the house as she was married and tell unnecessary things to my husband . ( woman from control group , age 32 ) when i was diagnosed with leprosy i felt that my husband 's behaviour had changed , he did not share anything with me and he pretended to be busy with work . ( woman affected by leprosy , age 33 ) before there were problems , when my father and mother - in - law knew about my disease , they hesitated to talk to me and come near me . ( woman affected by leprosy , age 33 ) when asked about the possibility of the husband of someone with either a disability or leprosy marrying and taking on a second wife , six women said they had never heard of this , 17 women said they had heard of this but had not experienced this themselves , four women indicated that only certain types of people do this , and two women affected by leprosy said they had experienced this themselves . the husband of one of these women had taken a second wife , because of her leprosy . another husband sent his wife away to her parents ' house and then had several affairs . some women with a disability pointed out the difference between men and women when it comes to remaining faithful to their marriage . one woman said , about taking on a second wife , if the husband has a disability then they marry a common woman or if he becomes disabled after marriage , then his wife stays with him , but if the woman is disabled then she can not marry a common man and if she becomes disabled then the husband brings another wife .... ( woman with physical disability , age 32 ) i feel that , if the problem that my husband has had had happened to me , my husband would have brought a second wife . but i am a woman so i can not do so and i love him . ( woman with physical disability , age 32 ) if the husband has a disability then they marry a common woman or if he becomes disabled after marriage , then his wife stays with him , but if the woman is disabled then she can not marry a common man and if she becomes disabled then the husband brings another wife .... ( woman with physical disability , age 32 ) i feel that , if the problem that my husband has had had happened to me , my husband would have brought a second wife . but i am a woman so i can not do so and i love him . ( woman with physical disability , age 32 ) there are positive and negative factors that influence the sexual relationship of women . factors that may have a positive influence include loving each other and being emotionally engaged , understanding each other , obeying the husband and / or giving priority to him , and the husband not drinking alcohol . two women said , if sexual intercourse is a mutual understanding then we can get pleasure . ( woman from control group , age 32 ) love helps for the good sexual relationship with my husband . ( woman affected by leprosy , age 35 ) if sexual intercourse is a mutual understanding then we can get pleasure . ( woman from control group , age 32 ) love helps for the good sexual relationship with my husband . ( woman affected by leprosy , age 35 ) factors that may have a negative influence on the sexual relationship of married women include the alcohol problem of the husband , being forced by the husband to have sex , disagreeing with the husband , and reduced interest in having sex on the side of the wife . only 11 women indicated not having any sexual problems . the husband drinking alcohol and , with thati feel so irritated but what can i do , we think of our husband as god and we should obey him . ( woman affected by leprosy , age 26 ) about being sexually abused , two women said , when i do not want to have sexual intercourse , my husband forces me . i used to earn money , bring food for you all but you do not want [ to have sex ] , then get out of the house ! ( woman affected by leprosy , age 32 ) he never asks about my health and forces me to have intercourse . ( woman with physical disability , age 33 ) of the women facing sexual abuse , three women were in the control group , three women had a disability , and five were affected by leprosy . furthermore , three of the four women who had a leprosy - related grade 2 impairment were being sexually abused by their husbands . in addition , of the women who had a husband with an alcohol problem ( n = 12 ) , all but one faced sexual abuse by their husbands , as illustrated below : there were problems , he used to drink alcohol and come near me and force me to have sexual intercourse . ( woman affected by leprosy , age 41 ) when he drinks alcohol and comes i feel irritated and he forces me to have sexual intercourse with him . ( woman from control group , age 32 ) sexual abuse and alcohol abuse seemed to go hand - in - hand with violence . many ( n = 7/10 ) women were either beaten or threatened to be beaten if they do not obey . this also became clear when talking about what happens if they do not agree with their husbands : if i refuse him he scolds me and raises a hand on me . ( woman with physical disability , age 33 ) if the husband likes to have sex , then we have to give , if not he certainly beats me . ( woman from control group , age 50 ) i have to give him everything he wants even when i am not feeling well , because he gets angry if i refuse to give . he warns me that he 'll have sexual pleasure with another girl if i can not give pleasure . ( woman from control group , age 28 ) five women affected by leprosy , of whom three also faced sexual abuse , faced additional problems while receiving treatment or when they were first diagnosed . these problems disappeared later on and were not experienced at the time of the interviews . they included having no intercourse at all due to fear of transmission of the disease , experiencing more distance and sometimes sleeping in separate beds while taking medicine : at first when he knew that i was affected by leprosy he did not sleep with me . once he came to the biratnagar clinic with me , he asked the doctor about the sexual relationship . he was told that it does not transfer to him so he started having sexual intercourse with me again . ( woman affected by leprosy , age 32 ) one woman did not want to talk about the problems she had before , before i had very bad problems , but now there is no effect , i do not want to remember the past and talk about that . ( woman affected by leprosy , age 35 ) he has the bad habit of drinking alcohol . i feel so irritated but what can i do , we think of our husband as god and we should obey him . ( woman affected by leprosy , age 26 ) when i do not want to have sexual intercourse , my husband forces me . i used to earn money , bring food for you all but you do not want [ to have sex ] , then get out of the house ! sometimes he raised a hand on me . ( woman affected by leprosy , age 32 ) he never asks about my health and forces me to have intercourse . ( woman with physical disability , age 33 ) there were problems , he used to drink alcohol and come near me and force me to have sexual intercourse . ( woman affected by leprosy , age 41 ) when he drinks alcohol and comes i feel irritated and he forces me to have sexual intercourse with him . ( woman from control group , age 32 ) if i refuse him he scolds me and raises a hand on me . ( woman with physical disability , age 33 ) if the husband likes to have sex , then we have to give , if not he certainly beats me . ( woman from control group , age 50 ) i have to give him everything he wants even when i am not feeling well , because he gets angry if i refuse to give . he warns me that he 'll have sexual pleasure with another girl if i can not give pleasure . ( woman from control group , age 28 ) at first when he knew that i was affected by leprosy he did not sleep with me . once he came to the biratnagar clinic with me , he asked the doctor about the sexual relationship . he was told that it does not transfer to him so he started having sexual intercourse with me again . ( woman affected by leprosy , age 32 ) before i had very bad problems , but now there is no effect , i do not want to remember the past and talk about that . we found that many women experience marital problems and / or sexual abuse , regardless of their leprosy or disability status . in addition , we found clear indications that leprosy may influence the marital and sexual relationship of married women in various ways . this included significant problems during treatment , which is often a full year , such as having no intercourse at all due to fear of contagion , experiencing more distance from close others , and husband and wife sleeping in separate beds . other studies found stigma to have negative consequences for persons affected by leprosy , leading to discrimination , problems in interpersonal relationships , and problems with social status . women affected by leprosy seem to face most problems when first diagnosed or while receiving treatment . the above problems may have been caused or aggravated by the fact that almost half of the women did not seem to know the cause of their disease and how leprosy is transmitted . thilakavathi and colleagues , who conducted in - depth interviews with 72 leprosy - affected men and women , of whom 48 were married , found that a few participants did not sleep in the same room as their spouses , but they did not elaborate on this . they also found that most of their interviewees lacked basic knowledge on the transmission and cause of leprosy . this happened to two women with grade 2 impairments due to leprosy in our study . qualitative evidence suggests that women are more likely to be deserted by their spouses than men , but conclusive evidence is not yet available . research in south - east nepal found that , of the nine men and ten women interviewed , three husbands had left their leprosy - affected wife and one wife had left her leprosy - affected husband . a study in south africa showed that of 23 married subjects , 9 men and 7 women had been deserted by their marriage partners because of leprosy . we can not tell whether the frequency of divorce found by scott , which is much higher than in our study , is due to sampling error , bias in the samples , or actual cultural differences , since the present study was only designed to explore the impact of leprosy , not to determine the prevalence of marital problems or divorce due to leprosy . our findings indicate that divorce is only the tip of the iceberg of marital problems that may be due to leprosy or other causes . an important finding is the high frequency of alcohol abuse among the husbands of the participants . this occurred in all three groups and therefore points to a more structural phenomenon in society . a larger survey using randomsampling will have to confirm whether the greater frequency of alcohol abuse among the husbands of leprosy - affected women compared to the other women included in this study is real , or a result of sampling error . jhingan and colleagues looked at alcohol dependence in dharan , in eastern nepal , and found the prevalence of alcohol dependence to be 25.8 % . they found dependence to increase with age , peaking with 41 % in the age group 4554 , compared to 10.7 % in the 1524 age group . several studies found the risk of sexual abuse and violence towards women to increase when husbands are drunk or are alcoholics . these studies were also conducted in developing countries and highlight the important role of alcohol use in sexual abuse . the present study seems to confirm the relationship between alcohol abuse and sexual abuse : most of the women who had a husband with an alcohol problem experienced sexual abuse and all husbands who sexually abused their wives reportedly had an alcohol problem . we did not find any literature on the relationship between alcohol abuse and sexual abuse when the spouse has an impairment . sexual abuse by the husband occurred in all groups , but the frequency was higher among women affected by leprosy . another study assessed the occurrence of violence against young married women aged 1524 years in rural nepal . as many as 53 % reported having experienced some form of violence in their lifetime and 46 % reported experiencing sexual violence . no or little interspousal communication and low autonomy of women were associated with violence against women . other studies that investigated sexual violence against young married women found a similar prevalence ( 49 % ) . lamichhane and colleagues associated women 's lower status in family and society with violence against women , particularly young women in rural nepal . also pradhananga and shrestha and puri and colleagues stress the low status of women in nepal . deepak and colleagues , who looked at violence and sexual violence against persons with disabilities in india , found that 14 % of their 146 participants reported experiences of sexual violence during the previous 12 months . the presence of visible impairments among leprosy patients and its influence on acceptance by others have been highlighted by other studies . kopparty , who looked at coping