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\title{Happy Hysterectomy? Quality of Life after in Rural Women of Central India}
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             \author[1]{Dr. Priyakshi  Chaudhry}

             \author[2]{Dr. Deepti  Shrivasatva}

             \affil[1]{  JNMC (Jawaharlal Nehru Medical College)}

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\date{\small \em Received: 12 December 2014 Accepted: 2 January 2015 Published: 15 January 2015}

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\begin{abstract}
        


 Hysterectomy Is One Of The Most Common Gynaecological Operation Performed  Globally With An Incidence Of Approximately 30% In Women >60 Yrs. Of Age.   Studies  Have Shown That Most Women Received Hysterectomy Due To Disabling  Symptoms Such As Menstrual Pain, Menorrhagia, Unexplained Uterine Bleeding And Chronic  Pelvic Pain Related With Non-Malignant Pathologies Like Simple Endometrial Hyperplasia,  Fibroid, Prolapse. There Are So Many Management Modalities To Cure These Symptoms, As  These Have An Adverse Effect On A Woman?s Quality Of Life. Most Women Reported A  Reduction In Physical Symptoms And Pain And An Increase In Health Perceptions After  Hysterectomy. 2  But In Rural Set Up Hysterectomy Is Still A Treatment Of Choice Even For All  These Benign Pathologies.In This Study We Tried To Assess Qol After Hysterectomy For These  Conditions. 

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
ysterectomy Is One Of The Most Common Gynaecological Operation Performed Globally With An Incidence Of Approximately 30\% In Women >60 Yrs. Of Age. \hyperref[b0]{1} Studies Have Shown That Most Women Received Hysterectomy Due To Disabling Symptoms Such As Menstrual Pain, Menorrhagia, Unexplained Uterine Bleeding And Chronic Pelvic Pain Related With Non-Malignant Pathologies Like Simple Endometrial Hyperplasia, Fibroid, Prolapse. There Are So Many Management Modalities To Cure These Symptoms, As These Have An Adverse Effect On A Woman's Quality Of Life. Most Women Reported A Reduction In Physical Symptoms And Pain And An Increase In Health Perceptions After Hysterectomy. \hyperref[b2]{2} But In Rural Set Up Hysterectomy Is Still A Treatment Of Choice Even For All These Benign Pathologies.In This Study We Tried To Assess Qol After Hysterectomy For These Conditions.     
\section[{II. Aims and Objectives}]{II. Aims and Objectives}\begin{figure}[htbp]
\noindent\textbf{No} \par 
\begin{longtable}{P{0.17586206896551723\textwidth}P{0.1343390804597701\textwidth}P{0.12945402298850575\textwidth}P{0.14899425287356322\textwidth}P{0.13922413793103447\textwidth}P{0.12212643678160919\textwidth}}
\tabcellsep Pre Op\tabcellsep Day\tabcellsep Day 14\tabcellsep 6 Weeks\tabcellsep 3 Months\\
\tabcellsep (N=300)\tabcellsep 7(N=300)\tabcellsep (N=258)\tabcellsep (N=220)\tabcellsep (N=183)\\
Mobility\tabcellsep 30(10\%)\tabcellsep 60(20\%)\tabcellsep 30(11.7\%)\tabcellsep 15(6.6\%)\tabcellsep 0(0\%)\\
Self Care\tabcellsep 30(10\%)\tabcellsep 60(20\%)\tabcellsep 46(17.6\%)\tabcellsep 22(10\%)\tabcellsep 9(4\%)\\
Usual Activity\tabcellsep 30(10\%)\tabcellsep 105(35\%)\tabcellsep 46(17.6\%)\tabcellsep 22(10\%)\tabcellsep 15(8.1\%)\\
Pain And Discomfort\tabcellsep 120(40\%)\tabcellsep 135(45\%)\tabcellsep 23(8.8\%)\tabcellsep 10(4.6\%)\tabcellsep 3(1.6\%)\\
Anxiety And Depression\tabcellsep 120(40\%)\tabcellsep 60(20\%)\tabcellsep 14(5.8\%)\tabcellsep 12(5.3\%)\tabcellsep 9(4\%)\end{longtable} \par
 
