title: Fecal incontinence

text: Functional FI is common. The Rome process published diagnostic criteria for functional FI, which they defined as "recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years". The diagnostic criteria are, one or more of the following factors present for the last 3 months: abnormal functioning of normally innervated and structurally intact muscles, minor abnormalities of sphincter structure/innervation (nerve supply), normal or disordered bowel habits, (i.e., fecal retention or diarrhea), and psychological causes. Furthermore, exclusion criteria are given. These are factors which all must be excluded for a diagnosis of functional FI, and are abnormal innervation caused by lesion(s) within the brain (e.g., dementia), spinal cord (at or below T12), or sacral nerve roots, or mixed lesions (e.g., multiple sclerosis), or as part of a generalized peripheral or autonomic neuropathy (e.g., due to diabetes), anal sphincter abnormalities associated with a multisystem disease (e.g., scleroderma), and structural or neurogenic abnormalities that are the major cause.


title: Fecal incontinence

text: There is no globally accepted definition, but fecal incontinence is generally defined as the recurrent inability to voluntarily control the passage of bowel contents through the anal canal and expel it at a socially acceptable location and time, occurring in individuals over the age of four. "Social continence" has been given various precise definitions for the purposes of research; however, generally it refers to symptoms being controlled to an extent that is acceptable to the individual in question, with no significant effect on their life. There is no consensus about the best way to classify FI, and several methods are used.


title: Fecal incontinence

text: Symptoms can be directly or indirectly related to the loss of bowel control. The direct (primary) symptom is a lack of control over bowel contents which tends to worsen without treatment. Indirect (secondary) symptoms, which are the result of leakage, include pruritus ani (an intense itching sensation from the anus), perianal dermatitis (irritation and inflammation of the skin around the anus), and urinary tract infections. Due to embarrassment, people may only mention secondary symptoms rather than acknowledge incontinence. Any major underlying cause will produce additional signs and symptoms, such as protrusion of mucosa in external rectal prolapse. Symptoms of fecal leakage (FL) are similar, and may occur after defecation. There may be loss of small amounts of brown fluid and staining of the underwear.


title: Fecal incontinence

text: FI can be divided into those people who experience a defecation urge before leakage (urge incontinence), and those who experience no sensation before leakage (passive incontinence or soiling). Urge incontinence is characterized by a sudden need to defecate, with little time to reach a toilet. Urge and passive FI may be associated with weakness of the external anal sphincter (EAS) and internal anal sphincter (IAS) respectively. Urgency may also be associated with reduced rectal volume, reduced ability of the rectal walls to distend and accommodate stool, and increased rectal sensitivity.


title: Fecal incontinence

text: There is a continuous spectrum of different clinical presentations from incontinence of flatus (gas), through incontinence of mucus or liquid stool, to solids. The term "anal incontinence" often is used to describe flatus incontinence, however it is also used as a synonym for FI generally. It may occur together with incontinence of liquids or solids, or it may present in isolation. Flatus incontinence may be the first sign of FI. Once continence to flatus is lost, it is rarely restored. Anal incontinence may be equally disabling as the other types. Fecal leakage, fecal soiling and fecal seepage are minor degrees of FI, and describe incontinence of liquid stool, mucus, or very small amounts of solid stool. They cover a spectrum of increasing symptom severity (staining, soilage, seepage and accidents). Rarely, minor FI in adults may be described as encopresis. Fecal leakage is a related topic to rectal discharge, but this term does not necessarily imply any degree of incontinence. Discharge generally refers to conditions where there is pus or increased mucus production, or anatomical lesions that prevent the anal canal from closing fully, whereas fecal leakage generally concerns disorders of IAS function and functional evacuation disorders which cause a solid fecal mass to be retained in the rectum. Solid stool incontinence may be called complete (or major) incontinence, and anything less as partial (or minor) incontinence (i.e. incontinence of flatus (gas), liquid stool and/or mucus).


title: Fecal incontinence

text: In children over the age of four who have been toilet trained, a similar condition is generally termed encopresis (or soiling), which refers to the voluntary or involuntary loss of (usually soft or semi-liquid) stool. The term pseudoincontinence is used when there is FI in children who have anatomical defects (e.g. enlarged sigmoid colon or anal stenosis). Encopresis is a term that is usually applied when there are no such anatomical defects present. The ICD-10 classifies nonorganic encopresis under "behavioural and emotional disorders with onset usually occurring in childhood and adolescence" and organic causes of encopresis along with FI. FI can also be classified according to gender, since the cause in females may be different from males, for example it may develop following radical prostatectomy in males, whereas females may develop FI as an immediate or delayed consequence of damage whilst giving birth. Pelvic anatomy is also different according to gender, with a wider pelvic outlet in females.


title: Fecal incontinence

text: Several severity scales exist. The Cleveland Clinic (Wexner) fecal incontinence score takes into account five parameters that are scored on a scale from zero (absent) to four (daily) frequency of incontinence to gas, liquid, solid, of need to wear pad, and of lifestyle changes. The Park's incontinence score uses four categories:


title: Fecal incontinence

text: The fecal incontinence severity index is based on four types of leakage (gas, mucus, liquid stool, solid stool) and five frequencies (once to three times per month, once per week, twice per week, once per day, twice or more per day). Other severity scales include: AMS, Pescatori, Williams score, Kirwan, Miller score, Saint Mark's score and the Vaizey scale.


title: Fecal incontinence

text: FI may present with signs similar to rectal discharge (e.g. fistulae, proctitis or rectal prolapse), pseudoincontinence, encopresis (with no organic cause) and irritable bowel syndrome.


title: Fecal incontinence

text: FI is generally treatable with conservative management, surgery or both. The success of treatment depends upon the exact causes and how easily these are corrected. Treatment choice depends on the cause and severity of disease, and the motivation and general health of the person affected. Commonly, conservative measures are used together, and if appropriate surgery carried out. Treatments may be attempted until symptoms are satisfactorily controlled. A treatment algorithm based upon the cause has been proposed, including conservative, non-operative and surgical measures (neosphincter refers to either dynamic graciloplasty or artificial bowel sphincter, lavage refers to retrograde rectal irrigation). Conservative measures include dietary modification, drug treatment, retrograde anal irrigation, biofeedback retraining anal sphincter exercises. Incontinence products refer to devices such as anal plugs and perineal pads and garments such as diapers/nappies. Perineal pads are efficient and acceptable for only minor incontinence. If all other measures are ineffective removing the entire colon may be an option.


title: Fecal incontinence

text: Dietary modification may be important for successful management. Both diarrhea and constipation can contribute to different cases, so dietary advice must be tailored to address the underlying cause or it may be ineffective or counter productive. In persons with disease aggravated by diarrhea or those with rectal loading by soft stools, the following suggestions may be beneficial: increase dietary fiber; reduce wholegrain cereals/bread; reduce fruit and vegetables which contain natural laxative compounds (rhubarb, figs, prunes/plums); limit beans, pulses, cabbage and sprouts; reduce spices (especially chilli); reduce artificial sweeteners (e.g. sugar free chewing gum); reduce alcohol (especially stout, beer and ale); reduce lactose if there is some degree of lactase deficiency; and reduce caffeine. Caffeine lowers the resting tone of the anal canal and also causes diarrhea. Excessive doses of vitamin C, magnesium, phosphorus and/or calcium supplements may increase FI. Reducing olestra fat substitute, which can cause diarrhea, may also help.


title: Fecal incontinence

text: Pharmacological management may include anti-diarrheal/constipating agents and laxatives/stool bulking agents. Stopping or substituting any previous medication that causes diarrhea may be helpful in some (see table). There is not good evidence for the use of any medications, however.


title: Fecal incontinence

text: In people who have undergone gallbladder removal, the bile acid sequestrant cholestyramine may help minor degrees of FI. Bulking agents also absorb water, so may be helpful for those with diarrhea. A common side effect is bloating and flatulence. Topical agents to treat and prevent dermatitis may also be used, such as topical antifungals when there is evidence of perianal candidiasis or occasionally mild topical anti-inflammatory medication. Prevention of secondary lesions is carried out by perineal cleansing, moisturization, and use of a skin protectant.


title: Fecal incontinence

text: Evacuation aids (suppositories or enemas) e.g. glycerine or bisacodyl suppositories may be prescribed. People may have poor resting tone of the anal canal, and consequently may not be able to retain an enema, in which case transanal irrigation (retrograde anal irrigation) may be a better option, as this equipment utilizes an inflatable catheter to prevent loss of the irrigation tip and to provide a water tight seal during irrigation. A volume of lukewarm water is gently pumped into the colon via the anus. People can be taught how to perform this treatment in their own homes, but it does require special equipment. If the irrigation is efficient, stool will not reach the rectum again for up to 48 hours. By regularly emptying the bowel using transanal irrigation, controlled bowel function is often re-established to a high degree in patients with bowel incontinence and/or constipation. This enables control over the time and place of evacuation and development of a consistent bowel routine. However, persistent leaking of residual irrigation fluid during the day may occur and make this option unhelpful, particularly in persons with obstructed defecation syndrome who may have incomplete evacuation of any rectal contents. Consequently, the best time to carry out the irrigation is typically in the evening, allowing any residual liquid to be passed the next morning before leaving the home. Complications such as electrolyte imbalance and perforation are rare. The effect of transanal irrigation varies considerably. Some individuals experience complete control of incontinence, and other report little or no benefit. It has been suggested that if appropriate, people be offered home retrograde anal irrigation.