strategies of 500 families who had a leprosy - affected family member with and without disfigurement , found that the proportion of families having patients with deformities facing problems was ten times higher ( 57 % ) than those having patients with no deformities ( 5.7 % ) . it is therefore not unlikely that women with visible impairments would experience more discrimination and abuse than leprosy - affected women without visible impairments . their position in society may be low , possibly aggravated by alcohol abuse of the husband . furthermore , puri and colleagues found that 8 out of 15 women who refused to have intercourse with their husbands were beaten . being beaten or threatened with violence when not obeying their husbands was also reported by women in the present study . our study showed that a husband often has power over his wife and that wives are expected to obey their husband or otherwise may be expected to be punished . feelings were often not shared , because women felt their feelings and desires were not valued . these findings fit with the description of prevailing attitudes towards women described by regmi and colleagues . they stated that , in nepal , unequal power relations and lack of autonomy characterise the situation of married young women in many settings , the autonomy of married young women is particularly constrained and gender norms stress male entitlement to sex , even if forced within marriage . certain social roles are expected , and most of the women 's roles revolve around the household . an important finding was that most women had not received sexual education , or at least not before marriage . the few women who had sexual education before marriage received this sometime between grades 8 and 10 in school . there are major gaps in receiving information , services , and skills on sexual and reproductive health issues . the government of nepal has introduced sexual and reproductive health education in public schools for grades six to ten and in university curricula from 1998 onwards . regmi and colleagues assert that , in reality , young people do not have good access to appropriate information on sexual and reproductive health issues . this fits with our finding that several women who were in their twenties and who had secondary education or more indicated that they did not receive sexual education , despite the fact that a sexual and reproductive health education programme had already been introduced when they were in school . the current findings show that knowledge about leprosy and the relation between leprosy and marriage and sexual health should be addressed preventively whenever someone is diagnosed with leprosy . if at all possible , the spouse and possibly the in - laws of any newly diagnosed married patient should be included in such counselling efforts . materials addressing these issues should be developed and should be made available for distribution in primary health centres and other health facilities where persons affected by leprosy are diagnosed and treated . however , it was evident in our study that within - marriage violence and sexual abuse of women , aggravated by alcohol abuse of the husband , occurred in all groups regardless of health or disability status . sexual and reproductive health , freedom from violence , and freedom from discrimination are fundamental human rights that were systematically violated in the lives of many of the women interviewed . therefore , interventions to improve sexual health and safety of married women should be designed , tested , and implemented as a matter of urgency . the first limitation is the nonrandom sampling and small study size , as mentioned above . this , together with the specific geographic location of the present study , means that the results of the study can not be generalized to the whole study population or beyond . if men would have been included also , a more complete insight of the impact of leprosy on marital and sexual relationships could have been given . translating the interviews from nepali to english may have introduced some mistakes or misinterpretations , since not all words could be translated literally . the current study indicates that leprosy may influence the marital and sexual relationship of women in nepal in several ways . additional research is needed to gain more insight in the underlying reasons . knowing more about the factors that influence marital and sexual relationship may help patients as well as health workers deal with marital and sexual problems and may enhance their ability to anticipate and prevent problems . it will also inform policy and interventions to reduce within - marriage sexual abuse and violence . raising awareness of health workers concerning the risk of marital problems following a diagnosis of leprosy is essential . simple educational materials with facts about leprosy , explaining the absence of risk of transmission once someoneis being treated , would help health workers discuss these very important issues with their patients , preferably together with their spouses . on a wider scale , interventions to improve sexual health and safety of married women should be implemented as a matter of urgency . implementation research should investigate the appropriate format and manner in which this can be done . a larger study with a random sampleis needed to determine the extent of the problems identified and the added risk of being leprosy - affected or having a disability . many women in our study experienced marital problems and / or sexual abuse , regardless of their leprosy or disability status . fundamental human rights such as the rights to sexual and reproductive health , freedom from violence , and freedom from discrimination are systematically violated in the lives of many of the women interviewed.women affected by leprosy faced additional problems , related to fear of the disease , negative attitudes , and discrimination on account of leprosy.knowledge on the cause and transmission of leprosy was still lacking among leprosy - affected women and their community members . appropriate preventive and educational measures should be designed and tested to address these issues.lastly , women appear to have insufficient access to sexual education , despite programmes on sexual health education in schools and elsewhere . many women in our study experienced marital problems and / or sexual abuse , regardless of their leprosy or disability status . fundamental human rights such as the rights to sexual and reproductive health , freedom from violence , and freedom from discrimination are systematically violated in the lives of many of the women interviewed . women affected by leprosy faced additional problems , related to fear of the disease , negative attitudes , and discrimination on account of leprosy . knowledge on the cause and transmission of leprosy was still lacking among leprosy - affected women and their community members . lastly , women appear to have insufficient access to sexual education , despite programmes on sexual health education in schools and elsewhere . this should be addressed by the appropriate authorities .
output:
|
pubmedsumm77591 | [
{
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"value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: coronary heart disease ( chd ) accounts for the greatest number of deaths and disability worldwide , and burden of chds is on the rise in low - middle income countries ( lmics ) . the relationship between serum low - density lipoprotein cholesterol ( ldl - c ) , which correlates highly with total cholesterol ( tc ) , and chd risk has been observed throughout the world . it has been identified as a major risk factor for chd , and hence the primary target of cholesterol - lowering therapy as per reports of the adult treatment panel . it has been found that for every 1 % reduction in ldl - c , the relative risk for major chd events is reduced by nearly 1 % . hence , the accurate and standardize measurements of ldl - c are required for reliable classification of patients . recommendations for measurement of ldl - c were issued by a national cholesterol education program ( ncep ) expert laboratory panel in 1995 . the panel recommended standardization of the measurements , that is , achieving traceability of all results to accepted reference methods ( rms ) . the centre for disease control and prevention ( cdc ) uses - quantification as an rm , based on the lipid research clinics ( lrc ) . but the - quantification procedure is costly , labor intensive , time - consuming , not available everywhere and can be performed only on few samples a day . hence , its use is not feasible in routine laboratory especially in lmics . ncep and cholesterol reference method laboratory network of cdc certified commercially available direct ldl - c kits , and these have been available for use in routine clinical laboratories . but being costly , they are still not used in most of the indian laboratories . since ldl is important in chd risk assessment , the measurement of ldl should be accurate , and it should be cost - effective for the general population . most laboratories in lmics estimate ldl - c levels with the friedewald formula , based on the concentrations of tc , high - density lipoprotein cholesterol ( hdl - c ) , and triglycerides ( tgs ) . the calculation was actually proposed for use in epidemiologic studies but was later rapidly adopted and became the method of choice by routine clinical laboratories , in part for economic reasons . overestimation of very low - density lipoprotein cholesterol ( vldl - c ) and underestimation of ldl - c due to presence of chylomicrons , calculation requires a fasting specimen ( ideally 12 h fasting ) , calculation was recommended only for specimens with tgs up to 400 mg / dl , not useful in type iii hyperlipidemia or dysbetalipoproteinemia . a major disadvantage in calculating ldl by friedewald method is that the variability is a product of the combined variabilities in the three underlying measurements . in routine laboratories , variability appeared to be much higher ( 12 % ) as compared to variability in experienced and well - standardized lipid laboratories ( 4 % ) , as observed by the ncep expert panel . other limitations are underestimation of ldl - c in patients with diabetes mellitus , end - stage renal disease , hepatic failure and patients on hormone replacement therapy . moreover , ldl cholesterol includes intermediate density lipoprotein ( idl ) and lipoprotein ( a ) in it . increased concentration of idl and lp ( a ) are also associated with increased risk of chd . but because of their small concentration ( a few mg / dl ) , ncep working group on ldl cholesterol measurement suggested that ldl cholesterol value should not be corrected for the contribution of other atherogenic lipoproteins . it does not require hdl - c result for the calculation and hence can prove to be more cost - effective . since it uses only two analytes chances of analytical errorshowever , studies found that there was no advantage of anandaraja 's formula over friedewald formula for estimation of ldl - c by calculation . another modification in original friedewald 's formula for calculation of ldl was given by puavilai and laoragpongse which assumes that vldl constitutes one - sixth of total tgs and it is costly for serum ldl test from direct measurement , especially if it has to be tested several times in a year . the authors found modified formula to be more accurate than the original formula in estimation of ldl - c . it also partially overcame the problems of fasting , presence of diabetes , obesity and familial hypertriglyceridemia unlike seen with original friedewald formula . the literature on the use of this modified friedewald formula among indian population is not available . against this background , the present study was conducted ( i ) to determine that which of these calculated formulae ( original friedewald , anandaraja and modified friedewald ) show maximum correlation with direct low - density lipoprotein cholesterol method ( d - ldl - c ) estimation at different serum tg levels in indian population . we reviewed records of blood samples which were sent to our clinical biochemistry laboratory , department of biochemistry , lok nayak jai prakash hospital , new delhi for the estimation of fasting lipid profile . secondary data of 480 patients were collected after obtaining prior permission from the concerned authority . as a routine procedure , the samples were collected after 1012 h of overnight fast by withdrawing 3 ml of venous blood in plain vial . the samples were centrifuged at 3000 rpm for 15 min to obtain serum and were analyzed for lipid profile on the same day . serum cholesterol was estimated by cholesterol oxidase - peroxidase method using a commercial kit from beckman coulter on beckman coulter dxc ( beckman coulter ireland , inc .250 s. kraemer blvd . , brea , ca 92821 u.s.a . ) analyzer with a coefficient of variation ( cv ) of 