\caption{\label{tab_2}Table No 4}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.48429625076828514\textwidth}P{0.344980536775251\textwidth}P{0.009926244622003687\textwidth}P{0.010796967834460151\textwidth}}
Depression, Or Neither.At 24 Months, Women With Pain\tabcellsep \tabcellsep \tabcellsep \\
And Depression Had Reduced Prevalence Of Pelvic\tabcellsep \tabcellsep \tabcellsep \\
Pain (96.7\% Decreased To 19.4\%), Limited Physical\tabcellsep \tabcellsep \tabcellsep \\
Function (66.1\% To 34.3\%), Impaired Mental Health\tabcellsep \tabcellsep \tabcellsep \\
(93.3\% To 38.1\%), And Limited Social Function (41.1\%\tabcellsep \tabcellsep \tabcellsep \\
To 15.1\%). Women With Pain Only Improved In Pelvic\tabcellsep \tabcellsep \tabcellsep \\
Pain (95.1\% To 9.3\%) And Limited Activity Level (74.3\%\tabcellsep \tabcellsep \tabcellsep \\
To 24.2\%). The Group With Depression Only Had\tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{2}{l}{Improvement In Impaired Mental Health (85.1\% To Table No 5 : Visual Analogue Scale 33.1\%). Dyspareunia Decreased In All Groups.}\tabcellsep \tabcellsep \\
Vas Compared With Women Who Had Neither Pain Nor Pre Op(N=300) Day\tabcellsep Day 14\tabcellsep 6 Weeks\tabcellsep 3 Months\\
7(N=300) Depression, Women With Depression And Pain Had 3\tabcellsep (N=258)\tabcellsep (N=220)\tabcellsep (N=183)\\
0-20 To 5 Times The Odds Of Continued Impaired Quality Of 120(40\%) 45(15\%)\tabcellsep 30(11.7\%)\tabcellsep 22(10\%)\tabcellsep 4(2.4\%)\\
20-40 Life: Odds Ratio (Or) 2.73, 95\% Confidence Interval (Ci) 30(10\%) 75(25\%)\tabcellsep 61(23.5\%)\tabcellsep 15(6.6\%)\tabcellsep 15(8.1\%)\\
40-60 1.78-4.19 For Limited Physical Function; Or 3.41, 95\% Ci 45(15\%) 90(30\%)\tabcellsep 61(23.5\%)\tabcellsep 22(10\%)\tabcellsep 15(8.1\%)\\
60-80 2.13-5.46 For Impaired Mental Health; Or 5.76, 95\% Ci 60(20\%) 60(20\%)\tabcellsep 61(23.5\%)\tabcellsep 88(40\%)\tabcellsep 44(24.3\%)\\
80-100 2.79-11.87 For Limited Social Function; Or 4.91, 95\% Ci 45(15\%) 30(10\%)\tabcellsep 45(17.6\%)\tabcellsep 73(33.3\%)\tabcellsep 104(57.1\%)\\
V. Disscussion 2.63-9.16 For Continued Pelvic Pain; And Or 2.41, 95\% Ci 1.26-4.62 For Dyspareunia. And Concluded That Women With Pelvic Pain And Depression Fare Less Well 24 Months After Hysterectomy Than Women Who Have Either Disorder Alone Or Neither. Nevertheless, These Women Improve Substantially Over Their Preoperative Baseline In All The Quality Of Life And Sexual Function Areas Assessed. 4 Quality Of Life Was Measured In 348 Women Attending Gynaecological Outpatients Using Euroqol 5d. . Quality Of Life Was Then Measured In 131 Women Before And After Hysterectomy. Of The Outpatient Group 50\% Of The Women Reported Problems With Pain And 40\% With Depression. Women Undergoing Hysterectomy Reported Similar Preoperative Levels Of Pain And Depression. However, 6 Months Postoperatively There Were Significantly Fewer Women Complaining Of Both\tabcellsep \multicolumn{3}{l}{Surgery. Women In Employment, With More Years Of Education And Previous Blood Transfusion Had High Mcs Scores After Surgery. Conclusion: The Overall Self-Rated Health Status And Pcs Showed Significant Improvements After Hysterectomy. Having Had A Blood Transfusion, Being Educated And Employed Were Positively Associated With Mcs Score After Surgery. These Findings Are Vital For Preoperative Counselling For Women Undergoing Hysterectomy. 