title: Fecal incontinence

text: Biofeedback (the use of equipment to record or amplify and then feed back activities of the body) is a commonly used and researched treatment, but the benefits are uncertain. Biofeedback therapy varies in the way it is delivered, but it is unknown if one type has benefits over another.


title: Fecal incontinence

text: The role of pelvic floor exercises and anal sphincter exercises in FI is poorly determined. While there may be some benefit they appear less useful than implanted sacral nerve stimulators. These exercises aim to increase the strength of the pelvic floor muscles (mainly levator ani). The anal sphincters are not technically part of the pelvic floor muscle group, but the EAS is a voluntary, striated muscle which therefore can be strengthened in a similar manner. It has not been established whether pelvic floor exercises can be distinguished from anal sphincter exercises in practice by the people doing them. This kind of exercise is more commonly used to treat urinary incontinence, for which there is a sound evidence base for effectiveness. More rarely are they used in FI. The effect of anal sphincter exercises are variously stated as an increase in the strength, speed or endurance of voluntary contraction (EAS).


title: Fecal incontinence

text: Electrical stimulation can also be applied to the anal sphincters and pelvic floor muscles, inducing muscle contraction without traditional exercises (similar to transcutaneous electrical nerve stimulation, TENS). The evidence supporting its use is limited, and any benefit is tentative. In light of the above, intra-anal electrical stimulation (using an anal probe as electrode) appears to be more efficacious than intra-vaginal (using a vaginal probe as electrode). Rarely, skin reactions may occur where the electrodes are placed, but these issues typically resolve when the stimulation is stopped. Surgically implanted sacral nerve stimulation may be more effective than exercises, and electrical stimulation and biofeedback may be more effective than exercises or electrical stimulation by themselves. TENS is also sometimes used to treat FI by transcutaneous tibial nerve stimulation.


title: Fecal incontinence

text: In a minority of people, anal plugs may be useful for either standalone therapy or in concert with other treatments. Anal plugs (sometimes termed tampons) aim to block involuntary loss of fecal material, and they vary in design and composition. Polyurethane plugs were reported to perform better than those made of polyvinyl-alcohol. Plugs are less likely to help those with frequent bowel movements, and many find them difficult to tolerate.


title: Fecal incontinence

text: In women, a device that functions as an inflatable balloon in the vagina, has been approved for use in the United States.


title: Fecal incontinence

text: Surgery may be carried out if conservative measures alone are not sufficient to control incontinence. There are many surgical options, and their relative effectiveness is debated due to a lack of good quality evidence. The optimal treatment regime may be a both surgical and non-surgical treatments. The surgical options can be considered in four categories: restoration and improvement of residual sphincter function (sphincteroplasty, sacral nerve stimulation, tibial nerve stimulation, correction of anorectal deformity), replacement / imitation of the sphincter or its function (anal encirclement, SECCA procedure, non-dynamic graciloplasty, perianal injectable bulking agents), dynamic sphincter replacement (artificial bowel sphincter, dynamic graciloplasty), antegrade continence enema (Malone procedure), and finally fecal diversion (e.g. colostomy). A surgical treatment algorithm has been proposed. Isolated sphincter defects (IAS/EAS) may be initially treated with sphincteroplasty and if this fails, the person can be assessed for sacral nerve stimulation. Functional deficits of the EAS and/or IAS (i.e. where there is no structural defect, or only limited EAS structural defect, or with neurogenic incontinence) may be assessed for sacral nerve stimulation. If this fails, neosphincter with either dynamic graciloplasty or artificial anal sphincter may be indicated. Substantial muscular and/or neural defects may be treated with neosphincter initially.


title: Fecal incontinence

text: FI is thought to be very common, but much under-reported due to embarrassment. One study reported a prevalence of 2.2% in the general population. It affects people of all ages, but is more common in older adults (but it should not be considered a normal part of aging). Females are more likely to develop it than males (63% of those with FI over 30 may be female). In 2014, the National Center for Health Statistics reported that one out of every six seniors in the U.S. who lived in their own home or apartment had FI. Men and women were equally affected. 45–50% of people with FI have severe physical and/or mental disabilities. People with dementia are four times more likely to have fecal incontinence compared to people of similar ages.


title: Fecal incontinence

text: Risk factors include age, female gender, urinary incontinence, history of vaginal delivery (non-Caesarean section childbirth), obesity, prior anorectal surgery, poor general health and physical limitations. Combined urinary and fecal incontinence is sometimes termed double incontinence, and it is more likely to be present in those with urinary incontinence.


title: Fecal incontinence

text: Traditionally, FI was thought to be an insignificant complication of surgery, but it is now known that a variety of different procedures are associated with this possible complication, and sometimes at high levels. Examples are midline internal sphincterotomy (8% risk), lateral internal sphincterotomy, fistulectomy, fistulotomy (18-52%), hemorrhoidectomy (33%), ileo-anal reservoir reconstruction, lower anterior resection, total abdominal colectomy, ureterosigmoidostomy, and anal dilation (Lord's procedure, 0-50%). Some authors consider obstetric trauma to be the most common cause.


title: Fecal incontinence

text: While the first mention of urinary incontinence occurs in 1500 BC in the Ebers Papyrus, the first mention of FI in a medical context is unknown. For many centuries, colonic irrigation was the only treatment available. Stoma creation was described in 1776, FI associated with rectal prolapse in 1873 and anterior sphincter repair in 1875. During the mid 20th Century, several operations were developed for instances where the sphincters were intact but weakened. Muscle transpositions using the gluteus maximus or the gracilis were devised, but did not become used widely until later. End-to-end sphincteroplasty is shown to have a high failure rate in 1940. In 1971, Parks and McPartlin first describe an overlapping sphincteroplasty procedure. Biofeedback is first introduced in 1974. In 1975, Parks describes post anal repair, a technique to reinforce the pelvic floor and EAS to treat idiopathic cases. Endoanal ultrasound is invented in 1991, which starts to demonstrate the high number of occult sphincter tears following vaginal deliveries. In 1994, the use of an endoanal coil during pelvic MRI shows greater detail of the anal canal than previously. During the last 20 years, dynamic graciliplasty, sacral nerve stimulation, injectable perianal bulking agents and radiofrequency ablation have been devised, mainly due to the relatively poor success rates and high morbidity associated with the earlier procedures.


title: Fecal incontinence

text: Persons with this symptom are frequently ridiculed and ostracized in public. It has been described as one of the most psychologically and socially debilitating conditions in an otherwise healthy individual. In older people, it is one of the most common reasons for admission into a care home. Persons who develop FI earlier in life are less likely to marry and obtain employment. Often, people will go to great lengths to keep their condition secret. It has been termed "the silent affliction" since many do not discuss the problem with their close family, employers or clinicians. They may be subject to gossip, hostility, and other forms of social exclusion. The economic cost has not received much attention. In the Netherlands, outpatients were reported to have total costs of €2169 annually, and over half of this was productivity loss in work. In the US, the average lifetime cost (treatment and follow-up) was $17,166 per person in 1996. The average hospital charges for sphincteroplasty was $8555 per procedure. Overall, in the US, the total charges associated with surgery increased from $34 million in 1998 to $57.5 million in 2003. Sacral nerve stimulation, dynamic graciloplasty and colostomy were all shown to be cost effective.


title: Fecal incontinence

text: Some insults in Japan relate to incontinence, such as "kusotare/kusottare" and "shikkotare" which mean "shit hanger/leaker/oozer" and "piss leaker/oozer" respectively, though these have not been in common use since the 1980s.


title: Fecal incontinence

text: The case "Hiltibran et al v. Levy et al" in the United States District Court for the Western District of Missouri resulted in that court issuing an order in 2011. That order requires incontinence briefs funded by Medicaid to be given by Missouri to adults who would be institutionalized without them.


title: Fecal incontinence

text: Engineered anal sphincters grown from stem cells have been successfully implanted in mice. New blood vessels developed and the tissue displayed normal contraction and relaxation. In the future, these methods may become part of the management of FI, replacing the need for high morbidity implanted devices such as the artificial bowel sphincter.


title: False pregnancy

text: False pregnancy (or pseudocyesis, from the Greek "false" and "pregnancy") is the appearance of clinical or subclinical signs and symptoms associated with pregnancy although the individual is not physically carrying a baby. The mistaken impression that one is pregnant includes signs and symptoms such as tender breasts with secretions, abdominal growth, delayed menstrual periods, and subjective feelings of a moving fetus. Examination, ultrasound, and pregnancy tests can be used to rule out false pregnancy.


