Search

Background: Parasitic leiomyomas were first described as early as 1909 but are a rare condition. In recent years, due to the rise of laparoscopic surgery and power morcellation, several cases of parasitic leiomyomas associated with this surgical procedure have been reported.Methods: A literature search was performed using PubMed, Embase and Google Scholar with the following combination of keywords: leiomyoma OR uterine neoplasms OR uterine myomectomy OR laparoscopy OR hysterectomy OR peritoneal neoplasms AND parasitic. Papers describing parasitic leiomyomas were included. The results of these studies are summarized herein.Results: We retrieved abstracts of 756 papers. Of these, 591 were excluded for not fulfilling the inclusion criteria and 54 were removed as duplicates; after full-text assessment, 8 were rejected for presenting cases of malignancy and finally 103 were included in our systematic review. From these, we present information about 274 patients with parasitic leiomyomas. The mean age of women was 40 years (range 18-79 years); and 154 (56%) had no history of uterine surgery, the others (120, 44%) having had a previous myomectomy or hysterectomy. Of the total, 106 (39%) women had a history of power morcellation. The most frequent clinical symptom was abdominal pain (49%) and the most frequent presentation was disseminated peritoneal leiomyomatosis.Conclusions: While parasitic leiomyoma was first described a century ago, the recent introduction of laparoscopic power morcellation has increased the number of reported cases. [ABSTRACT FROM AUTHOR]

Abstract: As women vaccinated against measles transfer low amounts of antibodies, an increasing number of infants lack early protection through maternal antibodies until being immunised themselves. This paper reviews the literature on disease burden of measles in the population too young to be immunized according to the respective national recommendations during recent outbreaks in EU and EEA/EFTA countries. In addition, specific control strategies adopted to protect this young population are reviewed. Pubmed, Unbound Medline, Web of Knowledge and the Eurosurveillance database were searched using MESH terms: measles and epidemiology, measles and infants, prevalence of measles, measles and outbreaks and measles and epidemic. Additionally, data from Euvac.net and ECDC were consulted. Databases were searched from January 2001 to September 2011. Fifty-three papers were included in the analysis. The percentage of all measles cases during outbreaks affecting young infants ranged from 0.25% to 83.0%. Specific control strategies were adopted: e.g. administration of the first or second vaccine dose earlier than recommended. Infants younger than 12 months are often involved in measles outbreaks, and advancing the first vaccine dose could reduce the burden of disease. However, immunization before 9 months of age is not systematically recommended because of dysmature humoral immune responses of infants. High coverage and timely administration of the recommended series of vaccines are the most important measures to decrease measles incidence and measles circulation and protect vulnerable infants from infection. [Copyright &y& Elsevier]

Abstract Context Several drugs are approved and available for the treatment of lower urinary tract symptoms (LUTS) in men and women. However, the vast majority of available data, upon which the approval and recommendation in guidelines are based, considered only the role of the monotherapies and did not evaluate possible combination therapies. Objective This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS. Evidence acquisition A systematic literature search in the PubMed/Medline, Web of Science, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on male and female LUTS combination therapy published from March 2012 to December 2017 for men (in order to update a previous men-focused work) and from January 1988 to December 2017 for women. A total of 58 papers were identified. Evidence synthesis The most studied combination therapy for the treatment of male LUTS is the α1-adrenoceptor antagonist/5α-reductase inhibitor combination. This combination seems to be more efficacious in terms of several outcome variables, in particular in men who have moderate-to-severe LUTS and are at risk of disease progression. Also in terms of nocturia improvements, this combination is significantly more effective than the monotherapy. The other often studied combination treatment, in both male and female patients with LUTS, was the combination of antimuscarinics (in particular solifenacin) and mirabegron. This combination seems to be more effective in comparison with the monotherapies with respect to urinary incontinence and urgency urinary incontinence episodes and several other objective and subjective parameters, without relevant increase of adverse events. The combination of hormone therapy and antimuscarinics in women with LUTS does not seem to be useful. Conclusions For the treatment of LUTS in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs for those who do not experience sufficient benefit with monotherapy. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS, always seeking the optimal balance between efficacy and tolerability for a given patient. Patient summary Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women. Take Home Message For the treatment of lower urinary tract symptoms (LUTS) in men and women, combination therapy appears to be a promising option to optimize the efficacy of the available drugs. This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS. [ABSTRACT FROM AUTHOR]

Iron deficiency disproportionately affects infants, children, and women of reproductive age. It is more prevalent in developing countries but continues to be a problem in developed countries. Included among the consequences of iron deficiency are changes in cognitive performance, emotions, and behavior. Although the behavioral and developmental sequela of iron deficiency in young children have received much interest, data on the consequences of iron deficiency in women of reproductive age are just beginning to emerge. Interest in this area increased as a result of the findings that brain iron is much more fluid than previously thought and iron-deficient animals experience non-development-dependent brain alterations. These findings, coupled with the symptoms often reported by iron-deficient women lethargy, inability to concentrate, difficulty with memory, etc.), have led researchers to begin to explore the relation between iron and neuropsychological outcomes in this population. This paper reviews findings from studies that have examined the brain functional consequences of iron deficiency in women of reproductive age. Additional consideration is given to the fact that detriments to cognition and behavior in a woman of reproductive age may have negative implications beyond the woman s health; specifically, they may negatively influence her children. Therefore, the roles that cognitive and behavioral changes in these women have, on their children's development is also reviewed. The paper concludes with a discussion on ways to use technological advances especially in neuroimaging techniques) to help us elucidate the role of iron in the brains of women of reproductive age. [ABSTRACT FROM AUTHOR]

Gestational Diabetes Mellitus is a condition strongly related to the development of type 2 diabetes later in life, although the risk and the onset have not been fully identified yet. Although glucose tolerance returns to normal levels after delivery in the majority of women with GDM, this condition represents an early stage in the natural history of T2DM. In addition, women with previous GDM exhibit an increased cardiovascular risk profile and a raised incidence of cardiovascular diseases. Lifestyle changes and pharmacological interventions might be able to reduce the incidence of type 2 diabetes in pGDM women, although results are still not conclusive. Long term continuous programs specifically addressed to women with pGDM should be implemented, with the ambitious target to encourage them to regularly check glucose tolerance, lipid profile and other parameters related to cardiovascular diseases, aimed at improving women's health. In this paper, we review the relationship between type 2 diabetes, cardiovascular diseases and a history of GDM. [ABSTRACT FROM AUTHOR]

