Journal articles on the topic 'Women's Medical Clinic of Providence'

Focused on three different protestant communities—puritans, pietists, and Methodists—this essay argues that eighteenth-century protestants were actively engaged in contemporary medical debates, and that their engagement was shaped by their faith in providence. Eighteenth-century protestants understood sickness as part of the created order, they interpreted medicine as a divinely-given tool for Christian action on behalf of the suffering, and they recognized an opportunity for mission in their healing efforts. Motivated by their understanding of God's providential oversight of sickness and health, they relied on empirical medicine, read widely in the emerging medical print culture, turned to networks of women's medical knowledge, and participated in theoretical debates over the soul's role in bodily health. This essay represents an important intervention both in medical history, which has overlooked or misunderstood the role of religion in eighteenth-century medical thought and practice, and in religious studies, in which studies of religion and medicine in America have focused almost exclusively on movements emerging since the nineteenth century and the rise of Arminianism.

24 Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p<.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p<.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.

Health education is an effort to convey the health message that is expected that people, groups, or individuals can gain knowledge about better health so that it can affect behavior. Video media is a health education tool used to facilitate the reception of health messages that rely on the senses of vision and hearing. Pregnant women are at considerable risk of being infected with COVID-19. There is still a low knowledge of pregnant women about COVID-19 at Cideng Medical Center Main Clinic by 40%. The purpose of this study is to analyze the differences in pregnant women's knowledge about COVID-19 before and after the provision of health education about COVID-19 at the Main Clinic of Cideng Medical Center CirebonDistrict in 2020. Research design using a quasi-experimental design with one group design pre test-post test without control design.The sampling technique used is accidental sampling. The population in this study was pregnant women, with a sample of 30 respondents.The results of the analysis with the Wilcoxon T-Test test in pregnant women before and after obtained a p-value of 0.000 from the results of the study obtained a value of p < 0.05 so that the hypothesis is accepted. The average increase in the knowledge level score of pregnant women between before and after being given health education was 2.13. There is an influence of health education on the level of knowledge of pregnant women about COVID-19 at the Main Clinic of Cideng Medical Center Cirebon Regency in 2020

Background Preoperative clinics have been shown to decrease operating room delays and cancellations. One mechanism for this positive economic impact is that medical issues are appropriately identified and necessary information is obtained, so that knowledge of the patients' status is complete before the day of surgery. In this study, the authors describe the identification and management of medical issues in the preoperative clinic. Methods All patients coming to the Preoperative Clinic during a 3-month period from November 1, 2003, through January 31, 2004, at the Brigham and Women's Hospital, Boston, Massachusetts, were studied. Data were collected as to the type of issue, information needed to resolve the issue, time to retrieve the information, cancellation and delay rates, and the effect on management. Results A total of 5,083 patients were seen in the preoperative clinic over the three-month period. A total of 647 patients had a total of 680 medical issues requiring further information or management. Of these issues, 565 were thought to require further information regarding known medical problems, and 115 were new medical problems first identified in the clinic. Most of the new problems required that a new test or consultation be done, whereas most of the old problems required retrieval of information existing from outside medical centers. New problems had a far greater probability of delay (10.7%) or cancellation (6.8%) than old problems (0.6% and 1.8%, respectively). Conclusions The preoperative evaluation can identify and resolve a number of medical issues that can impact efficient operating room resource use.

ABSTRACTGroup B streptococcus (GBS) infection is a leading cause of death among newborns in developed countries. Data on the burden of GBS in Asian countries are lacking. This study aimed to understand (i) the rate of maternal rectovaginal GBS carriage, (ii) the rate of vertical transmission of GBS, as determined by culturing ear, umbilicus, and nasal swabs, and (iii) the distribution of GBS serotypes. This prospective observational study was conducted between September 2012 and November 2013 at Kumudini Women's Medical College Hospital, a secondary-level hospital in Mirzapur, Bangladesh. The study enrolled pregnant women who visited the outpatient clinic for antenatal care (ANC) and/or delivered a child in the inpatient department of Kumudini Women's Medical College Hospital and the babies born to those mothers. Among 1,151 enrolled pregnant women, 172 (15% [95% confidence interval [CI], 13 to 17%]) carried GBS; among 68 babies born to mothers with carriage, 26 (38% [95% CI, 27 to 51%]) had GBS on their body surfaces, indicating vertical transmission. Typing of the isolates (n= 172) identified all 10 GBS serotypes, most commonly types Ia (40% [69/172 isolates]), V (23% [40/172 isolates]), II (14% [24/172 isolates]), and III (12% [20/172 isolates]). This study shows that Bangladesh has all of the ingredients for invasive GBS disease, including colonization of mothers by invasive serotypes and vertical transmission to babies.

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18–23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18–23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.

Starting to continue the medical report for the new 2-year period of activity of the obstetric clinic at Warsaw University, I will already dwell on the details concerning its external and internal device, as I consider sufficient and the information provided on this issue, which in the report for 1888-1889-1890. up to 15 / III (see the Journal of Akush. and Women's, big. for February, 1893). Everything said there is applicable in this place, as well as the direction that began, as we indicated in our place, from 1885 - from the time of the entry into the obstetric department of prof. N. V. Yastrebova embraces the present reporting years.

Objective. The main objective of the research is to determine the characteristics and dynamics of the treatment of women addicted to alcohol, at the Clinic for Addiction Diseases of the Institute for Mental Health, Belgrade. Methods. The sample consists of 136 women addicted to alcohol who were treated at the Clinic for Addiction Diseases of the Institute for Mental Health at the time of the study, as well as patients who had been treated in two wards for the last five years: Clinical ward and Daily hospital. The survey was conducted at the end of 2017 and during 2018. Secondary data sources, ie documentation from the Institute of Mental Health, were used in the research These include patient medical histories and medical records. Analysis of characteristics of women alcoholics aged 18-68 years, treated during 2018, at the Clinic for Addiction Diseases within the Institute for Mental Health in Belgrade. For the research and based on the research variables, a separate matrix was created to analyze the content which was completed for each patient covered by the research sample. Results. The age of the respondents ranges from 18 to 68 years. The results of the analysis of substance abuse in the primary family show that in more than half of the cases (51.5%) there is a history of substance abuse in the family. The key findings of the study show that the largest role in the treatment of women addiction is played by family members who participated in the treatment, and the outcome of treatment was positive with that kind of women. Conclusion. Based on the results presented and conclusions drawn to the specificity of women's alcoholism, the implication is that there is a link between family situation and support and the development of alcoholism and treatment.

One indirect causes of maternal mortality in Indonesia is "Three Delays", delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached, which has relation with the lack of women's ability in empowering herself to actively participate and to make suitable decisions about midwifery care they need. The research aims to explore the partnership between woman and midwife in midwifery care. A descriptive qualitative study was conducted using a convenience sample of six low-risk women after they had given birth and six midwives from six geographically distinct midwife-led care clinic in Bantul Regency. Data were collected through semi‑structured in‑depth interviews. The interview was conducted two to three times and recorded by audio record. Interviews were transcribed and analyzed by the thematic analysis according to Cresswell approach. Seven major themes were identified: (a) midwives ability to partner with women, (b) equality and reciprocity, (c) negotiation, (d) empowerment, (e) trust and time, (f) sharing power and responsibility, and (g) professional friendship. Most of the women are not capable to empower themselves such as less participating in decision making, less considerate in choosing a birthing position, and worsen by the limitations of midwives availability during the delivery process. Midwives need to reflect more the philosophy meaning inside the midwifery care and strengthen the midwifery professionals curriculum in order to persuade women as a partner who capable to empower themselves and to participate actively.

Background: This study investigated pregnant women's knowledge level, perception and attitudes towards caesarean section in the Obstetrics Unit at the Korle-Bu Teaching Hospital.Methods: We employed a descriptive cross-sectional survey design to conduct the study.Results: The findings of the study revealed that majority (82.2%) of pregnant women have considerable knowledge about conditions that predisposes a woman for caesarean section as well as the risk of complications. Factors which significantly encouraged respondents to undergo caesarean section deliveries were they being necessary to protect the health of their babies (85.8%), having more knowledge about caesarean section procedures and risks and trusting in the competence of the doctor (53%). On the other hand, the study identified some inhibiting factors such as 67% of women perceive that caesarean sections take away the joy of a woman, while giving birth. Respondents (56%) however, indicate that caesarean sections were not unnatural nor only reserved for those with medical issues or those who fear pain; they are not embarrassing to reveal to family, friends, etc.Conclusion: In the case of a tertiary hospital in Ghana, women attending antenatal clinic have acquired adequate knowledge and fairly good attitudes and perceptions about caesarean section, its benefits and possible complications. The findings of this study have important policy and practical implications for other levels hospitals.

AbstractWe wondered how many women had experienced a sensation of fullness in the ear during pregnancy. To address this question, data were obtained from a group of healthy women who attended the gynaecology clinic in our hospital as pregnancy cases between February 1995 and January 1998 and who volunteered to participate in our study. A control group was drawn from healthy female co-medical staff members of our hospital who had never been pregnant. The data used for comparing the two groups were taken from a questionnaire about ear problems that was presented to all subjects. The results suggest that ear problems may be increased in pregnancy, particularly for hypotensive pregnant women. However, even for pregnant women complaining of ear problems, pure-tone audiometry and impedance audiometry showed normal hearing in all cases. Furthermore, these women's complaints resolved completely on delivery of their babies.

ABSTRACT CONTEXT AND OBJECTIVES: Laparoscopy is a diagnostic method that is currently becoming consolidated for therapeutic use. It consists of endoscopically viewing the abdominal cavity. The aim here was to evaluate the indications for diagnostic videolaparoscopy and the intraoperative findings in an endoscopic gynecology clinic at a tertiary-level hospital over the last five years. DESIGN AND SETTING: Retrospective descriptive study on all diagnostic videolaparoscopy procedures of the last five years carried out in the endoscopic gynecology clinic of a tertiary-level hospital. METHODS: The medical records of 618 women who underwent diagnostic laparoscopy between 2008 and 2012 were analyzed. The clinical characteristics of these women, the indications for videolaparoscopy and the intraoperative findings were evaluated. RESULTS: The women's mean age was 32 ± 6.4 years. Most of the women had already undergone at least one previous operation (60%), which was most frequently a cesarean. The indications for performing videolaparoscopy were infertility in 57%, chronic pelvic pain in 27% and others (intrauterine device, adnexal tumor, ectopic pregnancy or pelvic inflammatory disease) in 16%. The main laparoscopic findings were tubal alterations in the group with infertility (59.78%) and peritoneal alterations in the group with chronic pelvic pain (43.54%). CONCLUSION: The main indications for videolaparoscopy in gynecology were infertility and chronic pelvic pain. However, in most procedures, no abnormalities justifying these complaints were found.

