Search

The purpose of this study is understanding women's experiences regarding health-related quality of life (HRQOL) in the context of living with coronary artery disease (CAD). Sampling was purposive and continued until data saturation. The women participated in semistructured interviews that were tape-recorded and completed in less than 1 hour. Conventional content analysis was used to analyze the data. Results indicate that CAD influenced the participants' HRQOL. This occurred through categories the investigators labeled 'dealing with one more thing,' 'surrendering roles and pleasures,' 'managing the health system,' 'understanding CAD,' and 'resolving to be strong.' The thoughtful responses of the women in this study suggest that understanding the HRQOL of women who have CAD lies in the context of considering their quality and quantity of social support. Thus, it behooves health care providers to assess patients' levels of social support and intervene as appropriate. Keywords: cardiovascular; clinical focus; qualitative methods; adult; population focus

The purpose of this meta-analysis was to examine the effectiveness of aerobic exercise interventions on cardiopulmonary function and body composition in women with breast cancer. Of 24 relevant studies reviewed, 10 studies (N = 588) met the inclusion criteria. The findings indicated that aerobic exercise significantly improved cardiopulmonary function as assessed by absolute V[O.sub.2] peak (standardized mean difference [SMD] .916, p < .001), relative V[O.sub.2] peak (SMD .424, p < .05), and 12-minute walk test (SMD .502, p < .001). Similarly, aerobic exercise significantly improved body composition as assessed by percentage body fat (SMD -.890, p < .001), but body weight and lean body mass did not change significantly. Aerobic exercise during or after cancer adjuvant therapy seems to be an effective means of improving cardiopulmonary function and decreasing percentage body fat in women with breast cancer. Further studies are needed to examine the long-term benefits of aerobic exercise. Keywords: exercise; meta-analysis; breast cancer; cardiopulmonary function; body composition

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.02.024 Byline: Myriam Khlat (a), Florence Jusot (b), Isabelle Ville (c) Abstract: This study investigates the relation between early life conditions and adult obesity in France, using a rich data set collected through the 2003 nationally representative Life History Survey. No salient factor emerged in men, while in women, after controlling for current socio-demographic characteristics, a relation was found between obesity and the following factors: father's occupation (OR=3.2 for women whose father was a clerical worker, versus those whose father was in a higher-level occupation); experience of economic hardship in childhood (OR=2.0), and; high parity (OR=2.1 for parities of more than 3 versus parity of 1). Neither early family history nor mother's working status surfaced as significant factors. Those findings highlight a definite gender pattern, with a strong association between early disadvantage and obesity in women, but not in men. Potential mechanisms are discussed, particularly the 'habitus', the 'thrifty phenotype' and the 'feast-famine' hypotheses, and possible interactions with childbearing and motherhood. An integration of social and biological perspectives is needed to reach a better understanding of the processes involved, and to achieve progress in primary and secondary prevention. Author Affiliation: (a) INED, 133 boulevard Davout, 75980 Paris Cedex 20, France (b) Universite Paris-Dauphine (Leda-Legos); Institut de Recherche et Documentation en Economie de la Sante, Paris, France (c) CERMES-INSERM, Villejuif, France

Summary This article provides an overview of cardiovascular disease (CVD) in women. It considers cardiovascular risk, investigations and treatment. Gender bias, controversies and current debates are highlighted. Issues concerned with [...]

The diagnosis of a chronic illness is a life changing event that affects the biological, psychological, and sociological aspects of a person's life. The purpose of the present study was to compare the experiences of pain, physical and psychological well-being, stress, patient satisfaction, social support, and attitudes toward menstruation of women who suffer from endometriosis and women who suffer from chronic migraine headaches. It was hypothesized that women with endometriosis would have more negative scores than women who have migraines on all measures because endometriosis is not understood by society to be a valid source of pain. Participants were 41 women with endometriosis and 32 women with migraines who were recruited from support groups and online listservs. Women with endometriosis reported significantly more pain, stress, and negative attitudes toward menstruation than did women with migraines. Implications for the differential treatment of women with chronic illnesses related to the menstrual cycle are discussed. doi: 10.1300/J013v46n01_08 KEYWORDS. Endometriosis, migraines, women's health, attitudes toward menstruation, pain, satisfaction with healthcare

