Postmenopausal Research Articles

SHORT-TERM RESIDENTIAL ACCOMMODATION IN STRATA PREMISES: A LEGAL AND TECHNICAL PERSPECTIVE

The perception of life changes towards quality living also plays a role in the demand for strata property, namely to live in a modern lifestyle by owning not just a house but a home with extensive housing conveniences and services such as security, privacy, covered parking space, gymnasium, swimming pool, landscaped garden and etc. In respect of short-term residential accommodation demand in strata units high rise buildings, notably, it is the current trend that the growth of high-rise buildings has dominated the real estate market. As a result, it produced rapid development in high-rise residential scheme. However, many residents are concern about privacy of the premise when the premise is overcrowded with STRA guests. The residents are concern that their privilege as residents will be affected with the presence of many STRA guests using the facilities in the apartments, which sometimes lead to nuisance in the premise. i.e. issues of parking, noise pollution and traffic congestion. In order to determine the legality of short-term residential accommodation in strata properties in Malaysia, comparative study with the position in New South Wales is made.

Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review.

We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention. In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O'Malley's methodological framework for scoping reviews. We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early. PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS's information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.

Testing of significant changes in big-five personality factors over time in the presence and absence of memory impairment and life-related stress

This study tests whether memory impairment and perceived increases in stress due to life changes independently contribute to similar personality changes, such as increased neuroticism and decreased conscientiousness. Longitudinal data from 12,912 participants aged 50+ from the Health and Retirement Study (2006–2020) were analyzed using Latent Growth Curve Models (LGCMs). Six LGCMs were simultaneously estimated to examine how changes in personality across three data points spanning 8 years are predicted by both the classification of memory impairment (MI) statuses assessed via the Telephone Interview for Cognitive Status and estimated increases in life stress. Decreases were observed in all Big Five personality factors (B = − 0.240/− 0.510, SE = 0.085/0.089) over the 8-year period. No significant differences in personality changes were found between MI cases and non-MI cases. Increased life stress was significantly associated with a rise in neuroticism (B = 0.587, SE = 0.094) and reductions in conscientiousness, extraversion, agreeableness, and openness (B ranges from − 0.223 to − 0.497). The findings emphasize adaptive/developmental shifts in personality in response to life stress rather than neuropathological ones related to memory impairment. Clinical assessment of personality changes in mid-to-late life should first consider psychological maladaptation to situational threats and challenges.

Changing Attitudes? Investigating the Link between Couples’ Pandemic Behavior, Cognitive Dissonance, and Gender Role Attitudes in Germany

Abstract Research found that not only macro-level processes like cohort replacements foster gender role attitude (GRA) change, but also life events and changes in lived realities. Framing the COVID-19 pandemic as a ‘natural experiment’ allows to reduce endogeneity when examining the association between emerging cognitive dissonance and GRA change. Estimating asymmetrical fixed effects regressions, I investigate the influence of changes in the division of family labor on GRAs for respondents with no pre-pandemic attitude-behavior discrepancy, using pairfam waves 11 and 13. Indeed, changes in behavior for respondents who had aligned behaviors and attitudes before the pandemic can be associated with GRA adaptation: A change toward an egalitarian division of family labor during the pandemic can be associated with more egalitarian GRAs. Likewise, a change toward an inegalitarian division can be associated with less egalitarian GRAs. These findings support the usefulness of cognitive dissonance as one explanatory mechanism for intra-individual attitudinal change.

Estrogens dynamically regulate neurogenesis in the dentate gyrus of adult female rats.