Purpose Patient advocacy plays an important role in alerting policymakers to the public’s concerns about women's cancers and advancing cancer awareness, early diagnosis and care in high-income countries. Patient advocacy for women's cancers is growing in low- and middle-income countries (LMICs) but remains less developed and understudied. This study aimed to describe facilitators and barriers to advocacy from the point of view of advocates for women's cancers participating in Eastern Europe/Central Asia Women's Empowerment Cancer Advocacy Network (WE CAN) Summits. Methods We conducted semistructured, in-depth interviews and focus group discussions with participants representing cancer advocacy organizations from 14 countries attending the 7th Eastern Europe and Central Asia Women’s Empowerment Cancer Advocacy Network (WE CAN) Breast and Cervical Cancer Advocacy Summit held in Romania in 2015. Discussions and interviews were recorded and transcriptions were coded and analyzed. Findings were presented and discussed at the 8th WE CAN EE/CA Summit in Ukraine in 2017. Results Nine in-depth interviews and three focus groups with a total of 36 participants were conducted. Challenges to advocacy included limited collaboration with the medical community, government, and local authorities; a lack of trust between survivors, physicians, and policymakers; difficulty in adapting existing early diagnosis and treatment recommendations to local context and resources; limited organizational professionalism and program monitoring; societal stigma toward cancer; and limited funding. Key facilitators included highly committed staff and volunteers, effective collaboration, and use of social media for networking and to obtain clinical information. Conclusion Our findings highlight the challenges and facilitators of patient advocacy in the Eastern Europe/Central Asia region, involving patient support groups, advocacy organizations, health care systems, policymaking, and societal attitudes and cancer awareness. To advance patient advocacy for women's cancers in the region, the following needs were identified: the dissemination of resourceadapted information for improving patient outcomes, improved program monitoring, and improved dialogue between survivors, medical professionals, and local governments. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Julie Gralow Consulting or Advisory Role: Puma, Novartis, Genentech/Roche, Pfizer, Merck, Sandoz, Astra Zeneca, Immunomedics Darya Kizub Employment: Everett Clinic Jo Anne Zujewski Employment: Leidos (part time as an independent contractor for Leidos in support of NCI Center for Global Health) Consulting or Advisory Role: performed consulting services for PMK biomedical and BeyondSpring Pharmaceutical

BackgroundTumor mutational burden (TMB), defined as the average number of somatic mutations per megabase (mut/Mb) of DNA in tumor cells, has emerged as a predictive biomarker for response to immune checkpoint inhibitor (ICI) therapy. With more widespread adoption of comprehensive genomic profiling (CGP) assays in the clinic, it is now possible to routinely assess TMB across a wide variety of advanced cancers. Here we performed a retrospective study of routine TMB results assessed from CGP testing across a large community health system to reveal novel insights into the proportion of patients that may benefit from ICI treatment.MethodsPatients in the Providence St. Joseph Healthcare system diagnosed with advanced or metastatic solid tumors and tested for TMB using CGP tests (TruSight Oncology 500, research use only) between July 2019 and July 2020 were considered in this study. Deidentified electronic medical record data and CGP results were abstracted for downstream study.ResultsA total of 1300 patients had one or more CGP tests with a TMB calculation. The median age of patients was 66 years, 51% were female, and 59% were white. TMB values ranged from 0–536 mutations per mut/Mb. Across tumor types, the proportion of patients with TMB ≥10 mut/Mb was 26% (n=341) and with TMB 5–9 mut/Mb was 27% (n=353). The proportion of patients with TMB ≥10 mut/Mb varied by tumor type: Melanoma (60%), NSCLC (42%), CRC (24%), pancreatic (5%). Of all the TMB-tested patients, 90 (7%) received IO therapy post testing. IO therapy use was highest among patients with TMB ≥10 mut/Mb (12%), followed by 7% with TMB of 5–9 mut/Mb, and 4% with TMB of 0–5 mut/Mb. Twenty-nine percent of TMB ≥10 also had high PD-L1 expression by IHC as compared to 8% of TMB <10. ICI therapy choice in this retrospective cohort appeared to be largely driven by other considerations (PD-L1 immunohistochemistry etc.) independent of TMB.ConclusionsA minority of TMB ≥10 patients assessed in this study received an ICI therapy, a result that is likely reflective of the lack of definitive guidelines for this emerging biomarker. As the adoption of TMB increases as a biomarker of immunotherapy response, there is a greater need to expedite the standardization of sample collection, processing, and bioinformatics in TMB assessment.Ethics ApprovalThis study was approved by the Providence St. Joseph Health Institutional Review Board, approval number STUDY2019000048.

Dobrovol'skaya Nadezhda was born in 1878 in Kiev province. After graduating with a gold medal of the women's gymnasium in Kiev Women's medical Institute in Petrograd, worked as an Intern in the clinic of Professor M. S. Subbotin (1902-1904), later a country doctor . 1907 – the assistant to the dissector, assistant Professor of Women's medical Institute (until 1917), supernumeraries medical surgical Academy in Petrograd (from 1914). Since 1911 – a doctor of medicine. In 1912 N.. A. suggested method of joining vessels of different diameter, "end-to-end" crossing them obliquely; I applied the hair to perform a vascular suture. 24 APR 1917 N..Dobrovolskaya apply in Tartu University about acceptance as a privatdozent at the Department of surgery. 14 Oct 1918 – the Board of the University of Voronezh electing her to the chair of surgical pathology with the dressing and the doctrine about dislocations and fractures of the medical faculty and became the first woman to lead the Department of surgery. In 1919, she described the symptom that got her name – a decrease in heart rate when Paltseva the compression of the artery proximal to arteriovenous fistula. To link their fate with the Soviet authorities she did not dare, and soon left Voronezh. N.. Dobrovolskaya served as a doctor in Wrangel's army, which retreated in the Crimea and were evacuated to Egypt (1920-1922). In 1921 N.. Take the art to the newly opened in France, the laboratory organised by the Pasteur Institute and the radium Institute (later, the Institute Curie), which was first headed by Professor Claude REGO, and then N.. Dobrovolskaya. It describes the brachyury mutation in mice is becoming one of the pioneers in understanding the development of the body as changes in gene expression, creates several pure lines of mice as models of human diseases. Nadezhda was a member of the boards of the society of Russian doctors of Mechnikov, Russian academic group, Russian section of the International Federation of University women, Association of Russian doctors abroad. Collaborated in the Brotherhood of the Martyr Albania and St. Sergius. N.. Dobrovolska has authored over one hundred scientific papers. In 1937 she was awarded the French Academy of Sciences for research in the field of hereditary cancer. In 1954, at the age of 76 N..Dobrovolskaya is dead.

This study of HIV-positive women at a clinic for HIV/AIDS in São Paulo examined their risk perception for HIV before they had learned of their diagnosis and their experiences with pre- and post-test counselling. A sample of 148 women was interviewed regarding demographics, HIV risk factors and risk perception, pre- and post-test counselling, and sexual and reproductive conduct. The majority (77%) had been infected by their partners—37% by an injecting drug user partner. More than half (53%) did not perceive themselves at risk before learning of their HIV status and, of 68 who had perceived themselves at risk, 29% did so only after their partners became ill. The majority (64%) did not receive any kind of pre-test counselling. Post-test counselling was reported by 83% but 14% reported being mishandled by a physician in the process. Findings suggest the importance of prevention efforts to reduce women's barriers to learning about HIV status and the necessity of improving the quality of pre- and post-test counselling.

Background: Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. Trained nurses provide fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment of reproductive tract infections (RTI) and refer for further tests and treatment indicated. Methods: We retrospectively reviewed and analyzed WHP medical records from women who presented for cervical cancer screening from 2007-2014. Results: In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment of RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. Conclusion: The WHP's experience using a cost-recovery model and offering multiple services in a single clinic rather than stand-alone cervical cancer screening may be a practical model to make cervical cancer screening services accessible, comprehensive and sustainable. Integrating other women's health services enabled women to address additional health care needs.

Abstract Purpose The risk of urinary tract infection (UTI) development after flexible cystoscopy (FC) is not well described. It remains difficult to assess the role of pre-FC antimicrobial prophylaxis to reduce UTI risk. Methods In fall 2017, the urology service at the Providence Veterans Affairs Medical Center implemented routine oral antimicrobial prophylaxis in its outpatient FC clinic. Outpatients were randomly selected for a retrospective chart review to compare patients who received pre-FC antimicrobials (cefuroxime 500 mg tablet or sulfamethoxazole/trimethoprim [800 mg/160 mg] tablet) and those who underwent FC prior to fall 2017 and did not receive prophylaxis. The primary outcome was presence of symptomatic UTI within 30 days post FC. Secondary outcomes included symptomatic UTI that met colony-forming unit (CFU)/mL guideline requirements, and UTI treatment received. Potential risk factors for UTI were also assessed. Results A total of 296 patients were included in the final analysis: 139 who did not receive and 157 who received a prophylactic antimicrobial before FC. Rates of symptomatic UTI, symptomatic UTI meeting CFU/mL guideline requirements, and postprocedure treatment for UTI were similar with and without antimicrobial prophylaxis (2.5% vs 2.2% [P &gt; 0.99], 1.9% vs 1.4% [P &gt; 0.99], and 2.5% vs 4.3% [P = 0.53], respectively). The mean number of days from FC to the start of UTI treatment was 7.9 (range, 1-18 days). Age over 65 years was the only risk factor present in all patients with a post-FC UTI, irrespective of antimicrobial prophylaxis. Conclusion The rate of post-FC symptomatic UTI was lower than rates previously described in the literature. The role of antimicrobial prophylaxis prior to FC warrants further exploration.

In the life of an individual scientific institution, as well as in the life of an entire society, there are certain periods, trends and trends are known, which, taken together, constitutes the history of this institution. These institutions, which have their own history, include university clinics. The history of these scientific and medical institutions usually has both bright and dark periods, depending not only on a purely scientific setting of the case, but often also on outsiders who have nothing in common with science that have no influence. Here, in a strictly scientific work, this is not the place to go into detail about such influences, but I would like to point out one of them as deserving special attention. This is the dependence of the clinic on city hospitals; it appears in the case when the University acquires one of the premises of city hospitals for clinical purposes. If the hospital business generally went hand in hand with the clinical one and pursued the same goals, then of course the interests of both that and the other institution would be completely identical and would not contradict one another.

