Linking women who test HIV‐positive in pregnancy‐related services to long‐term HIV care and treatment services: a systematic review

Objectives To quantify attrition between women testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV care and treatment services in low‐ or middle‐income countries and to explore the reasons underlying client drop‐out by synthesising current literature on this topic. Methods A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000–2010. Only studies meeting pre‐defined quality criteria were included. Results Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub‐Saharan Africa. The pathway between testing HIV‐positive in pregnancy‐related services and accessing long‐term HIV‐related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38–88% of known‐eligible women. Providing ‘family‐focused care’, and integrating CD4 testing and HAART provision into prevention of mother‐to‐child HIV transmission services appear promising for increasing women’s uptake of HIV‐related services. Individual‐level factors that need to be addressed include financial constraints and fear of stigma. Conclusions Too few women negotiate the many steps between testing HIV‐positive in pregnancy‐related services and accessing HIV‐related services for themselves. Recent efforts to stem patient drop‐out, such as the MTCT‐Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services.     

Traumatisme de l’inceste et destin du féminin

In the juvenile surrection can be added the violence of the sexual traumatism, hindering this possible moment of narcissistic reconstruction to an incest victim. We suggest analyzing the possible investment of female identity (envelope feminity and orifice feminity) to a prepubescent girl, victim of childhood incest. We put the hypothesis, which the expulsion of the representations bound to the incest affects the possible investment of the feminine body and its containment function. We referred to three studies, using projective tests, concerning teenagers (some were hospitalized after a suicide attempt and the others had no psychiatric care) and women, victims of childhood incest or which suffered from maltraitant in childhood. To our subject, the projective tests (Rorschach and Thematic Aperception Test) give evidence of the repression of the female identity, a lack of dynamism and mobility of the thought and relational problems. The question of the sexual identity seems evaded by the problem of the identity, the cruelty to one and others being a way of protecting herself from any link.     

Multimodal management of primary adenocarcinoma of the female urethra: About four cases

PurposeTo retrospectively analyse female patients treated for urethral adenocarcinoma, modalities of treatment and long-term outcomes.PatientsFour cases of primary female urethral adenocarcinoma were treated in the departments of urology and radiation-oncology at Georges-Pompidou and Necker hospitals (France) over a 7-year period.ResultsAll of them underwent surgery, with three presenting stage pT3-pT4 and one a positive cytology on inguinal node. Three patients received adjuvant cisplatin-based chemoradiotherapy up to 60 Gy, and one preoperative chemoradiotherapy at 45 Gy. Two recurrences were observed: one local relapse occurred at 9 months from the diagnosis and was treated by anterior pelvic exenteration followed by chemoradiotherapy, with no recurrence. One tumour relapsed both at the local level and on distant metastatic sites at 9 months from the diagnosis, and died 21 months after this progression. Median survival and progression-free survival are respectively 4.2 years and 13 months. Three patients are alive at 7, 4.5 and 3 years from diagnosis.ConclusionFemale urethral adenocarcinoma is a very rare entity and often present in locally advanced stages. Initial extensive surgery with pelvic exenteration should be considered, followed by chemoradiotherapy according to the surgical margins and lymph nodes involvement.     

The female urethral diverticula: apropos of 21 cases

PURPOSE: Our goal is to study the clinical, radiological and therapeutic particularity of the female urethral diverticula via a retrospective study of 21 cases. PATIENT AND METHODS: Twenty one females, with a mean age of 37 years (range 15 to 62 years) presenting an urethral diverticula, were treated between 1988 and 2000. Clinical examination made diagnosis in all cases. Cystorethrography shown a direct image of diverticula in 100% of cases and intravenous Pyelography in only 24% of cases. The urethral diverticula was excised via a transvaginal approach in all cases. RESULTS: Eighteen patients had favourable immediate outcome. Three patients presented an urethrovaginal fistula treated surgically in one case and by bladder drainage in one case. The last patient refused treatment and she was lost to follow-up. After a median follow-up of 54 months (range 18 to 120) only three patients have some urinary urgency that was treated by anticholinergics. CONCLUSION: Female urethral diverticula is a rare disease, the diagnosis is easy and only surgical excision gives good results.     

Étude épidémiologique prospective des pathologies dans le XV de France féminin de rugby de juillet 2006 à septembre 2010

The objective of this prospective study is to determine the rate of injury on the population of the French women's rugby team. It was conducted over 50 months from July 2006 to September 2010. The medical staff of the French team collected data during training and match exposure. One of the main results of the study is the significant difference in the incidence of injury leading to a sports interruption greater than 8 days between female and male (5.99/1000 hours vs. 42,1/1000 hours). Lower limb injuries represent half of the injuries observed in our study but the articular lesions represent 80.43% of the injuries leading to an interruption superior to 8 days with an incidence of 4.62/1000 hours of exposure per position. This confirms the data found in the medical literature. The ruptures of the anterior cruciate ligament, following a tackle, are the most severe lesions of our study. The forwards had a higher rate of injury than backs. The three positions most exposed to injuries are the nos. 8, 9 and 14. The players are most vulnerable when they are being tackled, during the runs and during the rucks. The study described significant differences concerning a much higher number of severe articular lesions, a more significant vulnerability of women in sustained tackles in a match situation and a different exposure of certain position, particularly the scrum-half and the right-wing.     

Les temps du transfert dans la clinique de l’hystérie : vers un paradigme de la construction névrotique ?

The psychiatric spheres of classification and exclusive treatment of the symptom do not make any more case of the hysteria as structure. Now the current clinical confronts us with the instigation of this clinical entity which it is questioning, according to a mode of thinking psychoanalytical, in the light of the analysis of the transfer. This analysis reveals different time and modalities of the transferential scene, the value of paradigm of which as for time of construction of the hysteria can be questioned. Worried about a theoretical and clinical reflection, the author aims, to question the psychogenesis of the hysteria, to question the position of the clinician in the course of the variations of the transferential dynamics.     

Le féminin et le maternel dans l’anorexie mentale, une passivité créatrice : ceci n’est pas une femme

In this study, anorexia nervosa has been examined from an etiopathogenic and psychoanalytical viewpoint. The sociocultural environment and transgenerational context have been analyzed as contributing factors in the dysfunction of early parent-child relations and the subsequent effect of this on the development of the child, particularly during adolescence. We have hypothesized that the “failure’’ on the part of the mother to express her feminine and maternal nature, and the absence of attention paid to her child’s own body are major contributing factors. This absence of expression of the maternal instinct does not favor a positive perception and integration into the child’s personality of the feminine aspect of its nature, and thus contributes to the development of a sado-masochistic attitude that is focused on the infantile stage. The most frequently encountered condition in the mothers of anorexic patients appears to be the resurgence during maternity and in the initial mother-infant exchanges of a syndrome that can be defined in terms of a mind-body split which is responsible for the child’s failure to construct a psychic and somatic self. The structuring of the self in the child, in particular the impulsive and identificatory aspects of its personality are negatively affected by the absence of a feminine role model, as when the self is separated from the carnal origin of the emotions this can cause a marked inability to constitute a body image. We therefore consider that in these pathologies, the underlying cause is an absence of focus on the somatic self, which has an effect on the initial construction of a body image. We hypothesize that a “body to body’’ transmission (in the form of body engrams) of a maternal psychopathology occurs, and that as the child is confronted with the unstructured development and lack of management of its mother’s feminine and maternal nature, it does not have a physical or psychic reference. Therefore the bodily sensations become linked to the development of a morbid autosensuality and autoeroticism, as they have not been physically or mentally stimulated in a positive manner by the object, that is to say by the mother.