title: False pregnancy

text: False pregnancy has a prominent psychiatric component as well as physical manifestations of pregnancy. It can be caused by trauma (either physical or mental), a chemical imbalance of hormones, and some medical conditions. Contributing psychological factors include a strong desire for pregnancy or misinterpretation of objective bodily sensations. Although rare, men can experience false pregnancy symptoms, called Couvade syndrome or "sympathetic pregnancy", which can occur when their significant other is pregnant and dealing with pregnancy symptoms. Psychotherapy, pharmacotherapy with antidepressants or antipsychotics, hormonal therapy, and uterine curettage are sometimes needed as treatment.


title: False pregnancy

text: While extremely rare in the United States because of the frequent use of medical imaging, in developing regions such as India and sub-Saharan Africa, the incidence of false pregnancy is higher. Rural areas see more instances of false pregnancy because such women are less often examined by a health care professional or midwife during the duration of believed pregnancy.


title: False pregnancy

text: In the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), false pregnancy is a somatic symptom disorder; it is listed as "not elsewhere classified", meaning it is in a category by itself, different from other somatic symptom disorders such as functional neurological symptom disorder (formerly known as conversion disorders). The word "pseudocyesis" comes from the Greek words which means "false" and which means "pregnancy".


title: False pregnancy

text: False pregnancy is sometimes referred to as "delusional pregnancy", but the distinction between the two conditions is inexact. Delusional pregnancy is typically used when there are no physical signs of pregnancy, but false pregnancy can also be delusional. Some authors consider the two conditions can be used interchangeably for research purposes.


title: False pregnancy

text: The symptoms of pseudocyesis are similar to the symptoms of a true pregnancy. Signs of false pregnancy include amenorrhea (missed periods), galactorrhea (flow of milk from breast), breast enlargement, weight gain, abdominal growth, sensations of fetal movement and contractions, nausea and vomiting, changes in the uterus and cervix, and frequent urination.


title: False pregnancy

text: Abdominal distention is the most common symptom. In pseudocyetic abdominal swellings, the abdomen becomes uniformly swollen, and the navel stays inverted. The wall of the abdomen adopts a muscular, tympanic character.


title: False pregnancy

text: The exact mechanisms behind false pregnancy are not completely understood, but psychological and endocrine components may play a substantial role. Women who experience false pregnancy often experience related feelings of stress, fear, anticipation, and general emotional disturbance. These strong emotions, along with dysfunctional changes in hormonal regulation, can significantly increase prolactin levels. Prolactinemia (high prolactin levels) can lead to many of the symptoms of true pregnancy, such as amenorrhea, galactorrhea, and tender breasts. Heightened activity of the central nervous system may contribute to the abdominal distension, sensations of fetal movement, and assumed contraction pains experienced by many women with false pregnancy.


title: False pregnancy

text: Endocrine changes observed in pseudocyesis include an increase in dopamine levels, nervous system activity, or dysfunction in the central nervous system. These changes may be responsible for amenorrhea, galactorrhea, and hyperprolactinemia seen in falsely pregnant women. Elevated sympathetic activity has been linked to the increased in abdominal size as well as the apparent feel of fetal movement and contractions.


title: False pregnancy

text: How abdominal distension develops is not fully understood and several causes have been proposed. A buildup in fat around the abdominal cavity, heavy constipation, habitual lordosis, and other causes may produce the appearance of a distended abdomen, and the resulting swelling can remain for months. After women with false pregnancy are placed under anesthesia, or are successfully persuaded that they are not pregnant, the distention promptly disappears, indicating that the proposed mechanisms are supplementary factors behind, but not the ultimate causes of, abdominal swelling. Manipulation of abdominal wall muscles, such as the diaphragm, is the most likely contributor to abdominal distention. For example, continuously contracting the diaphragm may give the appearance of a distended abdomen while forcing the intestinal units downwards. The sensations of fetal movement may also be related to contractions of the abdominal wall due to peristalsis, or movements of the gastrointestinal tract.


title: False pregnancy

text: About one in six false pregnancies is potentially influenced by concomitant medical or surgical conditions including gallstones, abdominal tumors, hyperprolactinaemia, constipation, tubal cysts, and esophageal achalasia.


title: False pregnancy

text: Psychiatric disorders, such as anxiety or mood disorders, personality disorders, and schizophrenia are common among women with false pregnancy, and may be linked to its development. Some women with depression may gain weight due to decreased physical activity and poor eating habits. Antipsychotics can induce pregnancy-like symptoms such as amenorrhea, galactorrhea, breast tenderness, and weight gain via raising prolactin levels.


title: False pregnancy

text: Psychological factors are associated with false pregnancy, including a strong desire for pregnancy; a misunderstanding of sensory changes in the body (for example, bloating or increased pressure on the pelvis); and depressive disorders that can lead to changes in the neuroendocrine system. Other social factors impacting include low educational status, marital issues, unstable relationship patterns, history of partner abuse, social deprivation, poverty, lower socioeconomic status, and unemployment. Other factors such as mental and physical trauma—like experiencing a miscarriage, infertility, loss of child, or sexual abuse—can manifest false pregnancy. Symptoms may arise in women who are experiencing grief after loss in their reproductive abilities, rejecting the idea of motherhood and pregnancy, or facing challenges in gender identity. Other psychological factors include recurrent miscarriages, stress of imminent menopause, tubal ligation (sterilization surgery), and hysterectomy.


title: False pregnancy

text: Evaluation required to confirm false pregnancies includes a pelvic exam, a blood or urine pregnancy test, and an ultrasound. A pelvic exam can show if conception has occurred, blood and urine can be tested for hormones released in pregnancy, and ultrasound shows the absence of the fetus. An ultrasound can accurately distinguish between a false and true pregnancy. There is no universal laboratory profile for women with false pregnancy; measured concentrations for prolactin, progesterone, follicle stimulating hormone, estrogen, and luteinizing hormone vary widely.


title: False pregnancy

text: In some cases, false pregnancy symptoms may mask underlying medical conditions such as abdominal tumors, central nervous tumors, ovarian cysts, or gallstones. Medical tests and imaging are recommended to rule out potentially life-threatening conditions.


title: False pregnancy

text: Delusional pregnancy is distinct from false pregnancy; although the distinction is "blurred", physical signs of pregnancy are not present in delusional pregnancy, while false pregnancy includes symptoms of true pregnancy. According to Gogia "et al." (2020), false pregnancy "involves a false belief that one is pregnant, but differs from delusional pregnancy in that it is a psychosomatic rather than psychotic or purely delusional belief". In delusional pregnancy, schizophrenia accounts for more than a third of cases.


title: False pregnancy

text: The symptoms of false pregnancy can be misinterpreted by the individual as a true pregnancy when the symptoms are actually caused by diseases (like hormone-secreting tumors, alcoholic liver disease, cholecystitis, urinary tract infection, gallstones) or exposure to a substance (like a medication), or other conditions like constipation.


title: False pregnancy

text: Additional interventions such as psychotherapy and pharmacotherapy are sometimes needed. Psychotherapy may be used when individuals have difficulty coming to terms with their false pregnancy, or remain symptomatic after knowing their false diagnosis. It allows patients to confront reality and accept the symptoms as illusions and provides an opportunity resolve other psychological stressors and trauma that may be implicated in manifestations of false pregnancy.


title: False pregnancy

text: There is no direct evidence for treating false pregnancy with pharmacotherapy, but medications may be used to restore hormonal and neurotransmitter imbalances which are implicated in physical manifestations of false pregnancy. Reduction in catecholamine levels have been observed in people with symptoms such as hyperprolactinemia and abdominal distentions. For most people, psychotherapy, pharmacotherapy (with antidepressants or antipsychotics), hormonal therapy, and uterine tissue removal is adequate to treat the condition.


title: False pregnancy

text: Antipsychotics have been shown to increase lactation and amenorrhea, and can trigger delusions. The delusion may be resolved with medication changes or adjustments. When underlying medical conditions or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, and constipation are identified, treatment may reduce the severity of the delusion.


title: False pregnancy

text: The rate of pseudocyesis in the United States has declined significantly since 1940. The rate in 1940 of one occurrence for approximately every 250 pregnancies had dropped by 2007 to between one and six occurrences for every 22,000 births. In Nigeria, the frequency of false pregnancies was 1 in 344 true pregnancies, and in Sudan false pregnancies were reported to be 1 in 160. There were about 550 cases documented in the literature , with most cases in those between the ages of 20 and 44.


title: False pregnancy

text: Women of reproductive age comprise the majority of pseudocyesis occurrences. About 80% of women who experience pseudocyesis are married. False pregnancies are more common in societies with certain cultures and religions, particularly in areas where there is a high degree of pressure for women to have multiple children, and for those children to be male.