Sexuality is one of the most important quality of life issues for both men and women. Sexual dysfunction is a highly prevalent women's sexual response is characterized as highly variable and influenced by a wide range of determinants, including physiologic, psychosocial, and contextual factors. The aim of this study was to assess the sexual satisfaction in pregnant women. This was a cross-sectional study involving 685 Japanese pregnant women aging between17-43 years, who were recruited from January 01, 2012 – January 01, 2014 at the antenatal clinic of Jichi Medical University Hospital. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Overall, 284/685, 41.45% of the 685 pregnant women were at risk for sexual dysfunction symptoms (FSFI scores ≤26); this rate was significantly higher among pregnant women in 3rd trimester (187/254, 73%; P<0.05). Furthermore, our present study showed that the 3rd trimester of pregnancy had lower mean scores in sexual satisfaction, desire, lubrication, orgasm, arousal and dyspareunia than 1st and 2nd trimester. According to these results, pregnant women in the third trimester of pregnancy have lower female sexual function scores than 2nd and 1st trimester of pregnancy.

AimThis systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion.MethodologyThis review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented.FindingsAfter detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma.ConclusionsThe review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting.

The purpose of the article is to make a wide-ranging, comprehensive research of J. Pensky’s personality through the prism of medical local study. Usage of archival historical sources and local periodicals gives us the opportunity to create a complete portrait of the Kharkiv surgeon. Research methods: the study uses general scientific and specifically historical methods of scientific research such as chronological, comparative-historical and retrospective ones in addition to the purely positivist methodology commonly used by historians of Medicine. Main results. The comprehension of J. Pensky’s figure clearly demonstrates the potential of medical local history for historical and medical research. It is concluded that he was a representative of Kharkiv physicians of Polish origin, migrants who, from the ground up, achieved general recognition, including the highest imperial. It is established that he was a talented scientist and surgeon-innovator, author and co-author of original surgical ideas and technologies, inventor of special needles and sutures, which significantly contributed to the development of surgery. Moreover, he was a brilliant administrator and public figure, one of the founders of the Women's Medical Institute, director of the University Surgical Clinic, the member and the Head of the Kharkiv Medical Society, the last Dean of IKhU Medical Faculty, activist of the Kharkovian Polonia. Practical significance. The article is based on archival documents that have not been known before; data could be used in educational work with students of medical educational institutions as well as in museum work. Originality. The article is written basing on original materials with usage of archival documents and it is the first scientifically-grounded paper dedicated to the prominent person. Scientific novelty: the role of Pensky in the case of Lagovskoy is defined for the first time; such medical advances as the “suture of Pensky-Kuznetsov” and the needle invented by the surgeon are emphasized, factual errors of previous researchers are corrected, the first thorough biography of the scientist is created. Article type: historic-biographical.

Objective: Evaluate the presence of association between the classification of the level of asthma control, using the method proposed by the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT)/Childhood-ACT and the forced expiratory volume in the 1st second (FEV1), in asthmatic children and adolescents treated with inhaled corticosteroids, followed up at the National Institute of Women's, Children's and Adolescents' Health FernandesFigueira of the Oswaldo Cruz Foundation (IFF / FIOCRUZ). Method: A cross-sectional study was carried out with a review of the medical records of all children between 7 and 17 years of age followed up at the Asthma Outpatient Clinic and referred to the Respiratory Insertion Test (PFR) sector between March 2013 and September 2014. In the same day were applied the C-ACT/ACT questionnaires, an asthma control method proposed by the GINA and the FEV1 value in a spirometrictest. Results: From the total number of records evaluated (72), 16 children were excluded because they did not meet the required criteria for performing spirometry. The sample studied (56 children) was predominantly male (58.9%) and median age was 12 (7-17) years. It was observed an association between FEV1 and GINA values ??(p <0.01). Conclusion: The results found in this study indicate that FEV1 measurement is a useful component among the instruments for assessing clinical control of asthma by GINA.

Abstract Objective This study aimed to evaluate the association between a patient's travel time to clinic and her prenatal care attendance. Study Design We conducted a retrospective cohort study of women (≥18 years) who received prenatal care and delivered at North Carolina Women's Hospital between July 1, 2014, and June 30, 2016 (n = 2,808 women, 24,021 appointments). We queried demographic data from the electronic medical record and calculated travel time with ArcGIS. Multinomial logistic regression models estimated the association between travel time and attendance, adjusted for sociodemographic covariates. Results For every 10 minutes of additional travel time, women were 1.05 (95% confidence interval [CI]: 1.02–1.08, p < 0.001) times as likely to arrive late and 1.03 (95% CI: 1.01–1.04, p < 0.001) times as likely to cancel appointments than arrive on time. Travel time did not significantly affect a patient's likelihood of not showing for appointments. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients (p < 0.05). Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women (p < 0.05). Conclusion Changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women.

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

Introduction Despite the considerable number of children withDo\Vll syndrome in Indonesia, there is little data available on thesuccess of intervention programs. This study was performed todefine factors affecting the intelligence of young children withDo\Vll syndrome.Objective To determine factors associated Mth lower intelligencein children with Down syndrome, including growth parametersand participation in intervention programs.Methods This cross􀁃sectional study was undertaken fromDecember 2010 to March 2011. Subjects were 60 childrenwith Down syndrome aged 2􀁃6 years who were enrolled inan intervention program at both the Medical RehabilitationDepartment, Cipto Mangunkusumo Hospital, and the Growthand Development Clinic, Harapan Kita Women's and Children'sHospital. Parents' data was obtained through self history􀁃takingand perusal of medical records. Subjects' anthropometricdata (body weight, body height, and head circumference) wasobtained through measurements using calibrated instruments.A psychologist administered IQ tests on the subjects. Results ofthe anthropometric and IQ tests were given to parents one weekfollowing the examinations.Results From the 111 children with Down syndromeregistered in the intervention programs, 60 children (36boys and 24 girls) met the inclusion criteria. The mean ageof subjects was 4 years 6 months. Most subjects were well􀁃nourished. Fifty􀁃five subjects had microcephaly. Eighty􀁃twopercent of subjects participated in the program regularly and70% of subjects had started in the program at less than 1 yearof age. Subjects' mean IQ was 52.8. Analysis showed thatgirls, subjects who were overweight and obese, subjects withmicrocephaly, those with irregular attendance in the program,and those living under the poverty line were at highest riskfor severe mental retardation.Conclusion Factors associated v.ith the intelligence in childrenwith Down syndrome were female gender, overweight/obesity, severe microcephaly, below􀁃poverty line economic status, andirregular participation in the program. [Paediatr Indones.2012;52:194-9].

Abstract Context.—The impact of viral infections during pregnancy on adverse pregnancy outcomes is not understood fully. Objective.—To assess the frequency of parvovirus B19, herpes simplex 2, and cytomegalovirus infections in relation to late abortions, in sera from Egyptian pregnant women to establish basic knowledge for future pregnancy care. In addition, to study the diagnostic value of specific immunoglobulin M (IgM) against those viruses compared with their genomes detection by polymerase chain reaction in maternal serum as a noninvasive method of laboratory diagnosis. Design.—Patients were recruited at the Women's Clinic, Mansoura University. One group of patients with recurrent spontaneous abortions (RSA) and a second group of pregnant women without a history of RSA were evaluated including demographic, medical, and clinical data. Virologic markers were evaluated for specific IgM and for viral DNA to cytomegalovirus, herpes simplex virus 2, and parvovirus B19. Results.—There was a statistically significant difference between the RSA group and the pregnant women without RSA group in frequency of parvovirus IgM (84% and 16.7%, respectively) (P &lt; .001) and herpes simplex IgM (40% for RSA) (P = .001). Parvovirus B19 viremia was positive in 48% RSA, herpes simplex virus 2 was positive in 32% RSA, and cytomegalovirus was positive in 12% RSA patients. For RSA patients with parvovirus viremia, the mean ± SD of IgM value was 78.5 ± 30.12 IU/mL, and for RSA patients with negative viremia it was 30.02 ± 17.64 IU/mL with statistically significant difference between both levels (P &lt; .001). Conclusions.—From this study, we conclude that viral infections with parvovirus B19 and herpes simplex 2 were frequently associated with recurrent abortions, and careful investigation for this condition must include evaluating these patients for the previously mentioned viruses. Serologic study by specific IgM for parvovirus and herpes simplex seem to be reliable as screening tests for high-risk pregnancy.

It is a biological fact that the health of mother and child are interdependent. The care, attention and affection given by the mother to her young offspring are of major significance in the psychobiological development of the infant and indeed, in subsequent personality development. Suggestions have been made that special attention to a pregnant woman brings double health benefits: to her as an adult member of society, and to the outcome of her pregnancy. Although childbearing is a natural process, women all over the world do not possess full faith in the ability and self-sufficiency of the human body to deliver safely a healthy baby. Pregnancy has been described as a unique and ambiguous state for women: it is not a usual condition nor a medically pathological state, so it is especially problematic. Several influences are known to affect women's pregnancy outcome. Factors relating to the mother—such as age, parity (or the number of births she has had), her age at marriage, socio-economic status such as education, occupation and income, and past obstetric history, are likely to be interdependent in their influence on pregnancy outcome. However, complications of pregnancy and delivery brought about by the interdependence of these factors can be prevented by careful antenatal care. Presumably, this type of care is closely related with modern medical science, thus only available in clinics. Consequently, the prevention of the many complications of pregnancy rests more with seeking careful antenatal care from the clinic than with any other factors.

Context: Globally, every minute, at least one pregnant woman dies from obstetric complications. Also, the majority of neonatal deaths occur during the first week of life. These mortality rates can be reduced by increased knowledge, positive attitude, and appropriate reaction regarding obstetric and newborn danger signs. Aim: of the study was to examine the effect of health education program on knowledge, attitude, and the reaction of pregnant women regarding obstetric and newborn danger signs. Methods: A quasi-experimental research (pre/post-intervention) design was utilized to achieve this study's aim. A purposive sample of 70 pregnant women was recruited according to inclusion criteria. This research was conducted in the Antenatal Outpatient Clinic at Benha University Hospital. Two tools were used for data collection. They were a Structured Interviewing Questionnaire and a Modified Likert Scale to assess women's attitude. Results: 77.1% had poor knowledge pre educational program compared by 92.9% post educational program intervention. Regarding attitude, 52.9% had a negative attitude preprogram compared to 87.1% had a positive attitude post-program with a statistically significant difference between the two phases regarding all knowledge elements. The majority of them (83.3%) had an appropriate reaction (seeking medical help) after the educational program than a few of them pre educational program. Conclusion: The implementation educational program significantly improved pregnant women’s knowledge, attitude, and reaction regarding obstetrics and newborn danger signs. The study recommended developing antenatal classes for all pregnant women about key danger signs, appropriate decisions, and reactions in obstetric and newborn danger signs. Further research regarding replicating this study on a large representative probability sample is highly recommended to achieve more generalization of the results.