3 % . serum tg was estimated by glycerol - 3 phosphate oxidase -3,5-dichloro-2-hydroxybenzenesulfonic acid method on the same analyzer using a commercial kit from beckman coulter with a cv of 3 % . hdl - c was estimated by a commercial kit from beckman coulter based on homogenous method ( with a cv of 3 % ) using a detergent which solubilizes only the hdl lipoprotein particles and releases hdl cholesterol to react with cholesterol esterase and cholesterol oxidase in the presence of chromogens to produce a color product . low - density lipoprotein cholesterol was estimated by direct homogenous method of daiichi pure chemicals , tokyo by using a commercial kit from beckman coulter on dxc analyzer with a cv of 2 % . homogenous method of ldl - c depends on unique detergent which solubilizes only the non - ldl lipoproteins and releases cholesterol to react with cholesterol esterases and oxidases to produce a noncolor forming reaction . a second detergent solubilizes the remaining ldl particles , and a chromogenic complex allows for color formation . low - density lipoprotein reagent is used to measure cholesterol concentration by a timed endpoint method . the change in absorbancethe change in absorbance is directly proportional to the concentration of cholesterol in the sample . apart from above method , ldl cholesterol was calculated by following formulae : friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . discrete data were reported as mean and standard deviation . paired t - test and pearson correlation were performed to find the significant difference and correlation in ldl - c concentration obtained by a direct method and different calculations , respectively . the level of significance was taken as p 0.05 . to examine the degree of agreement between the values obtained by the two methods , blandwas calculated using the formula : pd calculated ldl - c = ( calculated ldl - c d - ldl - c ) / d - ldl - c 100 . data collected were classified into three groups according to the serum tg concentrations ( mg / dl ) as group a : tg - 200 mg / dl and below , group b : tg - 201400 mg / dl , and group c : tg - 400 mg / dl and above . we reviewed records of blood samples which were sent to our clinical biochemistry laboratory , department of biochemistry , lok nayak jai prakash hospital , new delhi for the estimation of fasting lipid profile . secondary data of 480 patients were collected after obtaining prior permission from the concerned authority . as a routine procedure , the samples were collected after 1012 h of overnight fast by withdrawing 3 ml of venous blood in plain vial . the samples were centrifuged at 3000 rpm for 15 min to obtain serum and were analyzed for lipid profile on the same day . serum cholesterol was estimated by cholesterol oxidase - peroxidase method using a commercial kit from beckman coulter on beckman coulter dxc ( beckman coulter ireland , inc .250 s. kraemer blvd . , brea , ca 92821 u.s.a . ) analyzer with a coefficient of variation ( cv ) of 3 % . serum tg was estimated by glycerol - 3 phosphate oxidase -3,5-dichloro-2-hydroxybenzenesulfonic acid method on the same analyzer using a commercial kit from beckman coulter with a cv of 3 % . hdl - c was estimated by a commercial kit from beckman coulter based on homogenous method ( with a cv of 3 % ) using a detergent which solubilizes only the hdl lipoprotein particles and releases hdl cholesterol to react with cholesterol esterase and cholesterol oxidase in the presence of chromogens to produce a color product . low - density lipoprotein cholesterol was estimated by direct homogenous method of daiichi pure chemicals , tokyo by using a commercial kit from beckman coulter on dxc analyzer with a cv of 2 % . homogenous method of ldl - c depends on unique detergent which solubilizes only the non - ldl lipoproteins and releases cholesterol to react with cholesterol esterases and oxidases to produce a noncolor forming reaction . a second detergent solubilizes the remaining ldl particles , and a chromogenic complex allows for color formation . low - density lipoprotein reagent is used to measure cholesterol concentration by a timed endpoint method . the change in absorbancethe change in absorbance is directly proportional to the concentration of cholesterol in the sample . apart from above method , ldl cholesterol was calculated by following formulae : friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . discrete data were reported as mean and standard deviation . paired t - test and pearson correlation were performed to find the significant difference and correlation in ldl - c concentration obtained by a direct method and different calculations , respectively . the level of significance was taken as p 0.05 . to examine the degree of agreement between the values obtained by the two methods , blandwas calculated using the formula : pd calculated ldl - c = ( calculated ldl - c d - ldl - c ) / d - ldl - c 100 . data collected were classified into three groups according to the serum tg concentrations ( mg / dl ) as group a : tg - 200 mg / dl and below , group b : tg - 201400 mg / dl , and group c : tg - 400 mg / dl and above . there were 320 , 138 , and 22 patients in group a , b , and c , respectively . the mean ldl - c levels ( mg / dl ) were 117.02 , 106.63 , 102.25 , and 113.00 for d - ldl - c , f - ldl - c , a - ldl - c , and mf - ldl , respectively [ table 1 ] . no statistically significant difference was found in the mean of ldl - c calculated by modified friedewald method as compared to direct ldl - c . comparison between concentration of ldl - c measured by direct method and using different formulae ( n = 480 ) the calculated formulae underestimate ldl - c by 10.39 mg / dl , 14.77 mg / dl and 04.02 mg / dl by friedewald 's , anandaraja 's and modified friedewald 's method , respectively , in comparison to the direct method . on calculating the mean pd , it was found that mf - ldl - c differs by 3.44 % from the d - ldl - c which was much lower in comparison to the other two calculated formulae ( 8.88 % and 12.62 % by f - ldl - c and a - ldl - c , respectively ) [ table 1 ] . a strong correlation was found between all calculated ldl - c methods and d - ldl - c assay , that is , f - ldl - c versus d - ldl - c = 0.94 [ figure 1 ] ; a - ldl - c versus d - ldl - c = 0.93 [ figure 2 ] and mf - ldl - c versus d - ldl - c = 0.95 [ figure 3 ] . scatter plot of anandaraja low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.93 scatter plot of anandaraja low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.93 scatter plot of modified friedewald low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.95 to find the agreement between the direct and calculated ldl methods , blandaltman plot was prepared [ figures 46 ] but the negative bias in them indicates that although they correlate to one another they can not be used in place of direct ldl except the modified friedewald method where the negative bias was minimum . altman plot for low - density lipoprotein cholesterol estimated directly and by friedewald 's calculation . mean : 10.39 ( negative bias ) , standard deviation ( sd ) : 22.18 ; mean + 2 sd : + 33.97 ; mean 2 sd : 54.75 blandaltman plot for low - density lipoprotein cholesterol estimated directly and by anandaraja 's calculation . mean : 14.77 ( negative bias ) , standard deviation ( sd ) : 24.82 ; mean + 2 sd : + 34.87 ; mean 2 sd : 64.41 blandaltman plot for low - density lipoprotein cholesterol estimated directly and by modified friedewald 's calculation . mean : 4.02 ( negative bias ) , standard deviation ( sd ) : 21.46 ; mean + 2 sd : + 38.90 ; mean 2 sd : 46.94 comparison of ldl - c at different levels of tgs did not show statistically significant difference between d - ldl - c and calculated ldl - c by friedewald and modified friedewald 's method ( f - ldl - c and mf - ldl - c ) [ table 2 ] . at tg 200 mg / dl and tg : 201 - 400 mg / dl , a significant difference was found between measured ldl - c and calculated ldl - c by anandaraja 's method ( a - ldl - c ) . ldl - c ( in mg / dl ) by different methods at different serum level of tg ( mg / dl ) coronary heart disease is one of the most prevailing causes of morbidity and mortality . in lmics , friedewald formula is commonly used to estimate ldl - c in routine laboratories , despite its several limitations . there were no limitations proposed with anandaraja 's formula but as said earlier , no advantage was found over friedewald 's formula by authors . to the best of author 's knowledge , this is the first study in which modified friedewald formula given by puavilai et al . was evaluated in india , and comparison was made with original friedewald formula and anandaraja 's formula . our study pointed that there was a good correlation between all calculated ldl methods and direct method . there was a correlation of 0.94 between d - ldl - c and friedewald ldl in our study which was in concordance of other studies which say it to be ranging from 0.78 to 0.93 . the correlation between d - ldl - c and a - ldl - c in our study was found to be 0.93 which was similar to other studies , that is , correlation of 0.93 , 0.89 , and 0.81 . our study found a correlation of 0.95 between mf - ldl - c and d - ldl - c , which was higher than the one found by kamal et al ( r = 0.81 ) . even if there was a positive correlation but to find the actual relation between these methods blandthis suggests that there is the difference in results obtained by calculated and direct method . the reason of negative bias was that there was underestimation of calculated ldl from direct ldl . this underestimation was 10.39 % , 14.77 % , and 04.02 % by friedewald , anandraja and modified friedewald respectively in our study . similar findings were reported by gupta et al . that there is underestimation of 10 % and 14 % with friedewald and anandaraja methods , respectively . however , kamal et al . found underestimation of 17 % and 22 % by friedewald and anandaraja methods , respectively . on the other hand , kamezaki et al . reported underestimation of only 5.9 % with friedewald formulathe calculation of mean pd of three calculated methods from the direct method suggested that the difference was least with the modified friedewald method as compared to others , that is , 08.88 % , 12.62 % , and 03.44 % for friedewald , anandaraja , and modified friedewald , respectively . similar differences were reported in the study by gupta et al . where it was 8.8 and 11.4 % for friedewald and anandaraja , respectively . however , in the study by vujovic et al . , these differences were found to be 6.9 and 3.9 % for friedewald and anandraja methods , respectively . kamal et al . also studied difference of modified friedewald method in addition , and reported differences were 16.7 % , 22.35 % , and 10.5 % for friedewald , anandaraja , and modified friedewald , respectively , that is , least with modified friedewald method . since the negative bias was maximum for anandaraja formula , so if this is used many cases of chd may be denied of early initiation of treatment . direct methods are accurate and precise for estimation of ldl but when ldl is to be frequently measured in monitoring of chd , it adds to the cost of treatment . keeping in mind that ldl calculated by modified friedewald formula correlates well with direct ldl so to monitor treatment of patients of chd ( i.e. decrease in ldl - c and tg and increase in hdl ) it should be used in place of friedewald formula in routine laboratories for calculation of ldl .\noutput:\n"
},
{
"from": "agent",
"value": "purpose : the purpose was to compare the different calculated methods of low - density lipoprotein cholesterol ( ldl - c ) estimation and to determine which of them correlate best with the direct method.materials and methods : the records of 480 samples for lipid profile were analyzed . apart from the direct method , ldl - c was calculated by friedewald low - density lipoprotein cholesterol method ( f - ldl - c ) , modified friedewald low - density lipoprotein cholesterol method ( mf - ldl - c ) , and anandaraja low - density lipoprotein cholesterol method ( a - ldl - c ) . paired t - test and pearson correlation were evaluated between the different methods . degree of agreement between the calculated methods and direct method was detected by bland altman graphical plots.results : a strong correlation was found between all calculated ldl - c methods and direct low - density lipoprotein cholesterol method ( d - ldl - c ) assay , that is , f - ldl - c versus d - ldl - c = 0.94 ; a - ldl - c versus d - ldl - c = 0.93 and mf - ldl - c versus d - ldl - c = 0.95 . no statistically significant difference was found between d - ldl - c and mf - ldl - c . bland altman plot for mf - ldl - c showed minimal negative bias.conclusions : the study pointed out that mf - ldl - c correlated maximally with d - ldl - c estimation at all levels of triglycerides and mf - ldl - c can be used in place of d - ldl - c when the direct method can not be afforded ."
