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‘Endometriosis made zero sense to me’: what will it take to stop women suffering needlessly? | Society

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Prof Jason Abbott’s interest in gynaecology was piqued in the early 1990s when he treated a significant number of women complaining of troubling symptoms including – but not limited to – pelvic pain, fatigue, heavy bleeding, painful sex and painful bowel movements.

And while some of these women would eventually be given a diagnosis of endometriosis – a severe disorder in which tissue similar to the lining of the uterus grows outside the uterus, causing inflammation and pain – Abbott said the identification of the disease often provided no help in treating the symptoms.

‘What is endometriosis?’ interactive graphic

“The medical community thought we could cure endometriosis with a pill or a surgery,” Abbott said. “And if that didn’t fix it, well, it must be some other condition.

“I wanted to know how to help these people who had very unusual and diverse symptoms, some of whom responded brilliantly to surgery and medical treatment, and some of whom responded to nothing at all.

“There was no rhyme or reason to it. At the time, endometriosis was a disease that just made zero sense to me. I’ve spent the last 25 years trying to investigate further, and it highlighted the lack of evidence and research into this condition.”

Yet it was not until this month that Australia released its first draft guidelines for the clinical diagnosis and management of endometriosis, decades after Abbott began working in the field. It has meant women in Australia have faced an average of five to eight years between first presenting with symptoms and receiving a diagnosis (the delay used to be seven to 12 years), and that their symptoms are still often dismissed or poorly treated in the meantime, resulting in time off work, distress and mental health issues, unnecessary or useless treatments and surgery, and chronic pain.

A report published by the Brigham and Women’s hospital in the US in 2014 described how the science that informs medicine – including the prevention, diagnosis, and treatment of disease – “routinely fails to consider the crucial impact of sex and gender”.

“This happens in the earliest stages of research, when females are excluded from animal and human studies or the sex of the animals isn’t stated in the published results,” the report said.

“Once clinical trials begin, researchers frequently do not enrol adequate numbers of women or, when they do, fail to analyse or report data separately by sex. This hampers our ability to identify important differences that could benefit the health of all.”

One of the most catastrophic examples of this research gap is endometriosis. The disease affects 176 million people worldwide, or one in every nine women. In Australia about 830,000 women and gender-diverse people live with endometriosis. It is a multisystem, debilitating and chronic health problem. Abbott said this was why the release of the draft guidelines for the clinical diagnosis and management of endometriosis was such a pivotal moment.

“These guidelines are a testament to organisations like Endometriosis Australia and patients who have been a powerful force in advocating for women,” Abbott said. “It’s taken a huge amount of work. It’s now absolutely clear this can’t be cured with one treatment, this is a chronic disease, it’s recurrent, it often has a strong genetic component, and it can effect women not just during their reproductive life but their entire lives.

“We must make sure we treat everyone well and effectively.”

The causes of endometriosis are unclear but, along with the draft guidelines, the Australian government has invested funding towards research, education, and developing and implementing the National Action Plan for Endometriosis. While Australia has lagged behind countries such as the UK, which already has clinical guidelines, the significant research and education investment “means we are now definitely up to speed”, Abbott said.

Abbott was on the expert working group that drafted the guidelines, and acknowledges there are still gaps in them.

“Clinical guidelines must be based on evidence and, while we have researchers in areas in everything from diagnostic imagery to surgery, it all takes time to do and filter through,” he said. “Guidelines can’t be based on anecdotal evidence. We hope for the next iteration of these guidelines, we will be able to make substantive additions including to recommendations around surgery so there will be improvements for women’s healthcare for decades to come.”

There is also more to do to empower women, girls and other people with uteruses to understand that pain is not normal. Dr Mike Armour, a clinical advisory committee member for Endometriosis Australia, led a study published on 12 November in the Journal of Pediatric and Adolescent Gynecology that surveyed 4,202 adolescent and young Australian women aged 13 to 25 about menstrual health literacy and menstrual management.

The survey found the majority of young women did not seek medical advice for their menstrual symptoms but used information from the internet (50%) and engaged in self-management, most commonly taking over-the-counter medications such as paracetamol (51%) or ibuprofen (52%). “Despite having significant dysmenorrhea (period pain), the majority (51%) thought their period was normal,” the study found. “Women with higher pain scores were more likely to rate their period as ‘abnormal’
but not more likely to speak to a doctor. Only 53% of those at school at heard of endometriosis.”

Armour said from previous research it is clear most young women do not seek medical attention for their period pain but rather self-medicate, but his team wanted to find out if they had good information about what kind of self-care to use, whether they understood the kind of symptoms that should require a trip to the GP, and whether their personal development, health and physical education class or similar class was a good source of information.