title: False pregnancy

text: Although rare, pseudocyesis occurs more commonly in developing countries. It is reported more frequently in countries that place heavy emphasis on fertility and childbearing; such pronatalist beliefs are often highly prominent in developing countries. In , a woman is allowed to share her husband's property only if she bears children. In these countries (and other developing nations), infertile women often experience abuse, blame, and discrimination. Societal factors enforce the importance of female fertility in these countries, thus possibly contributing to pseudocyesis rates.


title: False pregnancy

text: In addition to men, mothers of pregnant women may experience Couvade syndrome, and a woman can experience multiple episodes of pseudocyesis in her lifetime.


title: False pregnancy

text: The perception of false pregnancy has evolved over time. In the late 17th century, French obstetrician François Mauriceau believed that the enlarged abdomens of falsely pregnant patients were caused by bad air. Physicians slowly began to acknowledge other potential causes of pseudocyesis, including its origin in the mind and in the body. In 1877, a physician named Joshua Whittington Underhill observed that physical symptoms can convince a woman of pregnancy, or a "disordered brain" can convince her that ordinary abdominal pains or bowel movements are instead fetal movements. The idea that pseudocyesis could result from a woman's perception of herself led to investigation into the role of emotions in cases of pseudocyesis. An investigator in the early 20th century observed that strong emotions can dry a woman's milk supply. The investigator went on to infer that the opposite was also true, and it was believed that strong emotions could bring about its production in women who are not pregnant. Alternatively, some physicians questioned the legitimacy of pseudocyesis as a condition. For instance, French obstetrician Charles Pajot stated in the 19th century, "there are no false pregnancies, only false diagnoses."


title: False pregnancy

text: In the mid-1960s, a woman who appeared to be in labor was not properly examined because delivery appeared imminent; it was thought that her water broke but the expelled liquid was urine. In 2010, a woman in the United States who was suspected of being in labor was given a C-section but there was no fetus.


title: False pregnancy

text: Mary Tudor, also known as "Bloody Mary", had a false pregnancy. After coming to terms with it, she reportedly believed that God had not made her pregnant because she had not sufficiently punished heretics.


title: False pregnancy

text: Anna O (Josef Breuer's patient as mentioned in 1895 by Breuer and Sigmund Freud in "Studies on Hysteria"), experienced false pregnancy in the context of preexisting mental health problems. After being diagnosed with hysteria, she believed she was pregnant by Breuer, her therapist. She even believed she was in labor as she was trying to have another session with Breuer. More recent publications suggest she had central neurological signs with a chronic cough that improved during high altitude stays. Those characteristics, as well as the ineffectiveness of psychoanalytic cures, seem to indicate a more organic diagnosis such as tuberculous meningitis or tuberculous encephalitis with partial temporal epileptic component.


title: My Hero Academia (season 6)

text: The sixth season of the "My Hero Academia" anime series is produced by Bones and directed by Kenji Nagasaki (chief director) and Masahiro Mukai, following the story of the original manga series starting from the first chapters of the 27th volume. It covers the ""Paranormal Liberation War"" arc (chapters 258–306), the season's first episode partially covers the rest of last season's chapter, while the rest will be the remaining chapters in this arc. It premiered on October 1, 2022, on ytv and NTV. The season will run for two consecutive cours, in which it will air for 25 episodes.


title: My Hero Academia (season 6)

text: The season follows the climactic battle between the Heroes with the students including Izuku Midoriya of U.A. High School, and the villains of the Paranormal Liberation Front led by Tomura Shigaraki. After Hawks, undercover the merged-villain group has put the pieces together from his investigation, the Heroes have assembled all of the information they need to confront them which leads to an all-out war that could change the superhuman society.


title: My Hero Academia (season 6)

text: Crunchyroll has licensed the season outside of Asia and is streaming it along with the English dub two weeks after the airing. Medialink licensed the season in Asia-Pacific. The season premiered on Adult Swim's Toonami programming block on December 4, 2022.


title: My Hero Academia (season 6)

text: For the first cour, the opening theme is by Super Beaver while the ending theme is "Sketch" by Kiro Akiyama.


title: My Hero Academia (season 6)

text: Toho will release the sixth season of the anime on DVD and Blu-ray in four volumes in Japan, with the first volume releasing on January 18, 2023, and the final volume set to be released on July 19, 2023.


title: Television content rating system

text: Television content rating systems are systems for evaluating the content and reporting the suitability of television programs for minors. Many countries have their own television rating system and countries' rating processes vary by local priorities. Programs are rated by the organization that manages the system, the broadcaster, or the content producers.


title: Television content rating system

text: A rating is usually set for each individual episode of a television series. The rating can change per episode, network, rerun, and country. As such, program ratings are usually not meaningful unless when and where the rating is used is mentioned.


title: Television content rating system

text: A comparison of current television content rating systems, showing age on the horizontal axis. Note however that the specific criteria used in assigning a classification can vary widely from one country to another. Thus a color code or age range cannot be directly compared from one country to another.


title: Television content rating system

text: Starting from September 2010, it is compulsory for broadcasters to show the plaque Comienza el horario apto para todo público () and Finaliza el horario apto para todo público () at 6:00 a.m. or 7:00 a.m. and 10:00 p.m. or 10:30 p.m. respectively. In addition, the plaque Atención: Contenido no apto para niños, niñas y adolescentes () is shown before news broadcasts.


title: Television content rating system

text: A television content rating system for Armenia was introduced in June 2006 (first tested in Yerevan in January 2006). The Armenian ratings are as follows:


title: Television content rating system

text: Classifications are intended to be equivalent to the Australian Classification Board (ACB) classifications of the same name. They're usually presented with the same shape and sometimes colour as their ACB counterparts.


title: Television content rating system

text: R 18+ and X 18+ restricted classifications are not permitted for free-to-air broadcast in Australia. Many R 18+ movies on DVD/Blu-ray are often edited on Free TV/cable networks, to secure an MA 15+ classification or lower. Some movies that were classified R 18+ on DVD have since been aired on Australian TV with an MA 15+ classification.


title: Television content rating system

text: Consumer advice is compulsory for all MA 15+ and one-off programmes, as well as very short series classified M or higher (such as feature films, miniseries and documentaries). When a programme carries consumer advice, appropriate abbreviations are displayed along with the classification symbol after each commercial break. In general, these abbreviations are as follows:


title: Television content rating system

text: For violence, coarse language and sex scenes, the intensity and/or frequency is mentioned in front of the consumer advice. These include: "mild", "stylised", "some", "frequent" or "strong". Example: "strong sex scenes".


title: Television content rating system

text: A television content rating system in Brazil was implemented following a consultation in 2006. Since then, the television networks themselves rate the shows, while the advisory rating () judges the content to guarantee that the rating is appropriate for that specific show. On broadcast networks, where the system is mandatory, the ratings are also translated in Brazilian Sign Language, and may also carry content descriptors. The icons must be shown at the start of each block of the show, and their respective promos.


title: Television content rating system

text: All rating is advisory unlike films. The Brazilian content rating system utilizes age-specific classifications (with the exception of L-rated programming), and consist of the following:


title: Television content rating system

text: The Canadian TV Classification System was created in late 1997 for English-language programs to use, which lined up with those of the American v-chip, both matching that system and allowing television manufacturers to use the same backbone firmware for both systems. The upper-right corner of symbols are shaped like the corner of a maple leaf, as is used in the national flag, and are rendered in black and white. The icons are intended to be shown once an hour lasting 15 seconds, although in the case of longer programs that do not start on the hour, some broadcasters show the rating at the start and at the top of each subsequent clock hour, while others show the rating at the start and again precisely one hour later. However, there are some networks like Global that only display the television rating at the beginning of the show. The icons are displayed in the upper-left corner and the size is mandated to be a minimum of 52 scan lines or pixels tall, and must also fully cover an American ratings icon if burned-in or broadcast live by an American broadcaster.


title: Television content rating system

text: Additionally, should a program contain content potentially unsuitable for some viewers, such as violence, coarse language, or nudity, members of the self-regulating Canadian Broadcast Standards Council (which does not include the CBC, although it still uses such warnings) are required to air a disclaimer at the beginning of the program and at the end of each commercial break, advising viewer discretion (such disclaimers are only required for the first hour if airing after 9:00 p.m.). This disclaimer is technically required even if the final commercial break comes immediately before the closing credits, and some (but not all) channels in fact observe this.


title: Television content rating system

text: Notably, the television rating given may depend on the level of cable and satellite, or if the program is broadcast over-the-air. Also, television ratings are generally considered more restrictive than movie ratings.