}
] | ***task***
the task is to summarize an input biomedical literature in six sentences
***input***
the input is a biomedical literature
***output***
the output is the summary of an input biomedical literature in six sentences
***documentation***
***examples***
input: coronary heart disease ( chd ) accounts for the greatest number of deaths and disability worldwide , and burden of chds is on the rise in low - middle income countries ( lmics ) . the relationship between serum low - density lipoprotein cholesterol ( ldl - c ) , which correlates highly with total cholesterol ( tc ) , and chd risk has been observed throughout the world . it has been identified as a major risk factor for chd , and hence the primary target of cholesterol - lowering therapy as per reports of the adult treatment panel . it has been found that for every 1 % reduction in ldl - c , the relative risk for major chd events is reduced by nearly 1 % . hence , the accurate and standardize measurements of ldl - c are required for reliable classification of patients . recommendations for measurement of ldl - c were issued by a national cholesterol education program ( ncep ) expert laboratory panel in 1995 . the panel recommended standardization of the measurements , that is , achieving traceability of all results to accepted reference methods ( rms ) . the centre for disease control and prevention ( cdc ) uses - quantification as an rm , based on the lipid research clinics ( lrc ) . but the - quantification procedure is costly , labor intensive , time - consuming , not available everywhere and can be performed only on few samples a day . hence , its use is not feasible in routine laboratory especially in lmics . ncep and cholesterol reference method laboratory network of cdc certified commercially available direct ldl - c kits , and these have been available for use in routine clinical laboratories . but being costly , they are still not used in most of the indian laboratories . since ldl is important in chd risk assessment , the measurement of ldl should be accurate , and it should be cost - effective for the general population . most laboratories in lmics estimate ldl - c levels with the friedewald formula , based on the concentrations of tc , high - density lipoprotein cholesterol ( hdl - c ) , and triglycerides ( tgs ) . the calculation was actually proposed for use in epidemiologic studies but was later rapidly adopted and became the method of choice by routine clinical laboratories , in part for economic reasons . overestimation of very low - density lipoprotein cholesterol ( vldl - c ) and underestimation of ldl - c due to presence of chylomicrons , calculation requires a fasting specimen ( ideally 12 h fasting ) , calculation was recommended only for specimens with tgs up to 400 mg / dl , not useful in type iii hyperlipidemia or dysbetalipoproteinemia . a major disadvantage in calculating ldl by friedewald method is that the variability is a product of the combined variabilities in the three underlying measurements . in routine laboratories , variability appeared to be much higher ( 12 % ) as compared to variability in experienced and well - standardized lipid laboratories ( 4 % ) , as observed by the ncep expert panel . other limitations are underestimation of ldl - c in patients with diabetes mellitus , end - stage renal disease , hepatic failure and patients on hormone replacement therapy . moreover , ldl cholesterol includes intermediate density lipoprotein ( idl ) and lipoprotein ( a ) in it . increased concentration of idl and lp ( a ) are also associated with increased risk of chd . but because of their small concentration ( a few mg / dl ) , ncep working group on ldl cholesterol measurement suggested that ldl cholesterol value should not be corrected for the contribution of other atherogenic lipoproteins . it does not require hdl - c result for the calculation and hence can prove to be more cost - effective . since it uses only two analytes chances of analytical errorshowever , studies found that there was no advantage of anandaraja 's formula over friedewald formula for estimation of ldl - c by calculation . another modification in original friedewald 's formula for calculation of ldl was given by puavilai and laoragpongse which assumes that vldl constitutes one - sixth of total tgs and it is costly for serum ldl test from direct measurement , especially if it has to be tested several times in a year . the authors found modified formula to be more accurate than the original formula in estimation of ldl - c . it also partially overcame the problems of fasting , presence of diabetes , obesity and familial hypertriglyceridemia unlike seen with original friedewald formula . the literature on the use of this modified friedewald formula among indian population is not available . against this background , the present study was conducted ( i ) to determine that which of these calculated formulae ( original friedewald , anandaraja and modified friedewald ) show maximum correlation with direct low - density lipoprotein cholesterol method ( d - ldl - c ) estimation at different serum tg levels in indian population . we reviewed records of blood samples which were sent to our clinical biochemistry laboratory , department of biochemistry , lok nayak jai prakash hospital , new delhi for the estimation of fasting lipid profile . secondary data of 480 patients were collected after obtaining prior permission from the concerned authority . as a routine procedure , the samples were collected after 1012 h of overnight fast by withdrawing 3 ml of venous blood in plain vial . the samples were centrifuged at 3000 rpm for 15 min to obtain serum and were analyzed for lipid profile on the same day . serum cholesterol was estimated by cholesterol oxidase - peroxidase method using a commercial kit from beckman coulter on beckman coulter dxc ( beckman coulter ireland , inc .250 s. kraemer blvd . , brea , ca 92821 u.s.a . ) analyzer with a coefficient of variation ( cv ) of 3 % . serum tg was estimated by glycerol - 3 phosphate oxidase -3,5-dichloro-2-hydroxybenzenesulfonic acid method on the same analyzer using a commercial kit from beckman coulter with a cv of 3 % . hdl - c was estimated by a commercial kit from beckman coulter based on homogenous method ( with a cv of 3 % ) using a detergent which solubilizes only the hdl lipoprotein particles and releases hdl cholesterol to react with cholesterol esterase and cholesterol oxidase in the presence of chromogens to produce a color product . low - density lipoprotein cholesterol was estimated by direct homogenous method of daiichi pure chemicals , tokyo by using a commercial kit from beckman coulter on dxc analyzer with a cv of 2 % . homogenous method of ldl - c depends on unique detergent which solubilizes only the non - ldl lipoproteins and releases cholesterol to react with cholesterol esterases and oxidases to produce a noncolor forming reaction . a second detergent solubilizes the remaining ldl particles , and a chromogenic complex allows for color formation . low - density lipoprotein reagent is used to measure cholesterol concentration by a timed endpoint method . the change in absorbancethe change in absorbance is directly proportional to the concentration of cholesterol in the sample . apart from above method , ldl cholesterol was calculated by following formulae : friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . discrete data were reported as mean and standard deviation . paired t - test and pearson correlation were performed to find the significant difference and correlation in ldl - c concentration obtained by a direct method and different calculations , respectively . the level of significance was taken as p 0.05 . to examine the degree of agreement between the values obtained by the two methods , blandwas calculated using the formula : pd calculated ldl - c = ( calculated ldl - c d - ldl - c ) / d - ldl - c 100 . data collected were classified into three groups according to the serum tg concentrations ( mg / dl ) as group a : tg - 200 mg / dl and below , group b : tg - 201400 mg / dl , and group c : tg - 400 mg / dl and above . we reviewed records of blood samples which were sent to our clinical biochemistry laboratory , department of biochemistry , lok nayak jai prakash hospital , new delhi for the estimation of fasting lipid profile . secondary data of 480 patients were collected after obtaining prior permission from the concerned authority . as a routine procedure , the samples were collected after 1012 h of overnight fast by withdrawing 3 ml of venous blood in plain vial . the samples were centrifuged at 3000 rpm for 15 min to obtain serum and were analyzed for lipid profile on the same day . serum cholesterol was estimated by cholesterol oxidase - peroxidase method using a commercial kit from beckman coulter on beckman coulter dxc ( beckman coulter ireland , inc .250 s. kraemer blvd . , brea , ca 92821 u.s.a . ) analyzer with a coefficient of variation ( cv ) of 3 % . serum tg was estimated by glycerol - 3 phosphate oxidase -3,5-dichloro-2-hydroxybenzenesulfonic acid method on the same analyzer using a commercial kit from beckman coulter with a cv of 3 % . hdl - c was estimated by a commercial kit from beckman coulter based on homogenous method ( with a cv of 3 % ) using a detergent which solubilizes only the hdl lipoprotein particles and releases hdl cholesterol to react with cholesterol esterase and cholesterol oxidase in the presence of chromogens to produce a color product . low - density lipoprotein cholesterol was estimated by direct homogenous method of daiichi pure chemicals , tokyo by using a commercial kit from beckman coulter on dxc analyzer with a cv of 2 % . homogenous method of ldl - c depends on unique detergent which solubilizes only the non - ldl lipoproteins and releases cholesterol to react with cholesterol esterases and oxidases to produce a noncolor forming reaction . a second detergent solubilizes the remaining ldl particles , and a chromogenic complex allows for color formation . low - density lipoprotein reagent is used to measure cholesterol concentration by a timed endpoint method . the change in absorbancethe change in absorbance is directly proportional to the concentration of cholesterol in the sample . apart from above method , ldl cholesterol was calculated by following formulae : friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . friedewald : friedewald low - density lipoprotein cholesterol ( f - ldl - c ) = tc ( tg / 5 + hdl - c ) modified friedewald : modified friedewald low - density lipoprotein cholesterol ( mf - ldl - c ) = tc ( tg / 6 + hdl - c ) anandaraja : anandaraja low - density lipoprotein cholesterol ( a - ldl - c ) = ( 0.9 tc ) ( 0.9 tg / 5 ) 28 . discrete data were reported as mean and standard deviation . paired t - test and pearson correlation were performed to find the significant difference and correlation in ldl - c concentration obtained by a direct method and different calculations , respectively . the level of significance was taken as p 0.05 . to examine the degree of agreement between the values obtained by the two methods , blandwas calculated using the formula : pd calculated ldl - c = ( calculated ldl - c d - ldl - c ) / d - ldl - c 100 . data collected were classified into three groups according to the serum tg concentrations ( mg / dl ) as group a : tg - 200 mg / dl and below , group b : tg - 201400 mg / dl , and group c : tg - 400 mg / dl and above . there were 320 , 138 , and 22 patients in group a , b , and c , respectively . the mean ldl - c levels ( mg / dl ) were 117.02 , 106.63 , 102.25 , and 113.00 for d - ldl - c , f - ldl - c , a - ldl - c , and mf - ldl , respectively [ table 1 ] . no statistically significant difference was found in the mean of ldl - c calculated by modified friedewald method as compared to direct ldl - c . comparison between concentration of ldl - c measured by direct method and using different formulae ( n = 480 ) the calculated formulae underestimate ldl - c by 10.39 mg / dl , 14.77 mg / dl and 04.02 mg / dl by friedewald 's , anandaraja 's and modified friedewald 's method , respectively , in comparison to the direct method . on calculating the mean pd , it was found that mf - ldl - c differs by 3.44 % from the d - ldl - c which was much lower in comparison to the other two calculated formulae ( 8.88 % and 12.62 % by f - ldl - c and a - ldl - c , respectively ) [ table 1 ] . a strong correlation was found between all calculated ldl - c methods and d - ldl - c assay , that is , f - ldl - c versus d - ldl - c = 0.94 [ figure 1 ] ; a - ldl - c versus d - ldl - c = 0.93 [ figure 2 ] and mf - ldl - c versus d - ldl - c = 0.95 [ figure 3 ] . scatter plot of anandaraja low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.93 scatter plot of anandaraja low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.93 scatter plot of modified friedewald low - density lipoprotein cholesterol against direct low - density lipoprotein cholesterol . there was a correlation of r = 0.95 to find the agreement between the direct and calculated ldl methods , blandaltman plot was prepared [ figures 46 ] but the negative bias in them indicates that although they correlate to one another they can not be used in place of direct ldl except the modified friedewald method where the negative bias was minimum . altman plot for low - density lipoprotein cholesterol estimated directly and by friedewald 's calculation . mean : 10.39 ( negative bias ) , standard deviation ( sd ) : 22.18 ; mean + 2 sd : + 33.97 ; mean 2 sd : 54.75 blandaltman plot for low - density lipoprotein cholesterol estimated directly and by anandaraja 's calculation . mean : 14.77 ( negative bias ) , standard deviation ( sd ) : 24.82 ; mean + 2 sd : + 34.87 ; mean 2 sd : 64.41 blandaltman plot for low - density lipoprotein cholesterol estimated directly and by modified friedewald 's calculation . mean : 4.02 ( negative bias ) , standard deviation ( sd ) : 21.46 ; mean + 2 sd : + 38.90 ; mean 2 sd : 46.94 comparison of ldl - c at different levels of tgs did not show statistically significant difference between d - ldl - c and calculated ldl - c by friedewald and modified friedewald 's method ( f - ldl - c and mf - ldl - c ) [ table 2 ] . at tg 200 mg / dl and tg : 201 - 400 mg / dl , a significant difference was found between measured ldl - c and calculated ldl - c by anandaraja 's method ( a - ldl - c ) . ldl - c ( in mg / dl ) by different methods at different serum level of tg ( mg / dl ) coronary heart disease is one of the most prevailing causes of morbidity and mortality . in lmics , friedewald formula is commonly used to estimate ldl - c in routine laboratories , despite its several limitations . there were no limitations proposed with anandaraja 's formula but as said earlier , no advantage was found over friedewald 's formula by authors . to the best of author 's knowledge , this is the first study in which modified friedewald formula given by puavilai et al . was evaluated in india , and comparison was made with original friedewald formula and anandaraja 's formula . our study pointed that there was a good correlation between all calculated ldl methods and direct method . there was a correlation of 0.94 between d - ldl - c and friedewald ldl in our study which was in concordance of other studies which say it to be ranging from 0.78 to 0.93 . the correlation between d - ldl - c and a - ldl - c in our study was found to be 0.93 which was similar to other studies , that is , correlation of 0.93 , 0.89 , and 0.81 . our study found a correlation of 0.95 between mf - ldl - c and d - ldl - c , which was higher than the one found by kamal et al ( r = 0.81 ) . even if there was a positive correlation but to find the actual relation between these methods blandthis suggests that there is the difference in results obtained by calculated and direct method . the reason of negative bias was that there was underestimation of calculated ldl from direct ldl . this underestimation was 10.39 % , 14.77 % , and 04.02 % by friedewald , anandraja and modified friedewald respectively in our study . similar findings were reported by gupta et al . that there is underestimation of 10 % and 14 % with friedewald and anandaraja methods , respectively . however , kamal et al . found underestimation of 17 % and 22 % by friedewald and anandaraja methods , respectively . on the other hand , kamezaki et al . reported underestimation of only 5.9 % with friedewald formulathe calculation of mean pd of three calculated methods from the direct method suggested that the difference was least with the modified friedewald method as compared to others , that is , 08.88 % , 12.62 % , and 03.44 % for friedewald , anandaraja , and modified friedewald , respectively . similar differences were reported in the study by gupta et al . where it was 8.8 and 11.4 % for friedewald and anandaraja , respectively . however , in the study by vujovic et al . , these differences were found to be 6.9 and 3.9 % for friedewald and anandraja methods , respectively . kamal et al . also studied difference of modified friedewald method in addition , and reported differences were 16.7 % , 22.35 % , and 10.5 % for friedewald , anandaraja , and modified friedewald , respectively , that is , least with modified friedewald method . since the negative bias was maximum for anandaraja formula , so if this is used many cases of chd may be denied of early initiation of treatment . direct methods are accurate and precise for estimation of ldl but when ldl is to be frequently measured in monitoring of chd , it adds to the cost of treatment . keeping in mind that ldl calculated by modified friedewald formula correlates well with direct ldl so to monitor treatment of patients of chd ( i.e. decrease in ldl - c and tg and increase in hdl ) it should be used in place of friedewald formula in routine laboratories for calculation of ldl .