Estrone and estradiol differentially modulate neuroplasticity and cognition. How they influence the maturation of new neurons in the adult hippocampus, however, is not known. The present study assessed the effects of estrone and estradiol on the maturation timeline of neurogenesis in the dentate gyrus (DG) of ovariectomized (a model of surgical menopause) young adult Sprague-Dawley rats using daily subcutaneous injections of 17β-estradiol, estrone or vehicle. Rats were injected with a DNA synthesis marker, 5-bromo-2-deoxyuridine (BrdU), and were perfused 1, 2, or 3 weeks after BrdU injection and daily hormone treatment. Brains were sectioned and processed for various markers including: sex-determining region Y-box 2 (Sox2), glial fibrillary acidic protein (GFAP), antigen kiel 67 (Ki67), doublecortin (DCX), and neuronal nuclei (NeuN). Immunofluorescent labeling or co-labelling of BrdU with Sox2 (progenitor cells), Sox2/GFAP (neural progenitor cells), Ki67 (cell proliferation), DCX (immature neurons), NeuN (mature neurons) was used to examine the trajectory and maturation of adult-born neurons over time. Estrogens had early (1 week of exposure) effects on different stages of neurogenesis (neural progenitor cells, cell proliferation and early maturation of new cells into neurons) but these effects were less pronounced after prolonged treatment. Estradiol enhanced, whereas estrone reduced cell proliferation after 1 week but not after longer exposure to either estrogen. Both estrogens increased the density of immature neurons (BrdU/DCX-ir) after 1 week of exposure compared to vehicle treatment but this increased density was not sustained over longer durations of treatments to estrogens, suggesting that the enhancing effects of estrogens on neurogenesis were short-lived. Longer duration post-ovariectomy, without treatments with either of the estrogens,was associated with reduced neural progenitor cells in the DG. These results demonstrate that estrogens modulate several aspects of adult hippocampal neurogenesis differently in the short term, but may lose their ability to influence neurogenesis after long-term exposure. These findings have potential implications for treatments involving estrogens after surgical menopause.

Physical symptoms in prolonged grief disorder: a case report.

Prolonged grief disorder (PGD) was added as a new disorder to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) in 2022. PGD is defined as an intense yearning or longing for the deceased and preoccupation with thoughts or memories of the deceased. The official diagnostic criteria for PGD do not include physical symptoms, but it is sometimes associated with somatic symptoms. We present the case of a patient suffering from facsimile illness who lost her husband due to the deterioration of a brain tumor. She suffers from similar physical symptoms (severe headache reminiscent of a brain tumor, and hypertension) as her deceased husband. We focused on the dual process model in which grief exposure and behavioral activation began, ensuring an oscillation between loss-oriented grief (e.g., crying, feeling a continuing bond) and restoration-oriented grief (e.g., attending to life changes, new roles/identities/relationships). Outpatient psychotherapy based on the dual-process model of grief improved her physical symptoms. This case report highlights the physical symptoms experienced by those bereaved by a deceased loved one. Exposure therapy and behavioral activation approaches based on the dual-process model of grief response were effective in reducing the physical symptoms of facsimile illness. Physical symptoms in deceased family members triggered by bereavement are often overlooked and need to be recognized.

The contribution of socio-demographic, health-related and psychological factors to the perception of changes in life following a few waves of the COVID-19 pandemic

BackgroundAs a result of the long-lasting COVID-19 pandemic, we have experienced numerous losses in psychological and economic domains. Research covering two years (2020-2021) of the pandemic suggests that at present, the period is also perceived in terms of gains. The factors affecting opinions about the losses and gains include personality traits, intensity of COVID-19 PTSD, age, and others. The study aimed to determine which aspects changed in life after two years of the pandemic, which were assessed as negative or positive, and which factors contributed to these opinions.Participants and procedureAn online survey was carried out and responses were received from an international sample of 418 adults. The following tools were used: the Ten Item Personality Inventory, Impact of Event Scale-Revised, and COVID-19 Sense of Life Changes Questionnaire.ResultsConscientiousness and emotional stability were those personality traits which increased positive perceptions of the past years of the pandemic. The older age of respondents contributed to a more negative opinion about the changes in life caused by the pandemic.ConclusionsThe personality traits of conscientiousness and emotional stability and younger age may protect against negative percep-tions of the two-year period of the pandemic.

Neonatal overfeeding promotes anxiety, impairs episodic-like memory, and disrupts transcriptional regulation of hippocampal steroidogenic enzymes