Women are approximately twice as likely as men to develop posttraumatic stress disorder (PTSD), but the cause of this disparity remains unclear. This study evaluated 2 alternative explanations of gender differences in PTSD, one pointing to an intrinsic vulnerability in women and the other emphasizing sexual violence across the life span. To test these competing theories, the authors analyzed National Violence Against Women Survey data from 591 victims of partner aggression. Results suggested that gender, when considered alone, has a small but significant effect on PTSD symptom severity. However, once models factor in sexual victimization history, the latter replaces gender as a key determinant of PTSD symptoms. These findings argue against theories of 'feminine vulnerability,' instead linking PTSD risk to sexually violent situations. Keywords: posttraumatic stress disorder, gender, sexual assault, partner aggression

Urinary incontinence, defined generally as involuntary leakage of urine, is a common health problem among women. There are several nonpharmacological, pharmacological, and surgical treatments available that are effective in managing the symptoms of this problem.

Research has been carried out on HIV-infected women in sub-Saharan Africa. The role of socioeconomic, demographic and environmental risk factors for pneumonia in these women has been investigated, and the details are reported.

Research has been conducted on C-reactive protein and its relationship to mortality in HIV-1-infected women. Results demonstrate that this protein can be a predictor of HIV disease mortality in women.

Research has been copnducted on proteinuria or elevated serum creatinine incidence in HIV-positive and HIV-negative women. The hypothesis that these abnormalities are mortality predictors has been tested, and the results suggest that proteinuria or elevated serum creatinine management should be a priority for HIV-infected people.

Research has been conducted on HTLV infection and its association with HIV and other risk factors. Results demonstrate that the association between HTLV-1 and HIV-2 for men and women was different and that that common sexual risk factors cannot explain the co-occurrence of HIV-2 and HTLV-1 in women.

Hysteria moved from being a disease that happened to both sexes to being primarily thought of as a disease of women by the end of the 18th Century. The popularity of hysteria as a diagnosis and the gendering of the disease is described.

Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD. Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk.

About one-fourth of the women living in some rural parts of South Africa may be HIV-positive, according to a study of 2,013 pregnant women who visited a prenatal clinic in Hlabisa in 1997. Twenty-six percent were HIV-positive, and among women between 20 and 24 years old, 34% were HIV-positive.

Objective To evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus. Design A pretest-posttest control group design. Participants received random group assignment. Subjects/setting Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program. Intervention Nine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubel's learning theory were also incorporated into program design and evaluation. Main outcome measures The effectiveness of the food label education program on participants' knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants' perceived confidence in using the food label. The validity and reliability of the instruments had been established previously. Statistical analyses Analysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results. Results The experimental group showed a greater gain than the control group in total knowledge (P, Nutrition therapy is an essential component of successful diabetes management. Food selection affects the nutrient and energy content of the diet and the metabolic control of levels of glycated hemoglobin, [...]

Our preliminary family studies have suggested that some female first-degree relatives of women with polycystic ovary syndrome (PCOS) have hyperandrogenemia per se. It was our hypothesis that this may be a genetic trait and thus could represent a phenotype suitable for linkage analysis. To investigate this hypothesis, we examined 115 sisters of 80 probands with PCOS from unrelated families. PCOS was diagnosed by the combination of elevated serum androgen levels and [less than or equal to]6 menses per year with the exclusion of secondary causes. The sisters were compared with 70 healthy age- and weight-comparable control women with regular menses, no clinical evidence of hyperandrogenemia, and normal glucose tolerance. Twenty-two percent of the sisters fulfilled diagnostic criteria for PCOS. In addition, 24% of the sisters had hyperandrogenemia and regular menstrual cycles. Circulating testosterone (T) and nonsex hormone-binding globulin-bound testosterone (uT) levels in both of these groups of sisters were significantly increased compared with unaffected sisters and control women (P < 0.0001 for both T and uT). Probands, sisters with PCOS, and hyperandrogenemic sisters had elevated serum luteinizing hormone levels compared with control women. We conclude that there is familial aggregation of hyperandrogenemia (with or without oligomenorrhea) in PCOS kindreds. In affected sisters, only one-half have oligomenorrhea and hyperandrogenemia characteristic of PCOS, whereas the remaining one-half have hyperandrogenemia per se. This familial aggregation of hyperandrogenemia in PCOS kindreds suggests that it is a genetic trait. We propose that hyperandrogenemia be used to assign affected status in linkage studies designed to identify PCOS genes.

