Advances in the surgical management of prolapse

Prolapse is an extremely common condition, for which 11% of women will have a surgical procedure at some point in their lives. The recurrence rate after most of the traditional surgical procedures is high and upto 29% of women who have had surgery for prolapse will require a further operation. In order to improve the surgical outcome, there is currently much interest in the use of grafts to augment traditional repairs and new procedures have been developed using specifically developed grafts. These have been combined with minimally invasive surgical techniques in an attempt to reduce surgical morbidity. These procedures may improve the outcome of surgery for prolapse. However, there is currently a lack of long-term data from randomized trials to demonstrate their effectiveness and safety.     

Menopause and sexual desire: the role of testosterone

The present short review underlines the role of testosterone (T) in the motivational and satisfaction components of women's sexuality and critically discusses the strategies to treat hypoactive sexual desire disorder (HSDD), a condition of low desire associated with personal and/or interpersonal difficulties, which is more common in surgical menopausal women. There are multiple ways androgens target the brain regions (hypothalamic, limbic and cortical) involved in sexual function and behaviour. Even though circulating available androgens have been implicated in several domains of sexual response, they seem to be related weakly to symptoms, such as low sexual desire, poor sexual arousal, orgasm and diminished well-being in postmenopausal women. The possibilities of treating low sexual desire/HSDD are multifaceted and should include the combination of pharmacological treatments able to maximize biological signals driving the sexual response, and individualized psychosocial therapies in order to overcome personal and relational difficulties. Transdermal T has been shown to be effective at a dose of 300 μg/day both in surgically and naturally menopausal women replaced with estrogen or not, without any relevant side-effects. However, the decision to treat postmenopausal women with HSDD with T is mainly based on clinical judgement, after informed consent regarding the unknown long-term risks.     

Male Migration,Women Left Behind,and Sexually Transmitted Diseases in Armenia

The effect of male circular labor migration on risks of sexually transmitted diseases (STDs) among women left behind has not been well studied. Our study examines this effect using data from a survey of 1,240 married women in rural Armenia, where international male labor migration has traditionally been very common. A multivariate comparison of women married to migrants and women married to non-migrants finds that the former, ceteris paribus, reported more STD symptoms, on average, and were more likely to report diagnosed STDs than the latter. However, in the case of STD symptoms, this effect is moderated by household income, as the predicted number of STD symptoms reported by migrants’ wives increases as income rises. The findings illustrate the complex tradeoffs that migration entails for left-behind women and are interpreted in the context of the literature on gender, migration, and STDs.     

Does Stage of Pelvic Organ Prolapse Affect Female Sexual Functions? A Retrospective Study

Objectives: The objective of this study was to investigate the effect of pelvic organ prolapse stage on sexual function in women. Methods: Prolapse stages, muscle strength, sexual function, and pelvic floor symptoms were assessed by Pelvic Organ Prolapse Quantification, by vaginal pressure measurement, by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and the Pelvic Floor Distress Inventory-20 (PFDI-20), respectively. Results: There was no difference between pelvic floor muscle strength, PISQ-12 subscales and PISQ-12 total scores based on prolapse stages (p > 0.05). When the Pelvic Organ Prolapse Distress Inventory and PFDI-20 scores of the women with stage 3/4 prolapse were compared with Stage 1 and Stage 2, there was a difference found between them (p < 0.001). Conclusions: Sexual function and muscular strength were not affected by prolapse stages.     

The Efficacy of Internal Family Systems Therapy in the Treatment of Depression Among Female College Students: A Pilot Study

College women are vulnerable to depression due to developmental and transitional life changes. Early diagnosis and effective treatment is critically important. Empirical support exists for the effectiveness of select treatment options (i.e., antidepressant medication, cognitive‐behavioral therapy [CBT], and interpersonal psychotherapy [IPT]), yet a significant percentage of those treated do not benefit. In this pilot study, Internal Family Systems (IFS) therapy was tested as an alternative approach. College women (N = 37) were randomly allocated to IFS treatment or treatment as usual (CBT or IPT). Results demonstrated a decline in depressive symptoms for both conditions and no significant differences in the magnitude or rate of change. The results provide preliminary evidence for the efficacy of IFS in the treatment of depressive symptoms.     