Abstract: Social expectations surrounding sickness have undergone a transformation in Western welfare states. Emerging discourses about patients’ roles and responsibilities do not however always map neatly onto patients’ actions, experiences or desires. This paper emerges from a study in Ontario, Canada. Drawing on in-depth interviews with 5 women diagnosed with breast cancer we explore the activity and effort prompted for patients by the routine professional practice of outlining treatment options and encouraging patients to choose between them. We highlight research participants’ complex responses to their responsibility for treatment decisions: their accepting, deflecting and reframing and their active negotiation of responsibility with professionals. The literature on treatment decision making typically characterizes people who resist taking an active role as overwhelmed, misinformed about the nature of treatment decisions, or more generally lacking capacity to participate. In this paper we suggest that patients’ expressions of ambivalence about making treatment choices can be understood otherwise: as efforts to recast the identities and positions they and their physicians are assigned in the organization of cancer care. We also begin to map key features of this organization, particularly discourses of patient empowerment, and evidence-based medicine. [ABSTRACT FROM AUTHOR]

Context: Acute uncomplicated cystitis is generally treated with short-term antibiotic therapy. However, recurrence of lower urinary tract infections (UTIs) is very common, especially in premenopausal women. These recurrent infections considerably affect a patient''s quality of life and have a huge financial and economic impact on society. Therefore, prevention of UTI recurrence is highly important. Objective: To provide an overview of the state of the art and the current controversies on the prophylaxis of recurrent UTIs. Evidence acquisition: This manuscript is based on presentations given at a satellite symposium held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Data were retrieved from recent review papers, original papers, and abstracts on recurrent UTIs. Evidence synthesis: Currently, antibiotic prophylaxis is recommended as a first-line strategy for the prevention of recurrent UTIs in the European Association of Urology guidelines. However, more and more uropathogens become resistant to certain types of antimicrobials. Hence, alternative prophylactic strategies are gaining importance. Oral administration of immunoactive Escherichia coli (E. coli) fractions (Uro-Vaxom®) is one of these methods. Our understanding of its mechanism of action has considerably grown over the past 20 yr. In several double-blind, placebo-controlled studies, oral immunostimulation with E. coli extracts significantly reduced recurrent UTIs compared with placebo. Moreover, this strategy was well tolerated. Two new Uro-Vaxom studies have been initiated to gather more data on the long-term efficacy, the treatment regimen, and the mechanism of action of this immunostimulant and to find broader indications for this therapy. Conclusions: Although scientific and clinical data on oral immunostimulation with E. coli fractions have increased significantly, more studies are needed to provide convincing evidence that this strategy is equally effective as antibiotic prophylaxis for the prevention of recurrent cystitis. [Copyright &y& Elsevier]

Objective: This study was undertaken to evaluate a diagnostic panty liner (VI-SENSE) (Common Sense, Caesarea, Israel) developed to facilitate diagnosis of vaginal infections by detecting disordered acidity level. Study design: Five hundred sixteen women with vulvovaginal symptoms were enrolled. Final clinical diagnosis included Amsel criteria, Gram stain analysis, pH determination, and Trichomonas vaginalis and Candida culture. VI-SENSE strip color status estimated by patients was compared with clinical diagnosis and pH measurement by using nitrazine paper. Statistical analysis included sensitivity and specificity calculations. Results: The VI-SENSE test was positive in 226 of 249 patients (90.8%) with bacterial vaginosis or trichomoniasis. Nitrazine pH paper revealed elevated pH in 165 (66.5%) and the amine test was positive in 160 (64.3%) patients. The VI-SENSE test was negative in 217 of 267 patients (81.3%) without trichomoniasis or bacterial vaginosis. The VI-SENSE was positive in 85 of 92 women (92%), with mixed vaginal infection including Candida and bacterial vaginosis or trichomoniasis. Amine test, nitrazine pH paper and physician diagnosis relying only on speculum examination were inferior and positive in only 65 (70%), 59 (64%), and 66 (72%) patients, respectively. Conclusion: The VI-SENSE test was found to be superior to traditional individual tests in facilitating preliminary diagnosis of vaginal infections. [ABSTRACT FROM AUTHOR]

Introduction: Sacral nerve stimulation (SNS) is increasingly popular in the management of faecal incontinence. This paper reports the first 10-year experience of SNS in the management of faecal incontinence at a tertiary referral centre. Data was collected in a prospectively maintained database.Results: In total 130 patients were referred. The majority were women (94%) under 75-year-old (98%). Seven patients were found to have full-thickness rectal prolapse at the initial work-up and proceeded to rectopexy. Eighty-three patients underwent temporary SNS testing with 73.5% positive outcome, of which 52 patients had permanent implant insertion. There were four failures of SNS (7%) following implantation despite successful temporary testing, seven infection, one lead migration and three post-operative pain/numbness. One patient subsequently developed colorectal cancer requiring SNS removal. A higher frequency of episodes of incontinence was associated with positive SNS outcome (p = 0.007). There was no significant association between age, sex, type of faecal incontinence, previous anorectal/pelvic surgery, colonoscopic or USS findings and the likelihood of successful SNS. Of the 52 patients with SNS implants, 27 patients were seen only once for follow-up; the remaining 25 patients were seen more than once - five of these were part of our initial cases of routine 6- and 12-monthly follow-up, 6 patients were seen for adjustment of voltages, whereas the remaining 14 patients were seen for complications of the implants. If the initial five patients were excluded, only 38% of patients would have been seen more frequently on an as-required basis.Conclusion: SNS is a safe and effective option in the management of faecal incontinence. Of the initial work-up, endoscopy and examination-under-anaesthesia (EUA) or proctogram are essential and more likely to influence the likelihood of suitability of SNS testing. A patient-led drop-in approach to follow-up is feasible to allow patients to be seen on an as-required basis. [ABSTRACT FROM AUTHOR]

The diagnosis of the recurrent optic neuritis is commonly established clinically, and sometimes it could be challenging because the involved optic nerve does not always show significant enhancement on conventional contrast enhanced-T1 weighted imaging (CE-T1WI). In this paper, we reported a middle-aged female with early diagnosis of recurrent optic neuritis using contrast-enhanced T2 fluid-attenuated inversion recovery imaging (CE-T2FLAIR). The involved optic nerve presented evident enhancement on CE-T2FLAIR and no enhancement on CE-T1WI. This case suggested that the CE-T2FLAIR may be a useful diagnostic tool specifically for the recurrent optic neuritis in clinical practice. [ABSTRACT FROM AUTHOR]