Evidence that lymphangiomyomatosis (LAM) is caused by TSC2 (ital) mutations has been found but genetic transmission of LAM has not been reported. On chromosome 16p13 loss of heterozygosity has been found in angiomyolipomas and lymph nodes of women with LAM, a rare disease which involves diffuse proliferation of smooth muscle cells and can only be treated by transplanting lungs. LAM may or may not be associated with tuberous sclerosis complex (TSC), an autosomal dominant tumor suppressor gene syndrome. Loss of heterozygosity is found in the chromosomal region for the TSC2 (ital) gene in 60% of tuberous sclerosis complex (TSC)-associated angiomyolipomas. It seems pathogenesis of sporadic LAM may be related to TSC2 (ital). Women with LAM may have low-penetrance germ-line TSC2 (ital) mutations or may be mosaic, having TSC2 (ital) mutations in the kidney and lungs and not in other organs.

Young women should be taught safe sex and other ways to prevent HIV infection while they are teenagers, preferably before they begin having sex. Data on AIDS in US women from the Centers for Disease Control and Prevention reveal that women made up 19% of all adult AIDS cases in 1995. Black women and women living in the Northeast and in urban areas had the highest rates. The biggest increases in the 1990's were seen in the South and in heterosexual women. The greatest increase in the rate of AIDS development occurred in women who were 21 to 25, indicating that they became infected while teenagers., Context. -- The effect of the acquired immunodeficiency syndrome (AIDS) epidemic on women is substantial and warrants an updated analysis. Objective. -- To describe AIDS incidence trends in women. Design. -- We analyzed national surveillance data on women 13 years of age and older with AIDS reported through June 1996. Data were adjusted for reporting delay, unreported risk, and the 1993 change in AIDS surveillance case definition to assess overall trends and examine trends by age group and birth cohort. Setting. -- Surveillance conducted by the Centers for Disease Control and Prevention in collaboration with state and local health departments. Results. -- In 1995, women accounted for 19% of AIDS cases in adults; AIDS incidence rates per 100 000 women were highest in black women (50.1), women in the Northeast (22.3), heterosexual contacts (5.5), and women living in metropolitan statistical areas with more than 1 million residents (15.9). Greatest increases in rates between 1991 and 1995 by region and mode of transmission were in the South and in heterosexual contacts. Greatest increases in AIDS incidence rates were observed in heterosexually infected women born between 1970 and 1974, ie, women who were 14 to 18 years old in 1988. Conclusions. -- These trends predict continued growth of the number of AIDS cases in women, especially in those in the South and those infected heterosexually, and suggest that successive cohorts of young women may be at risk for human immunodeficiency virus infection as they reach adolescence and young adulthood. Prevention programs must reach young women before they initiate sexual activity and drug use. JAMA. 1997;278:911-916

Stable carbon and nitrogen isotopes were analysed on bone collagen of 43 Sudanese Nubians from the X-Group period to test dietary hypotheses for the high frequency of osteopenia in this population. Stable carbon isotope ratios indicate that both normal and osteopenic individuals consumed the same mixed diet of C3 and C4 sources, which are assumed to have been constituted by the grain staples wheat/barley and sorghum/millet respectively. Females with osteopenia, however, have significantly elevated [[Delta].sup.15]N values. The enrichment effect is greatest in the third and fifth decades of life, and is consistently patterned with microstructural and frequency differences previously reported by other researchers. It is suggested that [[Delta].sup.15]N is reflecting differences in urea excretion and the renal processing and clearance of calcium and phosphorus. The study not only alerts us to the susceptibility of stable nitrogen isotopes to non-dietary (i.e. physiological) factors, but also identifies nitrogen isotope ratios as a possible new marker for osteopenia. KEY WORDS osteopenia; stable carbon and nitrogen isotopes; Nubia; nutrition; reproduction; kidney function

Health care providers should educate themselves about the risk factors and preventive measures concerning secondary amenorrhea, or menstrual dysfunction, and related osteoporosis. Amenorrhea in adolescent and young adult women can lead to a reduction in bone density and eventual osteoporosis. Anorexia nervosa, oral contraceptives, and long-term, strenuous exercise can lead to amenorrhea. A physical assessment of patients with amenorrhea and possibly a prescribed change in diet and exercise routine can help prevent loss of bone density mass.

