The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

The value of community wellbeing for locality based practice

This presentation put forward six propositions regarding the value and character of community wellbeing, in particular the economic contribution of social and community programs and initiatives. The six propositions are: 1. Community wellbeing is a useful umbrella concept 2. Everyone benefits from public programs 3. There is an economic as well as social cost of not responding well 4. Local government is key in fostering community wellbeing 5. Good practice involves bringing together a number of perspectives and levers, including social and cultural initiatives 6. Engaging with the community around wellbeing offers an opportunity to enhance the political process

Social Work and theatre: considering intersections

Theatre is a cultural and artistic form that involves a process of communication between creators and is received in a space and time located in the public sphere, which has meant that, over the centuries, it has acted as a space for expression, exchange and debate regarding all manner of ideas, causes and struggles. Implicit within this process are processes of expression, creation and reception, by way of which people demonstrate, analyse and question ways of seeing and understanding life, and ways of being and existing in the world. This gives rise to educational, cultural, social and political potential, which has been endorsed in numerous studies and investigations. In this work, in which theoretical orientation is established through a review of the relevant literature, we consider different intersections that occur between theatre and social work in order to also show that dramatic and theatrical expression offers substantive methodologies for achieving some objectives of social work, particularly in areas such as critical literacy, reflexivity and recognition, awareness raising, social participation, personal and/or community development, ownership of cultural capital and access to personal and social wellbeing.

Social dimensions of macroeconomic policy: report of the Executive Committee on Economic and Social Affairs of the United Nations

Introduction The social agenda is long-term in nature, in the sense that poverty alleviation along with a better distribution of income, wealth and opportunities are long-term goals. A sound macroeconomic policy, on the other hand, has to do largely with the consistent management of short-term policy instruments pursuing a sustainable and predictable pace for aggregate economic variables and major prices (wages, inflation, interest rates and exchange rates). In spite of the different arena and rationale in which they play, there are strong links between the two. First and most obvious, macroeconomic adjustment and structural reform are more likely to be sustainable when they are equitable. Second, social intervention —i.e., policies, programmes and reforms aimed at improving social performance in the long run—, needs stable funding which is not always available in view of macroeconomic constraints. Third, macroeconomic instability —especially episodes of recession or hyperinflation— increases poverty and inequality, while restoring macroeconomic equilibrium does not restore previous social balances. Finally, there is no unique macroeconomic policy mix to tackle a given situation, and the policy options may not be neutral from a social standpoint. Monetary, fiscal and exchange rate policies, together with structural reform, have major consequences for the social wellbeing of societies, not only in terms of protection against shocks and crises but also in terms of equity. Many, if not all, of the necessary social policies are of a domestic nature. This report thus concentrates on domestic strategies aimed at maximizing the linkages between consistent macroeconomic policies and social progress. Pursuing them, however, depends to a considerable extent on the international enabling environment in which the global financial system, the unsettled debt crisis and increasing ODA flows play a significant role. Countries operate in a world economy where market players everywhere immediately scrutinize domestic monetary, financial or fiscal policy decisions and the performance of exchange rate regimes of individual countries. Under these conditions, the room for manoeuvre of policymakers has become considerably constrained. Consequently, it is becoming increasingly complex to incorporate the social dimensions into such policy decisions, to the extent that external analysts consider that authorities are sacrificing sound macroeconomic policies. The main message of the report is that the expediency of short-term economic efficiency as embedded in much of the advice on macroeconomic stability needs to be tempered by long-term development objectives. The report starts with a short historical background which describes the ascendancy of macroeconomic policies over social development policies (chapter I). It continues with an evaluation of the relation between macroeconomic consistency and social effort (chapter II), and the importance of sustainable and stable growth for social progress (chapter III). The report then turns to the need for an equity-enhancing growth strategy (chapter IV) and an analysis of the priorities of social policies in an integrated approach to growth (chapter V). The final chapter adds some final institutional remarks.