Vulvodynia, defined as vulvar pain or burning sensation for more than 3 months, without an identifiable cause, can occur at any age. In this paper, the authors address the classification, epidemiology, etiology, diagnosis, and treatment of this condition, focusing on postmenopausal women. In postmenopausal women, vulvar pain and dyspareunia can often be attributed to low levels of estrogen resulting in vulvovaginal atrophy. While correction of vulvovaginal atrophy is an important part of the management of these patients, it will usually be insufficient to manage vulvodynia. The treatment of vulvodynia includes general care measures, topical, oral, or injectable agents, psychological approaches, pelvic floor rehabilitation and, in some cases, surgery. No particular intervention has been shown to be superior, so a "trial and error" strategy is usually used. [ABSTRACT FROM AUTHOR]

Post-hysterectomy vaginal vault prolapse (PHVP) is a recognised although rare complication following both abdominal and vaginal hysterectomy and the risk is increased in women following vaginal surgery for urogenital prolapse. The management of PHVP remains challenging and whilst many women will initially benefit from conservative measures, the majority will ultimately require surgery. The purpose of this paper is to review the prevalence and risk factors associated with PHVP as well to give an overview of the clinical management of this often complicated problem. The role of prophylactic primary prevention procedures at the time of hysterectomy will be discussed as well as initial conservative management. Surgery, however, remains integral in managing these complex patients and the vaginal and abdominal approach to managing PHVP will be reviewed in detail, in addition to both laparoscopic and robotic approaches. [ABSTRACT FROM AUTHOR]

During last decades an increasing number of herbal products specifically targeting women's disorders has appeared in the worldwide marketplace. This growth highlights the need for a critical evaluation of quality, safety and efficacy of these products. Analytical techniques applied to the quality control of the main medicinal plants used for women health (relief of menopause and menstrual related symptoms) have been reviewed. Thanks to the innovation in analytical technology, identification and detection of secondary metabolites dramatically improved. In particular, hyphenated techniques have proved to be the most suitable for the rapid identification of compounds in plant matrix. Moreover, taking into account that differences in sample quality are not only found in the main compounds or in the chemical markers but also in the low-concentration compounds, fingerprint analysis might be a simple way for identification and quality control of herbal products containing a large number of low amounts of unknown compounds. Furthermore in several papers the informations obtained from the analysis of a plant have been processed by statistical elaborations. Medicinal plants here discussed are classified on the basis of the chemical markers used for their quality control. [ABSTRACT FROM AUTHOR]

The possible association between endometriosis and atherosclerosis represents an emerging topic in the field of women’s health. In this Clinical Opinion paper, we analyze this theme focusing on the pathogenetic mechanisms of both diseases, deeply discussing about what is already known about this association and producing starting points about what we consider suitable to research in the near future with regard to cardiovascular involvement in women affected by endometriosis. We have identified 5 reports specifically carried out to investigate the relationship between atherosclerosis and endometriosis; these studies show the presence of subclinical atherosclerosis in women affected by endometriosis, susceptible of regression after surgical removal of endometriosis, with a possible prognostic relevance for variations of cardiovascular risk in these women. However, to date, no studies in literature have been carried out to investigate the real incidence of cardiovascular events in women with endometriosis. [ABSTRACT FROM AUTHOR]

Thyroid cancer, the commonest of endocrine malignancies, continues increasing in incidence being the 5th more prevalent cancer among women in the United States in 2012. Familial thyroid cancer has become a well-recognized, unique, clinical entity in patients with thyroid cancer originating from follicular cells, that is, nonmedullary thyroid carcinoma. Hereditary nonmedullary thyroid cancer may occur as a minor component of familial cancer syndromes (familial adenomatous polyposis, Gardner's syndrome, Cowden's disease, Carney's complex type 1, Werner's syndrome, and papillary renal neoplasia) or as a primary feature (familial nonmedullary thyroid cancer [FNMTC]). Although there is some controversy, some epidemiologic and clinical kindred studies have shown that FNMTC is associated with more aggressive disease than sporadic cases, with higher rates of multicentric tumours, lymph node metastasis, extrathyroidal invasion, and shorter disease-free survival. This way, preventing screening will allow earlier detection, more timely intervention, and hopefully improved outcomes for patients and their families. On the other hand, in the last years, an important number of genetic studies on FNMTC have been published, trying to determine its genetic contribution. However, the genetic inheritance of FNMTC remains unclear; but it is believed to be autosomal dominant with incomplete penetrance and variable expressivity. This paper provides an extensive overview of FNMTC from several points of view. Firstly, the impact of early detection on prognosis, secondly, the management and follow-up of FNMTC patients, and finally, the role of susceptibility loci, microRNAs (miRNAs) and telomerases in recently identified isolated cases of FNMTC. [ABSTRACT FROM AUTHOR]

Background Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). Methods Pregnant, public health patients, > 18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). Baseline results 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making < $10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. Conclusions A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study. [ABSTRACT FROM AUTHOR]

Abstract: Uterine leiomyomas, commonly called fibroids, are the leading indication for hysterectomy in the United States. Incidence increases with age from menarche to perimenopause. Regardless of their generally benign neoplastic character, uterine fibroids are responsible for significant morbidity in a large proportion of women of reproductive age. As uterine leiomyomas generally regress after menopause, the general attitude when women are approaching perimenopausal age is to avoid treatment and wait for menopause and a spontaneous resolution. When it is decided that treatment is needed, the choice for peri- and postmenopausal women is often hysterectomy. In the present paper we point out aspects of leiomyoma management that are unique to the perimenopausal period, and address future directions in care. We conclude that the management of uterine leiomyomas should not be overlooked in the perimenopausal period merely on the grounds that the pathology and symptoms are unlikely to persist after the menopause; on the other hand, opting for a quick resolution with total surgical removal of the uterus, as seen at present in many cases, should be avoided. Studies on the impact of therapy for fibroids should be performed not exclusively with premenopausal women but also with perimenopausal and postmenopausal women, both users and non-users of hormone replacement therapy. [Copyright &y& Elsevier]