An increasing number of young and sexually-active women are becoming involuntarily sterile because of an epidemic caused by Chlamydia trachomatis and Neisseria gonorrhea. These bacteria are responsible for the majority of STD-related reproductive tract damage in women. The asymptomatic nature of these bacteria makes detection and prevention more difficult. Furthermore, delay in treatment could complicate the infection which could lead to infertility. This could be prevented through prompt and accurate treatment in case of an infection and by educating people about chlamydia.

Vulvar lichen sclerosus can be treated most successfully when diagnosed in early stages. Women tend to be affected by this disease either before or after menopause. This condition may make intercourse and defecation painful. Although no cure is available, lifelong treatment with testosterone ointment can alleviate symptoms. Nurse practitioners can avoid misdiagnosis by a careful pelvic examination.

Cigarette smoking appears to increase the risk of age-related macular degeneration. Degeneration of the macula, which is the central part of the retina, is a common cause of visual impairment in the elderly. Data from 31,843 women participating in the Nurses' Health Study reveal that those who smoked 25 or more cigarettes per day during the 12-year study were 2.4 times more likely to develop macular degeneration. Even those who had quit were twice as likely to develop the visual disorder. Smoking could affect blood flow in the retina or increase the level of damaging oxidants.

Interstitial cystitis (IC) is a relatively rare and poorly understood chronic bladder condition affecting 10 times more women than men. Symptoms of IC include urinary frequency, urgency, and suprapubic pain. Many persons also have urethral and vulvar pain. Misconceptions about IC and IC patients may contribute to patients' difficulties obtaining an accurate diagnosis and may diminish the likelihood that they will access appropriate care. Many common symptoms of IC, including dyspareunia, can seriously compromise the ability to maintain a satisfying sexual relationship. Effective management of interstitial cystitis requires accurate information about the disease and possible related sexual problems. Patients and their partners need support from health care providers for making necessary modifications in the sexual relationship that can greatly contribute to an improved quality of life.

Women with breast cancer face an uncertain future because treatment does not insure a cure. Nurses should try to understand this situation, and should provide these patients with support, information, and the opportunity to discuss their feelings. Hermeneutic phenomenology and photographic hermeneutics were used in a study to interpret uncertainty for several women who had been treated for breast cancer.

Objectives. This study compares characteristics, behaviors, and human immunodeficiency virus (HIV) infection in women who reported same-sex contact and women who had sex only with men. Methods, Participants were patients attending a New York City sexually transmitted disease clinic. Structured questionnaires were administered by interviewers. Results. Overall, 9% (135/1518) of women reported same-sex contact; among these, 93% also reported contact with men. Women reporting same-sex contact were more likely than exclusively heterosexual women to be HIV seropositive (I7% vs 11%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.6), to exchange sex for money/drugs (48% vs 12%, OR = 6.7, 95% Cl = 4.6, 9.8), to inject drugs (31% vs 7%, OR = 6.3, 95% Cl = 4.1, 9,5), and to use crack cocaine 37% vs 15%, OR = 3.3, 95% Cl = 2.2, 4.8). HIV in women reporting same-sex contact was associated with history of syphilis (OR = 8.8), sex for crack (OR = 5.7), and injection drug use (OR = 4.5). Conclusions. In this study, women who reported same-sex contact were predominantly bisexual. They had more HIV risk behaviors and were more often HIV seropositive than women who had sex only with men. Among these bisexual women, heterosexual contact and injection drug use were the most likely sources of HIV. There was no evidence of female-to-female transmission. (Am J Public Health. 1995;85: 1366-1371), Inner city women who are bisexual appear to engage in more high-risk behaviors for HIV infection than their heterosexual counterparts. Researchers surveyed 1518 inner city women attending a clinic for sexually transmitted diseases. Ninety-one percent reported having only heterosexual sex since 1978, 0.7% had exclusively homosexual relationships since 1978, and 8% had relationships with both sexes. No woman with exclusively homosexual relations was HIV positive. Eighteen percent of bisexual and 11% of heterosexual women were HIV positive. Thirty-eight percent of women reporting same-sex relationships versus 13% of heterosexual women had three or more partners in the three months prior to the survey. Forty-eight percent versus 12% exchanged sex for drugs or money. Thirty-one percent versus 7% reported injection drug use, and 31% versus 15% reported crack cocaine use. Women reporting same-sex contact were 2 to 4.5 times as likely to report sexual contact with a person who injected drugs, a bisexual man, or an HIV positive person.