Diagnosis of cardiovascular disease in women

Cardiovascular disease (CVD, comprising coronary heart disease and stroke) is the leading cause of death in both sexes in developed countries. Although women are nine times more likely to die from CVD than they are from breast cancer, there is a general public belief that the most common cause of death is cancer. The symptoms of acute myocardial infarction and acute coronary syndromes differ between the sexes. Women are less likely to experience chest pain and may have non-specific symptoms. Normal or non-obstructive coronary disease, as detected by angiography, is more common in women. Scintigraphy improves the detection of coronary disease in women. There is an urgent need to increase awareness of both coronary heart disease in women and the limitations of commonly used diagnostic tools.     

The impact of procedure type, jurisdiction and other factors in workers' compensation on work-disability outcomes following carpal tunnel surgery

Carpal tunnel syndrome (CTS) is often work-related and associated with prolonged disability. While surgical treatment is common, an alternative endoscopic procedure has been promoted as a way of achieving better outcomes. However, little is known about typical use of the procedure and whether it actually achieves outcomes in community settings. From workers' compensation claims reported to an insurer in six jurisdictions during 1995-1999, we identified 1697 individuals with a single CTS surgery, 17% were treated using the endoscopic procedure. Bivariate analyses of post-surgical outcomes demonstrated that post-surgical work disability was shorter for those with endoscopic procedures (median 27 vs. 34 days, mean 62 vs. 85 days; p< 0.01). Medical costs following the procedure were also lower in the case of endoscopic procedure for those with any post-surgical medical costs (median $1,201 vs. $1,717, mean $5,733 vs. $7,084; p< 0.01). However, controlling for jurisdiction and other factors, these differences disappeared, suggesting that in CTS the type of care received was not a major determinant of outcomes. These findings reinforce the importance of community-based evaluations which include potential confounders to accurately evaluate the impact of medical technologies on work disability in occupational conditions.     

Marriage and gender inequality: work–family arrangements of Portuguese and British highly qualified women

This article examines work–family reconciliation processes in order to understand if, over the course of marital life, women become socially closer or further away from their partner. Drawing on work–life interviews with highly qualified women in Portugal and Britain, we compare these processes in two societies with different historical and social backgrounds. Findings reveal three main configurations of social (in)equality which emerge during married life: growing inequality in favour of the man, in favour of the woman or equality between spouses. With due attention to the importance of national specific factors, we present three main conclusions. First, (in) equality is built up over the course of marital life and female strategies for reconciling family and work are at the core of this process. Second, the national specificities can mould the effects of cross-national gender mechanisms. Third, the intersection between cross-cultural phenomena such as conservative attitudes towards domestic work and national specificities (such as the availability of part-time options) is a rather complex process which needs further research.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

College Women's Gynecological Health Care Practices and Preferences

Abstract

Panic disorder is characterized by recurrent, sudden, often unprovoked attacks of intense, diffuse autonomic discharge accompanied by severe anxiety as distinguished from ordinary generalized anxiety. Recent research indicates a biochemical abnormality that predisposes some individuals to the disorder, which generally begins in young adulthood and affects women twice as frequently as men. Untreated panic disorder follows a chronic, fluctuating course. Complications include hypochondriasis, anticipatory anxiety, phobic avoidance and agoraphobia, abuse of alcohol and sedative drugs, and depression.

Diagnosis is complicated by patients' complaints of physical rather than emotional symptoms. Workups can be avoided if the physician considers the diagnosis in apparently healthy young adults who present with episodic cardiac, gastrointestinal, neurologic, and/or respiratory symptoms. The physician needs to be able to distinguish the symptoms of panic disorder from those of ordinary anxiety and also to rule out medical conditions that mimic panic disorder.

Neither conventional benzodiazepines nor psychotherapy alone is very effective in stopping panic attacks, but alprazolam, imipramine, and phenelzine are all highly effective. Alprazolam has fewer troublesome side effects, but patience and perseverance are necessary to reach therapeutic levels with all three drugs. Inadequate dosage is the most common cause of treatment failure. Most patients do well once their attacks are controlled and do not require close follow-up. Patient education is an important part of long-term management because relapses are common.     

