Depression and anxiety in sterilised women in Iran

Sterilisation is an effective and convenient means of contraception and has become increasingly popular as a birth control technique throughout the world during the past 40 years. However some women who choose sterilisation may suffer a neurotic syndrome, which is manifested in the form of pain, depression and loss of libido.1We undertook a study designed to investigate depression, anxiety and post-operation regret rate in sterilised women referred to health centres in Tabriz, Iran in 2006. The study design was descriptive-analytical. The study participants comprised 300 women in the age range 25–45 years, of whom 150 women were sterilized between 1 and 10 years ago and 150 were a control group of non-sterilised women who used condoms, withdrawal or safe period methods for contraception. The control group was selected by a cluster random sampling method. Fifteen health centres were selected as a cluster from 96 health centres located in Tabriz. Ten women were selected randomly from each health centre using health documents. Women were eligible for inclusion in the study if they were aged between 25 and 45 years at the time of sampling, and if they had no history of psychological disorders and no recent sorrowful events. There were no differences between the two groups as regards the number of children, income or demographic characteristics. The women were contacted by telephone at their last known address and were asked to complete questionnaires. Data collection was done using Zung’s self-rating depression and anxiety scale in addition to questions about post-sterilisation regret. Data were collected from the subjects anonymously and analysed using SPSS (v. 11.5) statistics software. Analysis employed t-test, Chi-square test and descriptive statistics. The comparison of the means for depression in the two groups was not significantly different (p = 0.96), however the mean of anxiety in the case group was remarkably greater than the control group (p = 0.03). Insufficient poststerilisation rest was a significant risk factor for depression and anxiety (p = 0.008 and p = 0.02, respectively). Requesting information about reversal after tubal sterilisation was 2.7% and the post-sterilisation regret rate was 6%, which was significantly related to women’s conflict with their husbands about the decision-making process prior to sterilisation (p<0.001). The study findings as regards psychological disorders of sterilisation suggested that women undergoing sterilisation should ensure that they have a good rest after their operation in order to reduce the extent of psychological disorders. Unlike studies undertaken in other countries,2–4 women’s age, parity, marriage duration and the timing of sterilisation was unrelated to the women’s regret in our study. The earlier the sterilisation is carried out, the longer the woman’s remaining period of fertile life and the greater the chances of changes in her marital status and/or the loss of a child, both circumstances that may lead to a change in the desired family size and expression of regret. In our study, probably one of the reasons why women’s regret did not appear to be significantly related to young age of sterilisation was the infrequency of divorce or remarriage in our study population. Consistent with our study, Jamieson et al. reported that women who had substantial conflict with their husbands or partners prior to sterilisation were more than three times as likely to regret their decision and more than five times more likely to request a reversal than women who did not report such conflict.5 In our study, pre-sterilisation counseling was reported by 29.3% of subjects. With respect to personality and adaptability differences in facing the changes, pre-sterilisation counseling and post-sterilisation follow-up systems have an important role to play in women’s psychological and psychosexual health promotion

Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice

Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

Digital Atmospheres: Affective practices of care in Elefriends

This article develops the concept of digital atmosphere to analyse the affective power of social media to shape practices of care and support for people living with mental distress. Using contemporary accounts of affective atmospheres, the article focuses on feelings of distress, support and care that unfold through digital atmospheres. The power of social media intersects with people's support and care-seeking practices in multiple ways and not in a straightforward model of ‘accessing or providing support’. Indeed, we find that the caring relations developed through social media often need to be cared for themselves. The article draws on online and interview data from a larger project investigating how practices of care and support are (re)configured in the mental health-related social media site Elefriends. Users have to negotiate the disruption of moving support online, as well as the possibility of becoming subject to a fragility in care, in which caring for oneself becomes bound up in the ambiguities of caring for others. We argue that understanding how experiences of distress are shaped by social media is essential for understanding the implications of the increased digitisation of mental healthcare