The Management of Uterine Leiomyomas

Objectives: The aim of this guideline is to provide clinicians with an understanding of the pathophysiology, prevalence, and clinical significance of myomata and the best evidence available on treatment modalities. Options: The areas of clinical practice considered in formulating this guideline were assessment, medical treatments, conservative treatments of myolysis, selective uterine artery occlusion, and surgical alternatives including myomectomy and hysterectomy. The risk-to-benefit ratio must be examined individually by the woman and her health care provider. Outcomes: Implementation of this guideline should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options, and reviewed the risks and anticipated benefits. Evidence: Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2013, using appropriate controlled vocabulary (uterine fibroids, myoma, leiomyoma, myomectomy, myolysis, heavy menstrual bleeding, and menorrhagia) and key words (myoma, leiomyoma, fibroid, myomectomy, uterine artery embolization, hysterectomy, heavy menstrual bleeding, menorrhagia). The reference lists of articles identified were also searched for other relevant publications. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to January 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. Benefits, Harms, and Costs: The majority of fibroids are asymptomatic and require no intervention or further investigations. For symptomatic fibroids such as those causing menstrual abnormalities (e.g. heavy, irregular, and prolonged uterine bleeding), iron defficiency anemia, or bulk symptoms (e.g., pelvic pressure/pain, obstructive symptoms), hysterectomy is a definitive solution. However, it is not the preferred solution for women who wish to preserve fertility and/or their uterus. The selected treatment should be directed towards an improvement in symptomatology and quality of life. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Caadian Task Force on Preventive Health Care (Table 1)

Epidemiology and management of uterine fibroids

Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African ancestry during their lifetime. This disease has a profound impact on health care delivery and costs worldwide. Though most women with fibroids are asymptomatic, approximately 30% of them will present with severe symptoms which can include abnormal uterine bleeding, anemia, pelvic pain and pressure, back pain, urinary frequency, constipation, or infertility, and will require intervention. Furthermore, fibroids have been associated with poor obstetrical outcomes. The current options for symptomatic fibroid treatment include expectant, medical, and surgical management, and interventional radiology procedures. This article reviews the recent progress and available management strategies for uterine fibroids and highlights areas where further research is needed to find new therapeutic targets and better personalize treatments.We provide a review of the management options for uterine fibroids.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154526/1/ijgo13102.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154526/2/ijgo13102_am.pd

Migration, Racism and the Hostile Environment: Making the Case for the Social Sciences

Cite as: Social Scientists Against the Hostile Environment (SSAHE)(2020). Migration, racism and the hostile environment : Making the case for the social sciences. London. https://acssmigration.wordpress.com/report/

Definition and criteria for diagnosing cesarean scar disorder.

IMPORTANCE: Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of associated symptoms. OBJECTIVE: To achieve consensus on defining the clinical condition that constitutes a symptomatic uterine niche and agree upon diagnostic criteria and uniform nomenclature for this condition. DESIGN, SETTING, AND PARTICIPANTS: A consensus based modified electronic Delphi (eDelphi) study, with a predefined Rate of Agreement (RoA) of 70% or higher. Experts were selected according to their expertise with niche-related consultations, publications, and participation in expert groups and received online questionnaires between November 2021 and May 2022. MAIN OUTCOMES AND MEASURES: Definition, nomenclature, symptoms, conditions to exclude, and diagnostic criteria of an illness caused by a symptomatic uterine niche. RESULTS: In total, 31 of the 60 invited experts (51.7%) participated, of whom the majority worked in university-affiliated hospitals (28 of 31 [90.3%]), specialized in benign gynecology (20 of 31 [64.5%]), and worked in Europe (24 of 31 [77.4%]). Three rounds were required to achieve consensus on all items. All participants underlined the relevance of a new term for a condition caused by a symptomatic niche and its differentiation from a sonographic finding only. Experts agreed to name this condition cesarean scar disorder, defined as a uterine niche in combination with at least 1 primary or 2 secondary symptoms (RoA, 77.8%). Defined primary symptoms were postmenstrual spotting, pain during uterine bleeding, technical issues with catheter insertion during embryo transfer, and secondary unexplained infertility combined with intrauterine fluid. Secondary symptoms were dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoiding sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-image, and discomfort during participation in leisure activities. Consensus was also achieved on certain criteria that should be met and conditions that should be excluded before making the diagnosis. CONCLUSIONS AND RELEVANCE: In this modified Delphi study, a panel of 31 international niche experts reached consensus for the constellation of symptoms secondary to a uterine niche and named it cesarean scar disorder

How a turn to critical race theory can contribute to our understanding of 'race', racism and anti-racism in sport

As long as racism has been associated with sport there have been consistent, if not coordinated or coherent, struggles to confront its various forms. Critical race theory (CRT) is a framework established to challenge these racialized inequalities and racism in society and has some utility for anti-racism in sport. CRT's focus on social justice and transformation are two areas of convergence between critical race theorists and anti-racists. Of the many nuanced and pernicious forms of racism, one of the most obvious and commonly reported forms of racism in sport, racial abuse, has been described as a kind of dehumanizing process by Gardiner (2003), as those who are its target are simultaneously (re)constructed and objectified according to everyday myth and fantasy. However, this is one of the many forms of everyday racist experiences. Various forms of racism can be experienced in boardrooms, on television, in print, in the stands, on the sidelines and on the pitch. Many times racism is trivialized and put down as part of the game (Long et al., 2000), yet its impact is rarely the source of further exploration. This article will explore the conceptualization of 'race' and racism for a more effective anti-racism. Critical race theory will also be used to explore the ideas that underpin considerations of the severity of racist behaviour and the implications for anti-racism. © The Author(s) 2010