output:
|
pubmedsumm34220 | [
{
"from": "human",
"value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: in their seminal book the task of medicine , dialogue at wickenburg , kerr white et al1 discussed the importance of broadening both the information base for understanding our patients problems and the framework for interpreting what we learn . outcomes : pendleton2 states that they may he immediate , such as patient satisfaction ; intermediate , for instance patient compliance ; or long - term , such as any change in the patient 's health the health outcome . pendleton2 has also stated that patients come to a doctor with an understanding of their problems which may be incomplete , rudimentary , and inaccurate , or it may be elaborate and entirely in agreement with current medical opinion . this last sentence forms a theory which embodies the patient 's health understanding . in their article on the consultation and health outcome , horder and moore3 have stated that there is a growing body of investigations into the effectiveness of doctor - patient communication . these studies relate specific aspects of communi - cation between doctor and patient to evidence about their effectiveness in improving outcomes . in this article , our discussion focuses on the importance of addressing and developing the patient 's health understanding in order to enhance the effectiveness of the medical intervention and improve the long - term health outcome . what are the indicators of effective doctor -- patient communication ? in their studies , sherrie h. kaplan and collegues4 have shown that patient satisfaction and compliance are necessary but limited as indicators . they have shown that optimal health outcomes depend not only on patient compliance ( participation ) but upon the extent of behavioral change . by making patients more active in the consultation they succeeded in changing the behaviour of the doctor as well as that of the patient . furthermore , they assert that generic measures of patients health ( subjective health status ) , in addition to available physiological measurements ( objective health status ) are the logical outcomes against which to assess effective doctor - patient communication . the consultation 's processes are dependent upon the entire context of the doctor - patient relationship , including the cultural belief systems within which that encounter occurs , as well as the personal belief systems of the two individuals concerned . in their book on the experience of illness , fitzpatrick and his co - authors5 state that there is much evidence suggesting that patients interpretations of their symptoms are governed by concepts and ideas of considerable complexity and variety . in developed countries the contemporary high - tech medical practice has in recent years failed to meet lay expectations . illness is culturally shaped in the sense that how we perceive , experience and cope with it is based on our cultural belief system . kleinman et al6 have proposed the term : patient 's explanatory model , which entails beliefs not only in terms of the cause of the illness , but also regarding the social and personal meaning of it . lay concepts of illness may have powerful symbolic significance , which can not be conveniently expressed in so many words by the patient , but which form an essential element of the meaning of the illness experience5 doctors and other health workers may too narrowly limit the search for meaning if they only look for references to bodily symptoms or causes in the lay ideas of illness . as to pendleton 's concept of health understanding , it can be viewed as not only encompassing kleinman 's patient model ( causal explanations and meaning of illness ) but also the patient 's factual knowledge of the disease and its course . lefcourt ( 1976 ) quoted by lau ( 1988 ) 7 has written that it is determined by the degree to which individuals perceive events in their lives as being a consequence of their own actions and thereby controllable ( internal control ) or as being unrelated to their own behaviour , and therefore beyond personal control ( external control ) . several major reviews of the literature linking locus of control beliefs to health behaviours exist .8 , 9 richard r. lau7 has stated that this concept has been applied to the area of health for at least 25 years , and is regarded as a generalised , relatively stable aspect of personality . internal beliefs have been linked to health protective behaviour and to the desire for more information . though its predictive value must be interpreted in combination with a high value placed on health , the concept of locus of control has implications as to the design of treatment regimens to optimise patient participation . jaspars et al ( 1983 ) 10 point out that individuals are motivated by far more complex processes than simply their level of control over events . they state that one of the most fundamental drives in human behaviour is the need to make sense of the environment . this means finding some ways to explain events , and this is often achieved by searching for their causes . this leads us to the concept of causal explanations of illness see kleinman et al above .6 jaspars et al ( 1983 ) 10 also emphasise that one must distinguish between control and causality . an individual may believe that an illness is caused by something external such as a virus , but at the same time that the illness can be controlled by personal behaviour ( internal control ) . these lay beliefs and theories about illness can be made more explicit by considering the site of illness aetiology as helman ( 1984 ) 11 does in his book . he postulates that lay theories of illness place the aetiology of ill - health in one of the following sites : within the individual patient in the natural world in the social world in the supernatural world within the individual patient in the natural world in the supernatural world social and supernatural aetiologies tend to be a feature of some communities in the developing world , while natural or patient - centered explanations of illness are more common in the western developed world . fitzpatrick et al ( 1984 ) 5 claim that one of the most striking qualities of lay concepts of illness is their very complexity , and that the structure of lay beliefs is also more flexible than one might think . in the light of the foregoing , the major elements of health understanding are : the meaning of illnessthe patient 's explanations of the cause of illness factual knowledge of the disease and its course the concept of locus of control the meaning of illness the patient 's explanations of the cause of illness factual knowledge of the disease and its course the concept of locus of control as the patient 's health understanding can be seen to consist of these major elements , doctors clearly need some form of clinical strategy enabling them to quickly and effectively elicit these health beliefs . how do these aforementioned theoretical considerations of lay concepts actually relate to countries outside the developed western world , such as those of the middle east , where transcultural differences are greater ? anthropological and social studies justify the conceptual distance we make between disease and illness . where only disease is treated , care will be less satisfactory to the patient and less clinically effective than where both disease and illness are treated together . of paramount importance is the negotiation between the patient 's explanatory model and that of the doctor , leading to an agreement , especially as related to expectations and therapeutic goals . unfortunately , the traditional biomedical viewpoint of medicine has disregarded these lay concepts of illness . as mentioned above , optimal health outcomes depend on the extent of behavioural change achieved by the patient . kleinman et al6 outline a clinical strategy by putting forward a set of specific questions to that end . with regard to the applicability of such instruments of enquiry into these lay theories , however , despite these difficulties and the fact that the instruments are mostly adapted from the west , these instruments have to be re - evaluated in each cultural setting , as do other tools of measurement for the assessment of subjective health status . in oman , with its traditional arabic culture now being offered alien , 20th century health care , the dichotomy between the patients understanding and expectations and those of the physicians is broad indeed . given the continued prevalence of traditional medicine - wasm ( branding ) , shamanistic practices , and ayurvedic - like herbal and hot - vs - cold treatments - which are all much more readily acceptable , even to many urbanised omanis , there is obviously a great need for appropriately designed health education in its widest sense . that this situation applies similarly in other arab countriesis evident from a study reporting the health - beliefs and behaviours of saudi women , where it was shown that there was a lack of understanding of specific causes of various illnesses .12 to answer some of the questions posed in this article , the authors suggest appropriately designed research into these aspects of health beliefs and understanding , including an audit of the research 's effects regarding improved health outcomes . the open discussion of patient 's concerns and ideas is an essential first step to offering personally appropriate health information .5 however , the prerequisite for the patient 's health understanding is appropriate information , and if patients do not understand even the basic premises , they do nt ask questions .13 therefore , it is essential to offer an explanation of the diagnostic label as well as of any advice offered , and , furthermore , an explanation that makes sense in terms of the patient 's own world view . secondly , it is important to offer a treatment plan that matches the patient 's own concepts as well as the prevailing cultural belief system . studies have shown the difficulties attendant upon the utilisation of western models of health behaviour and beliefs in middle eastern countries14 , and it is to be expected that such cross - cultural diversities between medicine and society as exist elsewhere in the world would pose similar problems . in line with this , pendleton et al . ( 1984 ) write of patients beliefs , concerns and expectations as being major elements of health understanding and of the importance of achieving a shared understanding of the problem between the doctor and the patient . the challenge faced by health care providers is to properly identify the health beliefs and understanding of their patients , and then to offer an appropriately matched patient education and treatment regimen . on the basis of this , doctors and patients should be able to plan together the optimal management of health problems , more confident that patient acceptability will be achieved and that improved compliance , through greater understanding , will follow .\noutput:\n"
},
{
"from": "agent",
"value": "literature regarding health belief models , health understanding and their effect on health outcome is reviewed . aspects of the major elements comprising health understanding including lay explanations of illness , locus of control and the affective meaning of symptoms are described . the particular problems posed by utilising these models in a developing middle eastern country are discussed , together with the importance of applied research to assess the feasibility of improving health outcome by enhanced health understanding ."