The objective of our study was to investigate the impact of neonatal overfeeding on cognitive functions and neurosteroidogenesis in male rats. Offspring were assigned to either small litters (SL; 4 pups/mother), resulting in increased milk intake and body weight gain, or normal litters (NL; 10 pups/mother). On postnatal day (PND) 21, half of the male rats were euthanized, while the remaining were kept under standard conditions (4 rats/cage) until PND70. At this stage, subjects underwent assessments for locomotor activity, anxiety levels via the elevated plus maze, and episodic-like memory (ELM) tests. By PND90, the rats were euthanized for brain dissection. Utilizing micropunch techniques, dentate gyrus (DG), CA1, and CA3 regions were extracted for analysis of mRNA expression and methylation patterns. At PND21, SL rats exhibited increased body and adipose tissue weights, alongside elevated cholesterol, glucose, and triglyceride levels compared to NL counterparts. By PND90, although metabolic disparities were no longer evident, SL rats demonstrated heightened anxiety-like behavior and diminished performance in ELM tests. Early life changes included a decreased expression of aromatase (P450arom) and 3α-HSD in CA1, with increased levels in CA3 and DG among SL rats. Additionally, PND90 rats from SL exhibited increased P450arom and decreased 5α-reductase 1 (5αR-1) expression in DG. Notably, some of these variations were correlated with changes in methylation patterns of their promoter regions. Our findings reveal that neonatal overfeeding exerts a long-term adverse effect on cognitive abilities and neurosteroidogenic pathways, underscoring the lasting impact of nutritional experiences during critical early postnatal development periods.

Cross-cultural adaptation and validation of Carolinas Comfort Scale to Brazilian Portuguese for inguinal hernia.

Inguinal hernias are highly prevalent worldwide and its surgical repair is one of the most common procedures in general surgery. The broad use of mesh has decreased the recurrence rates of inguinal hernia to acceptable levels, thus centering the attention on Quality of Life as a pivotal postoperative outcome. Carolinas Comfort Scale is a well-studied questionnaire designed to identify Quality of Life changes following hernia repair with mesh techniques. The aim of this study is to validate the CCS in Brazilian Portuguese for inguinal hernias. The original CCS was translated into Brazilian Portuguese according to cross-cultural adaptation guidelines. We conducted a cross-sectional study in individuals aged 18 and above who had undergone inguinal laparo-endoscopic hernia repair for at least 6months prior, between January 2019 and August 2022, at a Brazilian tertiary hospital. Participants answered an online survey containing the Brazilian CCS and the generic Patient-Reported Outcome Measure (PROM) Short-Form Health 36 (SF-36). Participants answered the same questionnaires in the follow-up after at least three weeks, with an additional question about satisfaction with surgery results. The survey was completed by 115 patients, of whom 78 (67%) responded to the follow-up questionnaire after 3 to 10weeks. CCS showed excellent internal consistency, with Cronbach's α of 0.94. Intraclass correlation coefficient ranged from 0.60 to 0.82 in the test-retest analysis. Compared to SF-36, a strong correlation was observed in the physical functioning dimension, and a moderate correlation was found in role-physical and bodily pain (Pearson's Coefficient Correlation = 0.502, 0.338 and 0.332 respectively), for construct analysis. The mean CCS score was significantly lower (p < 0.001) among satisfied patients compared to the unsatisfied ones. The Brazilian version of CCS is a valid and reliable method to assess long-term quality of life after inguinal laparo-endoscopic hernia repair.

Antarctic Soils Select Copiotroph-Dominated Bacteria.

The life strategies of bacterial communities determine their structure and function and are an important driver of biogeochemical cycling. However, the variations in these strategies under different soil resource conditions remain largely unknown. We explored the bacterial life strategies and changes in structure and functions between Antarctic soils and forest (temperate, subtropical, and tropical) soils. The results showed that the weighted mean rRNA operon copy number in temperate soils was 19.5% lower than that in Antarctic soils, whereas no significant differences were observed among Antarctic, subtropical, and tropical soils. An unexpected result was that bacterial communities in Antarctic soils tended to be copiotrophs, such as Actinobacteriota and Bacteroidota, whereas those in temperate soils tended to be oligotrophs, such as Acidobacteriota and Chloroflexi. Functional predictions showed that in comparison to copiotrophs in Antarctic soils, temperate-inhabiting oligotrophic bacteria exhibited an 84.2-91.1% lower abundance of labile C decomposition genes (hemicellulose, cellulose, monosaccharides, and disaccharides), whereas a 74.4% higher abundance of stable C decomposition (lignin). Genes involved in N cycling (nitrogen fixation, assimilatory nitrate reduction, and denitrification) were 24.3-64.4% lower in temperate soils than in Antarctic soils. Collectively, our study provides a framework for describing the life strategies of soil bacteria, which are crucial to global biogeochemical cycles.