Abstract: This paper reports the mineralogical and geochemical compositions of the Late Permian C2 and C3 coals (both medium volatile bituminous coal) from the Xinde Mine, near Xuanwei in eastern Yunnan, which is located close to the area with the highest female lung cancer mortality in China. The two coals are characterized by high ash yields and low sulfur contents. Three factors, including sediment-source region, multi-stage volcanic ash generation, and multi-stage hydrothermal fluid injections, were responsible for variations in the geochemical and mineralogical compositions of the Xinde coals. Trace elements, including V, Sc, Co, Ni, Cu, Zn, Se, Zr, Nb, Hf, and Ta, are enriched in the coals and were mainly derived from the sediment-source Kangdian Upland region. Major minerals in the samples of coal, roof, floor and non-coal sediment partings include quartz, kaolinite, and chamosite, as well as interstratified illite/smectite and anatase. Chamosite in the coal was derived from reactions between kaolinite and Fe–Mg-rich hydrothermal fluids. However, chamosite in the roof strata was directly precipitated from Fe–Mg-rich hydrothermal fluids or was derived from the alteration of precursor minerals (e.g., biotite) by hydrothermal fluids. Quartz in some samples is very high, especially in the roof strata of the C2 and C3 coal. Such high quartz, along with minor minerals including pyrite, chalcopyrite, sphalerite, calcite, celestite, vanadinite, barite, clausthalite and silicorhabdophane, were derived from multi-stage hydrothermal fluids. The floors of both the C2 and C3 coal seams are fully-argillized fine-grained tuffaceous claystone and the immediate roof of the C2 coal is argillized coarse-grained tuff. The original materials of the floors and roofs of these coal seams were high-Ti alkali basaltic volcanic ashes, as indicated by high TiO2, Nb, and siderophile elements, and the distribution patterns of rare earth elements. Two intra-seam tonstein layers in the C3 coal were identified based on their lateral persistence, mineralogical mode of occurrence and composition, as well as their elemental composition. The tonsteins are dominated by kaolinite, with minor quartz and possibly mixed-layer illite/smectite. Both tonsteins were derived from dacitic magma. The ratios of Nb/Ta, Zr/Hf, and U/Th are much lower in tonsteins than in the adjacent coal benches, which is attributed to the hydrothermal leaching. [Copyright &y& Elsevier]

Abstract: Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. This paper describes the recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease. InterLACE aims to advance the evidence base for women''s health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. Currently InterLACE draws on individual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of women''s health in seven countries. The rationale for this multi-study research programme is set out in terms of a life course perspective to reproductive health. The research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk. Although combining multiple international studies poses methodological challenges, InterLACE represents an invaluable opportunity to strength evidence to guide the development of timely and tailored preventive health strategies. [Copyright &y& Elsevier]

Abstract: Although testosterone therapy is being increasingly prescribed for men, there remain many questions and concerns about testosterone (T) and in particular, T therapy in women. A literature search was performed to elucidate the origin of, and scientific basis behind many of the concerns and assumptions about T and T therapy in women. This paper refutes 10 common myths and misconceptions, and provides evidence to support what is physiologically plausible and scientifically evident: T is the most abundant biologically active female hormone, T is essential for physical and mental health in women, T is not masculinizing, T does not cause hoarseness, T increases scalp hair growth, T is cardiac protective, parenteral T does not adversely affect the liver or increase clotting factors, T is mood stabilizing and does not increase aggression, T is breast protective, and the safety of T therapy in women is under research and being established. Abandoning myths, misconceptions and unfounded concerns about T and T therapy in women will enable physicians to provide evidenced based recommendations and appropriate therapy. [Copyright &y& Elsevier]

Abstract: Aims: The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman''s quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases. Method: A short literature review of the most relevant publications was undertaken evaluating current practice. Results: FSD can have a negative impact on women''s well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.’s STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed. Conclusions: Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas: [•] Effective training for HCPs. [•] FSD as an early presentation of sub-clinical disease. [•] The cost-benefit of early treatment of FSD. [•] A standardised, validated FSD screening tool. [•] Benefits of using FSD screener in routine clinical practice. [Copyright &y& Elsevier]

Abstract: Lumpectomy followed by whole breast radiation therapy (i.e. breast conservation therapy (BCT)) is the standard of care for management of early stage breast cancer. However, its utilization has not been maximized because of a number of reasons including the logistic issues associated with the 5–6weeks of radiation treatment. Also, pathological and clinical data suggest that most ipsilateral breast cancer recurrences are in the vicinity of the lumpectomy. Accelerated partial breast irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1–2cm margin, rather than the whole breast with higher doses of radiation in a shorter period of time. There has been growing interest for APBI and various approaches have been developed and are under phase I–III clinical studies. This paper reviews external beam conformal radiation therapy (EBCRT) as a possible technique to APBI. The various EBCRT approaches such as 3D conformal radiation therapy, IMRT, proton therapy, tomotherapy, and volumetric arc therapy are discussed. Issues with the implementation of these techniques such as target volume delineation and organ motion are also presented. It is evident that EBCRT has potential for APBI of a selected group of early breast cancer patient. However, issues with setup errors and breathing motions need to be adequately addressed. [Copyright &y& Elsevier]

Abstract: This paper described the application of cinematherapy in the context of an intensive day hospital treatment program for patients with eating disorders (EDs) for a 40-year-old woman (L.) with a diagnosis of binge-purging anorexia nervosa (AN). The treatment of EDs is complex and still not completely defined. On one hand it is necessary to treat symptoms and on the other hand the use of creative techniques in addition to psychotherapy could be useful to improve skills concerning the experience, recognition and description of patients’ emotions. Moreover their ability to think using metaphors and to give a meaning both to illness and treatment could be also improved. Theoretical and clinical implications are discussed. [Copyright &y& Elsevier]

Abstract: Receiving the diagnosis of Primary Ovarian Insufficiency (POI) can be emotionally difficult and confusing for young girls and their families. Parents need assistance in knowing how to help their daughters understand and live with the diagnosis in a way that allows for healthy growth and development. This paper provides a starting point for parents and clinicians with “Tips and Tools for Talking: Helping Your Daughter Understand Primary Ovarian Insufficiency”. [Copyright &y& Elsevier]

Abstract: Few cases of congenital malformation of the external auditory meatus have been reported in the paleopathological literature. This paper describes a case of unilateral aural atresia in an adult female skeleton from the Greek colonial site of Apollonia Pontica on the Black Sea coast of Bulgaria. The anomaly is described and its impact on this individual''s ability to hear is evaluated using modern clinical data. Despite the loss of directional hearing and a visible malformation of the external ear, this individual would likely have led a fairly normal life and would have been capable of performing any number of everyday tasks. [Copyright &y& Elsevier]

