Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management

Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.     

Ergonomic considerations in natural orifice translumenal endoscopic surgery (NOTES): a case study

Surgical technique evolved from traditional open surgery to laparoscopic surgery, offering patients reduced pain and quick recovery. Recently, a new approach called natural orifice translumenal endoscopic surgery (NOTES) has emerged. In NOTES, procedures may be transvaginal, transgastric, or transrectal or transesophageal. NOTES procedures present new ergonomic challenges to surgeons due to visualization and tissue manipulation challenges. An ergonomic analysis of NOTES cholecystectomy was conducted. As there is currently no standardization for performing NOTES, this analysis presents the results as a case study. Results showed NOTES procedures impose unique limitations on the surgeon's ability to perform surgical tasks autonomously, requiring collaboration and coordination amongst the surgical team members.     

Medicalization and the Market Economy: Constructing Cosmetic Surgery as Consumable Health Care

Throughout the last decade, cosmetic surgery has been a steadily growing industry. According to the American Society of Plastic Surgeons, in 2007, consumers spent 12.4 billion dollars on both surgical and minimally-invasive cosmetic procedures. This article draws upon in-depth interviews with individuals who have had cosmetic surgery, specifically focusing on how they construct and articulate their experiences in economic terms. Findings suggest that individuals characterize cosmetic surgery as a preventative or health-maintenance practice and often weigh the potential costs of surgery against other consumable goods they may wish to purchase. Additionally, there tends to be recognition that the services purchased are luxury items that are evaluated along the lines of cost and quality, supporting prior assertions that cosmetic surgery as a practice and an industry is qualitatively different from more traditional modes of health care. Finally, this article explores how the interaction between patient and physician, particularly from the patient's perspective, is increasingly transformed into an exchange between a consumer and service-provider.     

Buying and selling breasts: cosmetic surgery,beauty treatments and risk

This paper is concerned with the ways in which women are sold cosmetic surgery, and how they ‘make sense of’ their own participation in this market. It draws on ongoing ethnographic research to explore how a group of young women who have paid for breast augmentation surgery narrate their decision to undergo surgery, the choices they make as consumers of cosmetic surgery, and their experience of having surgery. These narratives are compared with the ways in which breast augmentation surgery is sold to them by the companies and medical professionals involved in the rapidly expanding market for breast augmentation surgery. The paper shows how this particular group of young white working‐class women shift between imagining the breast augmentation operation as a simple beauty treatment and recognizing it as medical surgery, and explores how this shapes their perceptions of the risks and benefits of buying new breasts. It also shows how those who market such procedures manage and manipulate perceptions of the process of breast augmentation surgery and the risks that attend on it in an effort to encourage this form of consumption.     

Surgery,Slavery and the Circulation of Knowledge in the French Caribbean

Over the course of the eighteenth century, the reputation of surgery in France dramatically improved. Similarly, surgery thrived in the French Atlantic. Surgical expertise was a necessity in colonies that served as naval bases. Moreover, the violent brutality engendered by colonial slaveholding meant that surgeons dominated health care in France's Atlantic empire. As a result of these factors, Europeans as well as white Creoles practised surgery. Degreed practitioners offered their services in cities, while plantation surgeons and managers held the knives on the plantations. Enslaved men and women practised surgery too. Some tended their fellow slaves in the plantation hospitals and cabins, while others performed surgical procedures in urban areas. Due to the practical need for surgery in colonial and slaveholding environments and the lively exchange of surgical information, the surgical craft flourished in the French Caribbean and was practised by both free and enslaved persons.     

The gendered contours of North Korean Migration: sexualized bodies and the violence of phenotypical normalization in South Korea

This article examines the gendered and sexualized contours of North Korean experiences in South Korea at a time when nearly 70% of the North Korean emigrants are women. South Korean television shows – e.g. reality programs – and marriage matchmaking organizations seek to portray North Korean women in a ‘positive’ way to the South Korean public, although, as this article will illustrate, these representations are of a very particular, sexualized kind. These representations are sometimes negative, and there is stigma attached to North Korean women, in which South Koreans assume, for example, that they are victims of human trafficking or that they have had relations with Chinese men during their migration. Furthermore, poor nutrition and other forms of structural violence in North Korea have molded North Korean bodies; there are often physical disparities between North and South Koreans. In South Korean society where short height is viewed as undesirable and where idealized, surgical notions of beauty dominate, the violence of gendered phenotypical normalization mark North Korean bodies as smaller, foreign, and strange. Based on ethnographic research in South Korea, this article argues that these gendered contours of North Korean migration amount to a different sort of structural violence in South Korea.     

