Journal articles on the topic 'Medical Women’s Federation'

This paper explores the influence of English female doctors on the creation of the International Planned Parenthood Federation (IPPF) and the production and circulation of contraceptive knowledge in England and, to a lesser extent in France, between 1930 and 1970. By drawing on the writings of female doctors and proceedings of international conferences as well as the archives of the British Medical Women’s Federation (MWF) and Family Planning Association (FPA), on the one hand, andMouvement Français pour le Planning Familial(MFPF), on the other, this paper explores the agency of English female doctors at the national and transnational level. I recover their pioneering work and argue that they were pivotal in legitimising family planning within medical circles. I then turn to their influence on French doctors after World War II. Not only were English medical women active and experienced agents in the family planning movement in England; they also represented a conduit of information and training crucial for French doctors. Transfer of knowledge across the channel was thus a decisive tool for implementing family planning services in France.

History of the Military medical academy is inextricably linked with the name of Peter I, who in 1715 laid the Vyborg district of St. Petersburg admiralty and land hospitals. In those hospitals, January 9, 1733 were formed hospital (surgeon’s) school for training local doctors, which were the prototype of the Academy. In 1786, the school joined to the surgeon’s main medical (medical and surgical) school, where seven professorships were established in 1795. December 18,1798 decree issued by Emperor Paul I «On the dispensation at the main hospital buildings for special medical schools and teaching theater». The construction of a special (separate) building made it possible to have the territorial and administrative independence of the educational institution. The main medical school received the status of Medical-Surgical Academy. In1809 the Academy became the Imperial, it was given the status and functions of the Russian academy of medical sciences. At the same period, there were formed three departments - medical, veterinary and pharmaceutical, allowing Academy initiated the medical, veterinary and pharmaceutical higher education in Russia. In 1858, at the Academy the Institute of doctors (the prototype of post-graduate) was created to prepare teachers for the medical faculties of Russian universities. Establishing in 1872 a «special education course for female scientists midwives», converted in 1876 in the women’s medical courses, the Academy has initiated the formation of women’s medical education, which in those days was not the only one in our country but also in Europe. Staff and graduates of the academy have covered themselves with unfading glory in all the wars in which Russia participated. The Academy in the XIX-XX centuries developed world renowned scientific medical schools which live today. Currently, the Military medical academy named after S.M. Kirov is the major higher military medical school, head research institution and a leading military medical establishment of the Ministry of Defense of the Russian Federation.

The optimal nutrition during pregnancy and lactation is extremely important for the health of both the mother and her infant. It allows realizing the «programming» potential of breastfeeding fully. The World Health Organization (WHO) emphasizes that to achieve better optimization of pregnant and lactating woman nutrition, it is necessary to enhance the introduction of relevant recommendations into practical work. The purpose of the current study is to analyze the results of a survey of women in Russia regarding their awareness of nutrition during lactation. Materials and methods. 1282 women of childbearing age (from 18 to 44 years old) from various regions of the Russian Federation took part in the survey. The questionnaire included 19 questions regarding the socio-demographic characteristics, duration of breastfeeding the nutritional features of women during breastfeeding, as well as the women’s opinions regarding the infant’s responses to changes in mother’s diet. The results of the study indicated that, despite the availability of recommendations coming from professional medical communities, no more than 30% of women received information about nutrition during breastfeeding from doctors. The Internet resources (non-medical websites and blogs) were shown to be the main source of knowledge about this issue (up to 60% of respondents). The results suggest from 30.2% to 42% of women in different age groups regularly to adhere to dietary recommendations. Whereas, they often had false ideas about «forbidden» and «allowed» foods. Thus, 30% of respondents noted nuts, jam, fresh vegetables, juice, fresh fruits as «forbidden» foods. Moreover, mothers with a first-born were significantly more likely to follow a diet compared to women with two (p < 0.001) and three or more children (p < 0.001). Conclusion. An analysis of the survey results showed that women have enough professional information about nutrition during lactation. Therefore, the work on the implementation of professional recommendations on nutrition for pregnant and lactating women should be intensified.

The news about the great victories of the Gallant Little Serbia in the Great War spread far and wide. Following on the appeals from the Serbian legations and the Serbian Red Cross, assistance was arriving from all over the world. First medical missions and medical and other help arrived from Russia. It was followed by the medical missions from Great Britain, France, Greece, The Netherlands, Denmark, Switzerland, America, etc. Material help and individual volunteers arrived from Poland, Canada, Australia, New Zealand, Ireland, Norway, India, Japan, Egypt, South America, and elsewhere. The true friends of Serbia formed various funds under the auspices of the Red Cross Society, and other associations. In September 1914, the Serbian Relief Fund was established in London, while in Scotland the first units of the Scottish Women?s Hospitals for Foreign Service were formed in November of the same year. The aim of this work was to keep the memory of the Scottish Women?s Hospitals in Serbia, and with the Serbs in the Great War. In the history of the Serbian nation during the Great War a special place was held by the Scottish Women?s Hospitals - a unique humanitarian medical mission. It was the initiative of Dr. Elsie Maud Inglis (1864-1917), a physician, surgeon, promoter of equal rights for women, and with the support of the Scottish Federation of Woman?s Suffrage Societies. The SWH Hospitals, which were completely staffed by women, by their participation in the Great War, also contributed to gender and professional equality, especially in medicine. Many of today?s achievements came about thanks to the first generations of women doctors, who fought for equality in choosing to study medicine, and working in the medical field, in time of war and peacetime.

The news about the great victories of the Gallant Little Serbia in the Great War spread far and wide. Following on the appeals from the Serbian legations and the Serbian Red Cross, assistance was arriving from all over the world. First medical missions and medical and other help arrived from Russia. It was followed by the medical missions from Great Britain, France, Greece, the Netherlands, Denmark, Switzerland, America, etc. Material help and individual volunteers arrived from Poland, Canada, Australia, New Zealand, Ireland, Norway, India, Japan, Egypt, South America, and elsewhere. The true friends of Serbia formed various funds under the auspices of the Red Cross Society, and other associations. In September 1914, the Serbian Relief Fund was established in London, while in Scotland the first units of the Scottish Women?s Hospitals for Foreign Service were formed in November of the same year. The aim of this work was to keep the memory of the Scottish Women?s Hospitals in Serbia and with the Serbs in the Great War. In the history of the Serbian nation during the Great War, a special place was held by the Scottish Women?s Hospitals ? a unique humanitarian medical mission. It was the initiative of Dr. Elsie Maud Inglis (1864?1917), a physician, surgeon, promoter of equal rights for women, and with the support of the Scottish Federation of Woman?s Suffrage Societies. The Scottish Women?s Hospitals, which were completely staffed by women, by their participation in the Great War, also contributed to gender and professional equality, especially in medicine. Many of today?s achievements came about thanks to the first generations of women doctors, who fought for equality in choosing to study medicine, and working in the medical field, in time of war and peacetime.

Aim. To identify predictors of malignant neoplasms (MN) of female sex sphere, to evaluate their sensitivity and specificity, to calculate prognostic coefficient (PC) and to create a computer program on its basis for automated processing of questionnaire data for arrangement of groups of risk for regular medical check-ups through the Internet (without participation of a physician) or on computers of women’s health clinics. Materials and Methods. The work was performed in two steps. The 1st step was an open questioning survey of 226 women, divided into 2 groups: the 1st group included women with MN of the sex sphere (n=125); the 2nd group included conventionally healthy women. The questionnaire included 82 positions: 19 open questions and 63 questions with a choice of an answer. The second stage consisted in a «blind» questioning of 120 women who visited a women’s health clinic. The questionnaire included 18 earlier identified predictors. A multifactor model was developed on the basis of questionnaire data and also using the material of medical histories and of histological examinations. Results. Using ROC-analysis of the questionnaire data, 18 significant predictors of MN of female sex sphere were identified. On their basis a formula was derived for calculation of PC for the risk of development of MN of female sex sphere with 72.8% sensitivity and 95% specificity, which was used for creation of a computer model for automated processing of questionnaire data with the aim of identification of groups of risks and for medical check-ups without participation of physicians through Internet sites of hospitals. Then, in result of closed questioning of women (n=120) by 18 predictors, 70 women got into a group of risk, in 47 of them (67%) MN of sex sphere were identified, 50 fell into a group of conventionally healthy women, of them 45 (90%) were healthy, and 5 (10%) had MN. Conclusions. 1) Multifactor statistical ROC-analysis of 82 questions and answers permitted to identify 18 predictors of MN of female sex sphere which can be used to scientifically substantiate identification of groups of risk for organization of regular prophylactic measures. 2) The conducted work permitted to create a computer program for automated processing of questionnaires for formation of groups of risk and for regular medical check-ups. We believe that introduction of questionnaire screening through the Internet with subsequent computer processing of the results without participation of physicians with permit to increase the coverage of women’s population of the Russian Federation with prophylactic measures against MN of the female sex sphere and to provide more time for receipt of primary patients, to simplify the work for creation of data base, and to increase the oncological alertness of women’s population.