Sid Chaplin: A Writer with a Cause

The aim of this article is to recover the radical subtext of both the life and work of Sid Chaplin by reasserting the essentially political dimensions of his writing. Chaplin devoted the whole of his career as a writer to documenting not only the decline of the coal mining industry in the north-east of Britain where he lived, but he also traced the impact this process had on the working-class communities that were dependent on the pits. In his two later novels set in the city of Newcastle, The Day of the Sardine (1961) and The Watchers and the Watched (1962), Chaplin went on to dramatize similarly troubled changes in urban working-class life in the 1950s and 60s. The article not only argues that it is this nexus of class, politics and literature that translates so convincingly into his Newcastle novels, it also claims that it is the fundamental radicalism of his own literary project that explains the problematic neglect of his work by both critics and readers.

Effect of hold-type on cyclic life and microstructural evolution of an austenitic stainless steel

The present work investigates the effect of different type of hold on the change in microstructure and cyclic life. i.e., number of cycles to failure of the 304LN grade austenitic stainless steel at an elevated temperature. The strain-controlled low cycle fatigue and creep-fatigue interaction tests were carried out in air at 540 °C for constant total strain amplitude levels of ± 0.5 % and ± 0.7 %. The duration of hold-time was maintained at a constant level of 600 s at peak tensile, compressive and both peak tensile-compressive strain during different creep-fatigue interaction tests. Due to incorporation of creep damage, the cyclic life of the creep-fatigue interaction-tested samples has been found to be lower than that of the low cycle fatigue-tested samples. The tensile-hold appears to have maximum impact on reduction in cyclic life during creep-fatigue interaction tests followed by tension-compression hold and compressive hold. The scanning electron microscopy and electron back scattered diffraction analyses of creep-fatigue interaction-tested samples have revealed that the grain size coarsening, reduction in twin boundary fraction and increase in average Kernel Average Misorientation are the key factors in reduction of cyclic life.

'There are things I have learned the hard way' Patient experiences on lasting challenges 4 months after Transient Ischemic Attack: A qualitative study.

Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA). To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life. Qualitative exploratory study with a phenomenological-hermeneutic approach. Individual semi-structured interviews and thematic analysis. Fifteen patients were included. Four themes were identified; (1) 'They say it is transient - no, not for me' where all participants described lasting challenges emphasizing invalidating fatigue and impaired social participation, (2) 'I am a changed person; how does this impact my future?' which reflects altered identity and elevated alertness to symptoms, (3) 'Time has been my ally and new perspectives have evolved' where most participants described improvement over time and a few considered the diagnosis a wake-up call to change lifestyle. Lastly (4) 'What would have helped me recover?' which unfolds that close, trustful relations influence positively. In addition, the system often failed to support. Participants described pressure to return to work and lack of trust and negative experiences when involving their general practitioner. During the 4 months since diagnosis, participants experienced limitations impacting physical, psychological and social domains. They felt uninformed that lasting challenges could affect them. Different coping strategies were activated, and participants with close, supportive relations managed better. A pressure to return to work and a lack of trust in the general practitioner affected their recovery negatively. Overall, return to everyday life after TIA was considered stressful and appropriate support lacking. To be able to support patients with challenges following TIA, we as healthcare professionals need to understand the identified impact and life changing circumstances. Currently the system seemingly is not able to provide timely, sufficient and competent support. WHAT PROBLEM DID THE STUDY ADDRESS?: We know from the literature that up to 1/3 of patients following transient ischemic attack experience lasting challenges measured on a variety of questionnaires. This is paradoxical to a diagnosis defined by focal neurological symptoms that resolve within 24 h. It is unknown how patients with lasting challenges experience the timeline from diagnosis and until 4 months after, how the diagnosis impacts the lives of these individuals, and what they believe as beneficial in returning to their everyday life. WHAT WERE THE MAIN FINDINGS?: These participants with self-reported lasting challenges experienced substantial impacts on physical, psychological and social domains. Further, they felt alone with their struggles and when in need of support from the healthcare system, it failed to provide this. A pressure to return to work and a lack of trust in the general practitioner affected return to everyday life negatively, whereas close and supportive relations facilitated positively. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will have an impact on the healthcare professionals that provide support and the (limited) follow-up services to patients after TIA. These healthcare professionals are often specialized nurses who need to know what these patients experience and need in order to act upon their struggles and provide timely support. The Standards of Reporting Qualitative Research (SRQR). Patients with TIA was involved in planning this study. They participated in a panel to plan a prospective observational cohort study and emphasized the importance of exploring the subjective perspectives of impact and prognosis for those patients struggling in a longer term (through qualitative interviews).