Born radicals? Prevent, positivism, and ‘race-thinking’

In the contemporary Western climate, counter-terrorism discourse dealing with so-called Islamic extremism appears to be obsessed with trying to understand the motives behind what prompts somebody to turn to terrorism. This paper will argue that attempts to locate extremist motives in such a way can be seen to reinforce earlier iterations of positivist criminology and race-thinking. Through a critical examination of the works of criminologist Cesare Lombroso, this paper will tease out the interconnections between his ‘criminal types’ thesis, and the British government’s current Prevent policy that seeks to identify ‘extremist types.’ By developing a rich critique of these positivist approaches, the paper will go on to question how we might think beyond the essentialism, reductivism, and racism/Islamophobia inherent within such frameworks. In this way, the paper raises a series of conceptual implications for criminology and terrorism studies, while at the same time, develops a contribution to critical race and ethnicity studies

Postcoloniality without race? Racial exceptionalism and south-east European cultural studies

The black Dutch feminist Gloria Wekker, assembling past and present everyday expressions of racialized imagination which collectively undermine hegemonic beliefs that white Dutch society has no historic responsibility for racism, writes in her book White Innocence that ‘one can do postcolonial studies very well without ever critically addressing race’ (p. 175). Two and a half decades after the adaptation of postcolonial thought to explain aspects of cultural politics during the break-up of Yugoslavia created important tools for understanding the construction of national, regional and socio-economic identities around hierarchical notions of ‘Europe’ and ‘the Balkans’ in the Yugoslav region and beyond, Wekker’s observation is still largely true for south-east European studies, where no intervention establishing race and whiteness as categories of analysis has reframed the field like work by Maria Todorova on ‘balkanism’ or Milica Bakić-Hayden on ‘symbolic geographies’ and ‘nesting orientalism’ did in the early 1990s. Critical race theorists such as Charles Mills nevertheless argue that ‘race’ as a structure of thought and feeling that legitimised colonialism and slavery (and still informs structural white supremacy) involved precisely the kind of essentialised link between people and territory that south-east European cultural theory also critiques: the construction of spatialised hierarchies specifying which peoples and territories could have more or less access to civilisation and modernity. South-east European studies’ latent racial exceptionalism has some roots in the race-blind anti-colonial solidarities of state socialist internationalism (further intensified for Yugoslavia through the politics of Non-Alignment) but also, this paper suggests, in deeper associations between Europeanness, whiteness and modernity that remain part of the history of ‘Europe’ as an idea even if, by the end of the 20th century, they were silenced more often than voiced

Cognitive Neuropsychology of HIV-Associated Neurocognitive Disorders

Advances in the treatment of the human immunodeficiency virus (HIV) have dramatically improved survival rates over the past 10 years, but HIV-associated neurocognitive disorders (HAND) remain highly prevalent and continue to represent a significant public health problem. This review provides an update on the nature, extent, and diagnosis of HAND. Particular emphasis is placed on critically evaluating research within the realm of cognitive neuropsychology that aims to elucidate the component processes of HAND across the domains of executive functions, motor skills, speeded information processing, episodic memory, attention/working memory, language, and visuoperception. In addition to clarifying the cognitive mechanisms of HAND (e.g., impaired cognitive control), the cognitive neuropsychology approach may enhance the ecological validity of neuroAIDS research and inform the development of much needed novel, targeted cognitive and behavioral therapies

Rioting and the politics of crisis

This paper draws on selected explanatory accounts of rioting that occurred in England in 2011 for the purpose of illustrating the ways in which scholarly critiques frame quite different senses of what kind of 'crisis' the riots represented. On one side the riots are understood within a 'race and policing' frame placing in a line of continuity with events across time and space and in an on-going crisis of racial subjugation. In direct contrast, another side treats the riots as a crisis of post-politics, in which nihilism has replaced purposive political action. While different types of politics are centred in both approaches, they differ remarkably in relation to racism, with the latter treating race as epiphenomenal. These frames are instances of how critical scholarly understandings draw on events, and it is argued they miss potentially far reaching senses of 'crisis' that can be drawn out of some aspects of rioting

Authenticity and Racism: Young boys in three inner city primary schools in Dublin

This paper examines the role of authenticity as a moral orientation and social evaluation in practices of racism. It will argue that discursive conceptions of authenticity disguise and legitimise racism within micro encounters. Using evidence from a qualitative study of minority children in Ireland, this paper explores how perceptions of ‘authenticity’ are bound within racist and gendered conceptions of whom can be said to legitimately embody nationally and locally authorised dispositions and identity markers. The specific context of how this played out through the locality of north Dublin and constructed notions of Irishness is examined. The wider implications of a discourse of authenticity are discussed in relation to assumptions of similarity, adaptation and integration. This paper contributes two unique insights, firstly, that the passive body (one’s appearance) has a central role in perceptions of authenticity and, secondly, that similarity in one’s active body (dispositions and tastes) does not necessarily act as a bridge to bring racialised groups together or facilitate integration