Failure In Women Research Articles

Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine

To determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response, death, or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI). Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines. Peripartum NVP exposure status was known for 6740 women initiating NNRTI-containing ART, of whom 751 (11%) reported prior use of NVP for PMTCT. There was no significant difference in mean CD4 cell change between those exposed or unexposed to NVP at 6 (+202 versus +182 cells/microl; P = 0.20) or 12 (+201 versus +211 cells/microl; P = 0.60) months. Multivariable analyses showed no significant differences in mortality [adjusted hazard ratio (HR), 1.2; 95% confidence interval (CI), 0.8-1.8] or clinical treatment failure (adjusted HR, 1.1; 95% CI, 0.8-1.5). Comparison of recent NVP exposure with remote exposure suggested a less favorable CD4 cell response at 6 (+150 versus +219 cells/microl; P = 0.06) and 12 (+149 versus +215 cells/microl; P = 0.39) months. Women with recent NVP exposure also had a trend towards elevated risk for clinical treatment failure (adjusted HR, 1.6; 95% CI, 0.9-2.7). Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes. However, evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes, highlighting the importance of ART screening and initiation early in pregnancy.

Predicting Failure of a Vaginal Birth Attempt After Cesarean Delivery

To identify a group of clinical factors that could be used to accurately predict failure in women attempting vaginal birth after cesarean (VBAC). We conducted a planned secondary analysis of a retrospective cohort study of women who were offered VBAC from 1996 to 2000 in 17 community and university hospitals. We collected information about maternal history and outcomes of the index pregnancy. We used univariable and multivariable statistical methods to develop a multivariable prediction model for the outcome of VBAC failure. A total of 13,706 patients attempted VBAC, with a failure rate of 24.5%. Six variables were significantly associated with VBAC failure in our final logistic regression model: gestational age at delivery, maternal age, maternal race, labor type (spontaneous, augmented, or induced), history of vaginal delivery, and cephalopelvic disproportion or failed induction (combined variable) as prior cesarean indication. The area under the receiver operating characteristics curve is 0.717. To achieve a sensitivity of approximately 75%, a false-positive rate of approximately 40% would result. Our results indicate that significant clinical variables (prelabor and labor) cannot reliably predict VBAC failure. II.

Placental Thrombosis in Experimental Anticardiolipin Antibodies‐Mediated Intrauterine Fetal Death

Anticardiolipin (aCL) antibodies are associated with stillbirths, recurrent miscarriages and recurrent in vitro fertilization implantation failure in women. Previous animal studies have demonstrated that these antibodies can cause early fetal demise and implantation failure in mice, but most previous studies have not allowed the immunized mice to proceed to the full term of gestation. Mice were immunized with either cardiolipin alone or cardiolipin in combination with beta2-glycoprotein I (beta2GPI) and have studied the effects of these antibodies on pregnancies which were allowed to progress to term. Immunization with cardiolipin alone induced significant levels of anticardiolipin antibodies in mice, but immunization with a combination of cardiolipin and beta2GPI produced even higher levels of antibodies. Mice with elevated levels of anticardiolipin antibodies had poor pregnancy outcomes. This study confirms previous results that anticardiolipin antibodies cause early pregnancy losses and also demonstrates that these antibodies cause stillbirth-like late fetal demise. This study further demonstrated that very high levels of anticardiolipin antibodies cause intrauterine death by facilitating the thrombotic episode in placenta. The present study concludes that the possible mechanism involves in stillbirth of aCL is possibly because of the thrombotic events of placenta.