title: Television content rating system

text: The Canadian rating system for English-language broadcasters (as well as third-language broadcasters, which broadcast in a language other than English or French) is as follows:


title: Television content rating system

text: French-language broadcasters use a rating system that is virtually identical to Quebec's Régie du cinéma's film rating system, with one additional category (8+):


title: Television content rating system

text: Exhibition of programmes classified with the "A" rating is only allowed from 10 p.m. until 7 a.m. (both in local time); however, most channels only broadcast these programmes until they closedown their daily broadcasts (as they still don't begin permanent 24/7 services). All TV channels are required to show a warning (either as a full-screen identification or as a scrolling text message in a lower-third format, if shown during programming) when adult programming on the channel begins. The only exception to that rule applies to cable TV channels.


title: Television content rating system

text: Since 1997, Colombian television networks are required to specify programmes within dubbed "family" and "adult" fringes, and must display a notice signifying the audience, both visually and in narration, the minimum age required to watch the programme, if it contains sexual or violent content, and if parental company is needed at the beginning of every programme. The networks must also air an 'institutional message' daily at 21:00, inviting children 12 years of age or less to "not to stay exposed to contents which have no essentially child[-oriented] nature." A message must be broadcast at 22:10, Monday through Friday, (22:30 Saturdays and Sundays) stating to viewers that the adult fringe has started. Most networks opt to display a scrolling text message instead.


title: Television content rating system

text: Pornography is prohibited from being transmitted over the air in Colombia, even in the adult fringes.


title: Television content rating system

text: In Croatia, television networks show the rating during the broadcast. The Hrvatska Radiotelevizija (Croatian Radiotelevision) channels, RTL Televizija, RTL 2, Nova TV and Doma TV all display warnings before a broadcast not meant for a general audience. Broadcasts meant for all audiences do not have a rating. With that in mind, the rating system is the following:


title: Television content rating system

text: In Cyprus, television networks displays warnings before a broadcast not meant for a general audience. Broadcasts meant for all audiences do not have a rating. With that in mind, the rating system is the following:


title: Television content rating system

text: On Czech television, programmes with potentially shocking or harmful content could air only between 10:00pm and 6am and with a star-shaped marker on either corner of the screen indicating it was for adults.


title: Television content rating system

text: Since 1 September 2020, the Medierådet for Børn og Unge (Media Council for Children and Young People) classifies all programs and films for television broadcast and video on demand release, using the same rating also used for theatrically released films and home media releases. On television, the age limit must be informed orally before the program starts or continues. The clear rating should be shown during the entire transmission time or a minimum first five minutes, and must be available in program listings. Films and series on VOD services must have age ratings and mention the content in them that explains why the content was given its rating. The location of the rating is up to the individual provider as long as it is visible to the consumer before choosing a film or program. The new television classification system only applies to domestic television and VOD services such as DR, TV 2, TV3, Kanal 4 and Viaplay, and as such do not apply to foreign services such as Netflix, HBO Max or Disney+. The requirements apply to all programming outside of news & current affairs, music, sports, live telecasts, instructional & leisure programs, programming of nonprofit, political or religious nature, preface of programs and teaching & research programs.


title: Television content rating system

text: The classification to which belongs each programme will be arranged by the "Consejo de Regulación y Desarrollo de la Información y Comunicación" (Regulatory and Development Council of Information and Communication) depending on the parameters which are considered relevant.


title: Television content rating system

text: The "Dirección de Espectáculos Públicos, Radio y Televisión" (Direction of Public Shows, Radio and Television), entity attached to the "Ministerio de Gobernación y Desarrollo Territorial" (Ministry of Interior and Territorial Development), regulates the contents exhibited in Salvadoran television.


title: Television content rating system

text: A content rating system was introduced for Finnish television broadcasts in 2004. The initial ratings system for television programmes shown on Finnish television channels consists of the following:


title: Television content rating system

text: A content rating system in French is regulated by the "Conseil supérieur de l'audiovisuel" (CSA). Each rating icon is translucent and, as of December 2012, is shown for the whole duration of the show.


title: Television content rating system

text: There initially was no ratings system for French television. In March 1961, following the broadcast of a film where a female nude was briefly visible, the "white square" was introduced. A white square, replaced by a white rectangle in 1964, was displayed in the corner of the screen. An off-screen voice warned at the beginning of the program that it was unsuitable for all audiences. This system continued until 1996 when the "Conseil supérieur de l'audiovisuel" replaced it with a system of five pictograms, indicating the suitability of the program. This system was replaced by the current system on 18 November 2002.


title: Television content rating system

text: In Germany, every broadcaster has to show a disclaimer displaying the sentence "Die nachfolgende Sendung ist für Zuschauer unter 16/18 Jahren nicht geeignet" before transmission if the programme contains potentially offensive content. This roughly translates to "The following programme is not suitable for viewers under 16/18". The checks many shows in private television.


title: Television content rating system

text: A new content rating system in Greece was introduced on 30 September 2019. The system is now associated with the age of viewers and has new visual symbols (replacing rhombus, circle, triangle, square and cross symbols), however, there are no mature-accompanied ratings compared to the previous system. The ratings are compulsory and are displayed and verbally announced at the beginning of each broadcast. These provisions are enforced by the Greek National Council for Radio and Television (ESR).


title: Television content rating system

text: Also, programmes suitable for ages 12 and up will be accompanied by a special word marker identifying their content, which is divided into the following four categories:


title: Television content rating system

text: The Hong Kong television rating system is since by generic code of television programmes standard of the Broadcasting Ordinance (Cap.562) on 11 December 1995. The current ratings are:


title: Television content rating system

text: The Hungarian content rating system has changed frequently. The ratings of the programmes broadcast often caused legal interferences, since the radio and television authorities have stricter guidelines about age appropriate rating categories for programs. If a programme is not marked with the television authority's choice of rating symbol, the airing channel often has to pay large penalties to Hungarian authorities. Broadcasters licensed in another country may have a different rating system than the one used in Hungary, or have no ratings. For example, Discovery Communications' channels used Dutch ratings, TV2's sister channels, DIGI's self-packaged educational channels, and before 2015, RTL Klub's sister channels all used the Romanian ratings, while ViacomCBS' Hungarian TV channels (such as Comedy Central, Comedy Central Family, and the Paramount Network) had no ratings although before airing a show not suitable for children, a channel will show a full-screen voiced-over slide and have a star-like icon in the top-right corner for a whole duration of a show. AMC's channels do the similar thing as ViacomCBS did. International broadcasters also do not have ratings.


title: Television content rating system

text: The earliest symbolic classification system was first used by the now-defunct TV channel, Msat in the late-1990s. These ratings is applicable only for films shown on TV. After Msat was shut down, commercial broadcaster TV2 have used that system while the public broadcaster MTV and commercial broadcaster RTL Klub (in addition to TV2's system) had used full-screen voiced-over slides before films, similar in function to the system used by TV2. These symbols are shown for a minute after a film had started, although in TV2, these symbols had also shown for a few seconds before the film begins.


title: Television content rating system

text: In 2002, a new rating system was devised, replacing the symbolic system. Ranking programmes and displaying the rating symbols became compulsory on every Hungarian television network. The new rating system caused trouble within these networks because the channels were required to display the ranking symbols during the entire duration of their programmes. The symbols were distracting to viewers, and networks feared that their constant presence could damage the television screen. Due to the complaints, the television authority allowed channels to choose to show the rating symbols on the left or on the right side of the screen. Later, channels were also allowed to increase the transparency of the symbols.


title: Television content rating system

text: The rating system was overhauled in 2010 by introducing the new classifications: the 6 rating and the optional GY rating, changing the 12 classification and renewing the looks of the symbols themselves.


title: Television content rating system

text: Similar ratings also apply to films shown in cinemas, however unlike in other countries a viewer cannot be denied access from entering a screening if they are not the age of the rating.


title: Television content rating system

text: Since July 8, 2021, because of the hungarian LGBT-law, several Hungarian channels - just like RTL Klub and TV2 - have also began to use these ratings on their commercial breaks.


title: Television content rating system

text: There was also formerly an X rating: however, due to a law change on October 1, 2022, X-rated content can no longer be aired on Hungarian Television. One notably X-rated film is Lewis. Before an X-rated film, the following must be said:


title: Television content rating system

text: In February 2013, in the wake of controversy over suspension of exhibition of the film "Vishwaroopam", the Ministry of Information & Broadcasting constituted a panel under the Chairmanship of Justice (Retd.) Mukul Mudgal to examine issues of film certification under the Cinematograph Act 1952. One of the terms of reference for the committee is to examine "the requirement of special categories of certification for the purposes of broadcasting on television channels and radio stations." But, the committee had not made any recommendations on this important matter.


title: Television content rating system

text: The Indonesian Broadcasting Commission (KPI) regulate broadcast television content that classifies television programme into several classifications:


title: Television content rating system

text: Italy has no unified classification for TV content. The classification system changes according to each station and is not legally binding. The first group to introduce the TV rating system was Mediaset in 1994, initially only on Canale 5. Italia 1 and Rete 4 adopted the rating system in 1997, while the thematic channels adopted it in 2009. Given the simplicity of the classification system, inspired by traffic lights, the other broadcasters also followed the example of Mediaset. The ratings adopted by Mediaset are the following:


title: Television content rating system

text: RAI introduced the TV rating system in October 2000, with a flashing red logo to indicate programmes that are suitable only for adults. In 2007 the classification system was expanded with new logos: red if the program is suitable only for adults and yellow if the parental guidance is suggested for children.


