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.     

An emerging model of maternity care: Smartphone,midwife, doctor?

BackgroundMobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information.AimTo describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision.MethodsThe 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity.FindingsiTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features.DiscussionThe popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of ‘shared maternity care’ needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care.     

Early Childhood Maltreatment and Pubertal Development: Replication in a Population‐Based Sample

Early experiences are critically important for female reproductive development. Although a number of early childhood hardships predict earlier physical development in girls, research on specific populations suggests a distinct effect of childhood sexual abuse compared to other adversities. This study leverages the National Longitudinal Study of Adolescent Health (N = 6,273 girls) to test the generalizability of these findings, examining associations of early physical abuse, sexual abuse, and physical neglect with pubertal timing. Child sexual abuse predicted earlier menarche and development of secondary sexual characteristics, whereas other types of maltreatment did not. In addition to replicating results from smaller, more specialized samples, these findings reinforce the value of considering puberty within a broader “life span” continuum of birth to adolescence.     

How to use programme theory to evaluate the effectiveness of schemes designed to improve the work environment in small businesses

Due to the many constraints that small businesses (SBs) face in meeting legislative requirements, occupational health and safety (OHS) regulatory authorities and other OSH actors have developed programmes which can reach out to SBs and motivate and assist them in improving the work environment. A number of conceptual models help to enhance our understanding of OHS interventions in SBs and their effectiveness. However, they have mainly been evaluated on output rather than the process relating to the change theory underlying the intervention, and hence have seldom been rigorously evaluated. Thus little is known about how particular features of SBs can be taken into account when designing and implementing national programmes. This paper shows how realist analysis and programme theory may be used as a framework for evaluating, developing and improving national intervention programmes for the improvement of the work environment and reducing injuries in SBs. It illustrates this for a specific New Zealand intervention: the Workplace Safety Discount scheme and its implementation in the agriculture sector. In practice, realist analysis should be performed during the planning, implementation and management stages so that ongoing findings can be fed back to the participant social actors to help them make appropriate changes to enhance the likelihood of success.     

Structural Characteristics of Electronic Gaming Machines and Satisfaction of Play Among Recreational and Problem Gamblers

Abstract

This study evaluated the impact of three specific modifications to the structural design of electronic gaming machines proposed by the New South Wales Liquor Administration Board, on player satisfaction. These modifications: reduction in reel spin speed, maximum bet limited to A$1.00 and removal of high denomination bill acceptors; were recommended as putative harm minimisation strategies within a larger government responsible gaming policy framework. Participants were a total of 363 patrons attending either a club or hotel venue in Sydney. Gambling behaviour and responses to a brief satisfaction questionnaire were obtained under conditions of play on modified and unmodified electronic gaming devices. Responses to satisfaction measures varied between hotel and club patrons and recreational and problem gamblers. Problem gamblers consistently reported less satisfaction and enjoyment playing machines. Overall, little effect on satisfaction or enjoyment was found for either social or problem gamblers in respect to concurrent modifications limiting maximum bet size and reducing high denomination bill acceptors. Slower machines were rated as less satisfying to play, but effects were small and did not appear to influence player’s stated intentions. It is yet to be determined if changes to structural characteristics of electronic gaming machines are associated with harm reduction.     

The Generational Effects on Collective Memories in the Context of International Migration: The Collective Memories of Koreans in South Korea and the U.S.

This article examines generational effects on collective memories of Korean history, while taking into account international migration. We asked 216 subjects in South Korea and the United States to name three important events in Korean history and to provide reasons for their selections. We found generational effects in both countries in a similar pattern. This is a remarkable social achievement of the U.S. emigrant subjects. The current study adds a cross-cultural perspective to the literature on collective memories, which has focused predominantly on U.S. and Western case studies. By comparing memories of people who share a national origin but live in different cultural contexts, the current study also intersects collective memories studies in other fields such as transnationalism and diaspora. Our findings suggest that future studies can benefit from a transnational approach to collective memories, which may or may not circulate across borders.     

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