}
] | ***task***
the task is to summarize an input biomedical literature in six sentences
***input***
the input is a biomedical literature
***output***
the output is the summary of an input biomedical literature in six sentences
***documentation***
***examples***
input: in their seminal book the task of medicine , dialogue at wickenburg , kerr white et al1 discussed the importance of broadening both the information base for understanding our patients problems and the framework for interpreting what we learn . outcomes : pendleton2 states that they may he immediate , such as patient satisfaction ; intermediate , for instance patient compliance ; or long - term , such as any change in the patient 's health the health outcome . pendleton2 has also stated that patients come to a doctor with an understanding of their problems which may be incomplete , rudimentary , and inaccurate , or it may be elaborate and entirely in agreement with current medical opinion . this last sentence forms a theory which embodies the patient 's health understanding . in their article on the consultation and health outcome , horder and moore3 have stated that there is a growing body of investigations into the effectiveness of doctor - patient communication . these studies relate specific aspects of communi - cation between doctor and patient to evidence about their effectiveness in improving outcomes . in this article , our discussion focuses on the importance of addressing and developing the patient 's health understanding in order to enhance the effectiveness of the medical intervention and improve the long - term health outcome . what are the indicators of effective doctor -- patient communication ? in their studies , sherrie h. kaplan and collegues4 have shown that patient satisfaction and compliance are necessary but limited as indicators . they have shown that optimal health outcomes depend not only on patient compliance ( participation ) but upon the extent of behavioral change . by making patients more active in the consultation they succeeded in changing the behaviour of the doctor as well as that of the patient . furthermore , they assert that generic measures of patients health ( subjective health status ) , in addition to available physiological measurements ( objective health status ) are the logical outcomes against which to assess effective doctor - patient communication . the consultation 's processes are dependent upon the entire context of the doctor - patient relationship , including the cultural belief systems within which that encounter occurs , as well as the personal belief systems of the two individuals concerned . in their book on the experience of illness , fitzpatrick and his co - authors5 state that there is much evidence suggesting that patients interpretations of their symptoms are governed by concepts and ideas of considerable complexity and variety . in developed countries the contemporary high - tech medical practice has in recent years failed to meet lay expectations . illness is culturally shaped in the sense that how we perceive , experience and cope with it is based on our cultural belief system . kleinman et al6 have proposed the term : patient 's explanatory model , which entails beliefs not only in terms of the cause of the illness , but also regarding the social and personal meaning of it . lay concepts of illness may have powerful symbolic significance , which can not be conveniently expressed in so many words by the patient , but which form an essential element of the meaning of the illness experience5 doctors and other health workers may too narrowly limit the search for meaning if they only look for references to bodily symptoms or causes in the lay ideas of illness . as to pendleton 's concept of health understanding , it can be viewed as not only encompassing kleinman 's patient model ( causal explanations and meaning of illness ) but also the patient 's factual knowledge of the disease and its course . lefcourt ( 1976 ) quoted by lau ( 1988 ) 7 has written that it is determined by the degree to which individuals perceive events in their lives as being a consequence of their own actions and thereby controllable ( internal control ) or as being unrelated to their own behaviour , and therefore beyond personal control ( external control ) . several major reviews of the literature linking locus of control beliefs to health behaviours exist .8 , 9 richard r. lau7 has stated that this concept has been applied to the area of health for at least 25 years , and is regarded as a generalised , relatively stable aspect of personality . internal beliefs have been linked to health protective behaviour and to the desire for more information . though its predictive value must be interpreted in combination with a high value placed on health , the concept of locus of control has implications as to the design of treatment regimens to optimise patient participation . jaspars et al ( 1983 ) 10 point out that individuals are motivated by far more complex processes than simply their level of control over events . they state that one of the most fundamental drives in human behaviour is the need to make sense of the environment . this means finding some ways to explain events , and this is often achieved by searching for their causes . this leads us to the concept of causal explanations of illness see kleinman et al above .6 jaspars et al ( 1983 ) 10 also emphasise that one must distinguish between control and causality . an individual may believe that an illness is caused by something external such as a virus , but at the same time that the illness can be controlled by personal behaviour ( internal control ) . these lay beliefs and theories about illness can be made more explicit by considering the site of illness aetiology as helman ( 1984 ) 11 does in his book . he postulates that lay theories of illness place the aetiology of ill - health in one of the following sites : within the individual patient in the natural world in the social world in the supernatural world within the individual patient in the natural world in the supernatural world social and supernatural aetiologies tend to be a feature of some communities in the developing world , while natural or patient - centered explanations of illness are more common in the western developed world . fitzpatrick et al ( 1984 ) 5 claim that one of the most striking qualities of lay concepts of illness is their very complexity , and that the structure of lay beliefs is also more flexible than one might think . in the light of the foregoing , the major elements of health understanding are : the meaning of illnessthe patient 's explanations of the cause of illness factual knowledge of the disease and its course the concept of locus of control the meaning of illness the patient 's explanations of the cause of illness factual knowledge of the disease and its course the concept of locus of control as the patient 's health understanding can be seen to consist of these major elements , doctors clearly need some form of clinical strategy enabling them to quickly and effectively elicit these health beliefs . how do these aforementioned theoretical considerations of lay concepts actually relate to countries outside the developed western world , such as those of the middle east , where transcultural differences are greater ? anthropological and social studies justify the conceptual distance we make between disease and illness . where only disease is treated , care will be less satisfactory to the patient and less clinically effective than where both disease and illness are treated together . of paramount importance is the negotiation between the patient 's explanatory model and that of the doctor , leading to an agreement , especially as related to expectations and therapeutic goals . unfortunately , the traditional biomedical viewpoint of medicine has disregarded these lay concepts of illness . as mentioned above , optimal health outcomes depend on the extent of behavioural change achieved by the patient . kleinman et al6 outline a clinical strategy by putting forward a set of specific questions to that end . with regard to the applicability of such instruments of enquiry into these lay theories , however , despite these difficulties and the fact that the instruments are mostly adapted from the west , these instruments have to be re - evaluated in each cultural setting , as do other tools of measurement for the assessment of subjective health status . in oman , with its traditional arabic culture now being offered alien , 20th century health care , the dichotomy between the patients understanding and expectations and those of the physicians is broad indeed . given the continued prevalence of traditional medicine - wasm ( branding ) , shamanistic practices , and ayurvedic - like herbal and hot - vs - cold treatments - which are all much more readily acceptable , even to many urbanised omanis , there is obviously a great need for appropriately designed health education in its widest sense . that this situation applies similarly in other arab countriesis evident from a study reporting the health - beliefs and behaviours of saudi women , where it was shown that there was a lack of understanding of specific causes of various illnesses .12 to answer some of the questions posed in this article , the authors suggest appropriately designed research into these aspects of health beliefs and understanding , including an audit of the research 's effects regarding improved health outcomes . the open discussion of patient 's concerns and ideas is an essential first step to offering personally appropriate health information .5 however , the prerequisite for the patient 's health understanding is appropriate information , and if patients do not understand even the basic premises , they do nt ask questions .13 therefore , it is essential to offer an explanation of the diagnostic label as well as of any advice offered , and , furthermore , an explanation that makes sense in terms of the patient 's own world view . secondly , it is important to offer a treatment plan that matches the patient 's own concepts as well as the prevailing cultural belief system . studies have shown the difficulties attendant upon the utilisation of western models of health behaviour and beliefs in middle eastern countries14 , and it is to be expected that such cross - cultural diversities between medicine and society as exist elsewhere in the world would pose similar problems . in line with this , pendleton et al . ( 1984 ) write of patients beliefs , concerns and expectations as being major elements of health understanding and of the importance of achieving a shared understanding of the problem between the doctor and the patient . the challenge faced by health care providers is to properly identify the health beliefs and understanding of their patients , and then to offer an appropriately matched patient education and treatment regimen . on the basis of this , doctors and patients should be able to plan together the optimal management of health problems , more confident that patient acceptability will be achieved and that improved compliance , through greater understanding , will follow .
output:
|
pubmedsumm93242 | [
{
"from": "human",
"value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: it has been observed from several studies that intracanal instrumentation does not remove all the microorganisms , but use of intracanal medicament helps in removal of remaining bacteria after cleaning and shaping . enterococcus faecalis is the commonly found microorganism in failed / infected root canals of both primary and permanent teeth . this bacterium is most resistant and can survive even in 10010,000 folds in starvation stage . various medicaments / irrigants are advised for disinfecting the root canal as well as for removal of microorganisms from inaccessible sites . commonly used irrigants are chlorhexidine gluconate , ethylenediaminetetraacetic acid ( edta ) , and sodium hypochlorite . chlorhexidine is effective against both gram - positive and gram - negative microorganisms since it is a broad - spectrum antimicrobial agent . chlorhexidine gluconate is used as the gold standard antimicrobial agent with the most potent chemotherapeutic activity against many microbes . sodium hypochlorite has undesirable side effects such as tissue toxicity , allergy , and disagreeable smell and taste . because of the side effects of non - herbal medicines , herbal medicines are gaining importance . herbal medicines such as tulsi , garlic extract , triphala , curcuma longa , clove oil , neem ( azadirachta indica ) extract , aloe vera , terminalia chebula , propalis , salvia officinalis , were tried by many researchers with relative efficacy . it has antimicrobial properties and is most commonly used for treating variety of diseases such as arthritis , bronchitis , diabetes , and skin diseases . tulsi has been tested for its antimicrobial properties against escherichia coli , klebsiella , candida albicans , staphylococcus aureus , enterococcus faecalis , and proteus . it is well known that neem leaves ( a. indica or ai ) have antibacterial , antifungal , antiviral , antioxidant , anti - inflammatory , antipyretic , and analgesic effects without any side effect . ai has several active constituents like nimbidin , nimbin , nimbolide , gedunin , azadirachtin , mahmoodin , margolone , and cyclictrisulfide which are responsible for its antibacterial action . there are very few studies on the antibacterial efficacy of herbal medicines ( neem and tulsi extracts ) on e. faecalis in endodontics . hence , our study was undertaken to assess the antimicrobial efficacy of herbal medicines ( tulsi extract , neem extract ) and chlorhexidine against e. faecalis in endodontics . sixty samples were categorized into four groups with 15 samples in each : group i : chlorhexidine gluconate 2 % as positive control , group ii : neem extract , group iii : tulsi extract , and group iv : distilled water as negative control group . eighteen grams of tulsi extract ( residue 6 % w / w ) was obtained by dissolving 300 g of tulsi powder in 1 l of ethanol . neem extract ( a. indica ) was prepared by washing fresh mature neem leaves in sterilized water and adding them to 50 ml ethanol . the alcohol part of the extract was separated in a water bath to obtain 25 ml of extract . chlorhexidine gluconate 2 % solution was used as the positive control for the study and distilled water as the negative control . brain heart infusion ( bhi ) broth and agaragar diffusion method was performed to assess the antibacterial efficacy of medicaments / irrigants ( chlorhexidine , tulsi extract , neem extract , and distilled water ) . chlorhexidine gluconate , tulsi extract , neem extract , and distilled water were added to specific wells and the agar plates were incubated at 37c for 24 h. zones of inhibition were checked after incubation of each plate against e. faecalis . they were recorded and statistically assessed using one - way analysis of variance ( anova ) test and spss software version 20 ( ibm ) ( p 0.001 ) . eighteen grams of tulsi extract ( residue 6 % w / w ) was obtained by dissolving 300 g of tulsi powder in 1 l of ethanol . neem extract ( a. indica ) was prepared by washing fresh mature neem leaves in sterilized water and adding them to 50 ml ethanol . the alcohol part of the extract was separated in a water bath to obtain 25 ml of extract . chlorhexidine gluconate 2 % solution was used as the positive control for the study and distilled water as the negative control . brain heart infusion ( bhi ) broth and agar were used to maintain cultures of e. faecalis . agar diffusion method was performed to assess the antibacterial efficacy of medicaments / irrigants ( chlorhexidine , tulsi extract , neem extract , and distilled water ) . chlorhexidine gluconate , tulsi extract , neem extract , and distilled water were added to specific wells and the agar plates were incubated at 37c for 24 h. zones of inhibition were checked after incubation of each plate against e. faecalis . they were recorded and statistically assessed using one - way analysis of variance ( anova ) test and spss software version 20 ( ibm ) ( p 0.001 ) . table 1 and graph 1 show the mean values of antibacterial actions of chlorhexidine gluconate ( 2 % ) , tulsi ( 4 % ) , neem , and saline medicaments against e. faecalis in millimeters . graph 1 shows the mean inhibition zone against e. faecalis from highest to lowest : chlorhexidine ( 26.4 ) neem ( 20.5 ) tulsi ( 16.9 ) distilled water ( 0 ) . one - way a nova results indicate statistically significant mean zone of inhibition of the three groups from each other at f = 1438.276 , p 0.001 . inhibitory zone against e. faecalis by various medicaments inhibitory zone against e. faecalis by various medicamentsnowadays use of natural extracts in dentistry is gaining popularity because of their lesser side effects . e. faecalis was taken in the present study because it has been identified as the most common species in root canal diseases . the present study has shown maximum inhibitory effect against e. faecalis by chlorhexidine followed by neem extract and then tulsi extract and no effect with distilled water . found highest antimicrobial effect with 0.2 % chlorhexidine compared to herbal medicament ( morinda citrifolia , garlic and turmeric ) , whereas vinothkumar et al . found that neem extract is more effective than sodium hypochlorite 5.25 % against e. faecalis . observed in their study 100 % inhibition of bacterial growth ( e. faecalis ) with chlorhexidine followed by m. citrifolia gel , aloe vera , papin gel , and calcium hydroxide . found that neem was highly effective against e. faecalis compared to 5.25 % sodium hypochlorite and other extracts . bazvand et al . , observed that herbal medicines ( propalis , aloe vera ) were effective against e. faecalis compared to chlorhexidine . several studies showed that herbal extracts are relatively effective as irrigants and help in removal of smear layer , such as amla , neem , and triphala . zakarea et al . found that castor detergent 20 % and papain enzyme 4 % ( mcp ) has the ability to completely eradicate e. faecalis bacteria from the infected root canal in vitro in 5 min . herbal extracts ( neem , tulsi ) have shown significant inhibitory effects against e. faecalis compared to 2 % chlorhexidine gluconate . hence , these can be used alternatively as endodontic irrigants / medicaments .\noutput:\n"
},
{
"from": "agent",
"value": "background : successful endodontic treatment depends on effective disinfection and complete sealing of root canal . various medicaments are advised for disinfecting root canal , such as herbal and non - herbal medicaments . this study was done to assess the antimicrobial activity of herbal medicines ( neem extract , tulsi extract ) and chlorhexidine against enterococcus faecalis in endodontics.materials and methods : agar diffusion method was used to evaluate the antimicrobial action of different medicines . sixty samples were segregated into four groups with 15 samples in each : group i : chlorhexidine 2 % , group ii : neem extract , group iii : tulsi extract , and group iv : distilled water . the inhibition zones against e. faecalis were recorded and statistically assessed using one - way analysis of variance ( anova ) test ( p < 0.05 ) . results : significant antibacterial effect against e. faecalis was observed with chlorhexidine followed by neem extract and tulsi extract.conclusion : herbal medicines seemed to be effective against e. faecalis compared to 2 % chlorhexidine gluconate ."
