Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: results from the LACE trial

Objective: To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. Methods: 760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy- General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe AEs adverse events within 6 months (Common Toxicology Criteria (CTC) grade ≥3); and (2) any Serious Adverse Event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors. Results: After adjusting for other factors, odds of occurrence of AE of CTC grade ≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077). Conclusion: Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. Funding: Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women’s Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health.

Community-based organizations on Lake Victoria: a lesson from the Tweyambe Fishing Enterprise in Muleba District, Kagera Region, Tanzania

This paper is aimed at government, non-government organizations, intergovernmental organizations and the general public as they work toward the development of their individual strategies and action plans. It has been recognized that community-based organizations have a particular relevance to the pursuit of sustainable resource management and may well contribute to the foundations of self-sustenance. Women on Lake Victoria, Tanzania presently face great challenges within the fishery. These include the lack of capital, interference by men, theft of fishing gear, time constraints and socio-cultural problems. In recent years, the fish trading and marketing sectors of the fishery, which have traditionally been dominated by women, have seen large incursions by male entrepreneurs. This move has endangered the role of women within the fishery. This paper focuses on the Tweyambe Fishing Enterprise (TFE), a well-known women's group based in Kasheno village in the Muleba District of Kagera Region in northwestern Tanzania. Inhabitants from the Haya ethnic group who make up some 95% of the population of Kagera Region dominate this village. The TFE has a series of initiatives aimed towards ecologically sound self-development

Literary portraits of basque-american women from shadow to presence

268 p.

Monitoring of the socio-economics status of fisher communties on Lake Victoria, Uganda

The objectives of the study was to provide information on the changes in the socio- economis status of the fisher communities.The study aimed at contributing to the following selected OVIs of the IFMP log frame:"10% increased in incomes from fish catches by fishing crews by EOP",20% women in BMUs reporting increased household incomefrom fishing by EOP","50% women and fishing crews in BMUs reporting greater say in fisheries decision making.

Assessment of the performance of beach management units (BMUs) on Lakes Victoria, Albert, Kyoga and George

Until the late 1990s the fisheries of Ugandan lakes had been managed by government where stakeholders were excluded from the decision-making process. In order to involve other stakeholders, co-management was adopted. Operationalising Co-management on landing sites has led to the formation of BMUs at gazetted landing sites. A BMU is made up of a BMU assembly and the BMU committee that it elects. A BMU committee should be: 30% boat owners; 30% boat barias 30% including fish processors, boat makers, local gear makers and repairers, fishing input dealers and managers and 10% fish mongers/traders; and if possible, 30% women. To operate at a particular landing site, one must be registered with the BMU. The BMU assembly is the supreme organ of a BMU empowered to elect, approve and remove the BMU committee

The (in)visible scar. Representation of the body in blogs by women with breast cancer

In this paper we analyze the representation of the body in blogs by women with breast cancer. Taking into account both texts and images, we study the representation of the body on the basis of the body problems proposed by Frank (1995): control, body-relatedness, other-relatedness and desire. In the blogs studied we find a desiring and dyadic body, which is understood as part of a network of affection and care. The diagnosis of cancer can generate both dissociation, when the body is experienced as a threat, and association, a wish to be connected to it. In relation to control, a clear will of predictability is observed but traces of assumption of contingency also appear.

Low prevalence of primary biliary cirrhosis in Victoria, Australia. Melbourne Liver Group

A prevalence study of primary biliary cirrhosis was carried out in the state of Victoria, Australia, by means of a mail survey of specialist physicians and a review of hospital records. Eighty four cases were identified, giving a prevalence of 19.1 per million population (95% confidence limits (CI) 15.3, 23.7), which is among the lowest in published reports. The prevalence in the Australian born, at risk population (women over the age of 24) was 51 per million (95% CI 37.5, 67.9). Both these figures are considerably lower than those in populations of similar age distribution in the UK and northern Europe. Since most Victorians are descended from British or European settlers, the low prevalence of primary biliary cirrhosis in this study supports the hypothesis that local environmental factors may be important in the pathogenesis of this disease.

Maria Victoria Atencia: Legend of Myself

In this collection of 65 short poems, Roberta Quance exemplifies the range, vitality and mysticism of work by one of Spain’s foremost, if controversial, contemporary female poets, drawing on the contents of a number of Spanish collections.