This article is devoted to V.V. Trofimov, Minister of Health of the RSFSR, an outstanding health care manager, who tried to introduce the modern methods of self-financing, automated information systems, etc., into the management of medical science during the period 1962-1983. At the initiative of V.V. Trofimov, for the first time in the country, the Main Department of research institutes and coordination of scientific research was established, the purpose of which was to ensure a scientific breakthrough in medicine through the development and implementation of innovative methods. The experience of joint work of health authorities, medical universities, and research institutions began to accumulate. It allowed solving problems of improving the quality of medical care according to united comprehensive plans. The material and technical base for public health protection was developed. During the tenth five-year plan alone, 20 large multi-specialty hospitals were built for 600-1200 beds, 88 polyclinics for 750-1200 visits per shift, 80 maternity hospitals and departments for 8849 beds were put into operation, 24 women’s consultations for 1000 visits per shift, and 13 multi-specialty children’s hospitals. The availability of medical personnel increased from 34.8 in 1975 to 40.0 in 1980 (per 10,000 population). The reform of the financing of medical institutions included the transfer of hospitals and polyclinics to economic accounting. The reform was introduced to enhance medical workers’ financial incentives to improve medical care, as savings increased doctors’ and nurses’ salaries. In essence, it was an anti-pod to the extensive, expensive way of conducting the national economy adopted in the country. As the first Editor-in-Chief of the journal “Health Care of the Russian Federation” and he prioritized innovative research in editorial policy for many years to come.

ObjectivesTo define incidence and injury patterns of International Ski Federation (FIS) World Cup (WC) women ski jumpers over three seasons.MethodsSki jump athletes competing in the Women’s FIS WC were recruited for prospective injury surveillance from 2017–2018 to 2019–2020. Team representatives recruited the athletes annually and prospectively recorded all injuries requiring medical attention. Retrospective end-of-season interviews corroborated injury surveillance. Medical doctors collected and processed the data. The 4-month competitive season was used to calculate the annual incidence of injuries per 100 athletes per season. Injury type, location, severity and aetiology were reported.ResultsAthletes from 19 nations were enrolled equalling 205 athlete-seasons. Mean age was 21.2 years (SD=3.8). Thirty-nine injury events resulted in 54 total injuries (26.3 injuries/100 athletes/season). Injuries were mostly acute (83%) and occurred on the ski jump hill (78%). The most common injury location was the knee (n=18, 33%). Crash landings were the most common cause of injury events (70%). Nearly half of the acute ski jump injury events occurred in snowy, windy or cloudy conditions (44%) and/or during telemark landings (46%), and most jumps (96%) were shorter than hill size. One third of the injuries were severe, and 78% of severe injuries involved the knee.ConclusionAcute injury events occur relatively frequently in elite women ski jumpers, most resulting in time-loss from sport and a significant proportion involving serious knee injuries. Crash landing was the leading cause of injury. This baseline information can be used to guide and evaluate future efforts at injury prevention.

ObjectivesTo describe the incidence, type, aetiology and severity of injuries sustained by the International Ski Federation World Cup level female ski jumpers during the 2017–18 season.DesignProspective cohort study.MethodsSixty-seven female ski jump athletes from 16 countries were followed throughout the 17-week winter season. Preseason baseline demographic data and injury history were recorded via questionnaire. Prospective biweekly reports and retrospective end-of-season interviews provided data on all injuries requiring medical attention.ResultsSeventeen injuries were recorded, corresponding to an incidence of 25.4 injuries/100 athletes/season. The incidence of time-loss and severe injuries were found to be 17.9 and 4.5, respectively. The knee was the most common site of injury (4/17; 23.5%). Fourteen injuries occurred on the ski jump hill and crash-landing was the most common mechanism of injury (10/14; 71%). Eighty-five per cent of all moderate and severe injuries occurred in snow or windy conditions. Length of jumps resulting in injury averaged 83.7% (95% CI 72.9% to 94.4%) of hill size. Moderate injuries causing 8–28 days absence from training activities were most common (7/17; 41%) and there were three severe injuries necessitating >4 weeks absence.ConclusionInjuries among elite female ski jumpers are common and the majority are acute, resulting in time loss from training and competition. The knee was the most common site of injury and poor weather conditions may be a risk factor. Future studies are needed to identify risk factors for injury and to guide injury prevention initiatives.

Infectious diseases are still one of the main causes of perinatal losses worldwide. The consequences for the fetus and the newborn vary from asymptomatic infection to sepsis, malformations and the fetal death. Examination of pregnant women for the presence of infectious agents is an important part of the antenatal care program. The purpose of the work was to assess the structure of infectious screening in various medical institutions in Moscow, as well as the comparison of the recommended in Russia examinations with the main programs of antenatal monitoring in the world. Material and methods. The retrospective study was executed on the basis of four medical institutions: two state women’s clinics and two commercial clinics (the total number of patients - 902 people). The comparison was made with antenatal care programs of the antenatal observation in Centers for Disease Control and Prevention (CDC), 2015 (Centers for Disease Control and Prevention) in the United States of America, and the National Institute for Health and Care Excellence (NICE), 2017 (National Institute for Health and Medical Quality assistance), Great Britain. Results. Basic screening of pregnant women for infection in the Russian Federation includes 8 items (serological study of the blood for syphilis, HIV, hepatitis B and C, rubella, toxoplasmosis, microscopic examination of genital secretions on Neisseria gonorrhoeae and fungi of the genus Candida), which is significantly higher than in the USA and Great Britain (5 and 4 respectively). According to the results of our study, the volume of the compulsory examination of pregnant women is wider than abroad, due to serological examination of blood for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) of types 1 and 2, microbiological examination of genital secretions, molecular biological diagnosis (polymerase chain reaction - PCR, real-time PCR). Conclusion. Screening of pregnant women for infection in public and commercial clinics has a number of differences. The actual scope of the survey is higher than recommended by the state. The Russian list of tests in comparison with foreign analogs is much wider in terms of the number of nosologies and the frequency of the research. It is necessary to conduct multicenter epidemiological studies throughout the Russian Federation to create optimal regional programs for examining pregnant women for infection that meet the criteria for effective screening.

ObjectiveTo assess the strategy and value of centralized surveillance of hydatidiform mole at a regional hospital in China and to investigate the necessity of prophylactic chemotherapy for high-risk complete hydatidiform mole.MethodsBetween February 2013 and February 2020, all women with hydatidiform mole in Dalian Women’s and Children’s Medical Center (Group) were registered for surveillance and treatment when indicated. Women with complete hydatidiform mole were categorized into low-risk and high-risk groups according to the criteria from Song Hongzhao’s trophoblastic neoplasia. Outcomes and treatments were analyzed retrospectively.ResultsIn total, 703 women with hydatidiform mole were registered for surveillance with a follow-up rate of 97.9% (688/703). 680 women were enrolled and 52 (7.6%) developed post-molar gestational trophoblastic neoplasia, all with low-risk International Federation of Gynecology and Obstetrics (FIGO) scores 0–5. Post-molar gestational trophoblastic neoplasia was diagnosed in 12.3% (51/413) of patients with complete hydatidiform moles and 0.4% (1/263) of patients were diagnosed with partial hydatidiform moles (χ2=32.415, p<0.001). Post-molar gestational trophoblastic neoplasia was diagnosed in 27.7% (28/101) of the high-risk complete hydatidiform mole group and in 7.4% (23/312) of the low-risk complete hydatidiform mole group (χ2=29.196, p<0.001). No difference in the pre-treatment assessments of patients with post-molar gestational trophoblastic neoplasia was found between the low-risk and high-risk complete hydatidiform mole groups (all p>0.05). All 52 patients with post-molar gestational trophoblastic neoplasia were cured, with a complete response rate of 61.2% (30/49) with first-line single-agent chemotherapy.ConclusionsA centralized hydatidiform mole surveillance program is feasible and effective and may improve the prognosis of patients with post-molar gestational trophoblastic neoplasia. Prophylactic chemotherapy is not recommended for women with high-risk complete hydatidiform mole with adequate surveillance.

Background: Premature ovarian insufficiency (POI) represents about 1percent among women who are in less than 40 years age group. It has great negative impact on psycho-social, sexual and overall, on the quality of life of women. Objective: This study was designed to investigate the comparison in lipid profiles, fasting blood sugar, systolic and diastolic blood pressure and waist circumference in between normal women and women with premature ovarian insufficiency (POI). Methods and materials: This was a cross-sectional comparative study. Fifty women (POI) were taken with purposive sampling as study group who were diagnosed as premature ovarian insufficiency of idiopathic cause from 18 to 40 years. 50 healthy women were taken as comparison group at the same age group. The study was done in the Obstetrics and Gynecology department of Z. H. Sikder Women’s Medical College, Dhaka from January 2020 to December 2021 over a period of two years. After taking written consent detailed information about the patients were collected in a predesigned data collection sheet for each patient. Metabolic syndrome (MS) was assessed for each one of POI. MS was diagnosed according the criteria of IDF (International diabetic federation). Results: Serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and fasting blood sugar were significantly higher and high-density lipoprotein cholesterol (HDL-C) was reduced in women with POI(p<0.05). There were no differences in triglycerides. Waist circumference was higher significantly in women with POI (p<0.05). Conclusion: Early cessation of ovarian function is related with higher levels of TC, LDL-C, fasting blood sugar and waist circumference and lower HDL-C. Women with POI have higher risk of metabolic syndrome. Early detection and lifelong management should be provided to avoid complications.