Patient reported outcome measures at a large district general hospital post-mastectomy and implant based reconstruction.

11 Background: Breast reconstruction surgery for cancer can be a debilitating and life changing experience for patients, with complex affects on physical and mental health throughout the rehabilitation journey. We conduct a study on a cohort of patients undergoing this procedure, with focus on patient reported outcome measures. Methods: We reviewed all patients who underwent breast reconstruction surgery at our hospital from 2017 to 20223. Demographic, diagnosis, pre- and post-operative adjuvant treatment, and implant characteristics were collected. Psychosocial well being, physical wellbeing, satisfaction with breasts scales of the BREAST-Q were used. Independent t-test was conducted to find differences between PROMs for each group, and linear regression of age and implant size on each score. Results: 69 patients were contacted and 39 PROMS collected. The average age of patients was 57.6 years old. 40% were previous or current smokers and 40.8% had BMI&gt;30. 29 had pre-pectoral placement and 40 sub-pectoral. 17 had smooth implants and 52 textured. The average size of implant was 330mm. Immediate reconstruction was associated with a lower psychosocial score (66.0vs86.9, p=0.02) compared to multi-stage implants. Sub pectoral placement was associated with a higher (75.7vs61.9 p=0.046) psychosocial score than pre pectoral placement. Textured surface was associated with lower physical score than smooth surface (34.7vs50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusions: These findings underscore the importance of personalized approaches in surgery, considering implant type, placement technique, and patient age. Surgeons should prioritize patient preferences and needs to optimize post-surgical satisfaction and well-being.

AUTISM IN ADULTS: Feelings and changes after a late diagnosis

Previously considered a rare childhood disorder, autism today is a frequent diagnosis with increasing demand in all age groups, including people who were not diagnosed in childhood, but who perceive characteristics of this condition. This study, which is part of a broader research on the experience of Brazilian adults who were diagnosed with autism spectrum disorder (ASD) after 18 years, aims to explore the feelings and life changes of this group of people after the diagnosis. To this end, a qualitative research was carried out in which 12 participants were interviewed and the data were analyzed using the content analysis method, in its categorical aspect. Considering the objective of this work, in the analysis of the interviews, these categories emerged: alexithymia, relif, revisiting the past, self-compassion and acquired rights. As a result, relief was observed as a feeling of great relevance and predominance, accompanied by a process of understanding the past and self-compassion and self-respect. It was concluded that the late receipt of the diagnosis of autism by this group of participants allowed a better understanding of their characteristics and behaviors, reducing the pressure they exerted on themselves, in addition to enabling access to rights guaranteed by law.

Changes in Daily life due to the COVID-19 Pandemic and Mental Health Status in Korean Adolescents.

This study assessed the relationship between daily life changes and mental health in Korean adolescents during the COVID-19 pandemic. Data from middle and high school students who responded to the relevant survey items the 2021 Korea Youth Risk Behavior Survey were analyzed (n = 53,868). The survey assessed changes in economic status, physical activity, skipping breakfast, drinking, smoking, and mental health, including stress, depression, generalized anxiety disorder, and suicidal ideation, due to the COVID-19 pandemic. The overall prevalence of perceived stress, depression, generalized anxiety disorder, and suicidal ideation was 38.6%, 26.4%, 12.2%, and 12.4%. Adolescents whose economic status worsened due to COVID-19 had a higher risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in physical activity and breakfast consumption due to the COVID-19 pandemic were significantly associated with increases in perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Adolescents who increased their alcohol consumption had the highest risk of perceived stress, depression, generalized anxiety disorder, and suicidal ideation. Changes in economic status and health behaviors caused by the COVID-19 pandemic had a negative effect on the mental health of Korean adolescents. These results can be used to identify adolescents at high risk of developing mental health problems.

Prevention of Ovarian Cancer: Where are We Now and Where are We Going?