Older women living and coping with domestic violence

Although domestic violence is seen as a serious public health issue for women worldwide, international evidence suggests that women aged over 50 who are victims are suffering in silence because the problem is often ignored by health professionals. More UK research is needed to identify the extent of the problem, and services to meet the needs of older women. This study aims to bridge this gap by gaining a deeper understanding of how ‘older women’ cope with domestic violence and how it affects their wellbeing. Eighteen older women who were currently, or had been in an abusive relationship were recruited. Semi-structured interview schedules were used to discuss the personal nature of DV and its effects on wellbeing, ways of coping and sources of support. Findings suggest that living in a domestically violent context has extremely negative effects on older women’s wellbeing leading to severe anxiety and depression. Three-quarters of the women defined themselves as in ‘very poor’ mental and physical health and were using pathogenic coping mechanisms, such as excessive and long-term use of alcohol, prescription and non-prescription drugs and cigarettes. This negative coping increased the likelihood of these women experiencing addiction to drugs and alcohol dependence and endangered their health in the longer term. Our findings suggest that health professionals must receive appropriate education to gain knowledge and skills in order to deal effectively and support older women experiencing domestic violence.

Older Women Living with Domestic Violence: Coping Resources and Mental Health and Wellbeing

Background: Domestic violence represents a serious public health issue for women and their children worldwide. International evidence suggests that women aged over 50 who are victims of domestic violence are suffering in silence because the problem is ignored by professionals and policy makers. More UK research is needed to identify the extent of the problem, and services to meet the needs of older women.

Study aims: To bridge this gap by seeking to gain a deeper, systematic understanding of how ‘older women’ cope with domestic violence and how it effects their wellbeing, using a theoretical framework of ‘salutogenesis’ to consider coping resources used in lifelong abuse.

Methods: The study recruited a convenience sample of eighteen older women who are currently, or had been in an abusive relationship. A semi-structured interview schedule was used to discuss the personal nature, of domestic violence in their lives, and the pattern of abuse over time and its effects on their wellbeing, ways of coping and sources of support, barriers to reporting and accessing support, and experiences in seeking help.

Results: Living in a domestically violent context has extremely negative effects on older women’s wellbeing. Living with a perpetrator of long-term violence is predisposing these women to extremely negative health outcomes such as Post Traumatic Stress Disorder, anxiety and depression. Three-quarters of the women defined themselves as in poor mental health and were using pathogenic coping mechanisms, such as excessive and long-term use of alcohol, prescription and non-prescription drugs and cigarettes. This negative coping increased the likelihood of these women experiencing addiction to drugs and alcohol dependence and endangering their health and wellbeing in the longer term. Conclusions Public health interventions can work well from a ‘salutogenic’ perspective by finding ways to promote healthy behaviours that increase older women’s sense of wellbeing and coping. The application of this theoretical framework offers the potential for new knowledge to contribute to the discourse about wellbeing in older women dealing with domestic violence.

Factors affecting a woman's decision to leave an abusive relationship : the theory of planned behaviour /

The present study tested the appHcabiUty of Ajzen's (1985) theory of planned behaviour (TPB), an extension of Fishbein and Ajzen's (1975) theory of reasoned action (TRA), for the first time, in the context of abused women's decision to leave their abusive relationships. The TPB, as a means of predicting women's decision to leave their abusive partners' was drawn from Strube's (1988, 1991) proposed decision-making model based on the principle that the decision-making process is a rational, deliberative process, and regardless of outcome, was a result of a logical assessment of the available data. As a means of predicting those behaviours not under volitional control, Ajzen's (1985) TPB incorporated a measure of perceived behavioural control. Data were collected in two phases, ranging from 6 months to 1 year apart. It was hypothesized that, to the extent that an abused woman held positive attitudes, subjective norms conducive to leaving, and perceived control over leaving, she would form an intention to leave and thus, increase the likelihood of actually leaving her partner. Furthermore, it was expected that perceptions of control would predict leaving behaviour over and above attitude and subjective norm. In addition, severity and frequency of abuse were assessed, as were demographic variables. The TPB failed to account significantly for variability in either intentions or leaving behaviour. All of the variance was attributed to those variables associated with the theory of reasoned action, with social influence emerging as the strongest predictor of a woman's intentions. The poor performance of this model is attributed to measurement problems with aspects of attitude and perceived control, as well as a lack of power due to the small sample size. The insufficiency of perceived control to predict behaviour also suggests that, on the surface at least, other factors may be at work in this context. Implications of these results, and recommendations such as, the importance of obtaining representative samples, the inclusion of self-esteem and emotions as predictor variables in this model, a reevaluation of the target behaviovu" as nonvolitional, and longitudinal studies spanning a longer time period for future research within the context of decision-making are discussed.