}
] | ***task***
the task is to summarize an input biomedical literature in six sentences
***input***
the input is a biomedical literature
***output***
the output is the summary of an input biomedical literature in six sentences
***documentation***
***examples***
input: it has been observed from several studies that intracanal instrumentation does not remove all the microorganisms , but use of intracanal medicament helps in removal of remaining bacteria after cleaning and shaping . enterococcus faecalis is the commonly found microorganism in failed / infected root canals of both primary and permanent teeth . this bacterium is most resistant and can survive even in 10010,000 folds in starvation stage . various medicaments / irrigants are advised for disinfecting the root canal as well as for removal of microorganisms from inaccessible sites . commonly used irrigants are chlorhexidine gluconate , ethylenediaminetetraacetic acid ( edta ) , and sodium hypochlorite . chlorhexidine is effective against both gram - positive and gram - negative microorganisms since it is a broad - spectrum antimicrobial agent . chlorhexidine gluconate is used as the gold standard antimicrobial agent with the most potent chemotherapeutic activity against many microbes . sodium hypochlorite has undesirable side effects such as tissue toxicity , allergy , and disagreeable smell and taste . because of the side effects of non - herbal medicines , herbal medicines are gaining importance . herbal medicines such as tulsi , garlic extract , triphala , curcuma longa , clove oil , neem ( azadirachta indica ) extract , aloe vera , terminalia chebula , propalis , salvia officinalis , were tried by many researchers with relative efficacy . it has antimicrobial properties and is most commonly used for treating variety of diseases such as arthritis , bronchitis , diabetes , and skin diseases . tulsi has been tested for its antimicrobial properties against escherichia coli , klebsiella , candida albicans , staphylococcus aureus , enterococcus faecalis , and proteus . it is well known that neem leaves ( a. indica or ai ) have antibacterial , antifungal , antiviral , antioxidant , anti - inflammatory , antipyretic , and analgesic effects without any side effect . ai has several active constituents like nimbidin , nimbin , nimbolide , gedunin , azadirachtin , mahmoodin , margolone , and cyclictrisulfide which are responsible for its antibacterial action . there are very few studies on the antibacterial efficacy of herbal medicines ( neem and tulsi extracts ) on e. faecalis in endodontics . hence , our study was undertaken to assess the antimicrobial efficacy of herbal medicines ( tulsi extract , neem extract ) and chlorhexidine against e. faecalis in endodontics . sixty samples were categorized into four groups with 15 samples in each : group i : chlorhexidine gluconate 2 % as positive control , group ii : neem extract , group iii : tulsi extract , and group iv : distilled water as negative control group . eighteen grams of tulsi extract ( residue 6 % w / w ) was obtained by dissolving 300 g of tulsi powder in 1 l of ethanol . neem extract ( a. indica ) was prepared by washing fresh mature neem leaves in sterilized water and adding them to 50 ml ethanol . the alcohol part of the extract was separated in a water bath to obtain 25 ml of extract . chlorhexidine gluconate 2 % solution was used as the positive control for the study and distilled water as the negative control . brain heart infusion ( bhi ) broth and agaragar diffusion method was performed to assess the antibacterial efficacy of medicaments / irrigants ( chlorhexidine , tulsi extract , neem extract , and distilled water ) . chlorhexidine gluconate , tulsi extract , neem extract , and distilled water were added to specific wells and the agar plates were incubated at 37c for 24 h. zones of inhibition were checked after incubation of each plate against e. faecalis . they were recorded and statistically assessed using one - way analysis of variance ( anova ) test and spss software version 20 ( ibm ) ( p 0.001 ) . eighteen grams of tulsi extract ( residue 6 % w / w ) was obtained by dissolving 300 g of tulsi powder in 1 l of ethanol . neem extract ( a. indica ) was prepared by washing fresh mature neem leaves in sterilized water and adding them to 50 ml ethanol . the alcohol part of the extract was separated in a water bath to obtain 25 ml of extract . chlorhexidine gluconate 2 % solution was used as the positive control for the study and distilled water as the negative control . brain heart infusion ( bhi ) broth and agar were used to maintain cultures of e. faecalis . agar diffusion method was performed to assess the antibacterial efficacy of medicaments / irrigants ( chlorhexidine , tulsi extract , neem extract , and distilled water ) . chlorhexidine gluconate , tulsi extract , neem extract , and distilled water were added to specific wells and the agar plates were incubated at 37c for 24 h. zones of inhibition were checked after incubation of each plate against e. faecalis . they were recorded and statistically assessed using one - way analysis of variance ( anova ) test and spss software version 20 ( ibm ) ( p 0.001 ) . table 1 and graph 1 show the mean values of antibacterial actions of chlorhexidine gluconate ( 2 % ) , tulsi ( 4 % ) , neem , and saline medicaments against e. faecalis in millimeters . graph 1 shows the mean inhibition zone against e. faecalis from highest to lowest : chlorhexidine ( 26.4 ) neem ( 20.5 ) tulsi ( 16.9 ) distilled water ( 0 ) . one - way a nova results indicate statistically significant mean zone of inhibition of the three groups from each other at f = 1438.276 , p 0.001 . inhibitory zone against e. faecalis by various medicaments inhibitory zone against e. faecalis by various medicamentsnowadays use of natural extracts in dentistry is gaining popularity because of their lesser side effects . e. faecalis was taken in the present study because it has been identified as the most common species in root canal diseases . the present study has shown maximum inhibitory effect against e. faecalis by chlorhexidine followed by neem extract and then tulsi extract and no effect with distilled water . found highest antimicrobial effect with 0.2 % chlorhexidine compared to herbal medicament ( morinda citrifolia , garlic and turmeric ) , whereas vinothkumar et al . found that neem extract is more effective than sodium hypochlorite 5.25 % against e. faecalis . observed in their study 100 % inhibition of bacterial growth ( e. faecalis ) with chlorhexidine followed by m. citrifolia gel , aloe vera , papin gel , and calcium hydroxide . found that neem was highly effective against e. faecalis compared to 5.25 % sodium hypochlorite and other extracts . bazvand et al . , observed that herbal medicines ( propalis , aloe vera ) were effective against e. faecalis compared to chlorhexidine . several studies showed that herbal extracts are relatively effective as irrigants and help in removal of smear layer , such as amla , neem , and triphala . zakarea et al . found that castor detergent 20 % and papain enzyme 4 % ( mcp ) has the ability to completely eradicate e. faecalis bacteria from the infected root canal in vitro in 5 min . herbal extracts ( neem , tulsi ) have shown significant inhibitory effects against e. faecalis compared to 2 % chlorhexidine gluconate . hence , these can be used alternatively as endodontic irrigants / medicaments .