His research identified a number of issues, he said.

“We teach menstruation under the context of sexuality and sexual health linking it to puberty and relationships, how we change and transition,” Armour said.

“Traditionally menstruation has been taught in the context of sexual health practices and not a health issue on its own. There is very minimal content in the syllabus that actually explores menstruation. The syllabus doesn’t deal with pain management or self-care options.”

With poor education about pain and menstrual health, a lack of medical research into reproductive issues that affect them, and a traditionally poor understanding in the medical profession of pelvic pain and conditions related to it such as endometriosis, the average cost for a woman with endometriosis both personally and for society is about A$30,000 a year, previous research by Armour has found.

“This national guideline should assist with some of these issues – and there has been significant funding already allocated to improving GP education and awareness and to improving menstrual heath literacy through menstrual education,” he said.

Lesley Freeman is president of EndoActive Australia and New Zealand, a health promotion charity raising awareness of endometriosis, and the organisation was on the expert advisory group that informed the national action plan.

Freeman welcomed the guidelines, which are open for feedback until 24 December, but said she was concerned by some of the clinical language used, and lack of explanation about procedures. For example, under the guidelines for the signs and symptoms of endometriosis, it says a “pelvic examination” should be offered by clinicians.

“We get a lot of feedback from people with endometriosis and one thing that really upsets them, especially young women, is when a procedure isn’t explained,” Freeman said. “So they go in for a pelvic exam and think it might be an ultrasound or X-ray and don’t realise it is in fact an internal exam.

“That can come as a huge shock if you’re not prepared, and if you’re being examined by a man and not offered the option of having it performed by a woman. It can be very confronting to someone suffering pain and painful sex.”

It was also disappointing, she said, that it took until page 21 of the 63-page document before the target population for the guideline was identified – “women, non-binary and gender diverse people with suspected or confirmed endometriosis”.

“Up until recently women didn’t get included in much that was medical, including the research or the decisions that affected them,” she said. “That’s why it’s so important to state who this guideline is for upfront.

“Women have been missing from the conversation about their own health for so long.”

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Riot police squads intervene as pro-Israel and pro-Palestinian protesters clash in Montreal

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People wave flags atop cars in traffic during a demonstration to voice support for the people of Palestine, at Toronto City Hall in Toronto, Ontario, Canada, on 15 May 2021.


People wave flags atop cars in traffic during a demonstration to voice support for the people of Palestine, at Toronto City Hall in Toronto, Ontario, Canada, on 15 May 2021.

  • Violence
    between pro-Israel and pro-Palestine protesters in Montreal was condemned by
    Canadian Prime Minister Justin Trudeau.
  • Montreal’s
    city police force intervened and declared the protests illegal after tensions
    heightened and clashes broke out.
  • Israeli
    strikes killed 42 Palestinians in the Gaza Strip on Sunday, the worst daily
    toll in almost a week of clashes.

Montreal
– Canadian Prime Minister Justin Trudeau on Sunday condemned the violence and
“despicable rhetoric” that marked several weekend protests throughout
the country, after clashes between pro-Israel and pro-Palestinian protesters in
Montreal.

The
worst violence in years, sparked by unrest in Jerusalem, is raging between the
Jewish state and Islamist militants.

Israeli
strikes killed 42 Palestinians in the Gaza Strip on Sunday, the worst daily
toll in almost a week of deadly clashes.

Speaking
after protests in Montreal, Trudeau condemned what he said was “despicable
rhetoric and violence we saw on display in some protests this weekend”.

While
insisting on the “right to assemble peacefully and express themselves
freely in Canada”, Trudeau stressed in a tweet that there was no tolerance
for “antisemitism, Islamophobia, or hate of any kind”.

Earlier
on Sunday, Montreal police used tear gas following clashes between pro-Israel
and pro-Palestinian protesters.

Several
hundred demonstrators, draped in Israeli flags, had gathered in a central
Montreal square to express solidarity with the Jewish state.

‘Protesting is a right’

Although
the protest started peacefully, tensions ratcheted up with the arrival of
pro-Palestinian demonstrators and clashes soon broke out.

The
SPVM, Montreal’s city police force, declared the protests illegal, and squads
of riot police intervened, using tear gas to separate and disperse the two
groups, according to an AFP journalist at the scene.

The
police spent much of the afternoon in pursuit of the pro-Palestinian
protesters, who spread out and regrouped in commercial streets in the city centre.

Following
the clashes, Montreal Mayor Valerie Plante said on Twitter that
“protesting is a right”, but that “intolerance, violence and
anti-Semitism have no place here”.