An Unkind Cut Leading to a Broken Heart

Postpartum (or peripartum) cardiomyopathy (PPCM), which occurs late in pregnancy--or up to a few months after delivery--is associated with acute onset of heart failure in women with no history of heart disease (see Leinwand). Hilfiker-Kleiner et al . found that female mice lacking cardiomyocyte STAT3 (signal transducer and activator of transcription 3) developed PPCM. Pregnancy is associated with cardiac hypertrophy and increased capillary density, physiological changes that occurred in mice lacking cardiac STAT3. However, unlike mice that expressed cardiac STAT3, postpartum mice lacking cardiac STAT3 (CKO-PP mice) lost the increased capillary density. CKO-PP mice also had an attenuated increase in cardiac manganese superoxide dismutase and excessive cardiac production of reactive oxygen species, leading to increased abundance and activity of the proteolytic enzyme cathepsin D. Further, cardiac tissue from CK-PP mice stimulated cleavage of prolactin (a cathepsin D substrate) into an antiangiogenic 16-kD form. Increasing circulating prolactin stimulated cardiac damage in mice overexpressing cardiac cathepsin D, and persistent cardiac expression of 16-kD prolactin led to a pregnancy-independent decrease in capillary density and cardiac function. In contrast, pharmacological inhibition of prolactin secretion prevented PPCM. Analysis of left-ventricular tissue from women with PPCM revealed decreased STAT3 abundance; moreover, cathepsin D activity and 16-kD prolactin were increased in their serum. A preliminary study suggested that inhibiting prolactin release was protective of cardiac function in women at high risk of PPCM. Thus, the authors suggest that cardiac STAT3 is critical to postpartum cardiac function and propose that inhibiting prolactin release may represent a viable approach to PPCM treatment. D. Hilfiker-Kleiner, K. Kaminski, E. Podewski, T. Bonda, A. Schaefer, K. Sliwa, O. Forster, A. Quint, U. Landmesser, C. Doerries, M. Luchtefeld, V. Poli, M. D. Schneider, J.-L. Balligand, F. Desjardins, A. Ansari, I. Struman, N. Q. N. Nguyen, N. H. Zschemisch, G. Klein, G. Heusch, R. Schulz, A. Hilfiker, H. Drexler, A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 128 , 589-600 (2007). [Online Journal] L. A. Leinwand, Molecular events underlying pregnancy-induced cardiomyopathy. Cell 128 , 437-438 (2007). [Online Journal]

Differentially expressed genes implicated in unexplained recurrent spontaneous abortion

Recurrent spontaneous abortion occurs in approximately 3% of women with diagnosed pregnancies. The etiology in approximately 40% of recurrent spontaneous abortion is unexplained. To elucidate unexplained recurrent spontaneous abortion at the molecular level, we systemically identified differentially expressed genes during implantation window period in unexplained recurrent spontaneous abortion and characterized their functions in a human endometrial cell line. Expression levels of implantation-related genes selected from previously reported, various microarray data were determined to identify differentially expressed genes between normal fertile and unexplained recurrent spontaneous abortion subjects by real-time quantitative RT-PCR. Of 29 implantation-related genes, the transcript levels of cellular retinoic acid binding protein 2 and olfactomedin 1 were higher, whereas that of complement component 4 binding protein alpha was lower in subjects with unexplained recurrent spontaneous abortion, compared to normal fertile subjects. A correlation was evident between the transcript and protein levels of complement component 4 binding protein alpha and cellular retinoic acid binding protein 2. Expression of cellular retinoic acid binding protein 2 was positively correlated with retinoic acid-related genes in normal fertile subjects, but no significant association was observed in unexplained recurrent spontaneous abortion subjects. In relation to complement component 4 binding protein alpha, C5a receptor protein level was significantly higher in subjects with unexplained recurrent spontaneous abortion. Stable expression of cellular retinoic acid binding protein 2 and olfactomedin 1 in a human endometrial cell line inhibited cell growth and induced cell accumulation in the S and G 2-M phase fractions, but did not trigger apoptosis. This study represents the first systematic identification of differentially expressed genes in unexplained recurrent spontaneous abortion. Defective cell growth by the differentially expressed genes suggests their implication in implantation failure in women with unexplained recurrent spontaneous abortion.

Eleanor Rathbone and the Politics of Conscience (review)