To describe current and future strategies to reduce the burden of ovarian cancer through prevention. Current strategies in genetic testing are missing a substantial number of individuals at risk, representing a missed opportunity for ovarian cancer prevention. Past efforts at screening and early detection have thus far failed to improve ovarian cancer mortality, and novel techniques are needed. Surgical prevention is highly effective, but surgical menopause from oophorectomy has significant side effects. Novel surgical strategies aimed at reducing risk while minimizing these harms are currently being studied. To maximize ovarian cancer prevention, a multi-pronged approach is needed. We propose that more inclusive and accurate genetic testing to identify more individuals at risk, novel molecular screening and early detection, surgical prevention that maximizes quality of life while reducing risk, and broader adoption of targeted and opportunistic salpingectomy will together reduce the burden of ovarian cancer.

The Language Desert: Ecosystems of Praise and Barrenness in Saint-John Perse’s Anabase and Lorand Gaspar’s Sol absolu

Life changes that impelled Saint-John Perse and Lorand Gaspar into the desert are well known: Perse’s 1920 expedition into the Gobi Desert during his diplomatic assignment in China, and Gaspar’s residence in Jerusalem near the Judaean Desert, 1954 to 1970. More interesting is the poetic stratification that barren ecologies instill in Anabase (1924) and Sol absolu (1972). Perse’s adventurer prince encounters several climates during his inland journey yet binds particularly with the desert, which infiltrates his discourse and the texture of his self-image. Human geography becomes a means to master the habitat as a stepping-stone for personal assertion. Climate on the frontier inspires his encomiastic language of jubilation for quest and companions. Gaspar’s topography suggests a less rhetorical contact with environment, yet his desert’s materiality penetrates its inhabitants, nomads like the Beduin or the poet, who treks this desert via language. Gaspar’s poetics of barren environment is not as epic as Anabase (1924), yet the jubilation that tectonic challenge incites in his idiom is founded on interpenetration of psyche and ecosystem rather than the poetics of dominion deployed in Anabase. Omnipresent conceits of “living matter” and “material psyche” are critical to the understanding of these two desert poems.

Consulting citizens: Addressing the deficits in participatory democracy

‘Democracy’ is a pliable, and much abused concept, yet constitutional law cannot do without it. It is usually linked to the equally flexible notions of rule of law and constitutionalism. Due to many changes in public life around the world, entrenched ideas of governmental propriety, including being democratic, are undergoing a ‘loss of meaning’. The Constitution of the Republic of South Africa, 1996 explicitly requires democracy to be participatory. Despite various official efforts to formulate the modalities of public consultation and an established routine of public hearings and calls for comment on draft legislation and policies, it has not developed beyond a ‘box-ticking’ exercise, sometimes amounting to outright abuse. As a corrective to the shortcomings of standard electoral democracy a novel approach to the involvement of the citizenry in contentious decision-making has emerged in many parts of the democratic world. It takes the form of citizens’ assemblies composed to achieve descriptive representation rooted in an age-old method of randomised selection, known as ‘sortition’. To employ these mechanisms to realise genuine participatory democracy would require surmounting the difficulties presented by the complexity of South African society. Modern technology and advances in sortition methodology hold promises of overcoming the difficulties, but it would also require a political sea change.

Rising premature menopause and variations by education level in India

The proportion of women experiencing premature menopause is on the rise in India, particularly in the age groups of 30–39 years. Consequently, there is a need to understand the factors influencing the prevalence of premature menopausal status among women. Our study uses the data from 180,743 women gathered during the latest Indian version of the Demography Health Survey (National Family Health Survey-5). Our results suggest that close to 5% of women in rural areas and 3% of women in urban areas experience premature menopause, and this figure varies across Indian States. The regression results show that surgical menopause, lower levels of education, poorer wealth index, rural residence, female sterilization, and insurance coverage are key drivers of premature menopause. One of the striking factors is that the prevalence of premature menopause among those with the lowest levels of education (6.85%) is around seven times higher than those with the highest level of education (0.94%). We conducted a decomposition analysis to delve into the factors contributing to this inequality. The results show that undergoing a hysterectomy (surgical menopause) account for 73% of the gap in premature menopausal rates between women with the lowest and highest levels of education. This indicates that women with poor education are more likely to undergo hysterectomy at a younger age. This finding warrants further exploration as we would expect that women from lower socio-economic background would have limited access to surgical care, however, our results suggest otherwise. This perhaps indicates a lack of awareness, lack of alternative treatment options, and over-reliance on surgical care while neglecting conservative management. Our results have implications for addressing the diverse needs of the increasing number of women in their post-menopause phase and for focusing on conservative treatment options for these women.