The main factors of the working environment that harm a woman’s health in the course of work are considered to be physical exertion and functional overstrain, noise, chemical and biological factors, and microclimate. The most unfavorable sectors of the economy in the Republic of Bashkortostan are manufacturing, construction and the agricultural sector, where the largest number of jobs are registered that do not meet the hygienic standards for the above-mentioned production factors, which undoubtedly serves as the main cause of the development of occupational diseases among women. Material and methods.According to the medical records of the inpatient patient, the acts on the case of occupational disease and the registration form No. 30, the etiological causes and the structure of occupational morbidity by industry sectors of the Republic of Bashkortostan among women for 2016–2020 were studied. Results. Among the subjects of the Russian Federation, the Republic of Bashkortostan for the analyzed fiveyear period ranked 25–27th in terms of employment of women in jobs with harmful and (or) dangerous working conditions, and among the 14 regions of the Volga Federal District — 3–5 places. If in the period 2016–2019 among all the primary established occupational diseases from 32.4 to 43.0 % were women, then by 2020 more than half of all occupational diseases (54.7 %) were detected among women. Of the 114 cases of occupational diseases identified to 85 female workers, a third of them worked in health care (32.9 %), a slightly smaller part (30.6 %) — in mechanical engineering (manufacturing) and a fifth — in the agro-industrial complex (21.1 %). The leading place in the structure of occupational pathology of women was occupied by diseases associated with high physical overload and overstrain of individual organs and systems (54.2 %). The reason for the change in the structure of occupational diseases in the region in 2020 there was a new coronavirus infection-Covid-19 in medical workers, which brought diseases from the influence of a biological factor to the second position. Conclusion. The state of working conditions and occupational morbidity among women workers indicates the lack of an effective mechanism for protecting women’s labor and the need to develop effective legislative documents for the protection of their labor and health.

Abstract The aim of our study is to show the development of women's rowing and competition, as well as the reasons for its slow spread, taking into account the so called decisive era, the social environment, which, although in various ways, has greatly influenced it all over the world. One of the major research methods for collecting data was document analysis: we used the volumes of Gusztáv Götz's legacy1found in the sports history collection of the Hungarian Rowing Federation, whose spirit we also tried to preserve. In these volumes we found and analysed congressional reports, resolutions made by the national rowing federations, professional articles on rowing and papers on sports medicine. In addition, we studied the relevant literature, namely, studies dealing with the era from sociological, sports sociological and sports historical perspectives. Moreover, via membership in the Traditionalist Committee of the Hungarian Rowing Federation we had the opportunity to meet the great Hungarian female rowing champions of the 1950s, 1960s and 1970s, and we prepared structured in-depth interviews with them. Meeting most often with Anna Domonkos1, Ágnes Bán1, Zsuzsanna Rakitay1. The results show that the international rowing society was divided, the social and medical discourse differed from each other in the assessment of women's sports, sports historical traditions varied country by country and international sports politics also played a decisive role in the delay. With the results, our paper is intended to give a more thorough picture of the reasons why women's competition in rowing has expanded so slowly than the previous analyses did.

Проблема охраны репродуктивного здоровья женщин в Российской Федерации в условиях снижения рождаемости приобрела чрезвычайный характер в силу снижения качества репродуктивного потенциала государства. В современных условиях развитие акушерско -гинекологической помощи приобрело ряд аспектов, позволяющих оказывать ощутимое влияние на состояние репродуктивного здоровья женщин за счет своевременности диагностики, лечения и наблюдения за состоянием здоровья беременных, рожениц и родильниц. Соответственно, особую научно -практическую значимость приобретает оценка состояния и выявление основных проблем оказания акушерско -гинекологической помощи в амбулаторных условиях. В обзоре приведены исторические аспекты формирования и современное состояние организации амбулаторной помощи женскому населению, выявлены основы нормативно -правового обеспечения акушерско -гинекологической помощи, определены основные проблемы ее оказания. Установлено, действующая нормативно -правовая база оказания акушерско -гинекологической помощи в амбулаторных условиях имеет значительное количество недостатков и проблем, что влияет на качество обслуживания пациентов. Проведенный анализ показал несоответствие нормативной базы реальным потребностям населения, материально -техническим и финансовым возможностям медицинских организаций. Таким образом, в настоящее время в России ключевое значение имеет улучшение качества и доступности акушерско -гинекологической помощи в амбулаторных условиях. В условиях реформирования и оптимизации системы здравоохранения следует делать упор на увеличение объема медицинской помощи и усиление роли амбулаторно -поликлинической службы, в том числе в аспекте акушерско -гинекологической помощи. The problem of protecting the reproductive health of women in the Russian Federation in the context of a declining birth rate has become an emergency due to a decrease in the quality of the state of the reproductive potential. In modern conditions, the development of obstetric and gynecological care has acquired a number of specific features that make it possible to improve women’s reproductive health due to the timeliness of diagnosis, treatment and monitoring of the health of pregnant women, women in labor and puerperas. Accordingly, the assessment of the state and revealing the main problems in the provision of obstetric and gynecological care in an outpatient level acquires special scientific and practical significance. The review presents the historical aspects of the formation and the current state of the organization of outpatient care for the female population, identifies the basics of legal support for obstetric and gynecological care, and the main problems of its provision. It has been established. Current regulatory framework for the provision of obstetric and gynecological care on an outpatient basis is proved to have a significant number of shortcomings and problems, which affects the quality of patient care. The analysis performed showed that the regulatory framework does not correspond to the real needs of the population, the material, technical and financial capabilities of medical organizations. Thus improving the quality and accessibility of obstetric and gynecological care on an outpatient basis is currently of key importance in Russia. In the context of reforming and optimizing the healthcare system, emphasis should be made on increasing the amount of medical care and strengthening the role of outpatient services, including the aspect of obstetric and gynecological care.

Equal opportunities for women to participate in sports, including women originally considered male, are accompanied with a debate on the need for gender verification for fear of participation in women’s competitions of female athletes with genetic characteristics more typical of men, which, in some experts’ opinions, gives them unfounded starting advantages. Thus, it is necessary to consider legal, medical and ethical aspects of gender verification in high performance sports. The article analyzes the main alterations developed by the International Association of Athletics Federations (IAAF) Rules for selection of sportswomen with violations of gender formation for participation in competitions. Given the position of the Special Rapporteur of the UN Human Rights Council, the author considers the issue concerning the compliance of these changes with international principles and norms in the field of human rights protection with due regard to non — discrimination, respect for honor, dignity and integrity of the person. It is concluded that there is considerable uncertainty about admissibility of the use of testosterone level as a universal criterion for gender verification, as well as the availability of direct cause-effect relationship between the corresponding hormonal characteristics and the sports results achieved. The author draws attention to the ethical element of gender verification in sport related to the methods offered by IAAF to assess the sufficient level of femininity and the requirement of its adjustment to artificially determined indicators, even when the principle of confidentiality is declared.

Dobrovol'skaya Nadezhda was born in 1878 in Kiev province. After graduating with a gold medal of the women's gymnasium in Kiev Women's medical Institute in Petrograd, worked as an Intern in the clinic of Professor M. S. Subbotin (1902-1904), later a country doctor . 1907 – the assistant to the dissector, assistant Professor of Women's medical Institute (until 1917), supernumeraries medical surgical Academy in Petrograd (from 1914). Since 1911 – a doctor of medicine. In 1912 N.. A. suggested method of joining vessels of different diameter, "end-to-end" crossing them obliquely; I applied the hair to perform a vascular suture. 24 APR 1917 N..Dobrovolskaya apply in Tartu University about acceptance as a privatdozent at the Department of surgery. 14 Oct 1918 – the Board of the University of Voronezh electing her to the chair of surgical pathology with the dressing and the doctrine about dislocations and fractures of the medical faculty and became the first woman to lead the Department of surgery. In 1919, she described the symptom that got her name – a decrease in heart rate when Paltseva the compression of the artery proximal to arteriovenous fistula. To link their fate with the Soviet authorities she did not dare, and soon left Voronezh. N.. Dobrovolskaya served as a doctor in Wrangel's army, which retreated in the Crimea and were evacuated to Egypt (1920-1922). In 1921 N.. Take the art to the newly opened in France, the laboratory organised by the Pasteur Institute and the radium Institute (later, the Institute Curie), which was first headed by Professor Claude REGO, and then N.. Dobrovolskaya. It describes the brachyury mutation in mice is becoming one of the pioneers in understanding the development of the body as changes in gene expression, creates several pure lines of mice as models of human diseases. Nadezhda was a member of the boards of the society of Russian doctors of Mechnikov, Russian academic group, Russian section of the International Federation of University women, Association of Russian doctors abroad. Collaborated in the Brotherhood of the Martyr Albania and St. Sergius. N.. Dobrovolska has authored over one hundred scientific papers. In 1937 she was awarded the French Academy of Sciences for research in the field of hereditary cancer. In 1954, at the age of 76 N..Dobrovolskaya is dead.