title: Television content rating system

text: In Malaysia, a television rating system was revised in January 2012. Ratings are shown before the programme starts.


title: Television content rating system

text: The classification system of television programmes in Mexico is almost equivalent to that of the movie rating system of the country, and consists of the following:


title: Television content rating system

text: The classification system of television programmes in Morocco is established by the HACA. There are 4 categories. Before the airing of the program, an off-screen voice warned at the beginning of the programme that it was unsuitable for all audiences.


title: Television content rating system

text: The television rating system in the Netherlands was created in 2001 by the "Dutch Institute for the Classification of Audiovisual Media" (NICAM) and is known as Kijkwijzer (ViewingGuide or WatchWiser). The same rating systems are used for both television programmes and films, and serve partly as guidelines (Programmes with the classification 12, 14 and 16 years may only be broadcast from 8pm and with the classification 18 years from midnight. Cinemas and theaters in the country cannot provide films with the classification 16 years to people under the age of 16). They are the same as Dutch film ratings.


title: Television content rating system

text: On 1 May 2020, New Zealand realigned its television content rating system to a common system for free-to-air television, subscription television and on-demand services:


title: Television content rating system

text: On free-to-air television, programmes classified M can be broadcast between 9.00am and 3.00pm on weekdays (school term time only, as designated by the Ministry of Education) and from 7.30pm until 5.00am on a daily basis. Programmes classified 16 can only be broadcast after the 8.30pm watershed, while programmes classified 18 can only be broadcast after 9.30pm.


title: Television content rating system

text: On pay television, where content filtering is not available, programmes classified 18 can only be broadcast between 8.00pm and 6.00am on a daily basis and from 9.00am until 3.00pm on weekdays (school term time only). If content filtering is available, programmes classified 18 can be broadcast at any time. Explicit adult sex programmes classified 18 may screen only on premium channels.


title: Television content rating system

text: The following descriptor codes (audience advisories) may be added for programmes classified PG or higher:


title: Television content rating system

text: North Macedonia uses these symbols for each programming. Broadcasts meant for all audiences do not have a rating.


title: Television content rating system

text: A television content rating system was introduced in Norway in July 2015. Television broadcasters are obliged to classify their programmes in the following age categories: A (all ages), 6 years, 9 years, 12 years, 15 years or 18 years. The classification must be based on the guidelines made by The Norwegian Media Authority. Programmes in the different age categories must be transmitted according to the following time schedule during the day:


title: Television content rating system

text: Television broadcasters shall specify the age limit acoustically before the programme starts or clearly mark the programme with an age limit throughout its duration. Television broadcasters shall also specify the age limit in programme schedules and electronic programme guides.


title: Television content rating system

text: The age categories are also applicable to other platforms such as Video on demand-services, videogrammes (DVD, Blu-ray) and cinema theatres.


title: Television content rating system

text: The age rating system in Peru was introduced in 2005 by the then-President Alejandro Toledo and came into force for both radio and television broadcasts. Currently, the only free-to-air channels advising their audiences about the rating system are ATV, NexTV and La Tele, since most channels adopted their own system since 2009, starting with América Televisión.


title: Television content rating system

text: The ratings for television programmes are available on some Peruvian channels. The rating system used in Peru is listed below.


title: Television content rating system

text: In the Philippines, the Movie and Television Review and Classification Board, commonly known as MTRCB, implements and regulates local television content rating systems. In 1979, it only had implemented two television ratings: "General Viewership" (GV) later renamed (General Patronage/GP) in 1995 and "Parental Guidance" (PG), in the mid-1990s up until from now on, some advisories are simply written on the upper left side or at the lower right side of the television screen.


title: Television content rating system

text: On 6 October 2011, in order to encourage parents to supervise and be responsible with their children in watching television, the MTRCB revamped its rating system, implementing a three-tiered system:


title: Television content rating system

text: The new ratings was originally to have been a four-tiered system, composed of G (General Patronage), PG (Parental Guidance), SPG (Strong Parental Guidance), and M, but some time before the implementation of the new system, the "M" rating was dropped.


title: Television content rating system

text: The new ratings system is similar to the old one, but the look and the ratings themselves was completely revamped. All of these were only been implemented on Free to-Air Television stations. The new system consists of a new full-screen advisory of the programme's rating which is played before each programme, whatever the rating of such programme is, except in the case of programmes with SPG rating, wherein the rating must be aired twice (before the start of the programme and after each commercial break. e.g. in the middle part of the programme). A rating logo then appears at the bottom right of the screen during a programme if it was rated as such. Sometimes, when annotations are to be put and it takes the place of the logo, then it has to be put on the upper left side of the screen, opposite the logo of the TV station.


title: Television content rating system

text: On 9 February 2012, the SPG rating was implemented, which utilizes at least one of the following content descriptors:


title: Television content rating system

text: The SPG rating was first broadcast on the film "Cinco" which was aired in ABS-CBN, where it had its old advisory.


title: Television content rating system

text: Before 2000, Poland did not have any uniform classification system for television programmes. Some stations, however, applied their own system of signs: in front of the selected films TVP board applied the "Adult only" or "Film for adult audiences only". In Canal+ before the film to show in chart with key Canal+ in the appropriate colour (green, yellow, red). Until 27 February 2000, TVN decided to mark the so-called "adult movies" with a pulsating red 18+ logo. On 1 March 2000, an agreement was reached with Polish television broadcasters as "Friendly media" in order to introduce a uniform system of classification of television programmes. Nine television broadcasters - TVP, Polsat, TVN, Nasza TV, Canal+, Wizja TV, Polish Cable Television and TV Niepokalanow - had signed the agreement.


title: Television content rating system

text: The current Polish television rating system was introduced on 15 August 2005 and consists of five icons. The icons need to be broadcast which threw the entire duration of the programme. On 28 August 2011 changed the appearance of the characters:


title: Television content rating system

text: For a long time, the only existing regulation on Portuguese television was that programmes with potentially shocking or harmful content could air only between 10:30pm and 6am and with a red circular marker on the top-right corner of the screen indicating it was for audiences aged 16 and over.


title: Television content rating system

text: In 2006, all free-to-air networks decided to complement this rule with a shared, more detailed rating system for TV shows:


title: Television content rating system

text: These logos must be shown during 10 seconds in the beginning of any programme and after every break. If a programme is rated 16, it can only be broadcast between 10:30pm and 6am. However, most cable channels in Portugal use the Spanish classification system.


title: Television content rating system

text: The Romanian content rating system has changed frequently. The ratings of the programmes broadcast often caused legal interferences, since the radio and television authorities have stricter guidelines about age appropriate rating categories for programs. If a programme is not marked with the television authority's choice of rating symbol, the airing channel often has to pay large penalties to Romanian authorities, except with 24h all-news channels, 24h advertising channels (teleshopping), pay television or pay-per-view channels (like Eurosport, HBO, etc.) and foreign broadcasting TV-channels (like TV5Monde, Deutsche Welle, arte, etc.) that are subjected to foreign audio-visual regulations from their country of origin.


title: Television content rating system

text: Few television networks (such as Antena 1 or Prima TV) used the same symbols, but in a green, yellow or red ring with a transparent symbol.


title: Television content rating system

text: In 2002, a new rating system was devised. Ranking programmes and displaying the rating symbols became compulsory on every Romanian television network. The new rating system caused trouble within these networks, because the channels were required to display the ranking symbols during the entire duration of their programmes. The symbols were distracting to viewers, and networks feared that their constant presence could damage the television screen. Due to the complaints, the television authority "allowed" channels to choose to show the rating symbols on the left or on the right side of the screen. Later, channels were also allowed to increase the transparency of the symbols.


title: Television content rating system

text: The current rating symbols were adopted in September 2002. On July 12, 2005, the symbols became transparent.


title: Television content rating system

text: Singapore has adopted the use of TV Ratings from 21 October 2011. They consist of PG and PG13 ratings for Free-to-Air TV and NC16 and M18 ratings in addition to the PG and PG13 ratings for Pay TV channels. For Free-to-Air TV, the shows rated PG may be aired anytime while PG13 should air between 10pm to 6am. For Pay TV, PG13 rated programmes can be shown anytime. Before the rated programme starts the TV channels will show a notification. From now on, only StarHub TV's and Singtel TV's self-packaged non-regional Pay TV channels ( e.g. StarHub TV's E City and Sensasi and Singtel TV's FashionTV HD and FashionTV HD on Demand, both of which features modeling nudity in certain programmes ) are enabled to carry NC16 and M18 rated content. FashionTV is also Singapore's first official M18 rated channel. M18 rated programmes can only be telecasted from 10pm onwards to 6am on Pay TV. Regional channels like Fox Life, Fox Movies and HBO Asia are unable to carry Media Development Authority's film ratings as they are targeted at the same region (a certain group of Asia territories), which results in programmes being subjected to external censorship of a much harsher nature outside Singapore territorial control. Only Video on Demand (VOD) Pay TV services are allowed to carry R21 content currently. G-rated programmes are not required to show a notification for any channel.