Reviewed by: Eleanor Rathbone and the Politics of Conscience Steven Fielding Eleanor Rathbone and the Politics of Conscience. By Susan Pedersen. New Haven and London: Yale University Press. 2004. xiv, 469 pp. £25.00. ISBN 03000102453. Biography continues to play a significant role in constructing popular understandings of the past. Yet, from determinist Marxists impressed by the influence of the economic structure to reactionaries enamoured with the power of tradition, professional historians have long questioned its merits. It is surprising therefore that someone of Susan Pedersen's standing has produced - despite its various strengths - such a conventional study of the life of Eleanor Rathbone. Pedersen's methodological conservatism is especially disappointing as the title of the book suggests she will analyse 'the politics of conscience' within which her subject played a leading part. Most accounts of British politics during the first half of the twentieth century normally cast Rathbone as a marginal figure. An Independent M.P. for the Combined Universities from 1929 until her death in 1946, she had already been active in Liverpool politics and most significantly had taken a prominent role within British feminism, invariably exerting a moderating influence. Rathbone's modus operandi was to apply insistent pressure on decision-makers to whom (thanks to her privileged [End Page 271] background) she had access. Rathbone was, in fact, one of the left-liberal 'great and the good' whose assumptions helped underpin the post-war welfare state, her main contribution being to ensure that wives not husbands were paid the new family allowance. As Pedersen complains, despite her achievements Rathbone is now a forgotten figure. Even contemporary feminists appear ignorant of her, their attentions having been grabbed by the more dramatically self-publicising - but less effective - Pankhursts. Yet, whether Rathbone merits such a lengthy and meticulously researched biography might be questioned. What is clear however is that while - if only due to her gender - she was an unusual political figure, in other respects Rathbone was fairly representative of the radical-liberal moral 'conscience'. It is a pity therefore that the author focuses so much - and perhaps too sympathetically - on Rathbone herself rather the milieu of which she was a member. The Rathbones had for generations played a prominent role in Liverpool economic and political life, their favoured position being looked upon by family members as a 'sacred trust': their lives were meant therefore to be ones of 'service' and 'selflessness'. Unusually it was Eleanor rather than one of her brothers who took up this mantle and Pedersen paints an intriguing picture of how she came to take this path. The author explores the 'psychic cost' of her background on someone apparently de-sexed, de-personalized, and self-effacing to the point of mania such that she appeared to want to eviscerate her private self through activity within the public realm. Pedersen is less inclined to use Rathbone as a means of understanding the wider 'politics of conscience' as it had developed by the start of the twentieth century. On her death Sir Arthur Salter described Rathbone as 'the most selfless humanitarian I have ever known'. Yet, like sex and the Victorians, but in reverse, for Rathbone and her ilk 'selflessness' was everywhere and yet (this sceptic suggests) nowhere. Just to take one minor and obvious instance, at the height of the interwar depression, when the National government felt it necessary to cut unemployment relief, Rathbone allowed her friends to raise £200 to commission a portrait. The implicit - and presumably much-repressed - self-regard (both of the subject and her acquaintances) was surely worth subjecting to some form of critique. Ostensibly, Rathbone dedicated herself to the public realm, to enable women especially to gain political rights and then exercise them 'responsibly'. She did not however appreciate her assumptions about those rights and responsibilities being questioned. Thus, as Pedersen points out, Rathbone was disappointed with women's failure to act appropriately after fully gaining the vote in time for the 1929 general election. It was possibly this domestic disenchantment - along with the changing international situation - that saw Rathbone become interested in mobilizing help for refugees from fascism. However, it is the alacrity with which she defended her anachronistic position as...

Prospective cross-validation of three methods of predicting failing pregnancies of unknown location

We compared the performance of each of three tests for predicting pregnancy failure in the pregnancy of unknown (PUL) population. In a prospective observational study, we compared the performance of three models for the prediction of pregnancy failure in women with a PUL: (i) logistic-regression model incorporating vaginal bleeding, endometrial thickness (ET), initial serum progesterone and hCG levels; (ii) serum progesterone at 0 h; and (3) the hCG ratio. A total of 5942 consecutive pregnant women attending the Early Pregnancy Unit were scanned and 439 (7.4%) were classified as PULs. Of these women, 420 had complete data for serum hCG at 0 and 48 h, the hCG ratio, serum progesterone at 0 h, vaginal bleeding and ET. The final outcomes were 219 (52.1%) failing PULs, 167 (39.8%) intra-uterine pregnancies and 34 (8.1%) ectopic pregnancies. For the prediction of pregnancy failure in the PUL population, the area under the receiver operating characteristic (ROC) curve (AUC) for the logistic-regression model was 0.907 (Standard error (SE) 0.015), the AUC for serum progesterone was 0.952 (SE 0.010) and the AUC for the hCG ratio was 0.980 (SE 0.004). This improved performance of the hCG ratio was significant when compared with that of initial serum progesterone (P = 0.0076) and the logistic-regression model (P < 0.0001). Using the hCG ratio cut-offs of < 0.87 and <or=0.79, the serum progesterone cut-off of < 20 nmol l(-1) and the logistic-regression cut-off of >70% for the prediction of failing PUL, sensitivities were 86.3 and 82.2% (S), 87.2% (NS) and 78.1% (S), specificities were 97.0 and 98.0% (NS), 89.6% (S) and 88.6% (S), positive-likelihood ratios were 28.91, 41.30, 8.34 and 6.82 and negative-likelihood ratios were 0.14, 0.18, 0.14 and 0.25, respectively. The hCG ratio seems to be an optimal test for the prediction of pregnancy failure in a PUL population. The hCG ratio cut-off of 0.79 is recommended on the basis of minimizing risk to those PULs discharged at 48 h. Most importantly, when the hCG ratio is below a particular cut-off, these women can be discharged at 48 h without intervention and need for further follow-up.