Mitigating Social Risk in the Extractive Sector: Developing Intercultural Competence as a Tool for Negotiating Western-Indigenous Perspectives within the Undergraduate Mining Engineering Curriculum

Drawing upon critical, communications, and educational theories, this thesis develops a novel framing of the problem of social risk in the extractive sector, as it relates to the building of respectful relationships with indigenous peoples. Building upon Bakhtin’s dialogism, the thesis demonstrates the linkage of this aspect of social risk to professional education, and specifically, to the undergraduate mining engineering curriculum, and develops a framework for the development of skills related to intercultural competence in the education of mining engineers. The knowledge of social risk, as well as the level of intercultural competence, of students in the mining engineering program, is investigated through a mixture of surveys and focus groups – as is the impact of specific learning interventions. One aspect of this investigation is whether development of these attributes alters graduates’ conception of their identity as mining engineers, i.e. the range and scope of responsibilities, and understanding of to whom responsibilities are owed, and their role in building trusting relationships with communities. Survey results demonstrate that student openness to the perspectives of other cultures increases with exposure to the second year curriculum. Students became more knowledgeable about social dimensions of responsible mining, but not about cultural dimensions. Analysis of focus group data shows that students are highly motivated to improve community perspectives and acceptance. It is observed that students want to show respect for diverse peoples and communities where they will work, but they are hampered by their inability to appreciate the viewpoints of people who do not share their values. They embrace benefit sharing and environmental protection as norms, but they mistakenly conclude that opposition to mining is rooted in a lack of education rather than in cultural values. Three, sequential, threshold concepts are identified as impeding development of intercultural competence: Awareness and Acknowledgement of Different Forms of Knowledge; Recognition that Value Systems are a Function of Culture; Respect for varied perceptions of Social Wellbeing and Quality of Life. Future curriculum development in the undergraduate mining engineering program, as well as in other educational programs relevant to the extractive sector, can be effectively targeted by focusing on these threshold concepts.

Postpartum fatigue and driving : relating experiences, thoughts and opinions 12 weeks post-birth

Fatigue in the postnatal period is such a common experience for most mothers that the term ‘postpartum fatigue’ (PPF) has been coined to describe it. When new mothers experience extreme fatigue, it follows that their physical health, mental health, and social-wellbeing is negatively affected. It is interesting to note that there is a distinct lack of empirical investigations focusing on the link between PPF and increased risk of injury; particularly when the links between fatigue and increased risk of road crashes are well documented. The purpose of this investigation was to undertake pilot research to develop an understanding of the duration of PPF and the performance impairments experienced by new mothers when involved in safety-sensitive activities, such as driving a motor vehicle. Semi-structured interviews were undertaken with women (N = 24) at 12 weeks postpartum living in South-east Queensland, Australia. Key themes were identified; with a particular emphasis towards understanding the link between the participant’s experience of postpartum fatigue and the impact this has on their overall cognitive and physiological functioning, as well as their experience of the driving task. Further, sleep/wake data was collected and using the Karolinska Sleepiness Scale (KSS) the potential crash risk for this group of mothers is discussed. It is proposed that the findings of this investigation could be used to improve current knowledge among new mothers and practitioners regarding the mechanisms and consequences of fatigue and to inform interventions that lead to a decreased risk of injury associated with postpartum fatigue.

Quality of life of women with lower-limb lymphedema following gynecological cancer

Secondary lower-limb lymphedema can develop following treatment for gynecological cancers, and has debilitating effects on quality of life (QoL). Lymphedema can limit mobility and ability to perform daily activities, and have adverse effects on psychological and social wellbeing. When assessing the effect of lymphedema treatment methods, the focus is on change in clinically measured lymphedema status, rather than QoL outcomes. Considering that treatment for lymphedema involves a significant and ongoing commitment from patients, it is essential to determine whether the benefits to patients outweigh the burden associated with treatment. This article summarizes the results of studies assessing the impact of lower-limb lymphedema on QoL in women with gynecological cancer, evaluates their methodologies and discusses limitations and priorities for future research.

Sustainability outcomes of infrastructure sustainability rating schemes for road projects