She said:

Montreal is a city of peace.

Several
thousand pro-Palestinian demonstrators had gathered on Saturday in central
Montreal to denounce what they said were Israeli repression and “war
crimes” in Gaza.

“Terrorist
Israel”, some protesters chanted, while others held up a banner that read,
“Stop the genocide of Palestinian children”.

Pro-Palestinian
protests happened the same day in multiple Canadian cities, including Toronto,
Ottawa and Vancouver.


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Peter Thiel Helps Fund an App That Tells You What to Do

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“How would you feel about being able to pay to control multiple aspects of another person’s life?” asks the BBC.

“A new app is offering you the chance to do just that.”

When writer Brandon Wong recently couldn’t decide what takeaway to order one evening, he asked his followers on social media app NewNew to choose for him. Those that wanted to get involved in the 24-year-old’s dinner dilemma paid $5 (£3.50) to vote in a poll, and the majority verdict was that he should go for Korean food, so that was what he bought…

NewNew is the brainchild of Los Angeles-based entrepreneur Courtne Smith. The app, which is still in its “beta” or pre-full release stage, describes itself as “a human stock market where you buy shares in the lives of real people, in order to control their decisions and watch the outcome”. For many of us that sounds a bit ominous, but the reality is actually far less alarming. It is aimed at what it calls “creators” — writers, painters, musicians, fashion designers, bloggers etc. It is designed as a way for them to connect far more closely with their fans or followers than on other social media services and, importantly, monetise that connection…

Whenever a vote is cast the creator gets the money minus NewNew’s undisclosed commission… In addition to voting, followers can also pay extra — from $20 — to ask a NewNew creator to do something of their choosing, such as naming a character in a book after them. But the creator can reject all of these “bids”, and if they do so then the follower doesn’t have to part with the money…

Co-founder and chief executive Ms Smith, a 33-year-old Canadian, has big plans for NewNew, and has some heavyweight backers. Investors include Peter Thiel, the billionaire co-founder of PayPal, and the first outside person to put money into Facebook. Others with a stake in the business include leading US tech investment fund Andreessen Horowitz, and Hollywood actor Will Smith (no relation to Courtne). Snapchat has also given technical support.

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Sandpapergate will haunt Australia cricket forever: ex-bowling coach

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Cameron Bancroft. (Photo by Brenton Geach - Gallo Images/Getty Images)


Cameron Bancroft. (Photo by Brenton Geach – Gallo Images/Getty Images)

The 2018 ball-tampering scandal will haunt Australian cricket forever, much like the infamous underarm delivery of 40 years ago, the team’s former bowling coach David Saker said on Monday.

Saker was responding to opening batsman Cameron Bancroft suggesting that Australia’s bowlers knew about the plan in Cape Town to alter the ball which earned him a nine-month ban and rocked the game.

Saker was Australia’s bowling coach when Bancroft was caught trying to rough up the ball with sandpaper during the third Test against South Africa.

While refusing to be drawn on who knew what, Saker said “the finger-pointing is going to go on and on and on”.

“It’s like the underarm, it’s never going to go away,” he told Fairfax Media, referring to a 1981 incident when Trevor Chappell bowled underarm to ensure New Zealand lost a one-day match at the Melbourne Cricket Ground.

The notorious delivery is still cited in New Zealand and in cricketing circles as a prime example of unsporting conduct.

However, the ball-tampering scandal – dubbed “sandpapergate” – had a greater impact on Australian cricket, with the then-captain Steve Smith and his deputy David Warner suspended for a year from all cricket and stripped of their leadership roles.

Darren Lehmann also quit as coach and all the top brass from Cricket Australia left after a scathing review blasted their “arrogant and controlling” win-at-all-costs culture.

No one else among the team or coaching staff was held to account but Bancroft’s remarks in an interview with The Guardian newspaper hinted that the team’s bowlers at least knew about the plan.

“Obviously what I did benefits bowlers and the awareness around that, probably, is self-explanatory,” he said.

Saker added: “There was a lot of people to blame. It could have been me to blame, it could have been someone else. It could have been stopped and it wasn’t, which is unfortunate.

“Cameron’s a very nice guy. He’s just doing it to get something off his chest … He’s not going to be the last.”

In response, Cricket Australia said that if anyone had new information, they would look into it.

Saker said he was not opposed to a fresh investigation but added “I just don’t know what they’re going to find out.”