Deficient expression of monoamine oxidase A in the endometrium is associated with implantation failure in women participating as recipients in oocyte donation

Successful implantation depends both on the quality of the embryo and on the endometrial receptivity. The latter depends on progesterone-induced changes in gene expression, a process that has been characterized by microarray analysis. One of the genes whose transcription appears to be enhanced during the receptive period is monoamine oxidase A (MAO-A). Our first objective was to confirm the increased expression of MAO-A in the endometrium during the receptive phase of spontaneous normal cycles using real time PCR and immunofluorescence. The second objective was to examine the endometrial expression of MAO-A during the receptive phase induced by exogenous estradiol (E(2)) and progesterone in patients whose endometrium was shown to have been either receptive or non-receptive to embryo implantation in repeated cycles of oocyte donation. Results showed that MAO-A transcript levels increased between the pre-receptive (LH+3) and receptive phase (LH+7) in all spontaneous cycles examined, with a median increase of 25-fold. Immunofluorescent labelling demonstrated MAO-A localization to the glandular and luminal epithelium with an increasing positive score between LH+3 and LH+7. Conversely, prior failure of embryo implantation was associated with a 29-fold decrease in MAO-A mRNA levels and a substantial reduction in MAO-A protein immunofluorescent label score. These results show a strong association between endometrial receptivity and MAO-A expression in the endometrial epithelium, suggesting an important role for this enzyme in normal implantation.

P-38: Gonadal chromosome mosaicism in cells of the follicular fluid predicts reproductive failure in women undergoing in vitro fertilization

To determine whether the detection of gonadal chromosome mosaicism by Fluorescent in situ hybridization (FISH) on cells of the follicular fluid predicts a significant increase in spontaneous abortion rates in women undergoing in vitro fertilization.

Fatty acid amide hydrolase deficiency limits early pregnancy events

Synchronized preimplantation embryo development and passage through the oviduct into the uterus are prerequisites for implantation, dysregulation of which often leads to pregnancy failure in women. Cannabinoid/endocannabinoid signaling via cannabinoid receptor CB1 is known to influence early pregnancy. Here we provide evidence that a critical balance between anandamide synthesis by N-acylphosphatidylethanolamine-selective phospholipase D (NAPE-PLD) and its degradation by fatty acid amide hydrolase (FAAH) in mouse embryos and oviducts creates locally an appropriate "anandamide tone" for normal development of embryos and their oviductal transport. FAAH inactivation yielding higher anandamide or experimentally induced higher cannabinoid [(-)-Delta9-tetrahydrocannabinol] levels constrain preimplantation embryo development with aberrant expression of Cdx2, Nanog, and Oct3/4, genes known to direct lineage specification. Defective oviductal embryo transport arising from aberrant endocannabinoid signaling also led to deferred on-time implantation and poor pregnancy outcome. Intercrossing between wild-type and Faah-/- mice rescued developmental defects, not oviductal transport, implying that embryonic and maternal FAAH plays differential roles in these processes. The results suggest that FAAH is a key metabolic gatekeeper, regulating on-site anandamide tone to direct preimplantation events that determine the fate of pregnancy. This study uncovers what we believe to be a novel regulation of preimplantation processes, which could be clinically relevant for fertility regulation in women.

Tension-free vaginal tape: analysis of risk factors for failures

To investigate whether there are any demographic, clinical, or urodynamic variables associated with an increased risk of failure in women undergoing surgery with tension-free vaginal tape (TVT). We retrospectively analysed 325 consecutive patients who had been operated with the TVT procedure. Patients were assessed with a complete history, physical examination, and urodynamic testing. The operation was done under local or epidural anesthesia and any further surgical procedure was added as indicated. The postoperative evaluation included collection of data on intra- and postoperative complications and analysis of outcomes. The outcome of surgical treatment was evaluated subjectively and objectively. The Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA) was used for data analysis; P<0.05 was considered significant. The overall complication rate was 14%, voiding dysfunction being the most common. Three hundred and one women were available for the analysis of surgical outcome and the mean follow-up was 34+12 months (median 32 months). Subjectively, 269 women (89%) were cured by the procedure and 13 (4.3%) reported marked improvement. An objective cure was achieved in 263 (87%); 38 patients still having leakage while coughing during postoperative cystometry. Among the numerous presumed risk factors for failed antiincontinence surgery only urethral hypomobility and recurrent stress urinary incontinence were significantly associated with failure of the TVT procedure in our study. However, even in these complicated situations, the cure rate was more than 70%.

Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure

The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.

Predictors of Mortality and Hospitalization in Women with Heart Failure in the Digitalis Investigation Group Trial

We performed a retrospective follow-up study of 1926 women with heart failure who participated in the Digitalis Investigation Group trial. Adjusted hazard ratios and 95% confidence intervals for covariates that were significant independent predictors of all-cause mortality were age in years (1.02; 1.01-1.03; P<0.001), NYHA class IH-IV (1.56; 1.31-1.87), diabetes (1.63; 1.36-1.95), glomerular filtration rate in mL/min/1.73 m(2) (0.99; 0.98-4).996; P=0.001), pulmonary congestion by chest x-ray (1.57; 1.22-2.02), left ventricular ejection fraction (LVEF) (0.99; 0.98-0.993; P<0.001), and use of digoxin (1.20; 1.02-1.42). Covariates that were significant independent predictors of hospitalization due to worsening heart failure were: nonwhite race (1.28; 1.03-1.58), NYHA class III-IV (1.55; 1.30-1.84), diabetes (1.75; 1.47-2.09), glomerular filtration rate as mL/min/1.73 m(2) (0.99; 0.986-0.996; P<0.001), pulmonary congestion by chest x-ray (1.42; 1.12-1.81), and use of ACE inhibitors (0.67; 0.49-0.91). Longer duration of heart failure, higher NYHA classes, diabetes, chronic kidney disease, pulmonary congestion, and lower LVEF were significant independent predictors of all-cause mortality, all-cause hospitalization, and hospitalization for heart failure in women with heart failure.

894: Incidence and Relative Risk of Sacral Neuromodulation Failure in Women with Voiding Dysfunction Status Post Hysterectomy

894: Incidence and Relative Risk of Sacral Neuromodulation Failure in Women with Voiding Dysfunction Status Post Hysterectomy

‘A Second Liberation’: Lobbying for Women's Political Representation in Zambia, Botswana and Namibia

The article looks at the efforts of women's movements in southern Africa to claim a stake in formal politics as an avenue to pursue their specific demands. After decades of exclusion, the importance of political representation was first realised by the women's movement in Zambia on the eve of the first democratic elections. The article looks at the failures of women's movements in one-party states in building fruitful alliances with women in political party movements, compares the strategies and varying experiences and successes of lobby groups in Zambia, Botswana and Namibia, and suggests that to achieve more equitable gender legislation, women in politics and in the women's movement should form an alliance that targets political parties directly.

Feminists Question Revolution

these books, we have two scholars examining the relationship between feminism and revolution through cases in Latin America. In Feminism and the Legacy of Revolution, Karen Kampwirth compares Nicaragua, El Salvador, and Chiapas-and in the process makes important contributions to both theory and our understandings of the cases themselves. In this exceptionally well-written book, Kampwirth asks why, in all three cases, many women separated from their respective revolutionary movements in the postwar era to create autonomous feminist organizations. Kampwirth's fieldwork and analysis is the most extensive in the Nicaraguan case, and the two chapters devoted to it respond to several key questions. For example, what accounts for women's organizations' success or failure in implementing feminist reforms? In comparing two Sandinista women's organizations' contributions to the contra war, she finds that the women's branch of the Rural

Heart Failure. Are Women Different?

The clinical syndrome of heart failure is very common in women. In fact, the majority of heart failure patients in the general population are female, in particular elderly women and women with a preserved ejection fraction. There are differences between heart failure in women and men in terms of epidemiology, pathogenesis, treatment response, and quality of care. The incidence is greater in men, but the prevalence at more advanced ages is higher in women. Prognosis seems to be better in women, although the mechanism responsible is not well understood. Clinical trials of heart failure have included fewer women than men, and this has limited our understanding of the efficacy of heart failure treatment in this group of patients.

