RESUMEN
Egypt and Tunisia began their fertility transition at almost identical fertility levels and at roughly the same time period, yet the difference in the pace of decline has been such that the total fertility rate (TFR) in Tunisia reached replacement level by the year 2001, whereas the TFR in Egypt remains above three live births per woman. This article draws on the secondary literature and on several nationally representative surveys from the two countries between 1978 and 2005 to provide empirical evidence of the difference in the pace of fertility decline and to analyze the determinants of the differential. Findings include (a) variation across the two countries in the consistency of fertility decline among the segments of the population leading the transition; (b) that the success of each country's family planning program was influenced by the role of political leaders and the extent of the program's integration within socioeconomic development objectives; (c) that the impact of contraception on TFR decline became an important factor in the mid-1980s; and (d) that the greatest determinant of the discrepancy in the pace of fertility decline is the disparity in age at marriage, which rose more significantly in Tunisia than in Egypt. The latter finding indicates that reaching replacement fertility in Egypt hinges primarily on further declines in marital fertility, resulting from reduction of wanted fertility and from an expansion of family planning program coverage and improved efficiency of service delivery and use.
Asunto(s)
Anticoncepción/estadística & datos numéricos , Servicios de Planificación Familiar/organización & administración , Fertilidad , Egipto/epidemiología , Servicios de Planificación Familiar/legislación & jurisprudencia , Femenino , Humanos , Matrimonio , Política , Política Pública , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Túnez/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
INTRODUCTION AND AIMS: Although once the preserve of tattoo artists, units within the UK have increasingly begun making use of the Clinical Nurse Specialist (CNS) to perform areola tattooing. Bringing the technique within the Breast Unit enhances continuity of care and makes use of skills that can be provided by the CNS. Our CNS is involved with both the patients' oncological management and the areola tattoo service. MATERIALS AND METHODS: The CNS-led service was investigated and patients' experiences of nipple tattooing were assessed. We present the results of a postal questionnaire and a prospective clinical audit of the procedure. RESULTS: Forty tattoos were done over a 2-year period with one self-limiting complication. Patient satisfaction was high both with the outcome and the experience of the procedure. Fading of the tattoo is a consistent finding frequently requiring further shading. CONCLUSION: Overall the patient's experience of a nurse lead 'in-house' tattoo service has been highly satisfactory and this is reflected by their high confidence rating and ease of access to the nurse. We believe that the role of the CNS in oncological treatment and reconstructions helps integrate the multidisciplinary experience for the patient.