Summary: A key issue in oral HPV infection is whether it can be associated with a genital HPV infection, or whether it can be considered as an independent event. This analysis evaluated the frequency and type-concordance of oral HPV infection in women with cervical HPV infection by means of: (i) a cross-sectional study on a sample (n =98) of Italian women; and (ii) a literature-based metanalysis, including the experimental study the subject of this Paper and nine other published studies (n =1017), which also examined the influence of oral sampling procedure (oral brushing vs oral rinse) and HIV status on oral HPV detection. The prevalence of oral HPV infection in the Italian study was 14.3% (95% CI: 7.4–21.2); the prevalence of type-concordance was 21.4% (95% CI: 0.0–43.6) and it was only marginally significant (P =0.05). The prevalence of oral HPV infection in the metanalysis was estimated as 18.1% (95% CI: 10.3–25.9); the prevalence of type-concordance was 27.0% (95% CI: 12.3–41.7), and it was statistically significant (P =0.002). The metanalysis also showed that the oral sampling procedure was not a determinant of HPV detection; however, HIV status increased the likelihood of oral HPV infection (HIV-positive vs negative: 27.2%; 95% CI: 22.1–32.2 vs 15.5%; 95% CI: 6.9–24.2) and type-concordance (HIV-positive vs negative: 46.8%; 95% CI: 34.7–58.9 vs 15.6%; 95% CI: 0.8–30.4). Oral HPV infection and type-concordance in women with cervical HPV infection are more prevalent than could be expected by chance; this finding is consistent with the notion of a degree of dependence of the oral site on the cervical site. Furthermore, oral HPV prevalence and type-concordance are influenced by immunity. [Copyright &y& Elsevier]

Abstract: Objective: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that seriously affects women''s health. The disorder is characterized by the formation of many follicles in the ovary. Currently the predominant diagnosis is to manually count the number of follicles, which may lead to inter-observer and intra-observer variability and low efficiency. A computer-aided PCOS diagnostic system may overcome these problems. However the methods reported in recently published literature are not very effective and often need human interaction. To overcome these problems, we propose an automated PCOS diagnostic system based on ultrasound images. Methods and materials: The proposed system consists of two major functional blocks: preprocessing phase and follicle identification based on object growing. In the preprocessing phase, speckle noise in the input image is removed by an adaptive morphological filter, then contours of objects are extracted using an enhanced labeled watershed algorithm, and finally the region of interest is automatically selected. The object growing algorithm for follicle identification first computes a cost map to distinguish between the ovary and its external region and assigns each object a cost function based on the cost map. The object growing algorithm initially selects several objects that are likely to be follicles with very high probabilities and dynamically update the set of possible follicles based on their cost functions. The proposed method was applied to 31 real PCOS ultrasound images obtained from patients and its performance was compared with those of three other methods, including level set method, boundary vector field (BVF) method and the fuzzy support vector machine (FSVM) classifier. Results: Based on the judgment of subject matter experts, the proposed diagnostic system achieved 89.4% recognition rate (RR) and 7.45% misidentification rate (MR) while the RR and MR of the level set method, the BVF method and the FSVM classifier are around 65.3% and 2.11%, 76.1% and 4.53%, and 84.0% and 16.3%, respectively. The proposed diagnostic system also achieved better performance than those reported in recently published literature. Conclusion: The paper proposed an automated diagnostic system for the PCOS using ultrasound images, which consists of two major functional blocks: preprocessing phase and follicle identification based on object growing. Experimental results showed that the proposed system is very effective in follicle identification for PCOS diagnosis. [Copyright &y& Elsevier]

Abstract: It is very important to obtain the parameters of deformation size and contraction frequency of women''s uterine musculature in medical research. This paper proposes a type of sensor for measuring these parameters and analyzes its force situation. The flexibility of the sensor makes it easy for doctors to let the sensor pass through woman''s narrow cervix and get to her uterine cavity. The experiment shows that the sensitivity of three coils in the sample sensor achieves 22.38nH/mm2 both for left and right coils, 22.84nH/mm2 for top coil, which can meet the requirements of sensitivity for testing the contraction situation of uterine musculature. Furthermore, an interface designed in the back end system can display the parameters of deformation size and vivid contraction situation of women''s uterine musculature in real-time. The sensor has been applied in some medical fields. [Copyright &y& Elsevier]

Standardisation of the classification of breast imaging reports will improve communication between the referrer and the radiologist and avoid ambiguity, which may otherwise lead to mismanagement of patients. Following wide consultation, the Royal College of Radiologists Breast Group has produced a scoring system for the classification of breast imaging. This will facilitate audit and the development of nationally agreed standards for the investigation of women with breast disease. This five-point system is as follows: 1, normal; 2, benign findings; 3, indeterminate/probably benign findings; 4, findings suspicious of malignancy; 5, findings highly suspicious of malignancy. It is recommended that this be used in the reporting of all breast imaging examinations in the UK. [Copyright &y& Elsevier]

Abstract: We examined the association between bone mineral density (BMD) and cardiovascular risk in a group of premenopausal women selected from the Southern province of Sri Lanka. One hundred six previously healthy premenopausal volunteers (aged 30–54yr) were recruited by open invitations. Subjects with previous history of diabetes, hypertension, epilepsy, chronic renal or liver disease, hyperlipidemia, ischemic heart disease, endocrine diseases, or prolonged inflammatory conditions were excluded. Subjects who were taking medications that can affect bone density, blood sugar, serum lipids, or blood pressure (BP) were also excluded. Women with the history of previous fractures were not excluded. BMDs in the spine, hip, and total body (TB) were measured using a Hologic Discovery scanner (Hologic Inc, Bedford, MA). BP, fasting glucose, and fasting lipids were also measured. Independent of body mass index (BMI) and age, TB bone mineral content (BMC) and spine BMD showed inverse and significant correlations with total cholesterol (TC), low density cholesterol, and the ratio between TC and high density lipoprotein cholesterol (r ranged from −0.24 to −0.27, p <0.05 for all). The highest mean lipid levels were seen among the women in the lowest third of spine BMD, whereas women in the upper third of spine BMD had the lowest lipid levels. The number of women with metabolic syndrome in the 3 tirtiles of spine BMD was not significantly different. Fasting glucose or BP had no association with either BMD or BMC. In conclusion, our data demonstrates an association, independent of age and BMI, between BMD and BMC or lipid levels among previously healthy, premenopausal women. This may explain the high cardiovascular risk seen in women with osteoporosis in old age. [Copyright &y& Elsevier]