Special Elections and the Growth of Women's Representation in the U.S. House of Representatives

High incumbency return rates slow the pace at which underrepresented groups can increase their ratio of membership in the U.S. House of Representatives. We document the fact that the special election process provides an important source of congressional turnover which is particularly advantageous to women seeking to win election to the House. In fact, we document that over one-third of all women entering the House during the decade studied entered through special elections. If women are to increase their proportion in the House of Representatives, either the size of the House needs to be increased or seates held by men must be replaced with seats held by women. As there is little chance that the size of the House will increase, women will have to replace men. This is, of course, happening, but at a very slow rate. Though many factors affect women's recruitment into the House, part of the problem is that incumbents, currently 89.2% men, seem to turn over at a very slow rate. In the 1988 election (a high point for incumbent return rates), only 7.6% of the Congress was new. Retention, it is argued, creates few opportunities for women, and other underrepresented groups, to enter Congress. However, conclusions about the relationship between turnover and the election of women based on biannual elections alone are incomplete because such explanations do not account for the influence of special elections.     

Sex role perceptions and the abortion decision

This paper is concerned with the relationship between two aspects of self‐concept—perception of gender role and perceived competence—and the decision to have an abortion as a solution to a problem pregnancy. It was hypothesized that (1) there will be a positive relationship between the choice of abortion and perceived competence, and (2) there will be a negative relationship between the choice of abortion and the degree to which female role is perceived traditionally. The data came from a broader study conducted throughout Michigan during 1974–75. The study group consisted of 921 women who chose to have an abortion. A comparison group included 360 women with problem pregnancies who chose to keep their child. Data were obtained through an anonymous questionnaire which included the two relevant indices. The abortion group was found to be significantly higher in perceived competence than those who chose to keep the child, and the black abortion group was significantly less traditional than the black group which chose to keep the child. These relationships remained significant when age was controlled. Race did not affect subjects' degree of perceived competence, but blacks were more traditional than whites regardless of decision.     

Effectiveness of couples treatment for spouse abuse

Despite its controversy, carefully conceptualized and delivered couples treatment appears to be at least as effective as traditional treatment for domestic violence, and preliminary data suggests that it does not place women at greater risk for injury. However, the body of research on which these conclusions rest is sparse. Only six experimental studies have been done, each using different eligibility criteria, outcome measures, and treatment approaches. Thus, further study of this modality is warranted. Marriage and family therapists have an important part to play in continuing to develop and test innovative ways of helping couples end violence and improve their relationships--an endeavor that promises to improve the quality of the partners' lives as well as those of their children.     

Debunking misconceptions about weight loss surgery

The recent and steady rise in the U.S. obesity index has resulted in a consumer-driven market for more effective treatment interventions for the morbidly obese population. Given the relatively poor outcomes associated with traditional approaches for treating obesity, such as diet programs, behavioral modification, and pharmacotherapy, weight loss surgical procedures represent a safe and effective option for those who meet selection criteria. To provide optimal treatment and consumer education, psychiatric nurses need to be well informed about the psychological and physiological aspects of these surgical procedures. This article clarifies six common misconceptions related to weight loss surgery.     

Unsanctioned births in China

This study hypothesizes that "unsanctioned" births (beyond the limit authorized by the government) in China are more likely among couples who have strong traditional fertility norms and less likely among couples who adopt new family planning norms. The theoretical framework is based on cultural conflict theory as developed by Sellin. Data are obtained from 6654 ever married women aged under 49 years from the 1987 In-Depth Fertility Survey for Guangdong province. Over 30% of the sample were married before 20 years of age. 20% had 1 child, 26.7% had 2 children, about 23% had 3 children, 13.9% had 4 children, and under 10% had 5 or more children. The average number of living children was 2.5. Findings reveal that socioeconomic status was significantly related to unsanctioned births; they were more common in less developed areas and among women of lower socioeconomic status (SES). Persons living in areas with a high monetary contribution per person in family planning efforts at the county level were less likely to have unsanctioned births. Women who lived in urban areas, worked in state enterprises, and had parents with high educational status were less likely to have unsanctioned births. They were more likely among women who married at an early age, lived with parents after the marriage, had female living children, and had failed pregnancies. They were also more likely among women who had arranged marriages, a traditional desire for large family sizes, an early marriage ideal, and a preference for sons. Knowledge of family planning and greater use of abortion were related to a lower incidence of unsanctioned births. Women who talked with their husbands about their family size desires were less likely to have unsanctioned births. Parental educational attainment only had an influence among rural women. Variables impacted on fertility differently in urban and rural areas.     