Purpose To examine outcomes of mammography screening among women ≥ 80 years to inform decision making. Patients and Methods We conducted a cohort study of 2,011 women without a history of breast cancer who were age ≥ 80 years between 1994 and 2004 and who received care at one academic primary care clinic or two community health centers in Boston, MA. Medical record data were abstracted on all screening and diagnostic mammograms, breast ultrasounds and biopsies performed, all breast cancers diagnosed through December 31, 2006, and on sociodemographics. Date and cause of death were confirmed using the National Death Index. Results The majority of patients (78.6%) were non-Hispanic white and 51.4% (n = 1,034) had been screened with mammography since age 80 years. Among women who were screened, eight were diagnosed with ductal carcinoma in situ, 16 with early stage disease (1.5%), two with late stage disease, and one died as a result of breast cancer. Many (110; 11%) experienced a false-positive screening mammogram that led to 19 benign breast biopsies, eight refused work-up, and three experienced a false-negative screening mammogram; 97 were screened within 2 years of their death from other causes. There were no significant differences in the rate, stage, recurrence rate, or deaths due to breast cancer between women who were screened and those who were not screened. Conclusion The majority of women ≥ 80 years are screened with mammography yet few benefit. Meanwhile, 12.5% experience a burden from screening. The data from this study can be used to inform elderly women's decision making and potentially lead to more rational use of screening.

1533 Background: Rural and indigenous women are generally considered to be at lower risk of breast cancer than women living in urban environments. However, a rising breast cancer incidence rates among those women has been reported. Moreover, up to 90% of those women are diagnosed as having advanced disease. With the aim to improve preventive programs in that population, this study evaluated socio-demographic factors associated with breast cancer early detection and women's knowledge about this malignancy. Methods: Between March 2008 and November 2008, women attending cancer screening programs in our clinic were asked to answer a questionnaire focusing on socio-demographic issues, breast cancer risk factors, breast self examination (BSE), mammography, and perception of breast cancer risk. Results: 838 consecutive women (median age 40 years, range: 15–85) were evaluated. 443 (53%) of them were 40 years and older. The highest education level was 9 years in 408 (49%), 72 (9%) were illiterates and 721 (86%) have no medical insurance. 104 (12%) women practice BSE. The main source of breast cancer awareness was physicians and media in 270 (32%) and 214 (26%) women, respectively. 285 (34%) women knew about breast cancer risk factors, 255 (30%) identified symptoms and signs, and 460 (55)% of them identified lump as the most common sign. 441 (53%) women recognized mammography as the best diagnostic tool in detecting breast cancer, but only 79 (18%) out of 443 women 40 years and older, reported having had a mammogram. Mammograms were not done in 364 (82%) women because of financial issues and difficulty in accessing facilities that perform mammography. 311 (37%) women thought that they were at higher risk of developing breast cancer. Conclusions: Rural and indigenous women have a poor knowledge about breast cancer. Low level education, lack of medical insurance, financial issues, insufficient mammography facilities, and low perception of breast cancer risk are the most important barriers to increase women´s participation in early breast cancer detection. These factors should be considered to improve preventive breast cancer programs. No significant financial relationships to disclose.

ABSTRACT Objective: The aim of this study was to evaluate the role of urodynamic test in diagnosis of urinary incontinence, comparing detailed data of history and physical examination, and some easy- to-apply clinical tests. Methods: A cross-sectional retrospective study was carried out by reviewing the medical charts of 55 patients with complaint of loss of urine, seen at the Urogynecology Service of Women's Health Outpatient Clinic of Hospital Universitário de Jundiaí, between October 2006 and March 2007. The patients answered a specific questionnaire involving the epidemiological and physical examination variables considered in this study. They were submitted to physical examination and urodynamic tests. Results: The complaint of loss of urine upon exertion, either isolated or associated with urge incontinence, was confirmed by urodynamic tests in most women, and only 4 of 49 symptomatic women had negative results. The clinical sign was present in 35 patients (63.6%), and 46 patients (83.6%) had the exertion component in the urodynamic test. The exertion component was observed in 10 (18%) out of 15 patients without symptoms (30%). The positive and negative predictive values of the clinical sign for diagnosis of any type of urinary incontinence in this studied group were 97.1 and 26.7%, respectively. As for the clinical complaint of urinary loss upon exertion, the positive and negative predictive values for any type of urinary incontinence were 92 and 40%, respectively. For the clinical complaint of urge incontinence, the positive and negative predictive values of 92.5 and 23.1%, respectively. Conclusions: It was concluded that the urodynamic evaluation is an important instrument to evaluate the severity of incontinence, although it was not necessary to diagnose loss of urine. The finding of urinary loss during physical examination had low sensitivity and specificity in diagnosis of the type of loss of urine. Urodynamic tests had better performance in demonstrating urinary incontinence in patients with complaint of incontinence upon exertion and without loss of urine seen upon physical examination than in confirming urge incontinence in patients with those symptoms.

In Ukraine, the state of pregnancy in adolescent girls aged 13–17 years is considered early or adolescent pregnancy. The problems of teenage pregnancy are extremely relevant in Ukraine: in ten years, almost 100,000 girls aged 16–17 became mothers, solving the problems of teenage births. The urgency of the problem of pregnancy in young girls gives grounds to consider and treat this issue as a serious social and psychological problem that requires further study and development of measures to prevent it. The purpose of the research is to study the state of reproductive health in young women among the population of Lviv region, determining the frequency of adolescent pregnancy and taking into account the contribution of gynecological pathology and menstrual disorders. A retrospective analysis of the primary medical records of 134 young women was conducted. We studied the frequency of adolescent births, social status, medical surveillance coverage during pregnancy, reproductive history in adolescent women for 4 years in Lviv Regional Clinical Hospital. Analysis of the prevalence of adolescent pregnancy showed that the frequency of childbirth in young women remained stable for four years: in 2014–2017, in the maternity wards of Lviv Regional Clinical Hospital, 134 women under the age of 18 gave birth, which is 0.82–0.98% of the total number of births. A significant majority (p <0.05) of them (78 women) were 17 years old (that is 58.2%) and 84 women lived in rural areas (62.7%); 97 women were not married (72.4%). Only 1/3 (34.3%) of young women were registered in a women's clinic before 12 weeks of pregnancy, and 10.4% of them were not followed up by doctors at all during pregnancy. The study of menstrual dysfunction, namely irregular menstruation, showed the presence of this indicator in more than 1/2 (80–59.7%) out of 134 young women. According to the results of the study, despite their young age, 127 (94.8%) of 134 women were pregnant for the first time, and 7 (5.2%) women had consecutive pregnancy. Among 7 (5.2%) women who had consecutive pregnancy, only 4 (3.0%) had an uncomplicated pregnancy, and three (2.2%) subjects had a history of one (0.7%) silent miscarriage, premature birth, medical abortion. More than 1/3 (50–37.3%) of young women gave birth to children with poor health. The most common cause of reproductive disorders in young women of the main group was prematurity of newborns (37.3%). The data obtained indicate the feasibility of studying adolescent motherhood, which will be especially valuable in the context of developing effective demographic policies.

Background: Pelvic inflammatory disease (PID) is associated with major medical and economic consequences for women of reproductive age. Identification of the risk factors associated with PID is crucial to efforts for prevention of these consequences. This study is done to evaluate the risk factors for PID in women attending OPD at Gangori hospital.Methods: This Study is an observational study, Conducted in Department of Obstetrics and Gynecology, Gangori hospital, SMS Medical College, Jaipur, From January 2015 to June 2015. Risk factors of PID were assessed in 70 women with PID (study group) and then it was compared with 70 controls attending the Women's Clinic at the same institution. Significance of difference in proportion in various variables of PID in both the group was inferred by odd’s ratio and Chi-square test. Logistic regression analysis was used to adjust for confounding variables.Results: A total of 70 women with PID and an equal number of controls were included. Cases were significantly younger than controls (p<0.001). The women were mainly of lower socioeconomic status. Risk factors identified by bivariate analysis were less than secondary level education, Odds ratio [OR] 5.29; (95% confidence interval: 1.680 to 16.675) P value 0.005. Parity >0, Odds ratio 2.521 (95% CI: 1.140 to 5.577) P value 0.033. Spontaneous abortion >0, Odds ratio 3.11 (95% CI: 1.311 to 7.362) P value 0.015. Lack of a birth control method, Odds ratio 7.18 (95% confidence interval: 3.091 to 16.662) p value<0.001. younger than 18 years at age of first sex, Odds ratio 2.84 (95% CI: 1.404 to 5.753) P value 0.006. Sex during the previous menses Odds ratio 5.39 (95% CI: 2.317 to 12.529) P value <0.001. Vaginal discharge/bleeding, Odds ratio 5.84 (confidence interval 2.717 to 12.578) P value <0.001. With multivariate analysis to control for confounders the risks still identified were sex during the previous menses, parity >0, lack of contraception, vaginal discharge and age at first sex.Conclusions: Identification of the risk factors associated with PID is most important effort for prevention of the disease and its sequelae. Educating the women, encouraging the use of condoms and other methods of contraception for PID prevention, sexually transmitted disease prevention and also birth control. Another finding is that, it is better to avoid coitus during the menses.

ABSTRACT Introduction Cervical cancer is the second most common cancer in women worldwide, and it is the principal cancer of women in most developing countries, where 80% of cases occur. This disease is preventable by screening and treatment of preinvasive condition. All sexually active women are at risk of acquiring a human papillomavirus (HPV) infection that may lead to cervical cancer in the future. Cervical cancer is a preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. The screening procedures are visual inspection of cervix with acetic acid (VIA), Pap smear, colposcopy, and HPV deoxyribonucleic acid test. Among them, colposcopy is effective in screening, taking colposcopy-directed biopsy as well as treatment of cervical intraepithelial neoplasia (CIN), such as cold coagulation, cryotherapy, and loop electro-surgical excision procedure. Hence, there is an obvious need to subject the women with VIA-positive report to colposcopy and directed biopsy. This study is done to evaluate the role of colposcopy in evaluation of VIA-positive cases. Objective Colposcopic evaluation of VIA-positive cases and detection of precancerous lesion of cervix for early management. Materials and methods This was a cross-sectional study done among married female patient aged 22 to 65 years, who had VIA-positive report, and attending the colposcopy clinic in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital from January 2014 to December 2016. Colposcopy-directed punch biopsy was taken from the abnormal colposcopic appearance and specimen sent for histopathological examination. Results Out of 97 cases, all had VIA-positive acetowhite areas. But colposcopy revealed that 76.29% had CIN and invasive lesions, while 23.71% had either normal or inflammatory lesions. Colposcopy-directed punch biopsy revealed that 59.79% cases had positive lesions like CIN or invasive carcinoma and 40.21% had neither CIN nor invasive lesions. Among positive lesions, about 34.02% had CIN I, 3.09% had CIN II, 0% had CIN III, and 22.68% had invasive carcinoma. In this study, sensitivity and specificity of colposcopy examination were found 94.83 and 51.28% respectively. Conclusion Cervical cancer presents as major cause of morbidity and mortality, especially in developing countries like Bangladesh. In developing countries, the various screening programs are implemented for its early detection and treatment. It is evident that colposcopy plays a very important role in early diagnosis and treatment of preinvasive and early invasive carcinoma of cervix. So wide use of colposcopy in screening program of Bangladesh can reduce many young women's morbidity and mortality. How to cite this article Kasem SB, Razzaque SA, Adiba R, Anika S, Begum F. Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix. J South Asian Feder Menopause Soc 2017;5(2):102-106.

