Postcesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity

OBJECTIVE: To estimate the prevalence and severity of postcesarean pelvic dysfunction. STUDY DESIGN: Using biopsychosocial interviewing at home, 184 postcesarean primiparas were compared to 100 vaginally delivered women regarding symptoms of stress incontinence, anal incontinence and dyspareunia. Delivery details were confirmed from medical records. RESULTS: Comparison of postcesarean vs. vaginally delivered women revealed stress incontinence in 33% vs. 54% and dyspareunia in 27% vs. 46%, both differences reaching statistical significance, unlike anal incontinence, which was manifest in 51% vs. 44%. When compared to emergency cesarean the relative risk of stress incontinence following an elective cesarean was 0.99 (0.71, 1.39), of dyspareunia 1.02 and of anal incontinence 1.05, indicating no statistically significant difference. Thirty (22%) stress incontinent and 4 (3%) fecally incontinent mothers used pads continuously, suggesting severe physical morbidity. Severe dysphoria (depression) was expressed by 41 (35%) stress incontinent mothers, 38 (30%) with dyspareunia and 34 (26%) with anal incontinence; the association of severe dysphoria with dyspareunia was statistically significant (OR = 2.504 [1.362, 4.602]). Few women came forward to seek help. CONCLUSION: Pelvic dysfunction was similar after elective or emergency cesarean. Compared to vaginal delivery, postcesarean stress incontinence and dyspareunia were less frequent but biopsychosocial morbidity could be severe.

Employee relations in an organisational context

In this textbook, Kathy Daniels writes about Employee Relations from an organisational context perspective. It is an ideal book for students studying Employee Relations modules on HR and business degree programmes at undergraduate level. It is also suitable for the CIPD elective, covering all the CIPD standards in this area, and provides a strong legal background to the topic. Online resource centre - PowerPoint slides - Lecturer's guide The success or failure of organisations is, in part, dependent on the success or failure of its employees and the relationship that they have with each other. Looking at Employee Relations from an organisational context perspective, this text is designed specifically to cater for the CIPD Employee Relations PDS module and for Employee Relations modules on HR and business degree programmes at both undergraduate and postgraduate levels.

Employment law:an introduction for HR and business students

The Aston Centre for Human Resources (ACHR) was created at Aston Business School, Aston University, in February 2006. The mission of the Centre is both to inform and influence practice through conducting high quality, challenging research in order to extend the existing theoretical frameworks and to develop new and relevant conceptual models to represent and guide the changing realities facing businesses and the people they employ in the 21st century. * Students studying an Employment Law module on a HR or general business degree, whether undergraduate or postgraduate. * Students taking the Employment Law elective on the CIPD's Professional Development Scheme (PDS). * Students studying Employee Relations or Diversity. This new edition has been thoroughly updated, and includes expanded coverage of the impact of EU Law, and Discrimination Law including ageism, sexual orientation, religious belief, harassment and disability. The text is ideal text for those business students on undergraduate and postgraduate courses who are taking a first module in Employment Law. It covers a comprehensive range of topics enabling students to gain a solid understanding of the key principles of the subject. The engaging, authoritative writing style and range of learning features make this a refreshingly accessible and student-friendly read. Each chapter includes summaries of topical and relevant cases, direction to key sources of legal information and suggestions for further reading whilst covering the CIPD’s standards for the Employment Law elective on the Professional Development Scheme (PDS). This text includes a range of case studies, tasks and examples to consolidate learning and includes a brand new section on Employment Law study skills to help students get to grips with how to access and read law reports, understand the sources of the law, find and use up-to-date legal information (particularly websites) and how to prepare for exams and written assignments.

Equality, diversity and discrimination:a student text

This text is designed specifically for the increasing number of students taking modules in Equality andDiversity, including those taking the CIPD specialist elective Managing Diversity and Equal Opportunities module. The authors’ combined experience is used to offer a mixture of a strong practical focus and a clear academic approach to create a balance of theory and practice. This text is the only accessible, up-to-date and student-focused text in the market that specifically features this subject area. his text is designed specifically for the increasing number of students taking a module in Equality and Diversity. The text contains a range of features to aid student learning, including: - Learning objectives - at the beginning of each chapter summarising the content of the chapter - Tasks - interactive tasks to encourage students to research around the subject - Case studies - thought-provoking examples of practice - Legal cases - examples of legal practice - Key Points - at the end of each chapter, a summary of key issues raised in the chapter - Examples to work through - at the end of each chapter, mini case examples with questions to check students' understanding.

Does post-caesarean dyspareunia reflect sexual malfunction, pelvic floor and perineal dysfunction?