title: Television content rating system

text: Slovakian government accepted a law in 2001 (updated in 2007), in which television stations are required to display one of the following icons during all the program and in promos:


title: Television content rating system

text: For content suitable for all children, a green "U" icon is available, but broadcasters are not required to use it. Programming suitable for all ages doesn't show a rating at all.


title: Television content rating system

text: Until 2007, all ratings went with faces: green smiley face - all viewers; orange sad face - suitable for 7, 12, 15 years and over; red very sad face - suitable for adults only.


title: Television content rating system

text: Slovenian government accepted a law in 2004, in which television stations are required to play a voiceover and age icon warning, which has to be at least 10 seconds long before programmes, inappropriate for some audiences begin. Additionally, one of the following icons (a white rhombus with the age number) has to be displayed for the duration of the programme:


title: Television content rating system

text: The original content rating icons (used before 2014) were a red triangle with a stylised eye for content rated +15, while adult-only content used a red circle with a stylised eye.


title: Television content rating system

text: Sometimes, age rating symbols are accompanied by additional symbols, which are not shown on-screen and warn the audience of the type of inappropriate content:


title: Television content rating system

text: The public broadcaster RTV Slovenija and most other broadcasters use three watersheds. 12+ rated content is shown between 8 PM and 5 AM, 15+ rated programmes are allowed between 10 PM and 5 AM, and adult-only content can be shown between midnight and 5 AM. Cartoons and children's programmes are screened until 7 PM.


title: Television content rating system

text: South African ratings are issued and certified by the Film and Publication Board, whilst the National Broadcasting Commission regulates the various films and programmes. All television stations, cinemas and distributors of DVD, video and computer games must display the following signage:


title: Television content rating system

text: The South Korean television rating system has been in force since 2000, and it started with only four classifications which are All, 7, 13 and 19. In February 2001, all programs except domestic dramas (which had been enforced since November 2002) has required to have a rating system. In 2007, rating 13 was changed into 12 and a new rating, 15 is introduced. Most programmes have to be rated, except the "exempt" rating below. Even if it qualifies for being exempt, a broadcaster may apply a rating.


title: Television content rating system

text: Rating icons may be transparent, and can be positioned either on the upper-left or upper-right corner of the screen. The icon has a size of at least 1/20 of the screen, and has black writing on a yellow circle with a white outline. These icons are shown for 30 seconds when the programme starts, and are shown again every 10 minutes, and when the programme resumes after commercial breaks. This does not apply to 19-rated programmes, where the icon must be visible throughout the entire programme. These regulations do not apply to the "All" rating, as it does not have an icon. A rating disclaimer is displayed on the start of the programme for five seconds stating "This programme is prohibited for children under the age of "X", so parental accompaniment is required" (, "I peurogeuraemeun X-se mimanui eorini/cheongsonyeoni sicheonghagi-e bujeokjeolhameuro bohoja-ui sicheongjidoga piryohan peurogeuraemimnida.") for 7, 12, and 15 ratings. "All" and "19" ratings have a different disclaimer, which say "This programme is suitable for all ages" (, "I peurogeuraemeun modeun yeollyeong-ui sicheongjaga sicheonghal su inneun peurogeuraemimnida.") and "This programme is prohibited for children under the age of 19" (, "I peurogeuraemeun sipguse mimanui cheongsonyeoni sicheonghagi-e bujeokjeolhan peurogeuraemimnida.") respectively.


title: Television content rating system

text: These ratings are used by all South Korean television broadcasters. Despite being intended for viewing outside of the country, KBS World also uses these ratings.


title: Television content rating system

text: South Korean television ratings do not include content descriptors or advisories as they do in other nations. The ratings are therefore used in a broader sense.


title: Television content rating system

text: Unrated programmes do not display any icon on the screen; in Catalonia, TP-rated shows do not show any icon as well. Nowadays rating symbols are shown during all the programme and in promos; each channel has its right to choose its design and where it has to be placed. The "Infantil" rating it's the exception, because it appears during the first five seconds. In Catalonia, only the 13, 16 and 18 ratings remain transparent in the screen, while the others (7, 10 and 12) are seen during the first 30 seconds.


title: Television content rating system

text: Taiwanese rating system for television programmes was introduced on 1 January 1999 with four symbols represented with four Chinese characters 普 for General, 護 for Protected, 輔 for Parental Guidance and 限 for Restricted, but changed on 13 June 2017 to unify the television age rating with Taiwan's video game and motion picture ratings, and there are five symbols,


title: Television content rating system

text: Television programmes free of circumstances listed in the preceding four articles and suitable for watching by general audiences may be listed as G .


title: Television content rating system

text: Television programmes free of circumstances listed in the preceding three articles but portraying any one of the following circumstances shall be listed as P.


title: Television content rating system

text: Television programmes free of circumstances listed in the preceding two articles but portraying any one of the following circumstances shall be listed as PG-12.


title: Television content rating system

text: Television programmes free of circumstances listed in Article 4 but portraying any one of the following circumstances shall be listed as PG-15.


title: Television content rating system

text: Television programmes portraying any one of the following circumstances shall be listed as R and be broadcast by encryption.


title: Television content rating system

text: In Thailand, a television rating system was introduced in 2006 alongside a movie rating system for movies. In September 2013, the television rating was revised.


title: Television content rating system

text: Under the new guideline, the so-called 'Free TV' channels have to label their programs and reschedule their shows to comply in the following categories:


title: Television content rating system

text: TV programs in Thailand are already labeled by a certain system of categories, a practice criticised by rights group as nanny-state censorship and ridiculed by some Netizens for its confusing standards.


title: Television content rating system

text: The TV content rating system in Turkey was introduced by RTÜK in 2006. The ratings are the following:


title: Television content rating system

text: News programmes, sports competitions, religious ceremonies and commercial communication broadcasts are exempt from the content rating system.


title: Television content rating system

text: The Ukrainian TV content rating system was adopted on 15 September 2003. It started with three classifications (●, ▲, ■). On 6 May 2016, the classifications were replaced, and TV shows that do not have age restrictions are not rated. The new ratings are as follows:


title: Television content rating system

text: The TV parental guidelines were first proposed on December 19, 1996, as a voluntary-participation system—in which ratings are determined by participating broadcast and cable networks—by the United States Congress, the television industry and the Federal Communications Commission (FCC), and went into effect by January 1, 1997, on most major broadcast and cable networks in response to concerns from parents and advocacy groups regarding increasingly explicit sexual content, graphic violence and strong profanity in American television programming, and was designed to be used in conjunction with the V-chip, which the U.S. government had mandated to be built into all television sets manufactured from 2000 onward (and the vast majority of cable/satellite set-top boxes). The system—which is used for, including but not limited to, most television series, specials, made-for-television films, and theatrically released films re-edited for broadcast or basic cable telecast—has since been applied to internet-based television services (such as Hulu, Amazon Prime Video and Netflix), digital video retailers (such as Apple’s iTunes Store and Google Play) and digital media players (such as Amazon Fire TV, Apple TV, Android TV and Roku). The guidelines are not assigned to sports or news programs nor are they used during commercial advertisements, outside of promotional ads for network programs.


title: Television content rating system

text: The rating icons are required to be shown for 15 seconds at the start of each program, although since June 2005, many advertiser-supported network broadcasters and some syndication divisions also display the assigned rating for that particular program after each commercial break; for networks and syndicators that continue to run the rating icon once per hour during a program running longer than 60 minutes, the broadcaster may show the rating again during a segment/scene that starts closest to the top of the next clock hour. Premium channels—in addition to applying them to any offered original programming—may assign Parental Guideline ratings for theatrical or home video-released movies that either did not receive a Motion Picture Association-assigned rating or were aired as an "unrated" cut.


title: Television content rating system

text: Programs rated TV-G are generally suitable for all ages. The FCC states that "this rating does not signify a program designed specifically for children, most parents may let younger children watch this program unattended." The thematic elements portrayed in programs with this rating contain little or no violence, no strong language, and little or no sexual dialogue or situations.


title: Television content rating system

text: Some thematic elements, according to the FCC, "may call for parental guidance and/or the program may contain one or more of the following" sub-ratings, designated with an alphabetic letter:


title: Television content rating system

text: Up to four content descriptors can be applied along with an applied rating, depending on the kind of suggestive content featured in a program (with the exception of the "FV" sub-rating, due to its sole applicable use for children's programs). As the rating increases pertaining to the age, the content matters generally get more intensive. The 'suggestive dialogue' descriptor is used for TV-PG and TV-14 rated programs only, although certain networks may choose to rate their TV-MA programs with the descriptor, while the DLSV sub-ratings are only used with the TV-PG and TV-14 ratings.