Introduction: Data on hormonal intrauterine device (IUD) related adverse events in young women with inherited bleeding disorders (IBDs) are limited. Our primary objectives were to 1) examine adverse outcomes following IUD insertion in adolescents with heavy menstrual bleeding (HMB) and 2) compare IUD event-free survival in patients with and without IBDs. Methods: We performed a multi-center retrospective study of adolescents presenting to Young Women's Hematology Clinics at Nationwide Children's Hospital and Children's Medical Center, Dallas. All new patients with HMB at both clinics were enrolled in a HMB registry. We included registry participants who presented for evaluation of HMB between February 2014-February 2020 and had a levonorgestrel IUD placed. Electronic medical records were reviewed for clinical history, patient demographics, IBD diagnosis, IUD insertion, and post-IUD insertion follow up. We determined a priori IUD expulsion, removal due to malposition, or removal due to excessive pain or bleeding as clinically relevant adverse outcomes. Results: We identified 78 patients with IUD placement, of which 43 patients were diagnosed with IBDs. Of patients with IBD, the most common diagnoses were von Willebrand's disease/low von Willebrand factor (n=15), joint hypermobility syndrome/Ehlers-Danlos (n=15), and qualitative platelet disorder (n=9). The majority of patients were white (78%); 15% identified as Black. Nine percent of patients were Hispanic. Ninety percent of patients had failed at least one other method prior to IUD placement with the most common being combined estrogen/progestin oral contraceptive pills (79%), followed by progestin-only pills (37%), non-hormonal medications (DDAVP or anti-fibrinolytics) (26%), and depot medroxyprogesterone acetate (22%). Approximately half of the patients had an IUD inserted under general anesthesia (58%), with the remainder undergoing insertion in an outpatient clinic setting. Patients with IBDs were younger at time of IUD insertion (mean age 14 years, range 11-18) as compared to those without bleeding disorders (mean age 15 years, range 12-19, p=0.048). One-third (32%) of patients were sexually active prior to IUD insertion; this was not significantly different between groups. IUDs were found to be malpositioned or expelled on recheck in 21% of patients with IBD and 19% of patients without IBD (p=.87). Following IUD insertion, there was no significant difference in breakthrough bleeding that required treatment between the two groups, which occurred in 42% of patients with IBD and 26% in patients without IBD (p=.18). Patients with IBD were less likely than patients without IBD to request their IUD be removed prematurely (2% vs 20%, p&lt;0.05). Overall, we found an annual rate of 0.25 adverse IUD events per 1 year of IUD insertion, with all adverse events occurring in the first 20 months after placement. Conclusions and future directions: While rates of expulsion and malposition were not higher in adolescents with IBD when compared to those without, they were higher than that of the general population (20% in our adolescent population with HMB vs 10% in the general population of nulliparous women &lt;20 years of age, Madden et al, Obstetrics & Gynecology, 2015). Our study suggests that breakthrough menstrual bleeding after IUD insertion is equally likely in teens with HMB regardless of the diagnosis of IBD, with over a third of all patients requiring adjunctive therapy for breakthrough bleeding after IUD insertion. These findings highlight the need for appropriate counseling in this unique population as hormonal IUDs constitute an important treatment option for HMB in adolescents with and without IBD. Our work can inform shared decision making and patient counseling for the use of IUDs in young women with HMB and emphasizes the need for close follow-up after insertion to monitor for break through bleeding or malposition. Further research is needed to prospectively measure clinical outcomes and patient-reported outcomes after IUD insertion in young women with IBDs. Disclosures O'Brien: Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Abstract Introduction: Nearly 40% of adolescent women experience heavy menstrual bleeding (HMB), and identifiable bleeding disorders are diagnosed in only 20-60% of these patients. We suspect that qualitative platelet disorders contribute to HMB, but are under-diagnosed. A pilot study was conducted to evaluate platelet function in adolescent women with HMB employing four novel, small-volume, whole blood platelet function assays. In addition, primary and secondary hemostasis, bleeding phenotype, and quality of life were assessed. Methods: Patients referred to the Young Women's Hematology Clinic at Oregon Health & Science University for evaluation of HMB were offered participation in the study. Participants underwent standard review of their medical and family history and physical exam. Standard lab evaluation included CBC, PT, PTT, fibrinogen, thrombin time, Von Willebrand Panel, PFA-100, and iron studies with platelet aggregation or phenotyping performed if clinically indicated. Using less than 0.5 mL of whole blood, platelet function was assessed with four novel platelet function assays: assessment of platelet activation, secretion, and aggregation was assessed by flow cytometry analysis, while platelet adhesion and aggregation was assessed under shear in a capillary tube. Quality of life (QOL) was assessed using the PedsQL tool. Bleeding phenotype was assessed with the ISTH Bleeding Assessment Tool (ISTH BAT). Menorrhagia was assessed with the Pictorial Bleeding Assessment Chart (PBAC), the Philipp Tool and the clinical history. Results: Nine participants have enrolled on study to date, with 2 completing the 3-month visit. The median age of the cohort was 16 years (14-18 years). Eight out of nine categorized their period as heavy, 6 also had epistaxis, and 7 reported excessive bruising. The median ISTH BAT score was 4 (3-7). Of the 7 patients who had a Philipp Score obtained, 5 were positive. Median PBAC score was 161 (64-196). Median ferritin was 13 ng/mL (4-65 ng/mL). Median QOL psychosocial score was 70 (68.36-88.25), comparable to that of pediatric patients with cancer. Of the 9 participants, 6 had platelet aggregation and phenotyping. Four participants did not receive a bleeding disorder diagnosis, 1 was diagnosed with Type 1 VWD, 1 was diagnosed with bleeding disorder, NOS, and 1 was diagnosed with Ehlers Danlos Syndrome. Two participants were diagnosed with a qualitative platelet disorder (QPD): one based on platelet aggregation and one based on thromboelastography. The four novel platelet function assays confirmed platelet function abnormalities in the participants diagnosed with QPD's (Figure 1&2). Impaired platelet response to agonist stimulation was also observed in participants with non-platelet disorder bleeding disorder diagnoses and in participants without a bleeding disorder diagnosis. Conclusions: In this pilot study, the etiology of HMB in adolescent women was evaluated with four novel platelet assays in addition to standard assays of hemostasis. A bleeding disorder diagnosis was not made with standard evaluations in 4 out of 9 participants. The novel assays detected platelet abnormalities not observed using currently available clinical labs, and confirmed the presence of abnormal platelet function in participants with abnormal platelet function testing. These assays require significantly less blood volume than currently available assays and expand investigation of platelet function to platelet adhesion and platelet interactions in whole and flowing blood. Further work is needed to determine the sensitivity and specificity of the novel assays in detecting platelet dysfunction. Continued investigation into the impact of HMB on the adolescent female population is needed. Disclosures Haley: CSL Behring: Honoraria; Baxalta: Membership on an entity's Board of Directors or advisory committees. Recht:Biogen: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Biogen: Research Funding; Genentech: Research Funding; Novo Nordisk: Research Funding; Baxalta: Research Funding; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.

Introdução: A gestação na adolescência é considerada um problema de saúde pública. Neste contexto, o terapeuta ocupacional pode desenvolver sua abordagem com foco no desempenho ocupacional desta população, que se depara com um novo papel e na modificação de suas ocupações. Objetivo: Descrever as ações de terapia ocupacional com adolescentes gestantes sobre o desempenho em ocupações na rotina diária. Métodos: Estudo do tipo pesquisa-ação com abordagem qualitativa. Foi desenvolvido no ambulatório da Saúde da Mulher de um Hospital Universitário da cidade do Recife -- PE, entre março e julho de 2016, com 10 adolescentes gestantes. Os dados foram obtidos por meio de entrevista semiestruturada, consulta a prontuários e observação participante dos grupos, que gerou registros em diário de campo e gravações. Os princípios éticos da Resolução 466/12 do Conselho Nacional de Saúde, foram respeitados. Resultados: As ações foram iniciadas com o levantamento, junto às gestantes, de dificuldades no desempenho ocupacional, problematização esta que favoreceu as discussões posteriores, em direção à construção compartilhada de estratégias. As ocupações indicadas como problemáticas foram: calçar o sapato, depilar-se, atividade sexual, descanso e sono e mobilidade funcional. A partir daí, o grupo elaborou estratégias para melhorar sua performance nestas atividades, bem como qualidade de vida, respaldadas por orientações da terapeuta ocupacional. Conclusões: No estudo, foi possível identificar as dificuldades no desempenho ocupacional na rotina diária das gestantes, bem como favorecer a reflexão das mesmas sobre as estratégias de enfrentamento, para contribuir com a redução de agravos à saúde, promoção da autonomia e independência funcional. Abstract Introduction: Gestation in adolescence is considered a public health problem. In this context, the occupational therapist can develop his approach focusing on the occupational performance of this population, which faces a new role and on the modification of their occupations. Objective: To describe the actions of occupational therapy with pregnant adolescents, on the performance in occupations in the daily routine. Methods: A research-action study with a qualitative approach. It was developed at the Women's Health outpatient clinic of a University Hospital of the city of Recife - PE, between March and July 2016, with 10 pregnant adolescents. The data were obtained through a semi-structured interview, consultation of medical records and participant observation of the groups, which generated records in field diaries and recordings. The ethical principles of Resolution 466/12 have been respected. Results: The actions were initiated with the survey, along with pregnant adolescents, of difficulties in occupational performance, problematization that favored the later discussions, towards the shared construction of strategies. The occupations indicated as problematic were: wear shoes, depilation, sexual activity, rest and sleep, and functional mobility. From there, the group developed strategies to improve their performance in these activities, as well as quality of life, backed by occupational therapist guidelines. Conclusions: In the study, it was possible to identify the difficulties in occupational performance in the daily routine of pregnant women, as well as to favor their reflection on coping strategies, to contribute to the reduction of health problems, promotion of autonomy and functional independence.Key words: occupational therapy, pregnancy in adolescence, role playing, activities of daily living. Resumen Este artículo tiene como proposito analizar y debater lasposibilidades de laactuación de la terapia ocupacional enel âmbito de la Cultura, desde las reflexiones docentes generado por losestudiantes graduados enla Terapia Ocupacional enel centro de enseñanza superior (IES) publica. Hoy, laspoliticapublicasbrasileñaspresentanla cultura como derecho. Cultura, en neste caso, no sólo entendida como manifestaciones artísticas y estéticas, sino como uma cuestión de la identidade, protegiendotambiénsu diversidade. Para esta investigación, elegimosel enfoque cualitativo a partir de un enfoque analítico descriptivo, teniendo como base el método documentaldeldiario de campo de lasclases de los dos semestres consecutivos de la disciplina de Terapia Ocupacional Social de uncurso de una Universidad Publica. Los resultados obtenidos se dividieranentres categorias de análisis: (1) Cultura atravesandolapráctica, (2) Cultura como recurso y (3) Cultura como um campo de acción de la Terapia Ocupacional. Se entiende que la Cultura puede definir como campo específico de acción, con una finalidade determinada, lo que apunta para lanecesidad de los estúdios y uma formacción dirigida enparticular aaquellas políticas, servicios y prácticas. Los datos de este estudio especialmente sumado a las diversas experienciasde la Terapia Ocupacional enelámbito de la Cultura han demonstrado lanecesidad de replantearlaformaciónprofesional. Una pista importante llevaría a uma revisión de lasdirectrices curriculares nacionales, teniendo em cuentaelámbito de la Cultura como locus de produccióndelconociento y laintervencióndel terapeuta ocupacional. Se apunta que és necesarioinvertiren neste tipo de formación para laconsolidación de lasprácticas de el terapeuta ocupacional enelámbito de la Cultura.Palalvras claves: Terapia Ocupacional, Cultura, Ciudadanía Cultural, Formación Profesional.