INTRODUCTION: Primary health care is a fundamental element in protecting the health of the children’s population. This article presents a literature review on the problems of providing medical care to children of the first month of life. One of the main stages in an integrated approach to observation of children is the antenatal protection of the fetus, which is provided primarily by childrens clinics through prenatal patronage. To date, at this stage, there is still lack of coordination in the work of womens clinics and childrens clinics. After the discharge of newborns, prenatal care is replaced by home care for newborns, which is realized by both a doctor and a district nurse and represents a complete system with an integrated approach to appropriate examinations. Observance of the frequency of both prenatal and primary patronages, which is regulated by the federal normative acts, is ensured by the professional level of district pediatricians and district nurses, as well as by the appropriate provision of the primary link with personnel. Lack of specialists in medical organizations providing primary health care to children is reflected in the increased burden on the medical and nursing staff. According to the research conducted in different regions of the Russian Federation, the number of population attached to a health locality, often significantly exceeds the recommended standard of 800 people per one locality. All this leads to non-standardized loads on the staff, and has a significant impact on the quality of medical care provided. This, in turn, leads to dissatisfaction of the patients legal representatives with the availability, quality and completeness of the medical care provided. CONCLUSION: The presented information, based on the data of the literature review devoted to the quality of medical care for children of the first month of life in childrens polyclinics, is aimed at optimizing the conditions for improving affordable and high-quality medical care, improving the health of the child population, reducing infant mortality.

IntroductionSwabhimaan is a community-based programme to improve adolescent girls’ and women’s nutrition in the rural areas of three Indian states—Bihar, Chhattisgarh and Odisha with high prevalence of undernutrition.Methods and analysisSwabhimaan has a nested prospective, non-randomised controlled evaluation. Since 2017, five intervention sites receive community-led interventions through national government’s livelihood mission supported women’s self-help group federations and five control sites will initiate these activities 36 months later, in 2020. Community-led activities aim to improve coverage of 18 interventions including adequacy of food consumed, prevention of micronutrient deficiencies, access to basic health services and special care of nutritionally ‘at risk’ girls and women, improving hygiene and access to water and sanitation services and access to family planning services. The evaluation includes baseline (2016–2017), midline (2018–2019) and endline (2020–2021) surveys covering 6638 adolescent girls, 2992 pregnant women and 8755 mothers of children under 2. The final impact analysis will be by intention to treat, comparing primary and secondary outcomes in five intervention areas and five control areas. The primary outcomes are: (1) a 15% reduction in the proportion of adolescent girls with a body mass index (BMI) <18.5 kg/m2; (2) a 15% reduction in the proportion of mothers of children under two with a BMI <18.5 kg/m2and (3) and a 0.4 cm improvement in mean mid-upper arm circumference among pregnant women.Ethics and disseminationAll procedures involving human subjects were approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, Bihar, Chhattisgarh and Odisha and in compliance with guidelines laid down in the Declaration of Helsinki. Evidence will inform maternal and preconception nutrition policy at national and state level.Trial registration number58261b2f46876 and CTRI/2016/11/007482; Pre-results.

ABSTRAK Hipertensi merupakan kondisi medis dengan jumlah keseluruhan kasus penyakit yang terjadi di dunia bernilai tinggi. Kasus hipertensi di dunia diperkirakan sebesar 22% dari total penduduk dunia. Hipertensi sendiri mentotali 2/3 dari penderitanya berasal dari negara ekonomi menengah ke bawah. Sedangkan diabetes adalah penyakit metabolik endokrin yang kronik progresif atau menahun, ditandai dengan adanya hiperglikemia kronik (gula darah tinggi). Indonesia menempti peringkat ke-7 dalam jumlah tertinggi diabetes tipe 2 hal ini melansir data dari International Diabetes Federation pada tahun 2020. Tujuan penyuluhan ini adalah mampu meningkatkan kesadaran para warga binaan Lapas Perempuan Kelas II A Bandar Lampung untuk dapat hidup sehat dan meminimalisir dari dampak penyakit hipertensi dan dibetes mellitus. Sebagian besar peserta mendukung dan mengharapkan tindak lanjut baik dari penyuluhan. Selain itu pengukuran kadar gula pun berjalan sesuai rencana dan memperoleh hasil yang masih relatif baik meskipun masih terdapat hampir 30% dari jumlah peserta penyuluhan memiliki kadar gula di atas rata-rata. Peserta memiliki daya serap yang cukup baik dalam kegiatan ini, hal ini terlihat dari minat dan antusias peserta untuk lanjutan dari rangkaian kegiatan yang akan datang, serta menumbuhkan semangat ingin tahu dalam setiap pertanyaan yang diajukan oleh peserta kepada mentor, Terjalinnya keakraban dan suasana sesama peserta maupun dengan penyuluh. Kata Kunci: Hipertensi, Diabetes Mellitus, Lapas Perempuan, Penyuluhan, Hidup sehat ABSTRACT Hypertension is a medical condition with a high number of disease cases occurring in the world. Hypertension cases in the world are estimated to reach 22% of the total world population. Hypertension itself affects 2/3 of patients from low-middle economic countries. Diabetes is a chronic progressive or chronic metabolic endocrine disease, characterized by chronic hyperglycemia (high blood sugar). Indonesia ranks 7th in the number of people with type 2 diabetes, this is according to data from the International Diabetes Federation in 2020. This counseling aims to increase awareness of the inmates of Class II-A Bandar Lampung Women's Prison to be able to live healthily and minimize the impact of disease. . hypertension and diabetes mellitus. Most of the participants were supportive and expected good follow-up from the counseling. In addition, the measurement of sugar levels went according to plan and obtained relatively good results, although there were still almost 30% of the total counseling participants had sugar levels above the average. Participants have a fairly good absorption capacity in this activity, this can be seen from the interest and enthusiasm of the participants towards the continuation of the upcoming series of activities, as well as fostering curiosity in every question asked by participants to the supervisor, the formation of intimacy and atmosphere between participants as well as with extension workers. Keywords: Hypertension, Diabetes Mellitus, Women's Prison, Counseling, Healthy Living

Introduction: The objective of this study was to define the prevalence of metabolic syndrome (MS)is procreative women and its relationship with obesity in the eastern region of Morocco. The purpose of our work and to determine the prevalence of MS and its relation to obesity in the eastern region of Morocco Materials and methods: Our study was conducted in the oriental region of Morocco (Oujda-Angad). The study included 624 women aged 20-49 years healthy and non-pregnant. Anthropometric measurements were determined according to World Hearth Organization (WHO) standards.The medical tests were conducted in a private testing laboratory in Oujda. Data of demographic and socioeconomic level were collected using a questionnaire.The data were processed on SPSS. Results: The average age of the women surveyed was 33.42 ± 8.02 years. The BMI values indicated that the prevalence of obesity among women surveyed was 30,61% and the prevalence of overweight was 38,78%. The abdominal obesity affects 79,10% of women. The MS affects 21% (according to the definition of NCEP-ATP III) of women surveyed, while according to the definition of the International Diabetes Federation (IDF) prevalence increases to 35%. The MS increases with age, was affects 25% of women aged between 20 and 29 years, and 37,5% of women aged between 40 and 49 years. All women with MS were overweight (obesity included) (p = 0.004). With the exception of level of education all socio-demographic factors were not associated with the MS. Conclusion: The prevalence of metabolic syndrome in our study was higher. The MS was more pronounced among obese and illiterate women. The results of this study will help in the planning of control of these problems in the future.

ObjectiveIn cancer patients, the pathology report serves as an important basis for treatment. Therefore, a correct cancer diagnosis is crucial, and diagnostic discrepancies may be of clinical relevance. It was the aim of this study to perform a specialized histopathology review and to investigate potential clinical implications of expert second opinion pathology in endometrial cancer.MethodsPatients treated for endometrial carcinoma at the Tübingen University Women's hospital between 2003 and 2013 were identified. Original pathology reports were reviewed, and contributing pathologists were asked to submit original slides and paraffin blocks. Case review was subsequently performed by 3 pathologists specialized in gynecological pathology who were blinded for clinical information. For histological typing, the World Health Organization 2014 classification was used, grading and staging were performed according to International Federation of Gynecology and Obstetrics 2009. Risk assignment was performed based on the 2013 European Society for Medical Oncology clinical practice guidelines.ResultsIn 565 of 745 cases, which had originally been diagnosed as endometrial carcinoma, archival histological slides and blocks were available. In 55 (9.7%) of 565 cases, a major diagnostic discrepancy of potential clinical relevance was found after expert review. In 38 of these 55 cases, the diagnostic discrepancy was related to tumor type (n = 24), grade (n = 10) or myoinvasion (n = 4). In 17 cases, the diagnosis of endometrial carcinoma could not be confirmed (atypical hyperplasia, n = 10; endometrial carcinosarcoma, n = 4; neuroendocrine carcinoma, n = 1; leiomyosarcoma, n = 1; atypical polypoid adenomyoma, n = 1). Minor discrepancies not changing risk classification were also noted in 214 (37.9%) of 565, most frequently for grade within the low-grade (G1/G2) category (n = 184).ConclusionsA retrospective gynecopathological case review was shown to reveal limited but significant discrepancies in histological diagnoses as well as typing and grading of endometrial carcinomas, some directly impacting clinical management. Second opinion pathology therefore not only helps to improve the quality of translational research study cohorts but might also help to optimize patient care in difficult cases.