The construction and operation of infrastructure assets can have significant impact on society and the region. Using a sustainability assessment framework can be an effective means to build sustainability aspects into the design, construction and operation of infrastructure assets. The conventional evaluation processes and procedures for infrastructure projects do not necessarily measure the qualitative/quantitative effectiveness of all aspects of sustainability: environment, social wellbeing and economy. As a result, a few infrastructure sustainability rating schemes have been developed with a view to assess the level of sustainability attained in the infrastructure projects. These include: Infrastructure Sustainability (Australia); CEEQUAL (UK); and Envision (USA). In addition, road sector specific sustainability rating schemes such as Greenroads (USA) and Invest (Australia) have also been developed. These schemes address several aspects of sustainability with varying emphasis (weightings) on areas such as: use of resources; emission, pollution and waste; ecology; people and place; management and governance; and innovation. The attainment of sustainability of an infrastructure project depends largely on addressing the whole-of-life environmental issues. This study has analysed the rating schemes’ coverage of different environmental components for the road infrastructure under the five phases of a project: material, construction, use, maintenance and end-of-life. This is based on a comprehensive life cycle assessment (LCA) system boundary. The findings indicate that there is a need for the schemes to consider key (high impact) life cycle environmental components such as traffic congestion during construction, rolling resistance due to surface roughness and structural stiffness of the pavement, albedo, lighting, and end-of-life management (recycling) to deliver sustainable road projects.

Young people's uses of music for well-being

The period between 15 and 25 years is characterised by much personal change and is the peak age of onset of mental health problems. This prompts an interest in everyday strategies that young people might use to support their well-being. Music use is the preferred leisure activity among young people yet little is known about how music is linked to well-being in this population. This study aimed to develop and test a model of the relationships between young people’s use of music and their well-being, drawing on theories from the music psychology and clinical psychology fields. A qualitative analysis of transcripts from focus groups with 11 participants aged 15–25 years revealed four ways in which music listening links with well-being: relationship building, modifying emotions, modifying cognitions and emotional immersion. These linking variables were operationalised using questionnaire scores and tested on a new sample of 107 young people. Results of a multiple mediation analysis revealed that music listening was significantly related to all four linking variables, but not directly related to well-being as measured by the Mental Health Continuum. Nevertheless, the four linking variables indirectly mediated the effect of music listening on social wellbeing. The findings are consistent with earlier research on the role of music in emotion regulation and social connection although there are clearly other factors involved in determining young peoples’ well-being. These findings will help inform music-based interventions for young people.

The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys

Objectives: Multimorbidity is common in the older population, but the impact of combinations of chronic conditions on disability and quality of life (QoL) is not well known. This analysis explores the effect of specific combinations of chronic diseases on disability, QoL and self-rated health (SRH).

Design: We used data from two population representative cross-sectional studies, the Northern Ireland Health and Social Wellbeing Survey (NIHSWS) 2005 and the Survey of Lifestyle, Attitudes and Nutrition (SLAN) 2007 (conducted in the Republic of Ireland).

Setting: Randomly selected community-living participants were interviewed at home.

Participants: A total of 6159 participants aged 50 years and older were included in the analysis.

Outcome measures: Chronic conditions were classified as cardiovascular disease, chronic pain,diabetes or respiratory disease. Interaction terms estimated by logistic regression were used to examine the effects of multiple chronic conditions on disability, SRH and QoL.

Results: Each chronic condition group was correlated with each of the others after adjusting for sociodemographic factors. Those from Northern Ireland were more likely to report a limitation in daily activities (45%) compared to those from the Republic of Ireland (21%). Each condition had an independent effect on disability, SRH and QoL, and those with multiple chronic conditions reported the worst outcomes. However, there were no statistically significant positive interactions between chronic condition groups with respect to any outcome.

Conclusions: Chronic conditions affect individuals largely independent of each other with respect to their effect on disability, SRH and QoL. However, a significant proportion of the population aged 50 years and over across the island of Ireland lives with multimorbidity,and this group is at the highest risk of disability, poor SRH and poor QoL.

A autonomia da Perícia Criminal Oficial no âmbito da Polícia Federal: percepções e reflexões dos profissionais do Sistema de Justiça Criminal