Clínica Esperanza/Hope Clinic (CEHC) employs Navegantes, who are specially-trained bilingual Community Health Workers (CHW), as key team members who improve the ability of the clinic to provide care for and improve the health status of a large population of uninsured Spanish-speaking patients in Providence, Rhode Island. Given the growing demand for CHWs at the clinic and in the broader healthcare sector in the state, CEHC developed the Advanced Navegante Training Program (ANTP). The ANTP prepares community members to become certified CHWs who are equipped to provide patient navigation and lifestyle coaching as well as professional medical interpretation services. The ANTP is developed and taught by CEHC Navegantes who themselves are bilingual and bicultural peers of trainees as well as the population that CEHC serves. Upon graduation, ANTP trainees have been able to attain higher-paying and fulfilling careers in a range of healthcare and other community settings. The ANTP offers a low-cost, community-based model for training CHWs who are uniquely prepared to promote health and well-being among medically underserved patients.

As a way to integrate the presentations at PHA's June scientific sessions with clinical practice, Guest Editor Karen Fagan, MD, convened a group of attendees to discuss their experience in Orlando. The discussants included Todd Bull, MD, Associate Professor, Medical Director, Anschutz Intensive Care Unit, University of Colorado, Aurora, Colorado; Anna Hemnes, MD, Assistant Director, Center for Adult Pulmonary Vascular Disease, Vanderbilt University, Nashville, Tennessee; C. Gregory Elliott, MD, Professor of Medicine, University of Utah and Medical Director, Pulmonary Hypertension Center, Intermountain Medical Center, Murray, Utah; Vinicio A. de Jesus Perez, MD, Assistant Professor in Medicine and Staff Physician, Wall Center Adult PH Clinic, Stanford University Medical Center, Palo Alto, California; and Paul B. Yu, MD, PhD, Brigham and Women's Hospital, Boston, Massachusetts.

Dr Sima Samar was born in Jaghoori, Ghazni, Afghanistan, on 3 February 1957. She obtained her degree in medicine in February 1982 from Kabul University, one of the few Hazara women to do so. She practised medicine at a government hospital in Kabul, but after a few months was forced to flee for her safety to her native Jaghoori, where she provided medical treatment to patients throughout the remote areas of central Afghanistan.One year after the communist revolution in 1978, her husband was arrested and was never heard from again. Some years later, Dr Samar and her young son fled to the safety of nearby Pakistan. She then worked as a doctor at the refugee branch of the Mission Hospital in Quetta. In 1989, distressed by the total lack of healthcare facilities for Afghan refugee women, she established the Shuhada Organization and Shuhada Clinic in Quetta. The Shuhada Organization was dedicated to the provision of health care to Afghan women and girls, the training of medical staff, and education. In the following years, further branches of the clinic/hospital were opened in central Afghanistan.After living in Quetta as a refugee for over a decade, Dr Samar returned to Afghanistan in December 2001 to assume a cabinet post in the Afghan Interim Administration led by Hamid Karzai. In the interim government she served as Deputy Chairperson and first ever Minister for Women's Affairs. She was forced to resign from her post after receiving death threats and being harassed for questioning conservative Islamic laws, especially sharia law, during an interview in Canada with a Persian-language newspaper. During the 2002 Loya Jirga, several religious conservatives published an advertisement in a local newspaper calling Dr Samar the Salman Rushdie of Afghanistan.She currently heads the Afghanistan Independent Human Rights Commission (AIHRC).1 She was a nominee for the Nobel Peace Price in 2009.

Mammography and cervical screening are effective methods for early cancer detection in women. Recent reports showed that 69% of women ³45 years had a mammogram in the past 2 years and 16-55% of women had a Pap smear regularly. Internal medicine (IM) physicians are crucial players in women's health management and literature has identified that a physician’s gender impacts patient management in many areas of healthcare. We investigated mammogram and Pap smear recommendations by IM residents and examined differences in approaching women’s health issues between female and male residents. With IRB approval, one-hundred charts of new female patients were reviewed, which included female patients 45 years or older seen by IM residents for their first visit. All patients completed a questionnaire concerning previous medical conditions and care as part of clinic routine. Patient chart information, recommendations for mammogram and cervical cancer screening by the resident were recorded, along with the gender of the resident and supervising attending. The mean age of the patients was 61±9.3 years. Female residents were more likely to recommend a mammogram compared to male residents (36.7% and 16.4%, respectively). No significant differences in Pap smear recommendations were observed between female and male residents (9.3% and 10.1%, respectively). Attending physician’s gender did not influence screening recommendations. The recommendation rate for female patients to obtain important screening mammograms and Pap smears was low. These results are consistent with previous literature and indicate an urgent need for improved women’s health education in residency, with special attention to male residents. Keywords: Cancer prevention, Breast cancer, Cervical Cancer, Primary Care, Gender Disparity

Background: Breast cancer (BC) is a major public health problem worldwide. Considering the high prevalence and mortality of BC in postmenopausal women, and since the population of Iran is aging, this study aimed to investigate the knowledge and attitude of postmenopausal women in Jahrom, Iran regarding BC screening. Methods: This cross-sectional study was performed on postmenopausal women referred to Honari Clinic of Jahrom in 2019. To select the samples, 120 women were randomly selected from the existing medical files. Data collection tools included a demographic information questionnaire and the knowledge and attitude questionnaire on BC screening behavior. After explaining the objectives of the research to the participants and obtaining a consent form, the questionnaire was answered by them. The data were entered into SPSS software version 21 and tested by descriptive statistics, chi-square, Kruskal-Wallis, and one-way ANOVA tests. Descriptive statistics were used to examine demographic data. Results: The level of knowledge of most participants (49.2%) was moderate, and the majority of them (94.2%) had a positive attitude. There was a significant association between the mean score of knowledge and attitude in postmenopausal women with source of information (P = 0.004). Most information came from radio and television, physician, health system staff, and friends and relatives. There was no significant association between the mean score of knowledge and attitude of postmenopausal women with breast-related diseases and family history of BC. Conclusions: The mass media, especially radio and television, as well as physician and health system staff, play an important role in raising women's awareness to increase their participation in BC screening programs.