Abstract: As the AIDS epidemic developed in the United States, emphasis turned from estimates of HIV incidence in male populations to estimates of HIV prevalence in the larger population, and to estimates of prevalence in sentinel populations. The concern was that heterosexual contact with male intravenous drug users was responsible for increased HIV prevalence among young women. Increases in HIV infection in women of child bearing age would result in increases in the number of HIV infected children. Thus, women of child bearing age would become an especially important sentinel population. The Newborn Seroprevalence Project was part of a national population-based survey to assess HIV prevalence among women of child bearing age. Blood from every newborn was obtained and tested for the HIV antibody. The observed proportion of seropositive births obtained during a given year in a given age/race/region stratum was used to estimate HIV prevalence of all women in that stratum. The purpose of this paper is to estimate the stratum and population-specific HIV prevalence and prevalence proportions for New York City women of child bearing age in 1991, as well as to estimate the bias that results from using the sample proportion in these efforts. [Copyright &y& Elsevier]

Abstract: Hormone replacement therapy (HRT) in young postmenopausal women is a safe and effective tool to counteract climacteric symptoms and to prevent long-term degenerative diseases, such as osteoporotic fractures, cardiovascular disease, diabetes mellitus and possibly cognitive impairment. The different types of HRT offer to many extent comparable efficacies on symptoms control; however, the expert selection of specific compounds, doses or routes of administration can provide significant clinical advantages. This paper reviews the role of the non-oral route of administration of sex steroids in the clinical management of postmenopausal women. Non-orally administered estrogens, minimizing the hepatic induction of clotting factors and others proteins associated with the first-pass effect, are associated with potential advantages on the cardiovascular system. In particular, the risk of developing deep vein thrombosis or pulmonary thromboembolism is negligible in comparison to that associated with oral estrogens. In addition, recent indications suggest potential advantages for blood pressure control with non-oral estrogens. To the same extent, a growing literature suggests that the progestins used in association with estrogens may not be equivalent. Recent evidence indeed shows that natural progesterone displays a favorable action on the vessels and on the brain, while this might not be true for some synthetic progestins. Compelling indications also exist that differences might also be present for the risk of developing breast cancer, with recent trials indicating that the association of natural progesterone with estrogens confers less or even no risk of breast cancer as opposed to the use of other synthetic progestins. In conclusion, while all types of hormone replacement therapies are safe and effective and confer significant benefits in the long-term when initiated in young postmenopausal women, in specific clinical settings the choice of the transdermal route of administration of estrogens and the use of natural progesterone might offer significant benefits and added safety. [Copyright &y& Elsevier]

Abstract: The metabolic syndrome (MetS) is represented by the co-occurrence of multiple metabolic and physiologic risk factors for both type 2 diabetes mellitus and atherosclerotic cardiovascular diseases. In spite of its high frequency and association with morbidity and mortality in the adult population, very little is known about its magnitude in the elderly and about the validity of the diagnostic criteria commonly used. The objective of this paper is to assess the prevalence rate of MetS and the validity of the Adult Treatment Panel III (ATP III) diagnostic criteria in an elderly Caucasian cohort, considering data from the Italian Longitudinal Study on Aging (ILSA), a population-based study with a sample of 5632 individuals aged 65–84 years at baseline (1992). Logistic regression models and ROC curve were used to test the validity of the cut off levels proposed. The prevalence of MetS was 31.5% in men, and 59.8% in women. The cut off levels suggested for both men and women by the ATP III panel indicated a significant association with the MetS for all components. Actually, the ROC analysis would suggest lower levels for glycaemia (106mg/dl) in men, and higher levels for blood pressure in both men and women (145/95 and 135/90, respectively). Concluding, MetS is very common in the aged Caucasians and the diagnostic criteria proposed by the ATP III panel seem to be appropriate in older individuals. Small adjustments in the cut off levels could be suggested for glycaemia (men) and in blood pressure (men and women). [Copyright &y& Elsevier]

Abstract: Background: Breast cancer is the second leading cause of cancer-related deaths among women in most industrialized countries. Most breast cancers are considered sporadic, with only 5–10% estimated to be due to inherited susceptibility. The objective of this paper is to provide an overview of the effect of nutrition on breast cancer risk among gene mutation carriers as well as those with sporadic breast cancer. Methods: The published literature from 1999 to 2007 was reviewed to examine the relationship between nutrition and breast cancer among sporadic cases and gene mutation carriers. Results: Evidence suggests that fruits and vegetables, low-fat dairy products, fish, monounsaturated and polyunsaturated fatty acids, vitamin D, calcium, and phytoestrogens may reduce the risk of breast cancer. However, high intake of meat, poultry, total energy, total fat and saturated fatty acids may play a causative role in this disease. Conclusions: Diet in breast cancer pathogenesis is a modifiable risk factor on which to focus prevention efforts. Identification of the relationship between nutrition and breast cancer among sporadic cases and gene mutation carriers provides necessary data for breast cancer prevention. [Copyright &y& Elsevier]

Abstract: The compilers of the Hippocratic gynaecological treatises often recommend sexual intercourse as part of treatments for women’s diseases. In addition, they often prescribe the use of ingredients that are obvious phallic symbols. This paper argues that the use of sexual therapy in the Hippocratic gynaecological treatises was more extended than previously considered. The Hippocratic sexual therapies involve a series of vegetable ingredients that were sexually connoted in antiquity, but have since lost their sexual connotations. In order to understand the sexual signification of products such as myrtle and barley, one must turn to other ancient texts, and most particularly to Attic comedies. These comedies serve here as a semiotic guide in decoding the Hippocratic gynaecological recipes. However, the sexual connotations attached to animal and vegetable ingredients in these two genres have deeper cultural and religious roots; both genres exploited the cultural material at their disposal. [Copyright &y& Elsevier]

Studying sex and gender differences is critical to understanding diseases that affect women solely, disproportionately or differently from men. Although inclusion of both sexes is essential in clinical research, advanced technology and analysis methods offer tools to define complex biological and physicochemical differences and improve prevention, diagnosis and treatments for diseases in women and men. This paper identifies the potential for biomarker development, pharmacogenetics and bioinformatics in research under the FDA Critical Path Initiative. [Copyright &y& Elsevier]

