Jean Hailes

An Examination of the Association Between Types of Menopausal Hormone Therapy (Estrogen-Only Hormone Therapy Versus Combined-Hormone-Therapy Versus Tibolone) and Endometriosis Progression in Peri/Postmenopausal Women With a Previous Hysterectomy

Pakistan, Turkmenistan, and Kazakhstan are struggling from lack of trade diversification and post COVID-19 economic woes. These issues can be addressed via regional cooperation and expansion into each other's markets. Pakistan’s new geo-economics ambition and efforts to reach out to Central Asian Republics (CARs) is gaining momentum, with Gwadar port being touted as the go to port for CARs. Pakistan has a lot to offer these countries in terms of being a reliable source of imports, as well as being the closest outlet for their ocean trade. Presently, issue of access via unstable Afghanistan remains a major challenge, which has been a regular point of academic discussion. However, there hasn't been much discourse on the challenges and opportunities that await Pakistan, once stability in Afghanistan is regained and physical access issues between CARs and Pakistan are resolved. This work employs limited quantitative analysis to examine trade potential and proposes practical solutions to barriers to trade that must be addressed if these countries wish to be more than pawns in the New Great Game.

ABSTRACTObjective: To examine the psychometric properties of the Demoralisation Scale II (DS-II) and adapt it for use with women in the postnatal period.Background: Demoralisation is a psychological state characterised by a sense of incompetence and feelings of helplessness and hopelessness in response to a stressful situation. The postnatal period is a life stage of many disruptions. Women may lose their confidence and become demoralised if feeling unprepared for the tasks of motherhood. The DS-II is a 16-item scale developed among cancer patients, but with content that is also relevant postnatally, including items on sense of failure, helplessness, hopelessness, isolation, entrapment and loss of purpose.Methods: Rasch analysis was used to investigate the psychometric properties of the DS-II and refine the scale for postnatal use.Results: Participants were 209 women admitted with their babies to a residential early parenting programme. A 14-item revised scale was derived, the Postnatal DS-II, showing good psychometric properties, discriminant validity and sensitivity to change, and being well targeted to the sample.Conclusion: The Postnatal DS-II could have utility as an assessment tool, helping clinicians to understand better women’s postnatal experiences, assess the effectiveness of interventions and communicate with women in a meaningful and non-stigmatising way.

Up to 90% of individuals with Huntington's disease (HD)-a progressive, inherited neurodegenerative disorder-experience apathy. Apathy is particularly debilitating because it is marked by a reduction in goal-directed behaviors, including self-care, social interactions, and mobility. The objective of this study was to examine relationships between variables of apathy, functional status, physical function, cognitive function, behavioral status/emotional function, and health-related quality of life. Clinician-rated measures of physical, cognitive, and behavioral function, including one clinician-rated item on apathy, and self-reported measures of physical function, health-related quality of life, and emotional, cognitive, and social function were collected in a single session from 487 persons with the HD mutation (prodromal, N=193; early-stage manifest, N=186; late-stage manifest, N=108). Multiple linear regression models were used to examine which outcomes best predicted clinician-rated apathy after controlling for disease stage. Greater apathy related to less independence, increased motor impairment, and more clinician-rated behavioral problems (i.e., anger, irritability, depression). Similarly, poorer self-reported health-related quality of life; greater chorea; greater upper- and lower-extremity dysfunction; greater speech and swallowing dysfunction; worse anxiety, depression, and behavioral dyscontrol; worse cognitive function; and less satisfaction with social roles related to greater apathy. In conclusion, apathy related to physical, cognitive, and behavioral dysfunction across disease stages. Future work should explore whether clinical interventions targeting different functional domains may have the potential to reduce apathy in this patient population.

This article describes the study design of Parenting Today in Victoria: a representative survey of contemporary parenting experiences, behaviours, concerns and needs of parents. The aims of the study, sample design, survey content development processes, including pilot survey administration, data collection procedures and demographic characteristics of the sample are described. The survey was administered via computer assisted telephone interviewing using random dialling of landline and mobile phone numbers in 2016 to parents of children aged 0–18 years who were living in Victoria, Australia. The response rate was 57% with 2600 parents surveyed (40% fathers). The sample was broadly representative of the Victorian population on major demographic characteristics when compared to data from the Australian Census of Population and Housing (Australian Bureau of Statistics, 2011). However, adjustments were made for over representation of younger parents (16–34 years), more highly educated parents and for those living outside major cities. This survey provides rigorously collected, accurate and up-to-date information about the experiences, preferences and concerns of a large and representative sample of parents. Findings will provide vital new insights to inform policy decision making, service planning and future research aimed at understanding parents’ attitudes and behaviours, and the psychology behind their help-seeking.