The added value of virtual reality technology and force feedback for surgical training simulators

Laparoscopic surgery requires more specialized training of the surgeons than traditional open surgery. The Virtual Basic Laparoscopic Surgical Trainer (VBLaST) is being developed as a virtual version of the Fundamentals of Laparoscopic Skills (FLS) trainer. This study assessed the current haptic and virtual reality (VR) technology of a virtual peg transfer task of the VBLaST, based on the subjective preference of surgeons and their objective task performance measures. Twenty-one surgical residents, fellows and attendings performed a peg-transfer task in the FLS and the VBLaST. Each subject performed 10 trials on each simulator. Results showed that subjects performed significantly better on the FLS than on the VBLaST. Subjects showed a significant learning effect on both simulators, but with an accelerated improvement on the VBLaST. Even so, 81% of the subjects preferred the FLS over the VBLaST for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the haptic interface. Despite the subjective preference for the physical simulator, the performance results indicate an added value of VR and haptics in surgical training, which is expected to be demonstrated in more surgically relevant tasks such as suturing and knot-tying.     

Interview. Maria Isabal Plata,executive director of Profamilia,talks to Caroline Sweetman about the work of the organisation in Colombia

In this interview, Maria Isabal Plata discusses the work of the nongovernmental organization Profamilia in Colombia. Since its founding in 1965, Profamilia has assumed direct and indirect responsibility for nearly 70% of family planning (FP) and reproductive health activities in the country. These activities are complemented by a legal service program, an evaluation and research program, and a documentation center. In Colombia, women gained equal rights under the law in 1974 and a constitutional prohibition on discrimination in 1991, but sex stereotypes still dictate responsibility for family chores. When women realize their economic and social rights, poverty and inequalities will diminish. Thus, it is crucial to safeguard reproductive and sexual rights and ban violence against women. The traditional concept of family forces a disregard for the rights of family members and allows societies to oppose the interests of women. The aftermath of the UN Fourth Women's Conference in Colombia will be to work towards achieving full citizenship for women and democratic societies. The experience women's groups had at the conference has created a situation in which grassroots organizations can consider beginning to work with development organizations to achieve some of these goals.     

The provision of education and opportunities for future employment for pregnant schoolgirls and schoolgirl mothers in the UK

This paper will report on the results of three recent surveys into educational provision for pregnant schoolgirls and schoolgirl mothers: these surveys have examined the position in England and Wales, and for the first time, in Scotland and in Northern Ireland. As well as reporting what is currently available for young mothers in the UK, the paper will raise issues of entitlement to a full education for these young women, issues of equal opportunity and issues of access. It will seek to point to questions that need to be considered in terms of policy for young mothers and their children. The political debate in the UK has recently centred on the notion of these young women being a drain on the national purse. This paper will seek to address this notion, and will point to the need for access to credible courses leading to employment and childcare in order to increase the chances of these young women becoming taxpayers, and good parents.     

Vaginal douching practices among women attending a university in the southern United States

The authors assessed the frequency, characteristics, and motivational antecedents of vaginal douching practices among 125 White and 155 Black female college students. Overall, 40% of the students had ever douched and half of those women currently douche. Black women were most likely to be encouraged to douche by their mothers, whereas White women were more influenced by television advertisements. Among the sexually active women, being Black, using oral contraceptives, using spermicides, and being encouraged to douche by their mothers or by the media were independently associated with ever having douched. These associations were present among both Black and White women and were stronger when current douching was compared with never having douched. Women who were discouraged from douching by a physician or nurse were more likely to have stopped the practice. Douching is common, even among educated young women; nurses' and physicians' advice to stop douching appears to have a salutary effect.     