Primary means of reducing the risk of coronary heart disease in women include not smoking, lowering total cholesterol levels, engaging in physical activity, and treating high blood pressure and obesity. Women who smoke have 2 to 4 times the risk of coronary heart disease than women who do not. Decreasing levels of low-density lipoprotein and increasing levels of high-density lipoprotein reduce the risk. Women who are physically active may have 60% to 70% lower risk than inactive women. Moderate alcohol intake, antioxidant vitamins, and aspirin may also lower the risk. The use of oral contraceptives, sudden and early menopause, and removal of the ovaries increase the risk. However, normal menopause does not suddenly increase risk. Hormone replacement following menopause may help reduce risk, but may not benefit other aspects of women's health. Studies have shown that treating serious hypertension reduces CHD risk, however treating mild hypertension may not. Diabetes mellitus increases the risk of death from coronary heart disease by 3 to 7 times in women.

This paper discusses the microgeographies of unemployed women with multiple sclerosis, as they manage the physical, social and economic consequences of their illness. Recent directions in the geography of health and health care draw attention to the relationships between space, place and health experience, and in this paper a focus on the everyday lives of women with Multiple Sclerosis reveals the complex interweaving of space, physical impairment and gender in how they experience place. In-depth interviews were used in the study to investigate how women occupied and used home and neighbourhood space after leaving the paid labour force. The majority of women were found to experience shrinking social and geographical worlds which rendered their lives increasingly hidden from view as patterns of social interaction changed and use of public space diminished. The paper discusses the women's residential and household changes, mediated by marital and socio-economic status, and presents two brief case studies to illustrate the remapping of the meanings of work and place as women renegotiate their lifeworlds. The focus of the study on the spatio-temporal settings of the women's everyday lives revealed an interplay of biomedical discourse, policy structures, sociocultural norms and local sets of social relations that shaped the strategies the women used in reconstructing their lives. The women showed a diversity of responses, but these were all characterized by a restructuring of home and neighbourhood space, a reordering of personal relationships and increasing interpenetration of the public sphere in their private lives. The findings suggest that attention to the body in its geographical as well as social context provides an avenue for investigating the links between subjective experience and the broader social relations and processes which shape the illness experience. Key words - medical geography, gender, lifeworld, chronic illness, multiple sclerosis

Lactation is a hypermetabolic state in which nutrition plays an integral role. Adequate nutrient stores, combined with adequate diet, are crucial for maintaining maternal health (1). Cystic fibrosis is also […]

Women with a family history of breast cancer may have a higher risk of developing the disease themselves. This risk still may exist even if the closest family member with the disease is a third-degree relative such as cousins. Researchers examined the Mormon genealogical information from the Utah Population Database and data from the Utah Cancer Registry and the Utah Department of Vital Statistics to determine the family history risk of breast cancer. The risk of breast cancer was three times higher for individuals with the highest family history score than for those with the lowest family history score. The risk of breast cancer was approximately twice as high if the family member with breast cancer was a first-degree relative, a mother or sister, rather than a third-degree relative. Women whose mother had breast cancer had a higher risk than those whose sister had the disorder., Objective. - The purpose of this study is to assess the impact of family history on the fisk of developing breast cancer. Design. - A case-control study design was used. Setting. - To provide a comprehensive assessment of family history risk, we used the Utah Population Database, a linked database compiled of genealogy data of the descendants of Mormon pioneer families, cancer data from the Utah Cancer Registry, and mortality data from the Utah Department of Vital Statistics. Patients. - All women diagnosed with breast cancer who were in the genealogy database and the Utah Cancer Registry were included. Controls were women selected from the genealogy, who like cases had no record of previous cancer. They were matched to the cases by age and place of birth. Outcome. - Several definitions of family history were used. The total familial fisk variable, developed to work effectively in the Utah Genealogy Database, accounts for all family members, their degree of relatedness to the case, and the amount of time they were observed for possible cancer diagnosis. Results. - A threefold increase in risk, estimated by the odds ratio (OR), of breast cancer among those with the highest family history score (6% of cases) was observed when compared with those with the lowest family history score. The OR for women with a first-degree relative with breast cancer was 2.45 (95% confidence interval [CI], 1.84 to 3.06). If the nearest relative was a second-degree relative, the OR was 1.82 (95% CI, 1.39 to 2.24); if the nearest relative was a third-degree relative, the OR was 1.35 (95% CI, 1.07 to 1.64). A slightly greater risk was observed if the first-degree relative was a woman&apos;s mother (OR, 2.44; 95% CI, 1.77 to 3.42) rather than a sister (OR, 2.01; 95% CI, 1.66 to 2.43). Among subjects diagnosed before the age of 50 years, the disease experience of relatives prior to age 50 was most important, while for older subjects the experience of relatives of all ages was of roughly equal importance. Women who developed contralateral breast cancer within 3 years of initial diagnosis were nearly 10 times as likely as women without breast cancer to have a first-degree relative with breast cancer. Based on the fisk estimates in this study, we have estimated that approximately 17% to 19% of breast cancer in the population could be attributed to family history. Women who had a first-degree relative with colon cancer had a 30% increased risk of breast cancer. Conclusions. - In this study population, women with a family history of breast cancer, even if the nearest relative with breast cancer is a third-degree relative, are at increased risk of the disease. (JAMA. 1993;270:1563-1568)