The importance and power of the biomedical approach to health and illness cannot be under-estimated. It has underpinned Western understandings of medical science and technology; it has informed health systems and the training of medical personnel; and arguably it has become articulated in patients' experience of illness and treatment. The roots of this model are traced to the valorization of rational thought in the Enlightenment which, according to Lupton, was accompanied by the increasing professionalisation of medicine through university training of doctors and control over their licences to practice. Further, she argues the discovery of bacterial causes of scourges like tuberculosis, cholera and typhoid in the nineteenth century further increased the power and status of the profession to the extent that excellence in medicine became more closely associated with rigorous scientific knowledge than empathic bedside manner (84). The emerging doctrine of specific aetiology that evolved into biomedicine had replaced the older philosophical understanding of health as a state of equilibrium and disease as a lack of harmony between people and their environment (Dubos, 5-6; Morgan, Calnan and Manning 15). The patient's interpretation of illness and symptoms became reconfigured by the doctor as an identifiable disease state that can be investigated and (usually) treated, pharmacologically or surgically. Engel acknowledged the power of the biomedical model but labelled it reductionistic and dualistic. He said that it reduced illness to chemistry and physics and separated bodies from minds while conceptualising bodies as machines (131). Biochemical or biophysical abnormality becomes the criterion for diagnosis of the disease and the treatment of illness. The authoritative, objective, and scientific approach to medicine that constructs illness as not more than, but also no less than, a biochemical/physical effect of disease, in turn, constructs medical care as interventionist, scientific and empirical, but above all as the privileged domain of the physician. The same approach that defines the role of the physician ascribes a complementary but dependent role for the patient. The ill, after all, are expected to seek and then undergo treatment. Within such a paradigm, Parsons proposed an influential and much quoted set of institutionalised social expectations associated with the "sick role" to distinguish people who are ill from those who are well. Briefly, according to his theory, the sick person has some social privileges but also some social obligations: exemption from other normal social roles depending on the nature and seriousness of the illness; not responsible for the illness; should be motivated to get well; and should seek and co-operate with the treatment offered (436-37). Parsons' functionalism with its assumption of a homogeneous social structure and value system has attracted considerable criticism. At the very least, he did not differentiate between different medical conditions and their social and cultural implications. But, that said, his "sick role" or modified versions of it remains tied up with the biomedical framework of its context. Meanings of Illness or Minds, Emotions and Social Processes Ideas about illness (and wellness for that matter) are culturally dependent. Illness as the opposite of wellness, as non-health, is an impaired sense of well-being and in that sense at least, requires some self-diagnosis before treatment is sought. Individuals make judgements about their health against prevailing implicit standards of what it is to feel well (Eisenberg and Kleinman 13). As the cultural norms of illness change over time, what it means to be sick and what the "sick role" entails changes too (Christopoulos 93). The discursive label of illness, especially if the disease has specific moral connotations surrounding it, can have considerable consequences for the patient and their social identity to the extent that the "clinical label becomes a master status, one that swamps all other identities and compresses the identity of the person into a narrow and constricting mould" (George and Davis, 266) and circumscribes their sick role. Morris sees biomedicine as cultural discourse, specifically as a modernist narrative which is being challenged increasingly by "powerful alternative narratives that view human illness not as the malfunction of a biophysical mechanism but as the unique experience of a meaning-making and embodied cultural being" (7). Arthur Frank, Thomas Couser, Anne Hawkins and others have demonstrated how control of current understandings of illness is indeed moving away from medical practitioners and towards the patients themselves as they challenge the restriction and passivity of their sick role. The work of these researchers charts changing representations of illness as patients who choose to publish their narratives attempt to find meaning in their experience of illness. The narratives these people tell are often at odds with the biomedical accounts of their illness, or at least they are telling a different type of story - one that involves their reaction to and their experience of serious illness rather than just its onset, diagnosis, treatment and prognosis. These stories are sometimes triumphal accounts of overcoming illness, designed to inspire others in similar situations; sometimes dark, emotional accounts of overwhelming adversity and suffering. In providing such introspections of the meaning of illness for the patient's life (and even anticipations of death too), these texts re-negotiate the sick role. They are empowering accounts because they disrupt the sense of the sick role as a passive and silent state (Frank 3). The stories can be found in full length autobiographical accounts of encounters with serious illness like those discussed by Frank, Couser, and also Hawkins, but they are evident across a range of the mass media as well. Women's magazines are a particularly rich source where illness experiences of celebrities and ordinary folk are mixed in with other gossip, scandal, features and advice (Bonner and McKay 2000). Reality television shows (for example, those set in hospitals) also occasionally feature patients' experiences and their quest for meaning for their illness. While the internet offers unprecedented access to detailed medical information, dedicated sites also provide spaces for patients to tell their stories and chat rooms give the opportunity for patient-patient access and interaction in the absence of doctors. These electronic "virtual" communities provide new interactive forums for those with chronic conditions to discuss their fears, their needs and their activities (Patsos; Hardey). The texts produced by these media constitute a different version of the sick role and augment the meanings of illness by providing alternative or at least parallel resources to conventional medical interaction for those who are ill, their carers or those with vicarious interest. As Foucault demonstrated, medical knowledge, its associated "clinical gaze" and the representation of illness always need to be seen in its socio-historical context. The understanding of this "provides a perspective which is able to show, as does the cross-cultural perspective offered by anthropology, that the conventions of western biomedicine are no more 'scientific' or 'objective' than medical systems in other cultures or in other times" (Lupton 15). This type of approach does not necessarily call into question the medical definitions of disease, but points out the limitations of biomedicine without due attention to more cultural approaches. In that sense, the proliferation of patients' stories should be seen as a reaction to (rather than a rejection of) biomedicine and its modernist perspective that situates illness more in the professional domain of the doctor than in the experiential domain of the patient. Indeed, as Morris notes, "modernist biomedicine with its dualistic and reductive language of disease mechanisms now co-exists uneasily with a new concern (irreducible to mechanisms) for the role played in illness by minds, emotions, and social processes" (7). References Bonner, F., & S.McKay. "Challenges, Determination and Triumphs: Inspirational Discourse in Women's Magazine Health Stories." Continuum: Journal of Media and Cultural Studies 14.2 (2000): 133-144. Christopoulos, Katerina. "The Sick Role in Literature and Society." Journal of the American Medical Association 285.1 (3 January 2001): 93. Couser, G. Thomas. Recovering Bodies: Illness, Disability, and Life Writing. Madison: University of Wisconsin Press, 1997. Dubos, René. "Mirage of Health". Health and Disease. Ed. Nick Black. Milton Keynes: Open University Press, 1984. 4-9. Eisenberg, Leon, and Arthur Kleinman. "Clinical Social Science." The Relevance of Social Science for Medicine. Ed. Leon Eisenberg and Arthur Kleinman. Dordrecht: Reidel, 1981. 1-23. Engel, George. "The Need for a New Medical Model: A Challenge for Biomedicine." Science 196.4268 (8 April 1977): 129-36. Foucault, Michel. The Birth of the Clinic : An Archaeology of Medical Perception. Trans. A.M. Sheridan Smith. London: Tavistock, 1973. Frank, Arthur. "Reclaiming an Orphan Genre: The First-Person Narrative of Illness." Literature and Medicine 13.1 (Spring 1994): 1-21. George, Janet, and Alan David. States of Health: Health and Illness in Australia 3rd ed. South Melbourne: Addison Wesley Longman, 1998. Hardey, Michael. "Doctor in the House: The Internet as a Source of Lay Knowledge and the Challenge to Expertise." Sociology of Health and Illness 21.6 (1999): 820-835. Hawkins, Anne. Reconstructing Illness: Studies in Pathography. West Layfayette: Purdue University Press, 1993. Lupton, Deborah. Medicine as Culture: Illness, Disease and the Body in Western Societies. London: Sage, 1994. Morgan, Myfanwy, Michael Calnan, and Nick Manning. Sociological Approaches to Health and Medicine. London: Routledge, 1985. Morris, David. "How to Speak Postmodern: Medicine, Illness, and Cultural Change." The Hastings Center Report 30.6 (2000): 7-11. Parsons, Talcott. The Social System. Glencoe, Ill.: Free Press, 1951. Patsos, Mary. "The Internet and Medicine: Building a Community for Patients with Rare Diseases." Journal of the American Medical Association 285.6 (14 February 2001): 805.