Trata-se de uma pesquisa de natureza marcadamente descritiva, com etapas exploratórias, que visa a descrever as percepções e reflexões desveladas pelos sujeitos da pesquisa nas análises temáticas realizadas sobre diversas questões que envolvem o tema da autonomia da Perícia Criminal Oficial, no âmbito da Polícia Federal. Para esse fim, utilizou-se da metodologia da análise de conteúdo, segundo Bardin (1977). Os sujeitos da pesquisa foram escolhidos segundo o critério de acessibilidade e da natureza dos cargos, quais sejam: Delegado da Polícia Federal, Juiz Federal, Perito Criminal Federal e Procurador da República. Face à predominância do cunho qualitativo neste estudo, não há expectativas de generalizações dos resultados obtidos no campo, assim como a seleção desses sujeitos não priorizou pela representatividade quantitativa de cada cargo. O referencial teórico foi construído com o propósito de contextualizar e favorecer a compreensão do leitor sobre como é constituída a realidade em que se insere o objeto de estudo, buscando descrever os termos e conceitos necessários a essa compreensão, tais como: (i) o que é o Sistema de Justiça Criminal e como se deu seu processo de formação no Estado moderno; (ii) como é a estrutura e o fluxo processual básico do modelo brasileiro, com destaque para a posição que ocupam os órgãos ou Instituto de Criminalística; (iii) qual o nível de efetividade desse sistema, no Brasil, e quais os principais problemas que afetam a funcionalidade da Perícia Oficial em sua estrutura; (iv) quais os reflexos do uso dos paradigmas repressivo e preventivo, pelo Estado, no controle da violência, da criminalidade e da impunidade dos criminosos, visando a garantir a manutenção da ordem pública como bem coletivo; (v) que relevância tem o papel da Perícia Oficial para a efetividade do Sistema de Justiça Criminal, segundo o paradigma preventivo; (vi) o que é Criminalística e qual a natureza de sua atividade; e (vii) como se apresenta a atual estrutura administrativa e a rede de clientes da Perícia Oficial. Ao se aproximar do objeto de estudo, o pesquisador buscou descrever como se deu a origem do processo de autonomia da Criminalística, no Brasil, e como esse processo vem sendo desenhado como uma política de segurança pública, destacando as principais medidas administrativas e normativas adotadas no país que favoreceram a sua consolidação, tais como: a aprovação do PNSP (2002), do PNDH I (1996), do PNDH II (2002) e do PNDH III (2009), além da promulgação da Lei nº 12.030/2009, que assegura, de forma específica, a autonomia técnico-científica e funcional da função pericial criminal. Tratamento especial foi dado ao significado e ao alcance que têm as dimensões conceituais do termo “autonomia” para a função pericial. Em que pesem os resultados obtidos, as conclusões revelam que a complexidade do tema, teoria e prática, aguarda continuidade em pesquisas futuras.

Multifaceted impacts of sustainable land management in drylands: A review

Biophysical restoration or rehabilitation measures of land have demonstrated to be effective in many scientific projects and small-scale environmental experiments. However circumstances such as poverty, weak policies, or inefficient scientific knowledge transmission can hinder the effective upscaling of land restoration and the long term maintenance of proven sustainable use of soil and water. This may be especially worrisome in lands with harsh environmental conditions. This review covers recent efforts in landscape restoration and rehabilitation with a functional perspective aiming to simultaneously achieve ecosystem sustainability, economic efficiency, and social wellbeing. Water management and rehabilitation of ecosystem services in croplands, rangelands, forests, and coastlands are reviewed. The joint analysis of such diverse ecosystems provides a wide perspective to determine: (i) multifaceted impacts on biophysical and socio-economic factors; and (ii) elements influencing effective upscaling of sustainable land management practices. One conclusion can be highlighted: voluntary adoption is based on different pillars, i.e. external material and economic support, and spread of success information at the local scale to demonstrate the multidimensional benefits of sustainable land management. For the successful upscaling of land management, more attention must be paid to the social system from the first involvement stage, up to the long term maintenance.

Early patterns of sexual activity: age cohort differences in Australia

Patterns of first sexual activity among Australians born between the 1940s and 1980s were analysed using data from a national telephone survey of 1784 adults (876 males; 908 females). Sixty-one percent of those randomly selected from the Australian electoral roll and contactable by telephone responded. Many trends, including earlier first intercourse - from 20 to 18 years (females) and 18.8 to 17.8 years (males) - were established with the 40-49 year cohort, whose sexual debut was in the late 1960s-70s. Significant age-cohort effects saw women in the contemporary (18-29 year) cohort draw level with males for age at first intercourse and first sex before age 16 and before leaving school. First intercourse contraceptive use climbed from 30% to 80'%. Condom use quadrupled to 70%. Australian age-cohort effects are remarkably consistent with those in similar western cultures: gender convergence in sexual experience and increasing avoidance of sexually transmitted disease and pregnancy. If such trends continue, positive long-term outcomes for health and social wellbeing should result.