Abstract: The paper reviews the literature concerning health-related quality of life in women with urinary incontinence by using the Medical Outcomes Study Short Form (SF-36). The aim of this study was to determine the role of the SF-36 in the evaluation of urinary incontinence. Although some information regarding factors associated with health-related quality of life in women with urinary incontinence is currently available, this issue remains controversial since these factors had not been consistently found to have effects on quality of life. The scales of the SF-36 questionnaire have poor content validity for urinary incontinence, multidimensionality with difficulty of interpretation of any changes, and limited sensitivity to small changes in symptoms. The problem with using the SF-36 is that results are often insensitive to the specific condition measured and therefore fail to address many of the issues relevant to the disease. As a result, disease-specific instruments may be more beneficial in evaluating the impact of a specific urinary incontinence on quality of life and are more sensitive than their generic counterparts in detecting changes as a result of treatment. Since generic quality of life may be more susceptible to other factors such as co-morbid diseases than disease severity and reflect a wider aspect of daily life, these factors should also be evaluated in future studies. [Copyright &y& Elsevier]

Abstract: More women – and their families – are affected by the physical and psychological irregularities due to premenstrual symptoms than by any other condition. Up to 90% of women of childbearing age report perceiving one or more symptoms during the days before menstruation, symptoms which can alter their behaviour and wellbeing and which, therefore, can affect their family, social and work circle. However, and notwithstanding this general prevalence, the clinical entity that in a large number of cases results from these symptoms, commonly known as the premenstrual syndrome, still lacks defined and validated contents so that recommendations of treatments backed by adequate experimental and clinical evidence are only slowly appearing. In the present paper, we review recent experimental data as to a possible aetiology of the premenstrual problem. We propose a Premenstrual Profile, i.e. a new register of symptoms, to be used for the differential diagnosis of the three forms of the premenstrual alteration. Finally, we review the evidence-based recommendations from reliable sources as regards the treatment of “normal” and “abnormal” premenstrual symptoms. [Copyright &y& Elsevier]

Abstract: Gaining a diagnosis is considered to legitimate a person''s illness, to both the self and the wider social world, while also giving hope that treatments, and possibly a cure, will be found. A further function of diagnosis from the patient''s perspective is to give meaning to the illness experience, which is often uncertain and confusing. To do so, a diagnosis must itself have meaning. This paper explores the creation of meaning in a medically unexplained disorder, fibromyalgia syndrome (FMS). Semi-structured interviews, in which the diagnostic process was explored, were conducted with 17 people diagnosed with FMS in the United Kingdom, selected from a hospital database (16 women, 1 man). Documentary analysis was also undertaken on information available from support groups and health professionals. Although initially an acceptable diagnosis to sufferers, FMS was viewed as a mysterious label, which provided no meaning at the time of diagnosis. The sought information was accessed in an attempt to resolve its meaninglessness, but this proved problematic due to the ambiguous definition of FMS within the medical and support group literature, the invisible nature of the illness, and the lack of an environment where these uncertainties could be openly discussed. Informants varied in the degree of longer-term acceptance of a diagnosis of FMS, in relation to the concordance they achieved between the diagnosis and their experience of illness. [Copyright &y& Elsevier]

Abstract: New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on “female-controlled” preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-à-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations—for better and for worse—shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men. [Copyright &y& Elsevier]

Abstract: Migraine is a common, debilitating and costly disorder. Yet help-seeking for and rates of diagnosis of migraine are low. Drawing on ethnographic observations of pharmaceutical marketing practices at professional headache conferences and a content analysis of migraine advertising, principally in the USA, this paper demonstrates: (1) that the pharmaceutical industry directs its marketing of migraine medication to women; and (2) as part of this strategy, pharmaceutical advertisements portray women as the prototypical migraine sufferer, through representations that elicit hegemonic femininity. This strategy creates the impression that migraine is a “women''s disorder”, which, in turn, exacerbates gender bias in help seeking and diagnosis of migraine and reifies presumptions about the epidemiology of the disorder. I conclude that these pharmaceutical marketing practices have a paradoxical effect: even as they educate and raise awareness about migraine, they also create barriers to help seeking and diagnosis. [Copyright &y& Elsevier]

Abstract: Small size at birth is linked with an increased risk of chronic diseases in later life. Poor maternal nutrition during gestation may contribute to restricted fetal growth, leading to increased disease susceptibility in later life. Animal studies have shown that undernutrition during gestation is associated with reduced life span and increased disease susceptibility. The Dutch famine is a unique counterpart for animal models that study the effects of restricted maternal nutrition during different stages of gestation. This paper describes the findings from a cohort study of 2414 people born around the time of the Dutch famine. Exposure to famine during any stage of gestation was associated with glucose intolerance. We found more coronary heart disease, a more atherogenic lipid profile, disturbed blood coagulation, increased stress responsiveness and more obesity among those exposed to famine in early gestation. Women exposed to famine in early gestation also had an increased risk of breast cancer. People exposed to famine in mid gestation had more microalbuminuria and obstructive airways disease. These findings show that maternal undernutrition during gestation has important effects on health in later life, but that the effects on health depend on its timing during gestation. Especially early gestation seems to be a vulnerable period. Adequate dietary advice to women before and during pregnancy seems a promising strategy in preventing chronic diseases in future generations. [Copyright &y& Elsevier]

Social scientists concerned with studying the social and cultural meaning of illness problematize the relationship between disease and illness, noting that illness can exist without disease—abnormal physical changes in the body. What has received less attention is the existence of disease—made visible through technological advances—in the absence of illness. Cervical cancer (or the more ambiguous cervical abnormalities) is an example of a disease that is largely symptomless in its early stages and can occur in the absence of illness. In this paper I explore how women seek to understand and negotiate cervical cancer in the context of their everyday lives, as they are confronted with seemingly disparate and contradictory physical and psychological states of well-being, sickness, and disease. This experience is what I call living on the borderlands of health, disease, and illness, where all of these states are experienced concurrently and boundaries between them blur. Through observations of patient-doctor interactions, ethnographic interviews with doctors and women seeking treatment for cervical cancer and pre-cancerous abnormalities, I analyze how women try to understand their medical experience. And they do so with the added challenge of little information being shared with them by the doctors who treat them. While patients do not ask many questions of their doctors, this does not mean that women are disinterested in their health. In fact, they develop strategies for eliciting clinical information about their medical conditions and actively seek to make sense of their experiences. By problematizing the concepts of health, disease, and illness, and avoiding the tendency to see these as distinct and contradictory phenomenon, we can gain a better understanding of their interrelatedness, and how people negotiate this borderland. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Early psychosomatic research proposed a hydraulic model for anger expression and blood pressure (BP); that is, people who express their anger were believed to have lower BP. Unfortunately, subsequent evaluations of this model have produced inconsistent results. In this paper, it is posited that weak methods of measuring BP, failure to address gender differences, and exclusive emphasis on linear models may have contributed to inconsistent results. Design and measures: We investigated the possibility of curvilinear relationships between expressed anger and resting BP after controlling for traditional risk factors. Participants: Data from two samples of varying cardiovascular health status (one healthy, the other hypertensive) and ages were examined. Results: Across both samples, very low and very high self-reported expressed anger was associated with the lowest diastolic BP in women. There was no equivalent finding in men. Conclusion: Women, but not men, have lower BP when they report to openly express their angry feelings. The results support the value of exploring curvilinear relationships and gender differences in anger expression effects on cardiovascular health. [Copyright &y& Elsevier]

