Early Genital Surgery in Disorders/Differences of Sex Development: Patients' Perspectives.

Controversy continues over a proposed moratorium on elective genital surgery in childhood for disorders/differences of sex development (DSD). Empirical evidence on patient preference is needed to inform decision-making. We conducted a multicentre survey by cross-sectional questionnaire in 14 specialized clinics in six European countries. The sample comprised 459 individuals (≥ 16 years) with a DSD diagnosis, including individuals with congenital adrenal hyperplasia (CAH) (n = 192), XY DSD with prenatal androgen effect (A) (n = 150), and without (nA) (n = 117). Main outcome measures were level of agreement with given statements regarding genital surgery, including clitoris reduction, vaginoplasty, and hypospadias repair. A total of 66% of individuals with CAH and 60% of those with XY DSD-A thought that infancy or childhood were the appropriate age for genital surgery. Females with XY DSD were divided on this issue and tended to prefer vaginoplasty at a later age (XY DSD-A 39%, XY DSD-nA 32%). A total of 47% of males preferred early hypospadias surgery. Only 12% (CAH), 11% (XY DSD-A), and 21% (XY DSD-nA) thought they would have been better off without any surgery in childhood or adolescence. Individuals who had early genital surgery were more likely to approve of it. Outcome data failed to support a general moratorium on early elective genital surgery. Participant perspectives varied considerably by diagnostic category, gender, history of surgery, and contact with support groups. Case-by-case decision-making is better suited to grasping the ethical complexity of the issues at stake.Trial registration: German Clinical Trials Register DRKS00006072.

Redefining the "Normal" Worker: Law and Policy Choices for Work-Family Balance in Canada: Redéfinir le 'travailleur normal': Regard sur les choix législatifs et de politiques publiques en matière de conciliation travail-famille au Canada.

While the need to reconcile work and family life has been recognized in discrete ways in legislation and policy over the years, there has not been a substantial shift away from the archetype of the "unencumbered" (male) worker to a new model of the "normal" worker. In Canada and elsewhere, legislative protection does not allow women or men to effectively reconcile work and family responsibilities over the life cycle. This paper examines the different ways in which work-family balance is regulated, with a focus on the Canadian federal jurisdiction and the province of Quebec, and underlines the need for coherent labor and social policy. The paper also explores the development of multi-stakeholder initiatives on work-family balance, including the development of voluntary standards and a proposal for a work-family "framework" law to ensure coherence among different laws and programs affecting work-family balance. The paper concludes by confirming the need to move away from an individualized approach toward a more mainstreamed and collectivized approach to work-family balance. Résumé Bien que la nécessité de concilier travail et vie familiale ait fait l'objet d'une reconnaissance timide dans la législation et les politiques publiques au fil des ans, il n'y a pas eu de changement substantiel de l'archétype du travailleur « sans engagements ¼ (homme) vers un nouveau modèle de « travailleur normal ¼. Au Canada et ailleurs, la protection législative ne permet pas aux femmes ou aux hommes d'arrimer efficacement leurs responsabilités professionnelles et familiales au cours de leur vie. Cet article examine les différentes façons dont la conciliation travail-famille est réglementée, particulièrement en droit fédéral canadien et dans la province de Québec, et souligne la nécessité d'une politique sociale et de travail cohérente. Le texte explore également le développement d'initiatives multipartites, y compris l'élaboration de normes volontaires de style ISO et une proposition de loi-cadre travail-famille afin d'assurer une cohérence entre les différents lois et programmes touchant la conciliation famille-travail au Québec. L'article conclut en confirmant la nécessité de passer d'une approche individualisée à une approche plus intégrée et collectivisée de la conciliation travail-famille.

Strategies for managing work/life interaction among women and men with variable and unpredictable work hours in retail sales in Québec, Canada.

Increasingly, work schedules in retail sales are generated by software that takes into account variations in predicted sales. The resulting variable and unpredictable schedules require employees to be available, unpaid, over extended periods. At the request of a union, we studied schedule preferences in a retail chain in Québec using observations, interviews, and questionnaires. Shift start times had varied on average by four hours over the previous week; 83 percent had worked at least one day the previous weekend. Difficulties with work/life balance were associated with schedules and, among women, with family responsibilities. Most workers wanted: more advance notice; early shifts; regular schedules; two days off in sequence; and weekends off. Choices varied, so software could be adapted to take preferences into account. Also, employers could give better advance notice and establish systems for shift exchanges. Governments could limit store hours and schedule variability while prolonging the minimum sequential duration of leave per week.

Balancing work and family in the low-wage service sector: the role of legislated and collectively-bargained norms in Quebec.

OBJECTIVE: This paper looks at the role of legislated norms of general application in shaping "family-friendly" workplaces and their interaction with collectively-bargained standards in the retail service sector and more specifically, in a single unionized retail sector in Quebec, Canada. METHODS: The methodology used is traditional legal research methodology: analysis of laws, collective agreements and case law. The principal norms examined concern parental and family leave, working time and disparities between different employment statuses. RESULTS: A series of legislative provisions have been adopted in Quebec over the last 30 years whose objectives are the improvement of family-related leave and the reduction of working time. Unions have also negotiated provisions in collective agreements with these same goals. In the low-wage retail sector studied, the working time standards negotiated between the unions and the employers reflect the characteristics of the sector, most notably extended opening hours, seven days a week. Predictability of hours also varies according to employment status. Such issues as family-unfriendly working time arrangements (last-minute scheduling, asocial hours, etc.) and the need for flexibility in family-related leave are insufficiently taken into account by the legislated and bargained provisions. CONCLUSIONS: A fine analysis and comprehension of existing formal regulation, be it legislated or collectively-bargained, is required to fully understand workers' experiences with work-family balance and to identify the gaps between formal norms and the needs expressed by workers with respect to work-family balance.