Secrets beyond the Door: The Story of Bluebeard and His Wives (review)

Reviewed by: Secrets beyond the Door: The Story of Bluebeard and His Wives Rosan Augusta Jordan (bio) Secrets beyond the Door: The Story of Bluebeard and His Wives. By Maria Tatar . Princeton and Oxford: Princeton University Press, 2004. xiv + 247 pp., bibliography, index, illustrations. The story of Bluebeard, the mysterious character with a secret past hidden in a chamber of horrors, and of his wife's curiosity, which leads to her discovery that her husband is a wife murderer, is the subject of this book. Although not frequently appearing in present-day collections of fairy tales meant for children, the story of Bluebeard and the gory contents of the chamber he forbids his wife to enter has had "a powerful literary afterlife" (13), and writers continue to explore it today. In her study of the Bluebeard story, Maria Tatar, a literary scholar and a professor of Germanic Languages and Literature at Harvard University, demonstrates her familiarity with folklorists' conceptions of the changing nature of oral tales in response to changing cultural and temporal circumstances. The permutations of the Bluebeard story both in oral tradition and in literature seem endless, testifying to its ability to "reinvent itself" to reflect each new cultural [End Page 119] setting. Indeed, one of the questions this book addresses is why the story of Bluebeard and his wives has appealed to so many writers, filmmakers, and illustrators, despite its decline among oral storytellers. Tatar discusses an impressive number of "texts" and offers interpretations that provide insights into timely issues that reflect their differing cultural contexts. Her very thoroughness in doing so is part of the book's value to scholars. Her clear and accessible prose will appeal to both scholars and the more general reader. The book begins with a discussion of the texts most relevant to folklore study. Chapter 1, "The Attractions of 'Bluebeard': The Origins and Fortunes of a Folktale," focuses on Charles Perrault's "master narrative 'Bluebeard' and its relation to folkloric counterparts the world over" (7). Like most other literary renderings of the tale, Perrault's "Bluebeard" highlights the curiosity of the wife and suggests that curiosity is a distinctively feminine trait, associated here with both greed and disobedience, and possibly sexual infidelity as well. Bluebeard's barbarous acts, on the other hand, are framed as exceptional, atypical male behavior (in part by casting him as foreign and exotic and emphasizing the setting of the tale as in another time). According to Tatar, "folklorists" have also read Perrault's tale not as about the barbarous acts of the husband but primarily "as a story about a woman's failure to respond to the trust invested in her," focusing on the motif of the "bloody key as a sign of disobedience" (20). (As a folklorist, I naturally wanted to know which folklorists Tatar had in mind, but she does not name them in this book. Instead, a footnote refers the reader to her discussion of the tale in her 1987 book, The Hard Facts of the Grimms' Fairy Tales [Princeton, NJ: Princeton University Press, 1987, 161], where the "folklorists" are identified as Bruno Bettelheim and Alan Dundes, both of whom are psychoanalytical critics who were predictably drawn to comment on such an obvious sexually charged symbol as "a bloody key.") The "bloody key" to the door of the forbidden room is also depicted in many of the illustrations of Perrault's tale. The reproduction of numerous illustrations by various artists makes an interesting addition to Tatar's discussion of the text and supports her argument about how the tale was perceived in its time—at least by editors and illustrators of folktale collections. Over and over we see the wife, overcome by temptation and, keys in hand, opening the forbidden door. In addition to their focus on the wife's curiosity, the illustrations often manage to suggest she is greedy and acquisitive as well. Notably, the actual scene of slaughtered wives within the chamber is rarely portrayed. But what about versions of the tale from oral tradition? Unlike Perrault's narrative, Tatar tells us, folk versions of the tale emphasize the heroine's resourcefulness, courage, and initiative in her search for knowledge that...

Factors Contributing to Mammography Failure in Women Aged 40–49 Years

Factors Contributing to Mammography Failure in Women Aged 40–49 Years

Bilateral oophorectomy and premature menopause

The ovary is a complex metabolic organ. The follicles produce both androgens and estrogens, whereas the stromal tissue synthesizes androgens only. When menopause occurs, both androgen and estrogen levels decrease. The postmenopausal ovary remains a source of endogenous androgens that are converted to estrogen. The consequences of premature removal of the ovaries are not well known. The risks and benefits of menopausal hormone therapy (HT) in women with premature menopause have not been studied. Women who have had surgical menopause experience more severe symptoms and will need to stop estrogen therapy at some point in their lives. Intense symptoms such as hot flashes, night sweats, and insomnia will redevelop, so women should be given informed consent about the need for long-term use of HT and the greater difficulty in discontinuing therapy.