MS,exercise, and the potential for older adults

Multiple Sclerosis (MS) is an autoimmune disorder of the central nervous system. The average onset of the disease is 30 years of age, and it afflicts women more often than men (ratio of approximately 2:1). The symptoms of the disease include fatigue, motor weakness, heat sensitivity, reduced mobility, abnormal gait mechanics, and poor balance. These symptoms decrease cognitive and physical functional capacity of an individual and tend to result in sedentary lifestyle behaviors. A sedentary lifestyle among individuals with MS increases the risk of secondary diseases such as coronary heart disease and obesity, particularly as one ages. The effect of exercise in treating symptoms of MS has been under explored, perhaps due to the fact that exercise was thought to magnify MS-related fatigue and other symptoms. Recent research has challenged this notion, advocating exercise as an effective therapy for the management of MS, as well as maintaining overall fitness and improving quality-of-life measures. While the research shows clear benefits, the barriers to exercise participation among MS patients are significant. Recommendations for various forms of exercise are provided, along with strategies for overcoming barriers to participation.     

Identification and classification of postpartum psychiatric disorders.

1. Postpartum depression has been used as a catchall phase for many postpartum emotional symptoms. Categorizing a number of diverse disorders under one title has resulted in an inability to identify who is most at risk for developing postpartum problems. 2. The postpartum period is a particularly vulnerable period for depression, despite the fact that it is perceived as a time of joy and emotional well-being. 3. By increasing awareness among all health care professionals who care for women during the period following childbirth, postpartum psychiatric disorders can be identified early and treated correctly. 4. Limiting postpartum psychiatric disorders to postpartum depression may result in limited or inappropriate treatment options.     

The impact of conservative discourses in family policies, population politics, and gender rights in Poland and Turkey

This article uses childcare as a case study to test the impact of ideas that embody a traditional understanding of gender relations in relation to childcare. Conservative ideas regard increasing female labor market participation as a cause of decreasing fertility on the functioning of a set of general policies to increase fertility rates. It looks into the Polish and Turkish contexts for empirical evidence. The Polish context shows a highly institutionalized system of family policies in contrast to almost unessential institutions in Turkey. Formally, the labor market participation of women is much lower in Turkey than in Poland. Yet, given the size of the informal market in Turkey, women's labor participation is obviously higher than what appears in the statistics. Bearing in mind this divergence, the article suggests Poland and Turkey as two typologies for studying population politics in contexts where socially conservative ideas regarding gender remain paramount. We qualify ideas as conservative if they enforce a traditional understanding of gender relations in care-giving and underline women's role in the labor market as an element of declining fertility. In order to delineate ideational impact, this article looks into how ideas (a) supplant and (b) substitute formal institutions. Therefore, we argue that there are two mechanisms pertaining to the dominance of conservative conventions: conservative ideas may either supplant the institutional impact on family policies, or substitute them thanks to a superior reasoning which societies assign to them. Furthermore, conservative conventions prevail alongside women's customary unpaid work as care-givers regardless of the level of their formal workforce participation. We propose as our major findings for the literature of population politics that ideas, as ubiquitous belief systems, are more powerful than institutions since they provide what is perceived as legitimate, acceptable, and good for the societies under study. In the end, irrespective of the presence of institutions, socially conservative ideas prevail.     

Medical management of perimenopausal menorrhagia: an evidence-based approach

About one-third of women report heavy menstrual bleeding at some time in their lives. Menstrual blood loss increases with age. Menorrhagia is usually defined as heavy but regular menstrual bleeding of over 80 ml/cycle. Complaints of menorrhagia are common. Several medical therapies are suitable for perimenopausal women with either regular or irregular heavy bleeding. The most effective is intrauterine levonorgestrel. Other options are oral progestogens, the combined oral contraceptive pill, tranexamic acid, mefenamic acid, danazol and gonadotrophin-releasing hormone (GnRH) analogues. Systematic reviews and randomized controlled trials are discussed.     

