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Explaining women's employment under the Islamic state in Iran. Women, work and Islamism; ideology and resistance.
This study examines women's employment in Iran between 1979-1997, analysing the changing position of the Islamic state in reaction to economic circumstances and women's responses. In making this assessment the interaction between economic circumstances, the institutionalisation of gender inequality and also the responses of women are examined. This study demonstrates that economic forces and women's struggle for change undermined the Islamic state's gender relations.
The Islamisation of state and society which followed the 1979 revolution involved an attempt by the Islamic state to seclude women within the home in accordance with the state's gender and employment policy and practices. The power of the state to transform gender relations, however, was constrained by the Iran - Iraq war, as the survival of many families depended on women's earnings. The end of the war with Iraq and the return of men to the workforce did not result in women's return to the home. Economic reconstruction and inflation increased women's participation in the workforce. This study demonstrates that in 1997, women's participation in the labour force, despite a rigid sexual division of labour imposed ideologically by the Islamic state is no less than it was in pre-1979.
However, the state continued to strengthen patriarchal relationships within the home, employment and wider society, thus maintaining that women's participation in the workforce is by nature temporary and that ultimately a woman's place is in the home. Women of different classes and with different levels of religiosity responded to the economic circumstances and the state's gender ideology. Their participation in the political movements and their active role in the economy has raised gender consciousness. The result is an alliance between religious and secular women in urban areas who have demanded reforms and forced the Islamic state to return to the position of the reforms of pre-1979 in relation to women and the family, and women's education and employment
Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study
Background Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC).Methods The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity.Findings On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84-1.29], p = 0.711 and HR 1.18 [0.95-1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79-1.17], p = 0.67 and HR 1.48 [1.16-1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02-1.74], p = 0.037) and OS (HR 1.26 [1.03-1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3-3.52], p < 0.0010), resection of additional organs (OR 2.22 [1.62-3.02], p < 0.0010) and major hepatectomy (OR 3.81 [2.55-5.73], p < 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02-1.37], p = 0.031) but not OS (HR 1.05 [0.91-1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used.Interpretation In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international col-laborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit.Funding Cambridge Hepatopancreatobiliary Department Research Fund.Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)