Some of the greatest strides seen in Canadian women’s health and in gender equity in medicine can be attributed to Dr. May Cohen: an unyielding activist who dedicated her life’s work to advocacy. From spearheading the development of the first Women’s Health Office at McMaster University to serving as President of the Federation of Medical Women in Canada, her career is a testament to what can be achieved with a strong social conscience and unwavering determination.

In this article the author, the eightieth President of the Medical Women’s Federation and a clinical academic, reflects on disability, gender, and leadership. She draws on lessons from her sixteen-year NHS career in HIV Medicine in East London, UK. She explores her experiences and challenges as a Consultant Physician who became invisibly disabled and reflects on how her chosen leadership style has evolved in parallel. Readers are encouraged to reflect on invisible disability, ‘ableism’ and how to navigate conversations with colleagues.

Abstract The performance of goalkeepers can predict the final ranking of teams in tournaments. The aim of the study was to examine the percentages of goalkeepers of different national teams, according to the position on the field from which the pitch was taken, the location of the pitch in the goal and the ranking of the game. To this end, a documentary study based on the data collected by the International Handball Federation was carried out with 24 national teams that took part in the last absolute handball world championship (Germany 2017). The sample consisted of 7606 pitches made in 83 matches. The results showed that the highest percentage of saves was obtained with shots taken from the 9 meters and to the central and middle zone of the goal, and the lowest with throws in fast-breaks and to the lower and lateral areas of the goal. There were no significant differences in the variables analyzed according to the game ranking, except in pitching zone 1.

Abstract Competitions are considered of paramount importance for high-performancesports because they determine the entire orientation of the training process. When analyzing the calendar of the International Basketball Federation, it can be observed that international competitions occur in short periods of time. In this sense, the aim of this study was to verify the effects of the application of combined training in the short-term preparation period on the speed of athletes of the Brazilian women’s basketball team. Thirteen athletes participated in this study, who took part of the preparation for the 2015 Pan American Games. Athletes were submitted to anthropometric measures and biomotor capacity evaluation at cyclic speed -20m run, and acyclic speed - T test at the beginning (M0) and end of a 27 - day preparation period (M1). Considering the period available for training, the total duration percentage was:technical / tactical 73.7%, strength and conditioning: 5.7%, preventive: 10.5% and general and special warm up: 10.1%. After data collection, the Shapiro-Wilk test was used to verify normality and then, the Student’s T test was also applied. The main results indicate that the best time to evaluate cyclic speed (M0 and M1, respectively) was 3.34 ± 0.22s and 3.39 ± 0.21s and acyclic speed (M0 and M1, respectively), 9.30 ± 0.49s and 9.52 ± 0.57s.The results of the current study suggest that short-term intervention was not efficient to improve the cyclic and acyclic speed of female basketball athletes.

Objective: The metabolic syndrome (MetS) and subclinical CVD measures are associated with a higher risk of future cardiovascular disease (CVD) events. Furthermore, individuals with MetS have a greater burden of subclinical CVD, such as the presence of carotid plaque (CP) and larger adventitial diameter (AD). Midlife women proceeding through the menopausal transition are vulnerable to developing MetS and are also at greater risk of CVD, a risk that varies by race/ethnicity. We hypothesized that there are racial/ethnic differences in the association between MetS and measures of subclinical atherosclerosis. Methods: Participants from 6 sites of the Study of Women’s Health Across the Nation (SWAN) were analyzed if they were free of clinical CVD and had measures of CP and AD at the 12th annual visit. Women were identified as having MetS if they met the criteria defined by the International Diabetes Federation (IDF). Multivariable logistic and linear regression models were used to investigate the relationship of MetS with CP and AD overall and separately within each race/ethnicity group. Study site, age, height, LDL-C, smoking status, menopausal status, hormone use, and education level were included as covariates. Further analysis adjusted for inflammatory and metabolic biomarkers. Results: The 1454 women were, on average, 59.6 years old 43.5% had evidence of MetS, and 85.8% were postmenopausal. The race/ethnicity breakdown was 51.1% White, 30.3% Black, 12.7% Chinese, and 5.8% Hispanic. Overall, MetS was associated with the presence of CP and higher AD after adjusting for covariates (OR (95%): 1.65 (1.31, 2.08); β (SE): 0.344(0.035) mm, p< .0001, respectively). In race-specific models, MetS was significantly associated with AD in White, Black, Hispanic, and Chinese participants, adjusting for covariates (β (SE): 0.305 (0.043) p<.0001; 0.401(0.077) p<.0001; 0.466 (0.147) p= 0.0023; 0.291 (0.098) p = 0.0035; respectively). MetS was significantly associated with CP in White participants only (OR (95%): 1.89 (1.39, 2.57)). When high-sensitivity C-reactive protein and insulin resistance were included in the model, MetS remained significantly associated with AD in Black (0.327(0.86), p = 0.0002) and White (0.212(0.051) p<.0001) participants, and MetS remained significantly associated with CP in Whites participants (1.55 (1.08, 2.23)). Conclusion: MetS is associated with subclinical atherosclerosis, and the association varies by race/ethnicity in midlife women. This variation may help explain differences in incidence rates of CVD events between racial/ethnic groups.

ObjectiveTo determine the role of vaginal vault cytology as a surveillance tool for the detection of recurrence in patients with early stage cervical cancer treated with hysterectomy without adjuvant therapy.MethodsA retrospective cohort study was conducted of all women with cervical cancer treated with a hysterectomy from January 2000 to July 2016 at the Royal Brisbane & Women’s Hospital, Australia. Women included were diagnosed with the equivalent of International Federation of Gynecology and Obstetrics (FIGO) 2018 stage 1A1 to 1B3 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, received either simple or radical hysterectomy with or without pelvic lymph node dissection, and did not receive adjuvant therapy. Age, stage, histology, surgical procedure, and details of individual surveillance regimens including examination findings and indications and results for all vault cytology tests performed in the first 5 years following surgical management were collected.ResultsA total of 155 women met the inclusion criteria. Most cases were FIGO 2018 stage 1B1 (61.9%) and squamous cell carcinoma (64.5%). Included women underwent a median of 80 months of surveillance (range 25–200, IQR 64–108). In the first 5 years of surveillance, there were a total of 1001 vault cytology smears performed, with a median of 6 smears (IQR 5–9) per woman. A total of 19 smears were abnormal (1.9%). Of the cohort of 155 women, 19 (12.3%) had an abnormality detected; 1 (0.65%) had a high-grade intraepithelial abnormality and 2 (1.3%) had recurrences detected on cytology; however, a lesion was also seen and biopsied in all three women. A total of 16 of 1001 smears (1.6%) had low-grade abnormalities detected, all of which resolved with clinical observation only. All were alive and well at last review. There were in total 6 (3.9%) recurrences, 2 (33%) of which had abnormal cytology as above, and all of which had a lesion to biopsy and/or abnormal medical imaging.ConclusionsThe routine use of vaginal vault cytology in surveillance following hysterectomy for early stage cervical cancer did not appear to alter the detection of recurrent malignancy.

Abstract Study question What are the available preconception care policies, guidelines, recommendations and services as well as infertility care in South America ? Summary answer Preconception recommendations offered by both governament and medical societies in South America were fragmented and inconsistent and public fertility care is available in seven countries. What is known already Promoting preconception health can potentially improve women’s health and pregnancy outcomes. Evidence-based interventions exist to reduce many maternal behaviors and chronic conditions that are associated with adverse pregnancy outcomes such as tobacco use, alcohol use, inadequate folic acid intake, obesity, hypertension, and diabetes. Paternal factors are also influence pregnancy outcomes but male preconcepction health has received little attention so far and he focus remains on women. Study design, size, duration Cross-sectional evaluation including ann electronic search and investigation of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in south America (N = 11 countries): Argentina, Bolívia, Brasil, Chile, Colômbia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela) that took place in June 2020. No ethical approval was obtained as we used only public avalialble online information. Participants/materials, setting, methods Eleven South American countries) were included Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela.we searched Google using advanced search setup for each country with the following words: Preconception care; Pre-pregnancy care; Before pregnancy; Conception; Pregnancy planning; Preconceptual and variations and Policy; Guidelines, Recommendations and services. Data from the Latin American Registry (REDLARA, 2017) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) was also obtained . Main results and the role of chance Government preconcepction care recommendations were available in 10 countries and 11 had family planning guidelines. Seven countries offered either public clinics or financial aid for infertile couples. According to REDLARA 2017 report there are 122 registered centers in South America but the region host much more. The Brazilian registry shows 154 IVF clinics in 2018. Although most countries offered guidance on major issues including folic acid supplementation (n = 10), nutrition (n = 10), Vaccination (n = 11), alcohol consumption (n = 11), smoking (n = 10), relevant health topics such physical activity (n = 7) and obesity (n = 7) were left out in 58,3% of the countries. Medical societies provided guidelines on preconcpection care in 7 countries and for other health issues: folic acid supplementation (n = 5), nutrition (n = 5), Vaccination (n = 6), alcohol consumption (n = 4), smoking (n = 4), physical activity (n = 4)and obesity (n = 2). When male preconception care was considered, only two countries have public guidelines whereas no medical society provided specific recommendations for men. Sexually transmitted diseases (STD) was another topic of interest for both public (n = 10) and medical societies (n = 4). STD guidelines were heterogenous and focused more on treatment rather than prevention. FLASOG however displayed guidelines for peconception care and STD prevention. Limitations, reasons for caution The search was performed only in Google as it is the most opular search engine. We did not include other search pages asuch as Yahoo and limited our search to the first 3 pages for each search term as people rarely examine more thatn the first there pages. Wider implications of the findings: Current reccomendations are heterogeneous, fragmented and inconsitent and there is a lack of interest on male reproductive health y. Public fertility care is only available in 7 countries. Collaborative research among countries is necessary so as to develop evidence-based guidelines for preconcepction and fertility care for both men and women. Trial registration number not-applicable