The aim was to define post-caesarean dyspareunia as a sexual and pelvic-perineal symptom. Post-caesarean (80 elective, 104 emergency) and 100 vaginally delivered primiparae had domiciliary interviews at 10 months postpartum. A total of 50 (28% and 27%) post-caesarean and 46 (46%) vaginally delivered, reported dyspareunia. Severely impaired general sexual health occurred in 82 (24% elective, 25% emergency, 35% vaginally delivered) as category 3 (dyspareunia with sexual symptoms) and 27 (10% elective, 7% emergency, 12% vaginally delivered) as category 4 (reduced frequency <6). The risk of dyspareunia (RR 1.14, CI 0.73, 1.77) or impaired general sexual health (RR 0.93, CI 0.32, 2.74) was similar among those with or without perineal trauma. Both caesarean and perineal scars were associated with sexual malfunction. Primiparae with new incontinence had a lower risk of dyspareunia than impaired general sexual health. Awareness of the associations of post-caesarean dyspareunia and impaired general sexual health with incontinence would facilitate appropriate obstetric decision-making. Further research is indicated. © 2011 Informa UK, Ltd.

Pregnancy complications in hyperemesis-affected pregnancy:a large hospital database study

Objective: Vomiting in pregnancy is a common condition affecting 80% of pregnant women. Hyperemesis is at one end of the spectrum, seen in 0.5–2% of the pregnant population. Known factors such as nulliparity, younger age and high body mass indexare associated with an increased risk of this condition in the first trimester. Late pregnancy complications attributable to hyperemesis, the pathogenesis of which is poorly understood, have not been studied in large population-based studies in the United Kingdom. The objective of this study was to determine a plausible association between hyperemesis and pregnancy complications,such as pregnancy-related hypertension, gestational diabetes and liver problems in pregnancy, and the rates of elective (ElCS) and emergency caesarean section (EmCS). Methods: Using a database based on ICD-10 classification, anonymised data of admissions to a large multi-ethnic hospital in Manchester, UK between 2000 and 2012 were examined.Notwithstanding the obvious limitations with hospital database-based research, this large volume of datasets allows powerful studies of disease trends and complications.Results Between 2000 and 2012, 156 507 women aged 45 or under were admitted to hospital. Of these, 1111 women were coded for hyperemesis (0.4%). A greater proportion of women with hyperemesis than without hyperemesis were coded forhypertensive disorders in pregnancy such as pregnancy-induced hypertension, pre-eclampsia and eclampsia (2.7% vs 1.5%;P=0.001). The proportion of gestational diabetes and liver disorders in pregnancy was similar for both groups (diabetes:0.5% vs. 0.4%; P=0.945, liver disorders: 0.2% vs. 0.1%;P=0.662). Hyperemesis patients had a higher proportion of elective and emergency caesarean sections compared with the non-hyperemesis group (ElCS: 3.3% vs. 2%; P=0.002, EmCS: 5% vs.3%; P=0.00). Conclusions: There was a higher rate of emergency and elective caesarean section in women with hyperemesis, which could reflect the higher prevalence of pregnancy-related hypertensive disorders(but not diabetes or liver disorders) in this group. The factors contributing to the higher prevalence of hypertensive disorders arenot known, but these findings lead us to question whether there is a similar pathogenesis in the development of both the conditions and hence whether further study in this area is warranted.

Human brain slices for epilepsy research:pitfalls, solutions and future challenges

Increasingly, neuroscientists are taking the opportunity to use live human tissue obtained from elective neurosurgical procedures for electrophysiological studies in vitro. Access to this valuable resource permits unique studies into the network dynamics that contribute to the generation of pathological electrical activity in the human epileptic brain. Whilst this approach has provided insights into the mechanistic features of electrophysiological patterns associated with human epilepsy, it is not without technical and methodological challenges. This review outlines the main difficulties associated with working with epileptic human brain slices from the point of collection, through the stages of preparation, storage and recording. Moreover, it outlines the limitations, in terms of the nature of epileptic activity that can be observed in such tissue, in particular, the rarity of spontaneous ictal discharges, we discuss manipulations that can be utilised to induce such activity. In addition to discussing conventional electrophysiological techniques that are routinely employed in epileptic human brain slices, we review how imaging and multielectrode array recordings could provide novel insights into the network dynamics of human epileptogenesis. Acute studies in human brain slices are ultimately limited by the lifetime of the tissue so overcoming this issue provides increased opportunity for information gain. We review the literature with respect to organotypic culture techniques that may hold the key to prolonging the viability of this material. A combination of long-term culture techniques, viral transduction approaches and electrophysiology in human brain slices promotes the possibility of large scale monitoring and manipulation of neuronal activity in epileptic microcircuits.