Summary: Obesity and the female sex represent significant risk factors for osteoarthritis (OA). Few studies have demonstrated a metabolic link between obesity and OA, strengthening the likelihood that biomechanical factors mediate this relationship, possibly via the redistribution of increased body mass to weight-bearing joints. However, it is less plausible that the biomechanical factors that contribute toward the incidence of OA at weight-bearing joints, such as the knee, are similar to those at non-weight bearing joints, such as in the hand. This may suggest that non-examined or unidentified biomechanical and/or systemic factors may be important contributors to the aetiology of OA. Recent developments that have helped to better appreciate the pathophysiology of obesity offer new hope to understanding the link between obesity and OA. The discovery of the obesity gene (ob) and its product leptin may have important implications for the onset and progression of OA. For instance, the greater total body fat of the average adult female may partially account for the gender disparity toward OA, given that females theoretically demonstrate higher levels of adipose derived systemic leptin concentrations than their male counterparts. However, while it was previously thought that adipose cells were only capable of leptin production, osteoblasts and chondrocytes are also capable of leptin synthesis and secretion, inferring that local leptin production may be of great importance. For instance, significant levels of leptin were observed in the cartilage and osteophytes of people with OA, yet few chondrocytes produced leptin in the cartilage of healthy people. Leptin has also been demonstrated to induce anabolic activity in the chondrocytes of rats, which may ultimately confer structural joint changes. This paper hypothesizes that leptin may be an unexamined systemic or local factor that may mediate the metabolic link between obesity and OA and partially account for the gender disparity toward the disease. [Copyright &y& Elsevier]

Western medicine is seen as universally valid, but in reality it displays a wide range of national and local variability. Our paper focuses on one such case of local variation: the widespread use of progestins in France to treat various pre- menopausal conditions as well as for contraception. The case of progestins allows us to explore how specific styles of research may come to dominate a particular local medical culture, and how they are influenced by changing criteria of scientific validity and wider social relations. We argue that in the 1980s and 1990s a single prestigious research-oriented Parisian hospital service played a dominant role in the transformation of progestins into scientifically validated medical practice. This status was not called seriously into question until recently when foreign research on a different form of hormone therapy suggested that risk was associated with their use. We also propose that both the research around and medical use of progestins in France was shaped by the positive attitude of many French women, including feminists, to hormonal therapies and to the non-surgical specialty most closely associated with hormones, medical gynaecology. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: Clinical practice guidelines (CPGs) are tools that urinary incontinence (UI) specialists can use to update and communicate their expertise with other specialists, health authorities and general practitioners to help promote a more uniform approach to the initial management of women with UI. The objective of this paper was to assess available recommendations for the initial management of UI in women from urology organizations in Europe and North America and compare with the recommendation from the International Consultation on Continence (ICI). Methods:: A review of the medical literature was conducted to identify and compare relevant CPGs for the initial management of UI in women. Results:: The European Association of Urology (EAU) and the Spanish National Association of Urology (SNAU) have developed CPGs for the initial management of UI in women, both of which are similar to those developed by the ICI. Differences exist in the pharmaceutical treatment of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Few treatment options are supported by sufficient scientific evidence to qualify as “A-level” recommendations. Conclusion:: The recommended initial management of UI in women from the EAU and SNAU is in general agreement with that from the ICI, but some treatment options have limited scientific support. Endorsement or simplification accepted by urologists may enhance the credibility of CPGs and promote their adoption by other practitioners without detailed UI experience and improve the quality and consistency of care for women with UI. [Copyright &y& Elsevier]

The increased susceptibility of pregnant women to malaria infection has long been recognized, but the magnitude of the disease burden in this particular group, together with the pathophysiology of maternal malaria and the specific difficulties in treatment, have only recently been the focus of research. Most research on maternal malaria has derived from sub-Saharan Africa where transmission is high, whereas most of the studies on the treatment of malaria and the effect of non-falciparum species has been conducted in low-transmission areas of Asia. In this paper, we attempt to improve our understanding of the disease and its mechanisms from observed differences and similarities between contrasting areas of transmission, and to identify priorities for future research. [Copyright &y& Elsevier]

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women''s arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women''s health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research. [Copyright &y& Elsevier]

This paper is concerned with understanding why some women accept their invitation for free screening mammography and others do not. Free screening mammography is offered to women aged 50–64 in Britain. Uptake of invitations is about twice as high in leafy suburbs than in inner-city areas. Low uptake in inner-city areas has been attributed to ‘problems’ of black and minority ethnic women. The research reported here was carried out in Hackney, an inner city London borough with an ethnically diverse and socially deprived population. Hackney also has the lowest uptake of screening mammography in the country. Twenty focus groups were held. Participants included white, black and minority ethnic women. Eight focus groups were conducted in English; 12 in other languages. Some methodological issues raised by undertaking qualitative research in several languages are considered. The research demonstrates how the inclusion of white women in research which operationalises ethnicity minimizes the risk of developing an analysis focusing on ‘problems’ of black and minority ethnic women and encourages the development of general themes which may apply to all women. The analysis focuses on candidacy, that is, women''s assessment of risk of their disease, and compliance, that is, the explanations respondents volunteered for accepting or refusing an invitation to attend for mammography. Candidacy and ethnicity emerge as similar constructs, manipulated by women to make claims about their risk of breast cancer. Other, non-medical reasons were given for compliance which serve as a warning about assuming that, when women accept their invitation, they do so for same the reasons the architects of the National Health Service Breast Screening Programme had in mind. [Copyright &y& Elsevier]