2 Taipale K Et Al Conducted A Prospective Observational Study At University Referral Hospital In Helsinki.A Total Of 337 Women Entering For Routine Hysterectomy Due To A Benign Disease (210 Benign Uterine Or Ovarian Cause, 20 Endometriosis, 51 Uterovaginal Prolapse, 56 Menorrhagia) Were Taken And The Result Came Out Were Mean [Standard Deviation (Sd)] Hrqol Score (On A 0-1 Scale) In The Whole Group Improved From The Preoperative Of 0.905}\\
\tabcellsep \multicolumn{3}{l}{(0.073) To 0.925 (0.077) Six Months After The Operation}\\
\tabcellsep \multicolumn{3}{l}{(P < 0.001). The Largest Mean (Sd) Improvement Was}\\
Within 6 Weeks After Hysterectomy, Patients Had Returned To Normal Health And Bodily Functions. Symptom Relief After Hysterectomy Is Associated With A Marked Improvement In Hrqol.\tabcellsep \multicolumn{3}{l}{Seen In Patients With Endometriosis [0.048 (0.067)] Followed By Those With Menorrhagia [0.024 (0.054)], Benign Uterine Or Ovarian Cause [0.018 (0.071)], And Prolapse [0.017 (0.055)]. In The Whole Group, The Intervention Produced A Mean (Sd) Of 0.222 (1.270)}\\
Y.L Yang Et Al Had Done A Prospective Follow-\tabcellsep \multicolumn{3}{l}{Qalys At Mean (Sd) Direct Hospital Cost Of Euro3, 138}\\
Up Study Which Recruited 38 Women (Age Range, 33-\tabcellsep \multicolumn{3}{l}{(2,098). Consequently, The Cost Per Qaly Gained In The}\\
52 Years) Who Underwent Abdominal Hysterectomy For\tabcellsep \multicolumn{3}{l}{Whole Group Was Euro14,135 Varying From Euro3,720}\\
Non-Malignant Causes In University Of Taiwan The\tabcellsep \multicolumn{3}{l}{To 31,570 In The Disease Groups.And Concluded That}\\
Result Showed That Patients' Attitudes Toward\tabcellsep \multicolumn{3}{l}{The Cost Per Quality Gained For Hysterectomy For}\\
Hysterectomy And Subsequent Sexual Activity Were\tabcellsep \multicolumn{3}{l}{Benign Uterine Disorders Is Strongly Dependent on The}\\
Influenced By The Surgery. All Patients Showed\tabcellsep \multicolumn{2}{l}{Indication For Surgery. 3}\tabcellsep \\
Significant Improvements In The Physical Component\tabcellsep \multicolumn{3}{l}{Hartmann Conducted Cohort Study of 1249}\\
Summary (Pcs) Of Sf-36 (Mean, 42.1-51.0), But There\tabcellsep \multicolumn{3}{l}{Patients, Participants Were Interviewed, Before Surgery}\\
Was No Significant Difference In The Mental Component\tabcellsep \multicolumn{3}{l}{And At 5 Intervals After, Regarding Pelvic Pain,}\\
Summary (Mcs). The Significant Improvements Were\tabcellsep \multicolumn{3}{l}{Depression, Quality of Life, And Sexual Function. We}\\
Found From The Five Repeated Measurements Of The\tabcellsep \multicolumn{3}{l}{Compared Quality Of Life And Sexual Function At 6 And}\\
Self-Rated Health Status (Mean, 6.0-7.3). Haemoglobin\tabcellsep \multicolumn{3}{l}{24 Months Among Women With Preoperative Pelvic Pain}\\
Level Was The Most Important Predictor Of Hrqol Before\tabcellsep \multicolumn{3}{l}{Alone, Depression Alone, Both Pelvic Pain And}\end{longtable} \par
 
\caption{\label{tab_3}}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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