This paper reviews the factors which make non-immune pregnant women particularly vulnerable to falciparum malaria and examines the problems of adequately protecting them in relation to current control strategies. Women are most at risk in areas of high and continuous transmission, particularly during their first pregnancy, and also under conditions of unstable malaria which do not permit immunity to develop. Chemoprophylaxis is recommended for pregnant women in holoendemic and hyperendemic areas in Africa and Papua New Guinea. Chloroquine is safe, but drug resistance problems are beginning to limit its utility. Distribution is a formidable problem in rural areas with a poorly developed health care infrastructure, and research studies reveal widespread ignorance and lack of motivation. In countries in which primary health care systems are fairly well developed, and where malaria transmission is relatively less intense, the emphasis is on early diagnosis and treatment of cases. The assumption is made that women and men have equal access to medical facilities. The preponderance of reported cases among adolescent and adult males in some areas has been attributed solely to the well-known greater occupational risks in some traditionally male activities. Two recent studies, however, suggest that underprivileged women, weighed down by domestic chores, do not readily attend clinics at some distance from home, and therefore are liable to be missed in passive surveillance. It is essential that services within the village should be strengthened, but there are problems in implementation. Lacunae in existing knowledge are discussed.

A total of 910 mothers attending the Percy Boland Maternity Institute in Santa Cruz were investigated. Of these mothers, 9.5% transmitted Chagas' disease to their children. It was observed that the frequency of congenital transmission in the city was influenced by certain socio-cultural factors relating to the mother, such as increased fertility, early age of motherhood and blood transfusions, and also by the movement of migrants from other endemic regions of Bolivia and from rural areas in the same department. It is postulated that the persistence of the disease in the urban setting is due to a second-generation transmission cycle. Comments are made on how regions where Chagas' disease is endemic become risk areas for women migrating from non-endemic regions, as well as on the need to develop an adequate strategy for the control of this non-vectorial form of transmission of Chagas' disease.

There is insufficient and inadequate information to gauge the impact of schistosomal infection on the health of women. Biomedical research has equated women's health with the study of reproductive performance and reproductive organs and this narrow focus has left a number of important questions unanswered. Attempts to explore the economic and social aspects of schistosomal infection have been minimal and most research has focused on men rather than women. It has two characteristics: first, economists have relied on single performance indicators which are rooted in the cultural traditions of the research workers rather than the participants. Second, questionnaires have been used to elicit perceptions of health and illness; and local, culturally-specific information has not even been used to formulate the questions. Future research assessing the social and economic aspects of infection among women would be enhanced by undertaking inter-disciplinary research, with an ethnographic component; and blending qualitative with quantitative methods. Research assessing the impact of schistosomal infection on daily activities has been undertaken in Omdurman aj Jadida, Sudan. Biomedical and continuous observational data were blended with ethnographic information and the analyses of these data suggest that Schistosoma mansoni exerts a differential impact on female activity patterns. That is, infection by S. mansoni significantly impaired female activities in the agricultural sphere whereas infection by S. mansoni did not have any significant impact on female activities in the domestic sphere. Variations in the nature and extent of work undertaken by these two groups of women as well as differential exposure to solar radiation probably accounts for these recorded differences. The limited and tentative nature of biomedical, economic, sociological and anthropological information assessing the impact of schistosomal infection on the health of women adds to the current controversies about whether schistosomiasis should continue to be given priority as a public health problem. Further research is essential to clarify this important issue.