James K. Liao, MD, FACP, FACC, is associate professor of medicine at Harvard Medical School and the director of vascular medicine research at Brigham and Women's Hospital, where he oversees all areas of vascular research. He practices as a clinical internist and cardiologist with the Brigham Medical Group in Boston and attends on the Cardiology and Vascular Consult Service at Brigham and Women's Hospital.Dr. Liao received his medical degree at the University of California School of Medicine, San Francisco. He completed medical residency training at Brigham & Women's Hospital and clinical cardiology training at Massachusetts General Hospital, both in Boston.Dr. Liao received the American Federation for Medical Research Outstanding Investigator Award for his research on statins and heart failure. His work attempts to answer whether statins are beneficial in patients with nonischemic congestive heart failure. He found that statins might be effective in congestive heart failure owing to endothelial protective and anti-inflammatory effects.He has contributed to the medical literature, publishing in such journals as Science, Nature, Nature Medicine, Proceedings of the National Academy of Science USA, Molecular and Cellular Biology, Journal of Clinical Investigation, Circulation, and others. Dr. Liao has won numerous awards, including distinction for excellence in teaching from Harvard Medical School. He has published over 100 original reports, review articles, and book chapters and holds several US patents. He is a worldwide invited lecturer on cardiovascular biology.

This article studies Finnish abortion-seeking women in the 1950s and 1960s byinvestigating the life situations of the abortion-seeking women and their possibilitiesto regulate childbearing under the 1950 Abortion Act. During the 1950s and 1960s,abortion was legal in Finland only on medical, ethical or eugenic grounds. The dataconsists of patient documents of the Finnish Family Federations (Vestliitto) Tamperesocial counseling service (sosiaalineuvola) from the years 1955 and 1968 and thedocuments mainly comprise abortion requests. Results show that in 1955 83 percentand in 1968 68 percent of the abortion-seeking women were married. 90 percent ofthem had two or more children and the mothers often requested abortion because ofpoor financial or social circumstances. The family conditions of these women wereoften described as difficult, as they had the main responsibility for taking care of andproviding for their families. The majority of the abortion requests were denied. In 1955,only 16 percent of the abortion-seeking women received an affirmative decision fromthe Family Federation whereas the share of admitted abortions in 1968 was 42 percent.The documents show a severe collision between the womens wishes for abortion and thesocietys interest to prevent abortions for pronatalist reasons. The data also indicatesthat women were not treated equally because their own determined and persistantbehaviour as well as the doctoral practices influenced the abortion decisions.

Abstract STUDY QUESTION How should endometriosis be diagnosed and managed based on the best available evidence from published literature? SUMMARY ANSWER The current guideline provides 109 recommendations on diagnosis, treatments for pain and infertility, management of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents and postmenopausal women, prevention and the association with cancer. WHAT IS KNOWN ALREADY Endometriosis is a chronic condition with a plethora of presentations in terms of not only the occurrence of lesions, but also the presence of signs and symptoms. The most important symptoms include pain and infertility. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 December 2020 and written in English were included in the literature review. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were formulated and discussed within specialist subgroups and then presented to the core guideline development group (GDG) until consensus was reached. A stakeholder review was organized after finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help clinicians to apply best care for women with endometriosis. Although studies mostly focus on women of reproductive age, the guideline also addresses endometriosis in adolescents and postmenopausal women. The guideline outlines the diagnostic process for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic tests. The options for treatment of endometriosis-associated pain symptoms include analgesics, medical treatments and surgery. Non-pharmacological treatments are also discussed. For management of endometriosis-associated infertility, surgical treatment and/or medically assisted reproduction are feasible. While most of the more recent studies confirm previous ESHRE recommendations, there are five topics in which significant changes to recommendations were required and changes in clinical practice are to be expected. LIMITATIONS, REASONS FOR CAUTION The guideline describes different management options but, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in endometriosis care, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payments. C.M.B. reports grants from Bayer Healthcare and the European Commission; Participation on a Data Safety Monitoring Board or Advisory Board with ObsEva (Data Safety Monitoring Group) and Myovant (Scientific Advisory Group). A.B. reports grants from FEMaLE executive board member and European Commission Horizon 2020 grant; consulting fees from Ethicon Endo Surgery, Medtronic; honoraria for lectures from Ethicon; and support for meeting attendance from Gedeon Richter; A.H. reports grants from MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring; Consulting fees from Roche Diagnostics, Nordic Pharma, Chugai and Benevolent Al Bio Limited all paid to the institution; a pending patent on Serum endometriosis biomarker; he is also Chair of TSC for STOP-OHSS and CERM trials. O.H. reports consulting fees and speaker’s fees from Gedeon Richter and Bayer AG; support for attending meetings from Gedeon-Richter, and leadership roles at the Finnish Society for Obstetrics and Gynecology and the Nordic federation of the societies of obstetrics and gynecology. L.K. reports consulting fees from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; honoraria for lectures from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; support for attending meetings from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; he also has a leadership role in the German Society of Gynecological Endocrinology (DGGEF). M.K. reports grants from French Foundation for Medical Research (FRM), Australian Ministry of Health, Medical Research Future Fund and French National Cancer Institute; support for meeting attendance from European Society for Gynaecological Endoscopy (ESGE), European Congress on Endometriosis (EEC) and ESHRE; She is an advisory Board Member, FEMaLe Project (Finding Endometriosis Using Machine Learning), Scientific Committee Chair for the French Foundation for Research on Endometriosis and Scientific Committee Chair for the ComPaRe-Endometriosis cohort. A.N. reports grants from Merck SA and Ferring; speaker fees from Merck SA and Ferring; support for meeting attendance from Merck SA; Participation on a Data Safety Monitoring Board or Advisory Board with Nordic Pharma and Merck SA; she also is a board member of medical advisory board, Endometriosis Society, the Netherlands (patients advocacy group) and an executive board member of the World Endometriosis Society. E.S. reports grants from National Institute for Health Research UK, Rosetrees Trust, Barts and the London Charity; Royalties from De Gruyter (book editor); consulting fees from Hologic; speakers fees from Hologic, Johnson & Johnson, Medtronic, Intuitive, Olympus and Karl Storz; Participation in the Medicines for Women’s Health Expert Advisory Group with Medicines and Healthcare Products Regulatory Agency (MHRA); he is also Ambassador for the World Endometriosis Society. C.T. reports grants from Merck SA; Consulting fees from Gedeon Richter, Nordic Pharma and Merck SA; speaker fees from Merck SA, all paid to the institution; and support for meeting attendance from Ferring, Gedeon Richter and Merck SA. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (Full disclaimer available at www.eshre.eu/guidelines.).

The current paper aims to present the situation of COVID-19 cases recorded among the teams participating in Liga Florilor MOL and Liga Zimbrilor (the best senior leagues in Romania), the monthly distribution of the number of no-shows due to coronavirus and the analysis of teams’ adaptability to the new anti-COVID-19 regulations as regards the number of sanctions received for non-compliance with these rules. The novel coronavirus affected all teams participating in Liga Florilor MOL and Liga Zimbrilor. In total, 365 people including players and staff were infected with SARS CoV-2 during this season. Eight teams were in the situation of not being able to participate in handball tournaments, and 24 games were decided at the green table due to COVID-19, meaning 5.86% of the total number of games scheduled for the best men’s and women’s leagues in the 2020-2021 season. The Romanian Handball Federation organized 207 “bubble system” tournaments for all competitive categories, of which 31 were organized for Liga Florilor MOL (17) and Liga Zimbrilor (14). Throughout the season, the teams successfully adapted to the new rules against the spread of the SARS CoV-2 virus. The sanctions imposed for non-compliance with these rules, excepting the games ended 10:0, were extremely low in numbers. A single pecuniary penalty was applied, which was doubled by an exclusion from that tournament. In addition, a single warning was given to a team that violated the ban on using the locker room inside the sports hall.