output:
|
pubmedsumm103199 | [
{
"from": "human",
"value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: we administered questionnaires to gather information about standard knowledge , attitudes , and practices related to malaria and collected blood for testing with microscopy , rdt , and pcr ( technical appendix ) . specific , histidine - rich protein - 2 ( hrp - 2 ) / pan - plasmodium lactate dehydrogenase ( pldh ) rdt ( sd bioline malaria ag p.f / pan [ p. falciparum or other plasmodium species ] ; standard diagnostics , gyeonggi - do , south korea ) . we surveyed 631 children with a mean age of 2.4 years ( table 1 ) . bed net coverage was high ( 91.6 % ) and met targets for 2014 ( 5 ) . only 5 households ( 0.8 % of children surveyed ) reported use of indoor residual spraying . of the 3 districts , isingiro had the highest proportion of children living in the lowest wealth quartile ( 41.8 % ) and in households with thatched or leaf roofing ( 7.3 % ) ; this district also had the lowest consistent bed net use ( 85.7 % ) ( technical appendix table 1 ) . * falciparum infection only ; pf + , positive for p. falciparum monoinfection only ; pf / pan + , positive for p. falciparum monoinfection or p. falciparum mixed infection ; rdt , rapid diagnostic test ; mixed pf / pm , positive for p. falciparum monoinfection or p. malariae mixed infection . falciparum monoinfections , 7 ( 31.8 % ) were p. malariae monoinfections , 3 ( 13.6 % ) were p.sixteen ( 72.7 % ) of 22 blood - smear readings correlated directly with pcr results ( technical appendix table 2 ) . malaria parasite prevalence was 2-fold higher by rdt than by microscopy ( 6.7 % vs. 3.5 % ; table 1 ) . a comparison of the diagnostic performance of rdt and microscopy ( uncorrected by pcr ) indicates that agreement of results from these methods was high ( 94 % ) ; however , agreement was poor in detecting nonfalciparum infections ( = 0.15 ) compared with detecting overall infection ( = 0.41 ) and p. falciparum infection ( = 0.33 ) ( table 2 ) . pcr detected parasite dna in 53.7 % ( 22/41 ) of rdt - positive samples ; of these , 55 % ( 12/22 ) correlated with the correct rdt band pattern interpretation ( technical appendix table 2 ) . approximately one third ( 8/22 ) of children with microscopy - positive cultures had negative rdt results ( technical appendix table 3 ) . of these 8 discordant cases , 5 harbored pcr - confirmed p. malariae or p. ovale monoinfections ; all had parasite densities 1,060 / l ( technical appendix table 2 ) . conversely , two thirds ( 28/42 ) of rdt - positive samples were negative by microscopy . of the 28 children with rdt - positive and microscopy - negative samples , 8 ( 28.6 % ) had a malaria infection within the previous month ; 4 of those had detectable parasite dna . our findings indicate that strides in the control of p. falciparum malaria have continued in uganda . compared with data from 2010 , p. falciparum prevalence by microscopy had a 4 - and 5-fold decrease in urban and rural villages , respectively ( 3 ) . our estimates are consistent with prevalence estimates from 2009 ( 12 % ) and 20142015 ( 4 % ) ( 1,6 ) . in our study , falciparum species , particularly p. malariae , in contrast to the 1.2 % non p . in addition , 1 p. vivax monoinfection was detected by pcr in isingiro , confirming the continued presence of all 4 major species in uganda ( technical appendix table 2 ) ( 1 ) . furthermore , although most p. malariae cases were from isingiro , recent studies in other regions of uganda ( i.e. , northern and eastern ) have also reported a rise in nonone possible reason for the nearly equivalent prevalence of asymptomatic p. falciparum and non p . falciparum infections is the influence of seasonal fluctuations in species prevalence ; for example , p. malariae prevalence has been higher during the dry season in west africa ( 10 ) . another possibility is that the use of p. falciparum based rdts , which are advantageous because of low infrastructure costs and high prevalence of this species in uganda , has enabled nonwhat is apparent is that pldh / hrp - 2based rdts may not be the most sensitive diagnostic method to determine true prevalence in the future . in our study , rdt was negative in all 3 microscopy - identified p. ovale and in 3 of 7 p. malariae monoinfections , a finding that may be in part attributable to these species low parasite densities ( range 391,057 / l ) . identifying p. malariae and p. ovale infectionsis critical because p. malariae has been associated with chronic infections that can persist for years , including a chronic nephrotic syndrome that , once established , is unresponsive to treatment ( 10 ) . because these species have milder symptoms and lower parasite prevalence than p. falciparum , infections can remain undetected for extended periods , enabling persons to serve as reservoirs for ongoing transmission ( 2 ) . these species may transmit gametocytes more efficiently at low parasite densities ; a recent study found increased p. falciparum gametocyte production in the setting of mixed p. malariae infections ( 11 ) . in our study , 30 % of non p . finally , on the therapeutic side , studies have shown failure of parasite clearance after artemisinin - based combination therapy in nonp . ovale and p. vivax also form hypnozoites in the liver , and safe treatment with a 14 - day course of primaquine is necessary to clear parasitemia . six children in our study harbored p. ovale or p. vivax infections . from a malaria control perspective , the performance of the pldh / hrp - 2based rdt was suboptimal in our data , indicating a need for accurate diagnostic methods aimed at detecting plasmodium infections in this region . a diagnostic method that has been effective in resource - constrained settings is loop - mediated isothermal amplification ( lamp ) , which affords higher sensitivity in detecting low - level parasitemia , especially p. malariae infections that tend to exhibit lower parasite densities than p. falciparum and p. vivax ( 13 ) . in a 2013 rural uganda study , the sensitivity of lamp was 1.8-fold greater than microscopy , comparable to pcr ( 14 ) . wide - scale application of a field - friendly technique such as lamp might be possible in southwestern uganda , where asymptomatic persons might have low - density malaria infections that persist during the low malaria transmission season , enabling these persons to serve as reservoirs for ongoing transmission and disease ( 15 ) . effective methods for detecting and treating these infections are essential for controlling and eliminating malaria . detailed methods and tables describing risk factors for asymptomatic malaria infections and results of pcr - corrected samples found to be positive by microscopy and rapid diagnostic test .\noutput:\n"
},
{
"from": "agent",
"value": "a survey of asymptomatic children in uganda showed plasmodium malariae and p. falciparum parasites in 45 % and 55 % of microscopy - positive samples , respectively . although 36 % of microscopy - positive samples were negative by rapid diagnostic test , 75 % showed p. malariae or p. ovale parasites by pcr , indicating that routine diagnostic testing misses many non p . falciparum malarial infections ."
}
] | ***task***
the task is to summarize an input biomedical literature in six sentences
***input***
the input is a biomedical literature
***output***
the output is the summary of an input biomedical literature in six sentences
***documentation***
***examples***
input: we administered questionnaires to gather information about standard knowledge , attitudes , and practices related to malaria and collected blood for testing with microscopy , rdt , and pcr ( technical appendix ) . specific , histidine - rich protein - 2 ( hrp - 2 ) / pan - plasmodium lactate dehydrogenase ( pldh ) rdt ( sd bioline malaria ag p.f / pan [ p. falciparum or other plasmodium species ] ; standard diagnostics , gyeonggi - do , south korea ) . we surveyed 631 children with a mean age of 2.4 years ( table 1 ) . bed net coverage was high ( 91.6 % ) and met targets for 2014 ( 5 ) . only 5 households ( 0.8 % of children surveyed ) reported use of indoor residual spraying . of the 3 districts , isingiro had the highest proportion of children living in the lowest wealth quartile ( 41.8 % ) and in households with thatched or leaf roofing ( 7.3 % ) ; this district also had the lowest consistent bed net use ( 85.7 % ) ( technical appendix table 1 ) . * falciparum infection only ; pf + , positive for p. falciparum monoinfection only ; pf / pan + , positive for p. falciparum monoinfection or p. falciparum mixed infection ; rdt , rapid diagnostic test ; mixed pf / pm , positive for p. falciparum monoinfection or p. malariae mixed infection . falciparum monoinfections , 7 ( 31.8 % ) were p. malariae monoinfections , 3 ( 13.6 % ) were p.sixteen ( 72.7 % ) of 22 blood - smear readings correlated directly with pcr results ( technical appendix table 2 ) . malaria parasite prevalence was 2-fold higher by rdt than by microscopy ( 6.7 % vs. 3.5 % ; table 1 ) . a comparison of the diagnostic performance of rdt and microscopy ( uncorrected by pcr ) indicates that agreement of results from these methods was high ( 94 % ) ; however , agreement was poor in detecting nonfalciparum infections ( = 0.15 ) compared with detecting overall infection ( = 0.41 ) and p. falciparum infection ( = 0.33 ) ( table 2 ) . pcr detected parasite dna in 53.7 % ( 22/41 ) of rdt - positive samples ; of these , 55 % ( 12/22 ) correlated with the correct rdt band pattern interpretation ( technical appendix table 2 ) . approximately one third ( 8/22 ) of children with microscopy - positive cultures had negative rdt results ( technical appendix table 3 ) . of these 8 discordant cases , 5 harbored pcr - confirmed p. malariae or p. ovale monoinfections ; all had parasite densities 1,060 / l ( technical appendix table 2 ) . conversely , two thirds ( 28/42 ) of rdt - positive samples were negative by microscopy . of the 28 children with rdt - positive and microscopy - negative samples , 8 ( 28.6 % ) had a malaria infection within the previous month ; 4 of those had detectable parasite dna . our findings indicate that strides in the control of p. falciparum malaria have continued in uganda . compared with data from 2010 , p. falciparum prevalence by microscopy had a 4 - and 5-fold decrease in urban and rural villages , respectively ( 3 ) . our estimates are consistent with prevalence estimates from 2009 ( 12 % ) and 20142015 ( 4 % ) ( 1,6 ) . in our study , falciparum species , particularly p. malariae , in contrast to the 1.2 % non p . in addition , 1 p. vivax monoinfection was detected by pcr in isingiro , confirming the continued presence of all 4 major species in uganda ( technical appendix table 2 ) ( 1 ) . furthermore , although most p. malariae cases were from isingiro , recent studies in other regions of uganda ( i.e. , northern and eastern ) have also reported a rise in nonone possible reason for the nearly equivalent prevalence of asymptomatic p. falciparum and non p . falciparum infections is the influence of seasonal fluctuations in species prevalence ; for example , p. malariae prevalence has been higher during the dry season in west africa ( 10 ) . another possibility is that the use of p. falciparum based rdts , which are advantageous because of low infrastructure costs and high prevalence of this species in uganda , has enabled nonwhat is apparent is that pldh / hrp - 2based rdts may not be the most sensitive diagnostic method to determine true prevalence in the future . in our study , rdt was negative in all 3 microscopy - identified p. ovale and in 3 of 7 p. malariae monoinfections , a finding that may be in part attributable to these species low parasite densities ( range 391,057 / l ) . identifying p. malariae and p. ovale infectionsis critical because p. malariae has been associated with chronic infections that can persist for years , including a chronic nephrotic syndrome that , once established , is unresponsive to treatment ( 10 ) . because these species have milder symptoms and lower parasite prevalence than p. falciparum , infections can remain undetected for extended periods , enabling persons to serve as reservoirs for ongoing transmission ( 2 ) . these species may transmit gametocytes more efficiently at low parasite densities ; a recent study found increased p. falciparum gametocyte production in the setting of mixed p. malariae infections ( 11 ) . in our study , 30 % of non p . finally , on the therapeutic side , studies have shown failure of parasite clearance after artemisinin - based combination therapy in nonp . ovale and p. vivax also form hypnozoites in the liver , and safe treatment with a 14 - day course of primaquine is necessary to clear parasitemia . six children in our study harbored p. ovale or p. vivax infections . from a malaria control perspective , the performance of the pldh / hrp - 2based rdt was suboptimal in our data , indicating a need for accurate diagnostic methods aimed at detecting plasmodium infections in this region . a diagnostic method that has been effective in resource - constrained settings is loop - mediated isothermal amplification ( lamp ) , which affords higher sensitivity in detecting low - level parasitemia , especially p. malariae infections that tend to exhibit lower parasite densities than p. falciparum and p. vivax ( 13 ) . in a 2013 rural uganda study , the sensitivity of lamp was 1.8-fold greater than microscopy , comparable to pcr ( 14 ) . wide - scale application of a field - friendly technique such as lamp might be possible in southwestern uganda , where asymptomatic persons might have low - density malaria infections that persist during the low malaria transmission season , enabling these persons to serve as reservoirs for ongoing transmission and disease ( 15 ) . effective methods for detecting and treating these infections are essential for controlling and eliminating malaria . detailed methods and tables describing risk factors for asymptomatic malaria infections and results of pcr - corrected samples found to be positive by microscopy and rapid diagnostic test .
output:
|
pubmedsumm58858 | [{"from":"human","value":"***task***\nthe task is to summarize an input biomedical literature in six(...TRUNCATED) | "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***(...TRUNCATED) |
pubmedsumm68801 | [{"from":"human","value":"***task***\nthe task is to summarize an input biomedical literature in six(...TRUNCATED) | "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***(...TRUNCATED) |
pubmedsumm40803 | [{"from":"human","value":"***task***\nthe task is to summarize an input biomedical literature in six(...TRUNCATED) | "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***(...TRUNCATED) |
pubmedsumm53535 | [{"from":"human","value":"***task***\nthe task is to summarize an input biomedical literature in six(...TRUNCATED) | "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***(...TRUNCATED) |
pubmedsumm36000 | [{"from":"human","value":"***task***\nthe task is to summarize an input biomedical literature in six(...TRUNCATED) | "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***(...TRUNCATED) |
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