The development, assessment, and implementation of an evaluation of the EMPOWER Program at shelters for abused women /

The development, assessment, and implementation of a program evaluation instrument was carried out to evaluate the impact and efficacy of the EMPOWER Program. This intervention was created to educate residents at a shelter for abused women with an anticipated outcome of prevention. Participants included the staff and residents at 2 shelters in Southern Ontario. Client pre, post and follow-up measures were obtained and analyzed statistically and using keyword content analysis. A single staff measure was obtained and summarized using keyword content analysis. Qualitative results were suggestive of important change in participants. All women in the post and follow-up measures believed their participation in the EMPOWER Program provided them with the knowledge, skills, and confidence to avoid abusive relationships in the fliture. This transformational impact was repeatedly expressed in both resident and staff feedback. Limitations of this research, as well as suggestions for future study were discussed.

Comportements sexuels à risque, VIH/ITS et violence dans les milieux prostitutionnels de St-Marc et Gonaïves, Haïti

Les clients de TS sont considérés comme un groupe à risque de VIH et aussi agiraient comme un « pont de transmission » entre les TS et les femmes de la population générale. En dépit de leurs comportements sexuels à risque, les clients de TS ont été rarement étudiés. En conséquence, les objectifs spécifiques de cette thèse étaient : 1) estimer la prévalence du VIH, de la syphilis, du VHS-2 (virus de l’herpès simplex et 2) des facteurs de risque associés chez les clients de TS en Haïti, 2) examiner les déterminants de l’intention d’utilisation du condom, et 3) estimer la prévalence des comportements de violence et ses conséquences. Pour ce faire, une enquête transversale a été effectuée en 2006 auprès de 378 clients fréquentant les milieux de prostitution de St-Marc et de Gonaïves, en Haïti. Un questionnaire structuré ainsi que des échantillons de sang séché sur papier filtre ont été utilisés pour la collecte de données comportementales et biologiques. Notre premier article a montré une prévalence élevée du VIH et des ITS chez les clients. Ces hommes avaient plusieurs partenaires sexuelles avec lesquelles l’utilisation du condom variait. Les clients qui avaient déjà consommé de la marijuana, pratiquaient le vaudou, avaient des antécédents d’ITS ou étaient infectés par le VHS-2, avaient plus de chances d’être positifs au VIH. Le fait d’habiter Gonaïves, de ne pas être protestant, d’être employé et d’avoir déjà essayé la marijuana était associé à l’infection à la syphilis. Tandis que les clients plus vieux, ceux résidants à Gonaïves ainsi que ceux pratiquant le vaudou étaient plus souvent infectés par le VHS-2. Dans notre second article, nous avons démontré que les normes subjectives, le contrôle comportemental perçu et les attitudes étaient des déterminants importants de l’intention d’utilisation du condom. Les clients qui avaient des antécédents d’ITS ou avaient utilisé le condom lors de la dernière relation sexuelle avec la TS étaient aussi plus susceptibles d’avoir l’intention d’en faire usage dans le futur. Les résultats du dernier article ont montré que la prévalence des comportements de violence envers les partenaires intimes était élevée. De plus, la violence émotionnelle et physique était associée à l’utilisation inconstante du condom avec les différentes partenaires sexuelles. En conclusion, cette étude suggère que les clients de TS agiraient comme un pont de transmission facilitant la propagation du VIH/ITS dans la population générale en Haïti et que la violence semblerait également jouer un rôle dans la transmission de ces infections. Nos résultats soulignent le besoin d’interventions en prévention du VIH et des ITS ciblant cette population vulnérable, incluant la problématique de la violence.