A Feminist Analysis of Flight of Abused Women, Plight of Canadian Shelters: Another Road to Homelessness

The paper explores the link between women abuse and homelessness. Although the examples are drawn from Canada, the argument is that the plight of abused women is similar throughout North America. First, I discuss the stereotypes about homelessness and the conservative governments' stance toward the homeless. Second, I introduce abuse of women as another road to homelessness. Third, I review the literature on dependent children from abusive homes as victims and witnesses who need social protection. Fourth, I establish the important role shelters play for women fleeing abusive relationships, by tracing the history of shelters. The tenuous position of the shelters in relation to conservative governments is emphasized. The paper ends with the consequences of fear of homelessness for women and their children, and the public policy implications of the close link between abuse and homelessness.     

Occupational stress,relaxation therapies,exercise and biofeedback

Occupational stress is a widespread occurrence in the United States. It is a contributing factor to absenteeism, disease, injury and lowered productivity. In general stress management programs in the work place that include relaxation therapies, exercise, and biofeedback have been shown to reduce the physiological symptoms such as hypertension, and increase job satisfaction and job performance. Strategies to implement a successful stress management program include incorporating the coping activities into one's daily schedule, monitoring one's symptoms and stressors, and being realistic in setting up a schedule that is relevant and attainable. A short form of meditation, daily exercise program and the use of heart rate or thermal biofeedback can be helpful to a worker experiencing occupational stress.     

Darts,drink and the pub: the culture of female drinking

Sociologists and anthropologists have paid little attention to women's role in the pub. This article, based on fieldwork reseach, sets out to describe the use of two pubs by two different groups of women in an English village. Through these examples, we seek to illustrate not only the social class differences between the two groups of women but also their differential use of the pub. For many working-class women, as opposed to their middle-class counterparts, the pub represents an important social centre in the village - joining the darts team provides one of a limited range of available options to get away from responsibilities of home and kin. This is not the case for middle-class women. For them the pub represents only one of many options in their social lives and as a result they make less use of the pub and its facilities.     

The Grameen Bank in Bangladesh: Helping Poor Women with Credit for Self-Employment

Summary

Social work with poor women should include options for self-employment as avenues out of poverty. The Grameen Bank of Bangladesh exemplifies one micro-lending strategy to overcome traditional barriers and assist very poor women to earn an income and participate in the local economy. Credit lending principles combined with social development goals are highlighted, and the impact of this model discussed in terms of its success in alleviating poverty. Transferability of the model to the United States is discussed, and implications for social work offered.     

Neoliberal feminism: The neoliberal rhetoric on feminism by Australian political actors

Feminism seems to be experiencing a resurgence. This research examines an Australian case where this resurgence produces some bizarre outcomes and an uncomfortable mix of moderate and neoliberal feminisms, as conservative women distance themselves from the term feminist and conservative men embrace it. We rhetorically analyse the discourse of four conservative leaders using an ideographic analysis to reveal how political actors evoke ideologically laden terminology to support specific courses of action. For the conservative women, the ideograph feminist was too heavily laden with history. A more feminine‐liberal political discourse allowed them to explain their own success in individual terms and, by substituting support for feminism with a broader gender equality agenda, they could explain the government's policy approach of individualized rather than collective or state support to advance the needs of women. They are articulating a postfeminism sensibility themselves and neoliberal feminist other. For the conservative men, the ideograph feminist did not reflect on their own personal success or careers; they were happy to embrace it for purely political purposes to advance their standing with the voting public and saw no significance in terms of the government's policy approach of neoliberal feminism.     

A Feminist Analysis of Flight of Abused Women,Plight of Canadian Shelters: Another Road to Homelessness

The paper explores the link between women abuse and homelessness. Although the examples are drawn from Canada, the argument is that the plight of abused women is similar throughout North America. First, I discuss the stereotypes about homelessness and the conservative governments' stance toward the homeless. Second, I introduce abuse of women as another road to homelessness. Third, I review the literature on dependent children from abusive homes as victims and witnesses who need social protection. Fourth, I establish the important role shelters play for women fleeing abusive relationships, by tracing the history of shelters. The tenuous position of the shelters in relation to conservative governments is emphasized. The paper ends with the consequences offear of homelessness for women and their children, and the public policy implications of the close link between abuse and homelessness.