Ancient construction and artistic decoration of buildings in European countries as well as in Ukraine have similarities in styles, construction and decoration materials. The planning principles of urban development in Europe and Ukraine have similar roots in the styles dating back to the times of ancient Greece and Rome, which have been well preserved to our time. These styles of classicism and Gothic, baroque and renaissance perfectly harmoniously combine with each other and are complemented by modern buildings. Studying the architecture of the EU countries, we can state that Ukraine is an integral part of Europe. However, Ukraine unfortunately did not take proper care of architectural monuments. You can also add the destruction of thousands of buildings in Ukraine during the Second World War, which were not properly restored. Many buildings were completely destroyed, while others are still in an unsatisfactory condition. The policy of the Soviet Union was built on the principles of labor classism, where any identification with the bourgeoisie (which included private cottages, palaces, cathedrals, etc.) was cruelly rejected and forbidden. Most of the Temples were destroyed by the Soviet authorities, most of the palaces were rebuilt and lost their original beauty. As an example, we can cite the Shariv castle in the Kharkiv region, an architectural masterpiece that was transformed into a tuberculosis dispensary during the Soviet regime, and in the church of the Gamalivsk women's monastery in Shostka, Sumy region, a correctional colony was made, which is still an active colony (Fig. 6) and such Unfortunately, we have a lot of examples. The ancient buildings of the EU countries are protected and restored to preserve the historical style, buildings made of stone or brick are supplemented with modern materials, such as glass and metal structures. During the war with the Russian Federation, many buildings and architectural monuments were destroyed in Ukraine. Now the region needs to develop a unified strategy for the restoration of our state, including rebuilding buildings and structures that have historical and cultural value, form the principle of reproducing the architecture of our cities in accordance with the styles that were used in ancient times. In order to preserve historical objects, it is necessary to have a monument protection policy at the state level, state programs for the protection of cultural heritage, and to ensure the work of the relevant monument protection services. The main idea of the "Recommendations on the Preservation and Modern Role of Historical Ensembles" boils down to ensuring comprehensive protection of objects of historical and cultural and especially architectural heritage. Keywords: architecture, European buildings, classicism, gothic, modern, Ukrainian buildings, reconstruction of buildings, restoration of post-war Ukraine.