Objective: To systematically review the published literature relating to experiences of menopause, self-management strategies for menopausal symptoms and health-care needs among immigrant women. Methods: A systematic literature search of English-language publications was performed using Medline, Embase, PsychInfo, Cinahl and Scopus. Twenty-four papers reporting on 19 studies met our inclusion criteria and investigated immigrant women’s experiences of menopause and/or their self-management strategies for menopausal symptoms and/or their perceptions of menopause-specific health care. Findings: Of the 19 studies, 15 reported symptoms experienced during the menopausal transition. Three studies included questions regarding self-management strategies for menopausal symptoms and four enquired about perceptions of menopause-specific health care. Although the heterogeneity of the studies makes comparison difficult, their findings are broadly consistent. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women. The few studies that investigated self-management strategies for menopausal symptoms found that these were influenced by culture and those that assessed perceptions of menopause-specific health care found that they were mostly dissatisfied with the care they had received. Conclusion: More research is needed to improve understanding of how immigrant women manage the menopausal transition and how to provide culturally relevant menopause-specific health care.

Given the proliferation of pornography in personal, relational, and social realms, it is vital to understand women’s experiences of this accessible, stimulating, and versatile sexual material. We therefore conducted the first systematic review of research using qualitative methods published in English in peer-reviewed journals. Our search of five databases yielded 22 eligible articles. Thematic analysis of results revealed four broad themes: women encountering pornography, pornography and the self, pornography in the context of relationships, and making sense of pornography. Discussion of themes and subthemes included reflections on women’s explanations of intentional and unintentional encounters with pornography, conflicted perceptions of themselves in relation to female pornography actors, diverse perceived effects of pornography on intimate relationships, and tensions between women’s arousal to pornography and their values. It was evident that women’s experiences of pornography are complex and nuanced, often paradoxical, varying among and within individuals. Our synthesis of results and assessment of limitations suggest (a) that researchers need to define what they mean by pornography and specify any content used in their research and (b) that understanding would be enriched by research that is culturally contextualized and acknowledges public discourses about pornography.

IntroductionIntermittent iron-folic acid supplementation (IFA) is currently recommended for pregnant women in populations where anaemia prevalence among pregnant women is <20% or if daily iron is not acceptable. The effect of providing lower doses of antenatal elemental iron through intermittent regimes on longer-term health outcomes in childhood is unclear.MethodsA prospective cohort study conducted between May 2012 and May 2014 in Viet Nam among children of 36 months of age, born to women previously enrolled in a cluster randomised controlled trial of antenatal micronutrient supplementation (daily IFA (60 mg elemental iron) vs twice-weekly IFA (60 mg elemental iron) vs twice-weekly multiple micronutrient (MMN) supplementation (60 mg elemental iron)). Primary outcomes were height-for-age z-scores (HAZ), according to WHO growth standards and cognitive composite scores (Bayley Scales of Infant and Toddler Development, third edition) at 36 months of age.ResultsA total of 1017 children born to mothers enrolled in the cluster randomised trial were assessed at 36 months of age. Adjusted mean differences (MDs) in HAZ were –0.14 (95% CI –0.28 to –0.01) and –0.15 (95% CI –0.29 to –0.01) in children born to mothers who received twice-weekly IFA or MMN compared with those who received daily IFA. Children born to mothers who received twice-weekly MMN had lower composite motor scores compared with those who received daily IFA (MD –2.07, 95% CI –4.11 to –0.03). There were no differences in composite cognitive scores in the twice-weekly compared with daily regimens.ConclusionsLow-dose antenatal IFA supplementation (120 mg elemental iron per week) resulted in lower HAZ and motor composite scores in children compared with higher-dose antenatal IFA supplementation (420 mg elemental iron per week). This highlights the importance of adequate iron stores during pregnancy and the need for careful monitoring when lower-dose antenatal iron regimens are used.Trial registration numberAustralia New Zealand Clinical Trials Registry: 12610000944033.

This study was to describe and quantify the relationships among family poverty, parents' caregiving practices, access to education and the development of children living in low- and middle-income countries (LAMIC). We conducted a secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS). Early childhood development was assessed in four domains: language-cognitive, physical, socio-emotional and approaches to learning. Countries were classified into three groups on the basis of the Human Development Index (HDI). Overall, data from 97 731 children aged 36 to 59 months from 35 LAMIC were included in the after analyses. The mean child development scale score was 4.93 out of a maximum score of 10 (95%CI 4.90 to 4.97) in low-HDI countries and 7.08 (95%CI 7.05 to 7.12) in high-HDI countries. Family poverty was associated with lower child development scores in all countries. The total indirect effect of family poverty on child development score via attending early childhood education, care for the child at home and use of harsh punishments at home was -0.13 SD (77.8% of the total effect) in low-HDI countries, -0.09 SD (23.8% of the total effect) in medium-HDI countries and -0.02 SD (6.9% of the total effect) in high-HDI countries. Children in the most disadvantaged position in their societies and children living in low-HDI countries are at the greatest risk of failing to reach their developmental potential. Optimizing care for child development at home is essential to reduce the adverse effects of poverty on children's early development and subsequent life.