World and regional labour force trends and prospects

Changes in fertility during 1970-1985 will not have any effect on the composition of the world work force until 1985 because the people who will be of working age at that time have already been born. However, fertility for this period will directly influence the size of the age group 15-30 in the year 2000. Moreover, fertility trends for this period will have an indirect effect on participation of women in the labor force. The number of people in the labor force has proportionately followed total population. Just as total population is projected to increase in the single decade 1970-1980 by an amount equal to its size in 1750, so the labor force will increase by 360 million during the 1980's (its original size in 1750). By the end of the present century the world labor force may well number some 2,6000 million, reaching 3,000 million by the year 2010; 4,000 million by 2030; 5,000 million by 2070; and stabilizing at about 5,200 million by the end of the 21st century. There will be great regional variations. Increases will range from 20-35% in Europe and the U.S.S.R. to 100-120% in South Asia, Africa, and Latin America. For East Asia and North America the increases may amount to 60% by the year 2000 and 100% by 2050. In 1970 less developed regions had 2/3 the world's labor force; by 2000 they will have 3/4. In 1970 about 20% of the labor force in more developed regions were working in agriculture while in less developed regions 2/3 were so engaged. In other terms, in more developed regions 10 farmers supported 108 persons while in less developed regions 10 farmers supported only 38. According to Food and Agriculture Organization projections, by 2000 only 3.5% of the labor force in developed regions and 43.5% in less developed regions will be in agriculture. Differences in gross national product between regions is striking. In 1970 the less developed regions contained 70% of world population, 67% of the world labor force, 87% of the world agricultural labor, and produced 15% of its wealth. There are also sharp contrasts in participation in the labor force. In less developed countries more youths and older persons are in the labor force while in developed countries more women work. By the year 2000 female activity rates in more developed regions will increase for ages 20-64 and decrease for those under 20 and over 64. This will raise female participation in the labor force to 35%. In less developed regions female participation is expected to decline. The proportion of young workers is expected to increase in less developed and decline in more developed regions; the same will be true for older workers. The dependency burden will be concentrated among the young in less developed nations; in more devel oped regions there will be larger numbers of older dependents.     

Sex and aging in the city: Singapore

A survey was carried out on 307 healthy men and 774 women, aged between 30 and 70 years to evaluate the determinants of sex life in the highly urbanized Singapore population. The results showed that significantly more women (28.8%) as compared to men (16.3%) were currently sexually inactive. The main reason for sexual inactivity for women was being divorced or widowed (37.9%) and for men, the loss of interest in sex (42.8%). Relationship problems and being stressed out in life were the next two most common reasons for both men and women. Coital frequency for men and women between the ages of 30 and 55 years averaged about five to six times monthly and was significantly reduced to about three times monthly in those above 55 years old. More men (25.7%) wanted to have more frequent sex than women (5.4%), but were unable to fulfill their desire and the primary reason was that they were too stressed out in life. Results from this study revealed that sex life is determined not only by physiological, but also cultural, social and lifestyle factors. In Singapore, lifestyle factors accounted largely for sexual inactivity, and the inability to fulfill the desire for more frequent sex. The term ‘lifestyle impotency’ was coined to describe the group of men and women who were too stressed out in life to have sex. Therefore, there is a need to evolve a paradigm for the management of sexual dysfunctions by taking into account the underlying etiological factors which, as we have shown, may not be resolved by pharmaceutical interventions.     

Aging in Asia: A cultural,socio-economical and historical perspective

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no “single size fits all” solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.     

Labor force participation and fertility: a study of married women in Bangladesh

Most researchers support the notion that a direct negative relationship exists between married women's labor force participation and fertility behavior, yet female employment shows no consistent, general relationship with declining fertility at individual and societal levels. Specific conditions under which employment lowers fertility are therefore explored for the case of Bangladesh. The economic, sociological, and world-system theoretical approaches to the relationship and empirical studies in developing countries including Bangladesh are reviewed. 1975-76 Bangladesh Fertility Survey data on births, deaths, nuptiality, and family planning knowledge and practice for 5772 currently married women of 6513 ever married women under 50 sampled are subjected to multivariate analysis for the study. Analysis revealed that women's modern and traditional occupation as well as higher and secondary education significantly lower their fertility, and that higher age, Islamic religion, use of modern contraceptives, and husband's occupation in transitional and modern sectors have significant positive effects on fertility. The correlation between higher fertility and contraceptive use may be due to women's delay in practicing family planning until reaching desired parity and/or high infant mortality driving women to cease practice in order to replace lost offspring. Future research should be conducted with larger samples and also consider occupations of both husbands and wives. Societal attitudes about women's education should be reformed in support of opening rural schools for women. With 90% of women residing in rural areas and women with traditional occupations having lower fertility, more traditional sector opportunities for women in cottage industry and agriculture production are also recommended, and would help balance skewed urban growth and hypertrophication of the tertiary sector. Finally, motivational efforts should be focused upon encouraging younger instead of older married couples to limit fertility.     

The Differences in Role Division Between Partners in Long-term Marriages and Their Well-being

The study aims were to examine the relationships of 128 elderly couples married longer than 45 years and the role division between the partners, including a comparison of their perceptions of their first 3 years of their marriage with today. The research hypotheses were (a) there will be a change in the couple's perceptions about the traditional roles at the time of their marriage as opposed to today, and (b) men and women who recognize a change in traditional role division will experience better mental well-being than those who do not. The results showed a change in the couple's perceptions about traditional role division during the years of marriage. It was also found that these changes showed a positive correlation to the couple's mental well-being in those couples who recognized the changes.