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Mexico’s Andrea Meza crowned Miss Universe

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Miss Universe Andrea Meza


Miss Universe Andrea Meza

UPDATE:

MISS UNIVERSE 2020/2021 IS ANDREA MEZA FROM MEXICO:


UPDATE:

THE MISS UNIVERSE 2020/2021 TOP 5:

1. Mexico

2. India

3. Brazil

4. Dominican Republic

5. Peru


UPDATE:

HERE ARE THE MISS UNIVERSE 2020/2021 TOP 10 CONTESTANTS:

1. Jamaica 

2. Dominican Republic 

3. India

4. Peru 

5. Australia 

6. Puerto Rico

7. Thailand

8. Costa Rica

9. Mexico

10. Brazil


UPDATE:

MISS UNIVERSE TOP 21 IN SWIMWEAR:


UPDATE:

MISS UNIVERSE TOP 21: 

1. Columbia

2. Peru 

3. Australia 

4. France

5. Myanmar

6. Jamaica 

7. Mexico 

8. Dominican Republic 

9. USA

10. Indonesia 

11. Argentina 

12. India

13. Curaçao

14. Puerto Rico

15. Phillipines 

16. Brazil

17. Great Britain

18. Nicaragua

19. Thailand 

20. Costa Rica

21. Vietnam


 UPDATE:

MISS UNIVERSE SOUTH AFRICA NATASHA JOUBERT WALKS THE STAGE AT MISS UNIVERSE 2020/2021:


74 contestants will compete for the title of Miss Universe on 16 May in Hollywood, Florida. 

The Miss Universe pageant takes place on 16 May in the US (02:00 to 05:00 on 17 May SA time). The show will be broadcast live on 1 Magic (DStv Channel 103) with a repeat at 21:30. 

Reigning Miss Universe Zozibini Tunzi of South Africa will crown her successor at the end of the event.

Representing South Africa is Natasha Joubert, and South Africans are hoping for the “magic double” – back-to-back consecutive wins, which has only happened once before in the pageant’s history.

Natasha wowed crowds at the national costume competition last week and on Friday impressed during the preliminary round

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Miss Mexico crowned Miss Universe 2021

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By AFP Time of article published 16m ago

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Washington – Miss Mexico was crowned Miss Universe on Sunday in Florida, after fellow contestant Miss Myanmar used her stage time to draw attention to the bloody military coup in her country.

Sunday night marked the Miss Universe competition’s return to television, after the pageant was cancelled in 2020 for the first time due to the coronavirus pandemic.

Andrea Meza, 26, finished first ahead of the Brazilian and Peruvian finalists in a flashy televised event, hosted by American actor Mario Lopez and television personality Olivia Culpo.

Former Miss Universe contestants Cheslie Kryst, Paulina Vega and Demi-Leigh Tebow (who won the title in 2017) served as competition analysts and commentators, and a panel of eight women determined the winner.

Dressed in a sparkling red evening gown, Meza tearfully walked the catwalk as Miss Universe for the first time, before rushing back for a group hug with the other competitors.

Meza beat more than 70 contestants from around the globe in the 69th installment of Miss Universe, which was held at the Hard Rock Hotel & Casino in Hollywood, Florida.

In the days leading up to the final competition, Miss Myanmar Thuzar Wint Lwin, who made the top 21, made waves when she used her time in the spotlight to bring attention to the coup in her country.

“Our people are dying and being shot by the military every day,” she said during her biographical video, which showed photos of her taking part in the anti-coup protests. “Therefore I would like to urge everyone to speak out about Myanmar.”

Natasha Joubert, Miss Universe South Africa 2020 competes on stage in Ema Savahl swimwear during the MISS UNIVERSE® Preliminary Competition.

She also won the award for best national costume: during that competition segment on Thursday, she wore an outfit beaded in traditional Burmese patterns and held up a sign that said, “Pray for Myanmar.”

Myanmar has been in uproar since February 1, when the army ousted civilian leader Aung San Suu Kyi.

At least 796 people have been killed by security forces since then, according to a local monitoring group, while nearly 4 000 people are behind bars.

Miss Singapore Bernadette Belle Ong – who did not make the top 21 – also used the national costume portion to make a political statement.

Dressed in a glittering red bodysuit and matching thigh-high boots, she turned around to reveal her cape – in the colours of the Singaporean flag – was painted with the words “Stop Asian Hate.”

“What is this platform for if I can’t use it to send a strong message of resistance against prejudice and violence?” she wrote on Instagram alongside pictures of her outfit.

The United States in particular has seen a surge in anti-Asian violence in the past year, which activists have blamed on former president Donald Trump’s rhetoric, especially his repeated description of Covid-19 as the “China virus.”

The pageant has also drawn criticism in the past for objectifying the contestants.

In recent years, the competition has shifted image, focusing more on female empowerment and activism.

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