Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Qualified immigrants' success: exploring the motivation to migrate and to integrate

High-quality employees with international experience bring valuable advantages to internationally operating organizations. The growing number and importance of immigrants, and particularly qualified, university-educated immigrants, deserves more attention from international business practitioners and scholars. The market for highly qualified people within MNCs is increasingly becoming international, and ever more of them have migrated to a new country to advance their career. Such employees can be a source of competitive advantage for international firms. We use qualitative research with qualified immigrants (QIs) in France to argue that the success of QIs depends in large part on their motivation to integrate into their host country, which is largely explained by their motivation to migrate. From the qualitative data we derive four different types of qualified migrant, and suggest that the type will determine the success of the immigrant within, and outside, the organization. The relationship between the motivation to migrate and the motivation to integrate is moderated by “met expectations” and “organizational integration policies”, such that the effects of these, in turn, vary with type. Recognition of the types of QI and the moderating factors will be valuable for practitioners, as well as opening up research avenues for scholars.

Lipid metabolism in women

Differences in whole-body lipid metabolism between men and women are indicated by lower-body fat accumulation in women but more marked accumulation of fat in the intra-abdominal visceral fat depots of men. Circulating blood lipid concentrations also show gender-related differences. These differences are most marked in premenopausal women, in whom total cholesterol, LDL-cholesterol and triacylglycerol concentrations are lower and HDL-cholesterol concentration is higher than in men. Tendency to accumulate body fat in intra-abdominal fat stores is linked to increased risk of CVD, metabolic syndrome, diabetes and other insulin-resistant states. Differential regional regulation of adipose tissue lipolysis and lipogenesis must underlie gender-related differences in the tendency to accumulate fat in specific fat depots. However, empirical data to support current hypotheses remain limited at the present time because of the demanding and specialist nature of the methods used to study adipose tissue metabolism in human subjects. In vitro and in vivo data show greater lipolytic sensitivity of abdominal subcutaneous fat and lesser lipolytic sensitivity of femoral and gluteal subcutaneous fat in women than in men. These differences appear to be due to fewer inhibitory alpha adrenergic receptors in abdominal regions and greater a adrenergic receptors in gluteal and femoral regions in women than in men. There do not appear to be major gender-related differences in rates of fatty acid uptake (lipogenesis) in different subcutaneous adipose tissue regions. In visceral fat rates of both lipolysis and lipogenesis appear to be greater in men than in women; higher rates of lipolysis may be due to fewer alpha adrenergic receptors in this fat depot in men. Fatty acid uptake into this depot in the postprandial period is approximately 7-fold higher in men than in women. Triacylglycerol concentrations appear to be a stronger cardiovascular risk factor in women than in men, with particular implications for cardiovascular risk in diabetic women. The increased triacylglycerol concentrations observed in women taking hormone-replacement therapy (HRT) may explain the paradoxical findings of increased rates of CVD in women taking HRT that have been reported from recent primary and secondary prevention trials of HRT.

Early women law students at Cambridge and Oxford

This article examines the hitherto neglected history of the twelve women who studied law at Cambridge and Oxford in the years up to 1900. It concludes that the reason why so little has been written about them is, first, because women's experience has been routinely ignored in accounts of legal education ( and in history generally) and, second, because their entry to the university law schools was accomplished with very little fuss or opposition. This in turn was due not only to the fact that the law professors were generally sympathetic to higher education for women but also because the women themselves did not challenge university traditions or the men's curriculum.