IntroductionLike other forms of embodiment, pregnancy has increasingly become subject to representation and interpretation via digital technologies. Pregnancy and the unborn entity were largely private, and few people beyond the pregnant women herself had access to the foetus growing within her (Duden). Now pregnant and foetal bodies have become open to public portrayal and display (Lupton The Social Worlds of the Unborn). A plethora of online materials – websites depicting the unborn entity from the moment of conception, amateur YouTube videos of births, social media postings of ultrasounds and self-taken photos (‘selfies’) showing changes in pregnant bellies, and so on – now ensure the documentation of pregnant and unborn bodies in extensive detail, rendering them open to other people’s scrutiny. Other recent digital technologies directed at pregnancy include mobile software applications, or ‘apps’. In this article, we draw on our study involving a critical discourse analysis of a corpus of pregnancy-related apps offered in the two major app stores. In so doing, we discuss the ways in which pregnancy-related apps portray pregnant and unborn bodies. We place a particular focus on the ludification and gamification strategies employed to position pregnancy as a playful, creative and fulfilling experience that is frequently focused on consumption. As we will demonstrate, these strategies have wider implications for concepts of pregnant and foetal embodiment and subjectivity.It is important here to make a distinction between ludification and gamification. Ludification is a broader term than gamification. It is used in the academic literature on gaming (sometimes referred to as ‘ludology’) to refer to elements of games reaching into other aspects of life beyond leisure pursuits (Frissen et al. Playful Identities: The Ludification of Digital Media Cultures; Raessens). Frissen et al. (Frissen et al. "Homo Ludens 2.0: Play, Media and Identity") for example, claim that even serious pursuits such as work, politics, education and warfare have been subjected to ludification. They note that digital technologies in general tend to incorporate ludic dimensions. Gamification has been described as ‘the use of game design elements in non-game contexts’ (Deterding et al. 9). The term originated in the digital media industry to describe the incorporation of features into digital technologies that not explicitly designed as games, such as competition, badges, rewards and fun that engaged and motivated users to make them more enjoyable to use. Gamification is now often used in literatures on marketing strategies, persuasive computing or behaviour modification. It is an important element of ‘nudge’, an approach to behaviour change that involves persuasion over coercion (Jones, Pykett and Whitehead). Gamification thus differs from ludification in that the former involves applying ludic principles for reasons other than the pleasures of enjoying the game for their own sake, often to achieve objectives set by actors and agencies other than the gamer. Indeed, this is why gamification software has been described by Bogost (Bogost) as ‘exploitationware’. Analysing Pregnancy AppsMobile apps have become an important medium in contemporary digital technology use. As of May 2015, 1.5 million apps were available to download on Google Play while 1.4 million were available in the Apple App Store (Statista). Apps related to pregnancy are a popular item in app stores, frequently appearing on the Apple App Store’s list of most-downloaded apps. Google Play’s figures show that many apps directed at pregnant women have been downloaded hundreds of thousands, or even millions, of times. For example, ‘Pregnancy +’, ‘I’m Expecting - Pregnancy App’ and ‘What to Expect - Pregnancy Tracker’ have each been downloaded between one and five million times, while ‘My Pregnancy Today’ has received between five and ten million downloads. Pregnancy games for young girls are also popular. Google Play figures show that the ‘Pregnant Emergency Doctor’ game, for example, has received between one and five million downloads. Research has found that pregnant women commonly download pregnancy-related apps and find them useful sources of information and support (Hearn, Miller and Fletcher; Rodger et al.; Kraschnewski et al.; Declercq et al.; Derbyshire and Dancey; O'Higgins et al.). We conducted a comprehensive analysis of all pregnancy-related smartphone apps in the two major app stores, Apple App Store and Google Play, in late June 2015. Android and Apple’s iOS have a combined market share of 91 percent of apps installed on mobile phones (Seneviratne et al.). A search for all pregnancy-related apps offered in these stores used key terms such as pregnancy, childbirth, conception, foetus/fetus and baby. After eliminating apps listed in these searches that were clearly not human pregnancy-related, 665 apps on Google Play and 1,141 on the Apple App Store remained for inclusion in our study. (Many of these apps were shared across the stores.)We carried out a critical discourse analysis of these apps, looking closely at the app descriptions offered in the two stores. We adopted the perspective that sees apps, like any other form of media, as sociocultural artefacts that both draw on and reproduce shared norms, ideals, knowledges and beliefs (Lupton "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps"; Millington "Smartphone Apps and the Mobile Privatization of Health and Fitness"; Lupton "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps"). In undertaking our analysis of the app descriptions in our corpus, attention was paid to the title of each app, the textual accounts of its content and use and the images that were employed, such as the logo of the app and the screenshots that were used to illustrate its content and style. Our focus in this article is on the apps that we considered as including elements of entertainment. Pregnancy-related game apps were by far the largest category of the apps in our corpus. These included games for young girls and expectant fathers as well as apps for ultrasound manipulation, pregnancy pranks, foetal sex prediction, choosing baby names, and quizzes. Less obviously, many other apps included in our analysis offered some elements of gamification and ludification, and these were considered in our analysis. ‘Pregnant Adventures’: App Games for GirlsOne of the major genres of apps that we identified was games directed at young girls. These apps invited users to shop for clothes, dress up, give a new hair style, ‘make-over’ and otherwise beautify a pregnant woman. These activities were directed at the goal of improving the physical attractiveness and therefore (it was suggested) the confidence of the woman, who was presented as struggling with coming to terms with changes in her body during pregnancy. Other apps for this target group involved the player assuming the role of a doctor in conducting medical treatments for injured pregnant women or assisting the birth of her baby.Many of these games represented the pregnant woman visually as looking like an archetypal Barbie doll, with a wardrobe to match. One app (‘Barbara Pregnancy Shopping’) even uses the name ‘Barbara’ and the screenshots show a woman similar in appearance to the doll. Its description urges players to use the game to ‘cheer up’ an ‘unconfident’ Barbara by taking her on a ‘shopping spree’ for new, glamorous clothes ‘to make Barbara feel beautiful throughout her pregnancy’. Players may find ‘sparkly accessories’ as well for Barbara and help her find a new hairstyle so that she ‘can be her fashionable self again’ and ‘feel prepared to welcome her baby!’. Likewise, the game ‘Pregnant Mommy Makeover Spa’ involves players selecting clothes, applying beauty treatments and makeup and adding accessories to give a makeover to ‘Pregnant Princess’ Leila. The ‘Celebrity Mommy’s Newborn Baby Doctor’ game combines the drawcard of ‘celebrity’ with ‘mommy’. Players are invited to ‘join the celebrities in their pregnancy adventure!’ and ‘take care of Celebrity Mom during her pregnancy!’.An app by the same developer of ‘Barbara Pregnancy Shopping’ also offers ‘Barbara’s Caesarean Birth’. The app description claims that: ‘Of course her poor health doesn’t allow Barbara to give birth to her baby herself.’ It is up to players to ‘make everything perfect’ for Barbara’s caesarean birth. The screenshots show Barbara’s pregnant abdomen being slit open, retracted and a rosy, totally clean infant extracted from the incision, complete with blonde hair. Players then sew up the wound. A final screenshot displays an image of a smiling Barbara standing holding her sleeping, swaddled baby, with the words ‘You win’.Similar games involve princesses, mermaids, fairies and even monster and vampire pregnant women giving birth either vaginally or by caesarean. Despite their preternatural status, the monster and vampire women conform to the same aesthetic as the other pregnant women in these games: usually with long hair and pretty, made-up faces, wearing fashionable clothing even on the operating table. Their newborn infants are similarly uniform in their appearance as they emerge from the uterus. They are white-skinned, clean and cherubic (described in ‘Mommy’s Newborn Baby Princess’ as ‘the cutest baby you probably want’), a far cry from the squalling, squashed-faced infants smeared in birth fluids produced by the real birth process.In these pregnancy games for girls, the pain and intense bodily effort of birthing and the messiness produced by the blood and other body fluids inherent to the process of labour and birth are completely missing. The fact that caesarean birth is a major abdominal surgery requiring weeks of recovery is obviated in these games. Apart from the monsters and vampires, who may have green- or blue-hued skin, nearly all other pregnant women are portrayed as white-skinned, young, wearing makeup and slim, conforming to conventional stereotypical notions of female beauty. In these apps, the labouring women remain glamorous, usually smiling, calm and unsullied by the visceral nature of birth.‘Track Your Pregnancy Day by Day’: Self-Monitoring and Gamified PregnancyElements of gamification were evident in a large number of the apps in our corpus, including many apps that invite pregnant users to engage in self-tracking of their bodies and that of their foetuses. Users are asked to customise the apps to document their changing bodies and track their foetus’ development as part of reproducing the discourse of the miraculous nature of pregnancy and promoting the pleasures of self-tracking and self-transformation from pregnant woman to mother. When using the ‘Pregnancy+’ app, for example, users can choose to construct a ‘Personal Dashboard’ that includes details of their pregnancy. They can input their photograph, first name and their expected date of delivery so that that each daily update begins with ‘Hello [name of user], you are [ ] weeks and [ ] days pregnant’ with the users’ photograph attached to the message. The woman’s weight gain over time and a foetal kick counter are also included in this app. It provides various ways for users to mark the passage of time, observe the ways in which their foetuses change and move week by week and monitor changes in their bodies. According to the app description for ‘My Pregnancy Today’, using such features allows a pregnant woman to: ‘Track your pregnancy day by day.’ Other apps encourage women to track such aspects of physical activity, vitamin and fluid intake, diet, mood and symptoms. The capacity to visually document the pregnant user’s body is also a feature of several apps. The ‘Baby Bump Pregnancy’, ‘WebMD Pregnancy’, ‘I’m Expecting’,’iPregnant’ and ‘My Pregnancy Today’ apps, for example, all offer an album feature for pregnant bump photos taken by the user of herself (described as a ‘bumpie’ in the blurb for ‘My Pregnancy Today’). ‘Baby Buddy’ encourages women to create a pregnant avatar of themselves (looking glamorous, well-dressed and happy). Some apps even advise users on how they should feel. As a screenshot from ‘Pregnancy Tracker Week by Week’ claims: ‘Victoria, your baby is growing in your body. You should be the happiest woman in the world.’Just as pregnancy games for little girls portrayal pregnancy as a commodified and asetheticised experience, the apps directed at pregnant women themselves tend to shy away from discomforting fleshly realities of pregnant and birthing embodiment. Pregnancy is represented as an enjoyable and fashionable state of embodiment: albeit one that requires constant self-surveillance and vigilance.‘Hello Mommy!’: The Personalisation and Aestheticisation of the FoetusA dominant feature of pregnancy-related apps is the representation of the foetus as already a communicative person in its own right. For example, the ‘Pregnancy Tickers – Widget’ app features the image of a foetus (looking far more like an infant, with a full head of wavy hair and open eyes) holding a pencil and marking a tally on the walls of the uterus. The app is designed to provide various icons showing the progress of the user’s pregnancy each day on her mobile device. The ‘Hi Mommy’ app features a cartoon-like pink and cuddly foetus looking very baby-like addressing its mother from the womb, as in the following message that appears on the user’s smartphone: ‘Hi Mommy! When will I see you for the first time?’ Several pregnancy-tracking apps also allow women to input the name that they have chosen for their expected baby, to receive customised notifications of its progress (‘Justin is nine weeks and two days old today’).Many apps also incorporate images of foetuses that represent them as wondrous entities, adopting the visual style of 1960s foetal photography pioneer Lennart Nilsson, or what Stormer (Stormer) has referred to as ‘prenatal sublimity’. The ‘Pregnancy+’ app features such images. Users can choose to view foetal development week-by-week as a colourful computerised animation or 2D and 3D ultrasound scans that have been digitally manipulated to render them aesthetically appealing. These images replicate the softly pink, glowing portrayals of miraculous unborn life typical of Nilsson’s style.Other apps adopt a more contemporary aesthetic and allow parents to store and manipulate images of their foetal ultrasounds and then share them via social media. The ‘Pimp My Ultrasound’ app, for example, invites prospective parents to manipulate images of their foetal ultrasounds by adding in novelty features to the foetal image such as baseball caps, jewellery, credit cards and musical instruments. The ‘Hello Mom’ app creates a ‘fetal album’ of ultrasounds taken of the user’s foetus, while the ‘Ultrasound Viewer’ app lets users manipulate their 3/4 D foetal ultrasound images: ‘Have fun viewing it from every angle, rotating, panning and zooming to see your babies [sic] features and share with your family and friends via Facebook and Twitter! … Once uploaded, you can customise your scan with a background colour and skin colour of your choice’.DiscussionPregnancy, like any other form of embodiment, is performative. Pregnant women are expected to conform to norms and assumptions about their physical appearance and deportment of their bodies that expect them to remain well-groomed, fit and physically attractive without appearing overly sexual (Longhurst "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities"; Longhurst "'Corporeographies’ of Pregnancy: ‘Bikini Babes'"; Nash; Littler). Simultaneously they must negotiate the burden of bodily management in the interests of risk regulation. They are expected to protect their vulnerable unborn from potential dangers by stringently disciplining their bodies and policing to what substances they allow entry (Lupton The Social Worlds of the Unborn; Lupton "'Precious Cargo': Risk and Reproductive Citizenship"). Pregnancy self-tracking apps enact the soft politics of algorithmic authority, encouraging people to conform to expectations of self-responsibility and self-management by devoting attention to monitoring their bodies and acting on the data that they generate (Whitson; Millington "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games"; Lupton The Quantified Self: A Sociology of Self-Tracking).Many commentators have remarked on the sexism inherent in digital games (e.g. Dickerman, Christensen and Kerl-McClain; Thornham). Very little research has been conducted specifically on the gendered nature of app games. However our analysis suggests that, at least in relation to the pregnant woman, reductionist heteronormative, cisgendered, patronising and paternalistic stereotypes abound. In the games for girls, pregnant women are ideally young, heterosexual, partnered, attractive, slim and well-groomed, before, during and after birth. In self-tracking apps, pregnant women are portrayed as ideally self-responsible, enthused about their pregnancy and foetus to the point that they are counting the days until the birth and enthusiastic about collecting and sharing details about themselves and their unborn (often via social media).Ambivalence about pregnancy, the foetus or impending motherhood, and lack of interest in monitoring the pregnancy or sharing details of it with others are not accommodated, acknowledged or expected by these apps. Acknowledgement of the possibility of pregnant women who are not overtly positive about their pregnancy or lack interest in it or who identify as transgender or lesbian or who are sole mothers is distinctly absent.Common practices we noted in apps – such as giving foetuses names before birth and representing them as verbally communicating with their mothers from inside the womb – underpin a growing intensification around the notion of the unborn entity as already an infant and social actor in its own right. These practices have significant implications for political agendas around the treatment of pregnant women in terms of their protection or otherwise of their unborn, and for debates about women’s reproductive rights and access to abortion (Lupton The Social Worlds of the Unborn; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction). Further, the gamification and ludification of pregnancy serve to further commodify the experience of pregnancy and childbirth, contributing to an already highly commercialised environment in which expectant parents, and particularly mothers, are invited to purchase many goods and services related to pregnancy and early parenthood (Taylor "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption"; Kroløkke; Thomson et al.; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction; Thomas).In the games for girls we examined, the pregnant woman herself was a commodity, a selling point for the app. The foetus was also frequently commodified in its representation as an aestheticised entity and the employment of its image (either as an ultrasound or other visual representations) or identity to market apps such as the girls’ games, apps for manipulating ultrasound images, games for predicting the foetus’ sex and choosing its name, and prank apps using fake ultrasounds purporting to reveal a foetus inside a person’s body. As the pregnant user engages in apps, she becomes a commodity in yet another way: the generator of personal data that are marketable in themselves. In this era of the digital data knowledge economy, the personal information about people gathered from their online interactions and content creation has become highly profitable for third parties (Andrejevic; van Dijck). Given that pregnant women are usually in the market for many new goods and services, their personal data is a key target for data mining companies, who harvest it to sell to advertisers (Marwick).To conclude, our analysis suggests that gamification and ludification strategies directed at pregnancy and childbirth can serve to obfuscate the societal pressures that expect and seek to motivate pregnant women to maintain physical fitness and attractiveness, simultaneously ensuring that they protect their foetuses from all possible risks. 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