Probably the most (in)famous Australian teenager of recent times, now-17-year-old Kim Duthie—better known as the “St Kilda Schoolgirl”—first came to public attention when she posted naked pictures of two prominent St Kilda Australian Football League (AFL) players on Facebook. She claimed to be seeking revenge on the players’ teammate for getting her pregnant. This turned out to be a lie. Duthie also claimed that 47-year-old football manager Ricky Nixon gave her drugs and had sex with her. She then said this was a lie, then that she lied about lying. That she lied at least twice is clear, and in doing so, she arguably reinforced the pervasive myth that women are prone to lie about rape and sexual abuse. Precisely what occurred, and why Duthie posted the naked photographs will probably never be known. However, it seems clear that Duthie felt herself wronged. Can she therefore be held entirely to blame for the way she went about seeking redress from a group of men with infinitely more power than she—socially, financially and (in terms of the priority given to elite football in Australian society) culturally? The many judgements passed on Duthie’s behaviour in the media highlight the crucial, seldom-discussed issue of how problematic behaviour on the part of women might reinforce patriarchal norms. This is a particularly sensitive issue in the context of a spate of alleged sexual assaults committed by elite Australian footballers over the past decade. Given that representations of alleged rape cases in the media and elsewhere so often position women as blameworthy for their own mistreatment and abuse, the question of whether or not women can and should be held accountable in certain situations is particularly fraught. By exploring media representations of one of these complex scenarios, we consider how the issue of “complicity” might be understood in a rape culture. In doing so, we employ Auschwitz survivor Primo Levi’s highly influential concept of the “grey zone,” which signifies a complex and ambiguous realm that challenges both judgement and representation. Primo Levi’s “Grey Zone,” Patriarchy and the Problem of Judgement In his essay titled “The Grey Zone” (published in 1986), Levi is chiefly concerned with Jewish prisoners in the Nazi-controlled camps and ghettos who obtained “privileged” positions in order to prolong their survival. Reflecting on the inherently complex power relations in such extreme settings, Levi positions the “grey zone” as a metaphor for moral ambiguity: a realm with “ill-defined outlines which both separate and join the two camps of masters and servants. [The ‘grey zone’] possesses an incredibly complicated internal structure, and contains within itself enough to confuse our need to judge” (27). According to Levi, an examination of the scenarios and experiences that gave rise to the “grey zone” requires a rejection of the black-and-white binary opposition(s) of “friend” and “enemy,” “good” and “evil.” While Levi unequivocally holds the perpetrators of the Holocaust responsible for their actions, he warns that one should suspend judgement of victims who were entrapped in situations of moral ambiguity and “compromise.” However, recent scholarship on the representation of “privileged” Jews in Levi’s writings and elsewhere has identified a “paradox of judgement”: namely, that even if moral judgements of victims in extreme situations should be suspended, such judgements are inherent in the act of representation, and are therefore inevitable (see Brown). While the historical specificity of Levi’s reflections must be kept in mind, the corruptive influences of power at the core of the “grey zone”—along with the associated problems of judgement and representation—are clearly far more prevalent in human nature and experience than the Holocaust alone. Levi’s “grey zone” has been appropriated by scholars in the fields of Holocaust studies (Petropoulos and Roth xv-xviii), philosophy (Todorov 262), law (Luban 161–76), history (Cole 248–49), theology (Roth 53–54), and popular culture (Cheyette 226–38). Significantly, Claudia Card (The Atrocity Paradigm, “Groping through Gray Zones” 3–26) has recently applied Levi’s concept to the field of feminist philosophy. Indeed, Levi’s questioning of whether or not one can—or should—pass judgement on the behaviour of Holocaust victims has considerable relevance to the divisive issue of how women’s involvement in/with patriarchy is represented in the media. Expanding or intentionally departing from Levi’s ideas, many recent interpretations of the “grey zone” often misunderstand the historical specificity of Levi’s reflections. For instance, while applying Levi’s concept to the effects of patriarchy and domestic violence on women, Lynne Arnault makes the problematic statement that “in order to establish the cruelty and seriousness of male violence against women as women, feminists must demonstrate that the experiences of victims of incest, rape, and battering are comparable to those of war veterans, prisoners of war, political prisoners, and concentration camp inmates” (183, n.9). It is important to stress here that it is not our intention to make direct parallels between the Holocaust and patriarchy, or between “privileged” Jews and women (potentially) implicated in a rape culture, but to explore the complexity of power relations in society, what behaviour eventuates from these, and—most crucial to our discussion here—how such behaviour is handled in the mass media. Aware of the problem of making controversial (and unnecessary) comparisons, Card (“Women, Evil, and Gray Zones” 515) rightly stresses that her aim is “not to compare suffering or even degrees of evil but to note patterns in the moral complexity of choices and judgments of responsibility.” Card uses the notion of the “Stockholm Syndrome,” citing numerous examples of women identifying with their torturers after having been abused or held hostage over a prolonged period of time—most (in)famously, Patricia Hearst. While the medical establishment has responded to cases of women “suffering” from “Stockholm Syndrome” by absolving them from any moral responsibility, Card writes that “we may have a morally gray area in some cases, where there is real danger of becoming complicit in evildoing and where the captive’s responsibility is better described as problematic than as nonexistent” (“Women, Evil, and Gray Zones” 511). Like Levi, Card emphasises that issues of individual agency and moral responsibility are far from clear-cut. At the same time, a full awareness of the oppressive environment—in the context that this paper is concerned with, a patriarchal social system—must be accounted for. Importantly, the examples Card uses differ significantly from the issue of whether or not some women can be considered “complicit” in a rape culture; nevertheless, similar obstacles to understanding problematic situations exist here, too. In the context of a rape culture, can women become, to use Card’s phrase, “instruments of oppression”? And if so, how is their controversial behaviour to be understood and represented? Crucially, Levi’s reflections on the “grey zone” were primarily motivated by his concern that most historical and filmic representations “trivialised” the complexity of victim experiences by passing simplistic judgements. Likewise, the representation of sexual assault cases in the Australian mass media has often left much to be desired. Representing Sexual Assault: Australian Football and the Media A growing literature has critiqued the sexual culture of elite football in Australia—one in which women are reportedly treated with disdain, positioned as objects to be used and discarded. At least 20 distinct cases, involving more than 55 players and staff, have been reported in the media, with the majority of these incidents involving multiple players. Reports indicate that such group sexual encounters are commonplace for footballers, and the women who participate in sexual practices are commonly judged, even in the sports scholarship, as “groupies” and “sluts” who are therefore responsible for anything that happens to them, including rape (Waterhouse-Watson, “Playing Defence” 114–15; “(Un)reasonable Doubt”). When the issue of footballers and sexual assault was first debated in the Australian media in 2004, football insiders from both Australian rules and rugby league told the media of a culture of group sex and sexual behaviour that is degrading to women, even when consensual (Barry; Khadem and Nancarrow 4; Smith 1; Weidler 4). The sexual “culture” is marked by a discourse of abuse and objectification, in which women are cast as “meat” or a “bun.” Group sex is also increasingly referred to as “chop up,” which codes the practice itself as an act of violence. It has been argued elsewhere that footballers treating women as sexual objects is effectively condoned through the mass media (Waterhouse-Watson, “All Women Are Sluts” passim). The “Code of Silence” episode of ABC television program Four Corners, which reignited the debate in 2009, was even more explicit in portraying footballers’ sexual practices as abusive, presenting rape testimony from three women, including “Clare,” who remains traumatised following a “group sex” incident with rugby league players in 2002. Clare testifies that she went to a hotel room with prominent National Rugby League (NRL) players Matthew Johns and Brett Firman. She says that she had sex with Johns and Firman, although the experience was unpleasant and they treated her “like a piece of meat.” Subsequently, a dozen players and staff members from the team then entered the room, uninvited, some through the bathroom window, expecting sex with Clare. Neither Johns nor Firman has denied that this was the case. Clare went to the police five days later, saying that professional rugby players had raped her, although no charges were ever laid. The program further includes psychiatrists’ reports, and statements from the police officer in charge of the case, detailing the severe trauma that Clare suffered as a result of what the footballers called “sex.” If, as “Code of Silence” suggests, footballers’ practices of group sex are abusive, whether the woman consents or not, then it follows that such a “gang-bang culture” may in turn foster a rape culture, in which rape is more likely than in other contexts. And yet, many women insist that they enjoy group sex with footballers (Barry; Drill 86), complicating issues of consent and the degradation of women. Feminist rape scholarship documents the repetitive way in which complainants are deemed to have “invited” or “caused” the rape through their behaviour towards the accused or the way they were dressed: defence lawyers, judges (Larcombe 100; Lees 85; Young 442–65) and even talk show hosts, ostensibly aiming to expose the problem of rape (Alcoff and Gray 261–64), employ these tactics to undermine a victim’s credibility and excuse the accused perpetrator. Nevertheless, although no woman can be in any way held responsible for any man committing sexual assault, or other abuse, it must be acknowledged that women who become in some way implicated in a rape culture also assist in maintaining that culture, highlighting a “grey zone” of moral ambiguity. How, then, should these women, who in some cases even actively promote behaviour that is intrinsic to this culture, be perceived and represented? Charmyne Palavi, who appeared on “Code of Silence,” is a prime example of such a “grey zone” figure. While she stated that she was raped by a prominent footballer, Palavi also described her continuing practice of setting up footballers and women for casual sex through her Facebook page, and pursuing such encounters herself. This raises several problems of judgement and representation, and the issue of women’s sexual freedom. On the one hand, Palavi (and all other women) should be entitled to engage in any consensual (legal) sexual behaviour that they choose. But on the other, when footballers’ frequent casual sex is part of a culture of sexual abuse, there is a danger of them becoming complicit in, to use Card’s term, “evildoing.” Further, when telling her story on “Code of Silence,” Palavi hints that there is an element of increased risk in these situations. When describing her sexual encounters with footballers, which she states are “on her terms,” she begins, “It’s consensual for a start. I’m not drunk or on drugs and it’s in, [it] has an element of class to it. Do you know what I mean?” (emphasis added). If it is necessary to define sex “on her terms” as consensual, this implies that sometimes casual “sex” with footballers is not consensual, or that there is an increased likelihood of rape. She also claims to have heard about several incidents in which footballers she knows sexually abused and denigrated, if not actually raped, other women. Such an awareness of what may happen clearly does not make Palavi a perpetrator of abuse, but neither can her actions (such as “setting up” women with footballers using Facebook) be considered entirely separate. While one may argue, following Levi’s reflections, that judgement of a “grey zone” figure such as Palavi should be suspended, it is significant that Four Corners’s representation of Palavi makes implicit and simplistic moral judgements. The introduction to Palavi follows the story of “Caroline,” who states that first-grade rugby player Dane Tilse broke into her university dormitory room and sexually assaulted her while she slept. Caroline indicates that Tilse left when he “picked up that [she] was really stressed.” Following this story, the program’s reporter and narrator Sarah Ferguson introduces Palavi with, “If some young footballers mistakenly think all women want to have sex with them, Charmyne Palavi is one who doesn’t necessarily discourage the idea.” As has been argued elsewhere (Waterhouse-Watson, “Framing the Victim”), this implies that Palavi is partly responsible for players holding this mistaken view. By implication, she therefore encouraged Tilse to assume that Caroline would want to have sex with him. Footage is then shown of Palavi and her friends “applying the finishing touches”—bronzing their legs—before going to meet footballers at a local hotel. The lighting is dim and the hand-held camerawork rough. These techniques portray the women as artificial and “cheap,” techniques that are also employed in a remarkably similar fashion in the documentary Footy Chicks (Barry), which follows three women who seek out sex with footballers. In response to Ferguson’s question, “What’s the appeal of those boys though?” Palavi repeats several times that she likes footballers mainly because of their bodies. This, along with the program’s focus on the women as instigators of sex, positions Palavi as something of a predator (she was widely referred to as a “cougar” following the program). In judging her “promiscuity” as immoral, the program implies she is partly responsible for her own rape, as well as acts of what can be termed, at the very least, sexual abuse of other women. The problematic representation of Palavi raises the complex question of how her “grey zone” behaviour should be depicted without passing trivialising judgements. This issue is particularly fraught when Four Corners follows the representation of Palavi’s “nightlife” with her accounts of footballers’ acts of sexual assault and abuse, including testimony that a well-known player raped Palavi herself. While Ferguson does not explicitly question the veracity of Palavi’s claim of rape, her portrayal is nevertheless largely unsympathetic, and the way the segment is edited appears to imply that she is blameworthy. Ferguson recounts that Palavi “says she was able to put [being raped] out of her mind, and it certainly didn’t stop her pursuing other football players.” This might be interpreted a positive statement about Palavi’s ability to move on from a rape; however, the tone of Ferguson’s authoritative voiceover is disapproving, which instead implies negative judgement. As the program makes clear, Palavi continues to organise sexual encounters between women and players, despite her knowledge of the “dangers,” both to herself and other women. Palavi’s awareness of the prevalence of incidents of sexual assault or abuse makes her position a problematic one. Yet her controversial role within the sexual culture of elite Australian football is complicated even further by the fact that she herself is disempowered (and her own allegation of being raped delegitimised) by the simplistic ideas about “assault” and “consent” that dominate social discourse. Despite this ambiguity, Four Corners constructs Palavi as more of a perpetrator of abuse than a victim—not even a victim who is “morally compromised.” Although we argue that careful consideration must be given to the issue of whether moral judgements should be applied to “grey zone” figures like Palavi, the “solution” is far from simple. No language (or image) is neutral or value-free, and judgements are inevitable in any act of representation. In his essay on the “grey zone,” Levi raises the crucial point that the many (mis)understandings of figures of moral ambiguity and “compromise” partly arise from the fact that the testimony and perspectives of these figures themselves is often the last to be heard—if at all (50). Nevertheless, an article Palavi published in Sydney tabloid The Daily Telegraph (19) demonstrates that such testimony can also be problematic and only complicate matters further. Palavi’s account begins: If you believed Four Corners, I’m supposed to be the NRL’s biggest groupie, a wannabe WAG who dresses up, heads out to clubs and hunts down players to have sex with… what annoys me about these tags and the way I was portrayed on that show is the idea I prey on them like some of the starstruck women I’ve seen out there. (emphasis added) Palavi clearly rejects the way Four Corners constructed her as a predator; however, rather than rejecting this stereotype outright, she reinscribes it, projecting it onto other “starstruck” women. Throughout her article, Palavi reiterates (other) women’s allegedly predatory behaviour, continually portraying the footballers as passive and the women as active. For example, she claims that players “like being contacted by girls,” whereas “the girls use the information the players put on their [social media profiles] to track them down.” Palavi’s narrative confirms this construction of men as victims of women’s predatory actions, lamenting the sacking of Johns following “Code of Silence” as “disgusting.” In the context of alleged sexual assault, the “predatory woman” stereotype is used in place of the raped woman in order to imply that sexual assault did not occur; hence Palavi’s problematic discourse arguably reinforces sexist attitudes. But can Palavi be considered complicit in validating this damaging stereotype? Can she be blamed for working within patriarchal systems of representation, of which she has also been a victim? The preceding analysis shows judgement to be inherent in the act of representation. The paucity of language is particularly acute when dealing with such extreme situations. Indeed, the language used to explore this issue in the present article cannot escape terminology that is loaded with meaning(s), which quotation marks can perhaps only qualify so far. Conclusion This paper does not claim to provide definitive answers to such complex dilemmas, but rather to highlight problems in addressing the sensitive issues of ambiguity and “complicity” in women’s interactions with patriarchal systems, and how these are represented in the mass media. Like the controversial behaviour of teenager Kim Duthie described earlier, Palavi’s position throws the problems of judgement and representation into disarray. There is no simple solution to these problems, though we do propose that these “grey zone” figures be represented in a self-reflexive, nuanced manner by explicitly articulating questions of responsibility rather than making simplistic judgements that implicitly lessen perpetrators’ culpability. Levi’s concept of the “grey zone” helps elucidate the fraught issue of women’s potential complicity in a rape culture, a subject that challenges both understanding and representation. Despite participating in a culture that promotes the abuse, denigration, and humiliation of women, the roles of women like Palavi cannot in any way be conflated with the roles of the perpetrators of sexual assault. These and other “grey zones” need to be constantly rethought and renegotiated in order to develop a fuller understanding of human behaviour. References Alcoff, Linda Martin, and Laura Gray. “Survivor Discourse: Transgression or Recuperation.” Signs 18.2 (1993): 260–90. 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Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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