title: Television content rating system

text: An additional content descriptor, "E/I", is applied to select TV-Y, TV-Y7, and TV-G programs that are designed to meet the educational and informative needs of children aged 16 and under. A minimum of three hours of E/I-compliant programming must be broadcast per week by each television network; E/I programming must air between 6:00 a.m. and 10:00 p.m. to count toward this minimum.


title: Television content rating system

text: The American pay television industry uses a separate, unrelated content advisory system—used in conjunction with the TV Parental Guidelines and the Motion Picture Association rating system—that first went into effect on March 1, 1994, on participating cable-originated premium channels and pay-per-view services (led by the system's charter services, HBO, Cinemax, Showtime and The Movie Channel). Inspired by similar content guidelines that had already been included in the services’ monthly program guides, the voluntary-participation system provides guidance to pay-cable subscribers on the suitability of a program for certain audiences based on its content. Thematic material is rated based on a ten-code system, designated with a two- or three-letter abbreviation and corresponding descriptor:


title: Television content rating system

text: Up to five content descriptors can be applied, alongside the corresponding rating, to an individual program to advise viewers of content that may be inappropriate for minors, depending on age group, or for adults with particular sensitivities to certain kinds of mature content.


title: Television content rating system

text: Television content in Venezuela is regulated by the Law on Social Responsibility on Radio and Television ("Ley de Responsabilidad Social en Radio y Televisión"), introduced in January 2003. Free-to-air television broadcasters are required to classify their programmes using the following ratings:


title: Television content rating system

text: It is mandatory for all Venezuelan television station to broadcast a short presentation, before the broadcast of any programmes, made by the same channel, where the type of programme (recreational, informational, mixed, etc.), type of production (domestic or national independent) elements include containing (such as language, health, sex and/or violence) and lastly the rating of the programme.


title: Liz Sagal

text: Elizabeth Sagal (born October 9, 1961) is an American actress, screenwriter and film editor. Sagal is part of a family of entertainment industry professionals. She is the daughter of director Boris Sagal and the stepdaughter of Marge Champion. In addition to her twin sister Jean Sagal, two of her other siblings, older sister Katey Sagal and brother Joey Sagal, are notable in the industry and her other brother, David Sagal, is an attorney married to actress McNally Sagal.


title: Liz Sagal

text: Sagal and her twin sister, Jean Sagal served for a time as the "Doublemint Twins" in the ad campaign by Doublemint gum.


title: Liz Sagal

text: The pair also appeared together as cheerleaders in the 1982 movie, "Grease 2". In the 1980s, Liz and Jean starred in the television series "Double Trouble" that ran from 1984 to 1985. Sagal has since appeared on such shows as "Knots Landing" and "Picket Fences".


title: Liz Sagal

text: She played a part in the film "Howard the Duck", as a member of the fictional band "Cherry Bomb", in conjunction with which she contributed vocals to the songs "Hunger City", "Don't Turn Away (Reprise)", "It Don't Come Cheap" and "Howard the Duck".


title: Liz Sagal

text: She has worked as a writer on such shows as "Mad About You", "Monk" and "Charmed", also serving as executive story editor on the last. She also wrote for the Netflix reboot of "Lost in Space".


title: Gloster Gladiator

text: The Gloster Gladiator is a British-built biplane fighter. It was used by the Royal Air Force (RAF) and the Fleet Air Arm (FAA) (as the Sea Gladiator variant) and was exported to a number of other air forces during the late 1930s.


title: Gloster Gladiator

text: Developed privately as the Gloster SS.37, it was the RAF's last biplane fighter aircraft, and was rendered obsolete by newer monoplane designs even as it was being introduced. Though often pitted against more formidable foes during the early days of the Second World War, it acquitted itself reasonably well in combat.


title: Gloster Gladiator

text: The Gladiator saw action in almost all theatres during the Second World War, with a large number of air forces, some of them on the Axis side. The RAF used it in France, Norway, Greece, the defence of Malta, the Middle East, and the brief Anglo-Iraqi War (during which the Royal Iraqi Air Force was similarly equipped). Other countries deploying the Gladiator included China against Japan, beginning in 1938; Finland (along with Swedish volunteers) against the Soviet Union in the Winter War and the Continuation War; Sweden as a neutral noncombatant (although Swedish volunteers fought for Finland against USSR as stated above); and Norway, Belgium, and Greece resisting Axis invasion of their respective lands.


title: Gloster Gladiator

text: South African pilot Marmaduke "Pat" Pattle was the top Gladiator ace with 15 victories with the type.


title: Gloster Gladiator

text: During the 1920s, Britain's air defences had been based around interceptor aircraft capable of flying only for short ranges and at speeds of , but by 1930, figures within the Air Ministry were keen to supersede these aircraft. In particular, some dissatisfaction had arisen with the level of reliability experienced with the 'one pilot, two machine guns' design formula previously used; the guns were often prone to jams and being unreliable. The Air Ministry's technical planning committee formulated Specification F.7/30, which sought a new aircraft capable of a maximum speed of at least , an armament of no fewer than four machine guns, and such handling that that same fighter could be used by both day and night squadrons. Gloster, being already engaged with development of the Gloster Gauntlet, did not initially respond to the specification, which later proved to be beneficial.


title: Gloster Gladiator

text: The specification had also encouraged the use of the new Rolls-Royce Goshawk evaporatively cooled inline engine; many of the submissions produced by various aviation companies in response accordingly featured the Goshawk engine. However, the Goshawk engine proved to be unreliable, mainly due to its overcomplex and underdeveloped cooling system, and unsuited to use on fighter aircraft and this outcome stalled development of the aircraft intended to use it. A further stumbling point for many of the submitted designs was the placement of the machine gun breeches within arm's reach of the pilot. At the same time, the development of monoplane fighters such as the Hawker Hurricane and Supermarine Spitfire cast doubt over the future viability of the requirement altogether.


title: Gloster Gladiator

text: Gloster recognised that instead of developing an all-new design from scratch, the existing Gauntlet fighter could be used as a basis for a contender to meet Specification F.7/30. Development of what would become the Gladiator began as a private venture, internally designated as the SS.37, at Gloster, by a design team headed by H.P. Folland, who soon identified various changes to increase the aircraft's suitability to conform with the demands of the specification. Making use of wing-design techniques developed by Hawker Aircraft, the new fighter adopted single-bay wings in place of the two-bay wings of the Gauntlet, and two pairs of interplane struts were also dispensed with as a drag-reduction measure. The Bristol Mercury M.E.30 radial engine, capable of generating , was selected to power the SS.37, which provided a performance boost over the preceding Gauntlet. Another design choice was the fitting of a cantilever main undercarriage, which incorporated Dowty internally sprung wheel struts.


title: Gloster Gladiator

text: In spring 1934, Gloster embarked on the construction of a single SS.37 prototype. On 12 September 1934, the SS.37 prototype conducted its maiden flight, piloted by Gloster chief test pilot Gerry Sayer. Initially powered by a Mercury IV engine, the prototype was quickly re-equipped with a more powerful Mercury VIS engine. During flight tests, the prototype attained a top speed of while carrying the required four machine guns (two synchronised Vickers guns in the fuselage and two Lewis guns under the lower wing). According to aviation author Francis K. Mason, the Air Ministry were sceptical about the aircraft achieving such performance from a radial engine design, so funded a protracted series of evaluation trials.


title: Gloster Gladiator

text: On 3 April 1935, the prototype was transferred to the RAF, receiving the designation "K5200", and commenced operational evaluations of the type. Around the same time, Gloster proceeded to plan a further improved version, featuring an Mercury IX engine, a two-blade wooden fixed-pitch propeller, improved wheel discs, and a fully enclosed cockpit. "K5200" was later used to trial modifications for production aircraft, such as the addition of a sliding hood for the pilot.


title: Gloster Gladiator

text: In June 1935, production plans for the aircraft were proposed; two weeks later, a production specification, Specification F.14/35, had been rapidly drawn up, partially prompted by events in continental Europe, such as the invasion of Abyssinia by Fascist Italy and the rise of Adolf Hitler to power in Germany, in response to which the British government mandated an urgent expansion of the RAF to counter the emerging threats. This culminated in an initial order for 23 aircraft. On 1 July 1935, the aircraft formally received the name "Gladiator".


title: Gloster Gladiator

text: Manufacturing of the Gladiator was started at Gloster's Hucclecote facility. Production of the initial batch was performed simultaneously, leading to many aircraft being completed around the same time. On 16 February 1937, "K6129", the first production Gladiator, was formally accepted by the RAF; on 4 March 1937, "K6151", the last aircraft of the initial batch, was delivered. In September 1935, a follow-up order of 180 aircraft was also received from the Air Ministry; this order had the proviso that all aircraft had to be delivered before the end of 1937.


title: Gloster Gladiator

text: The first version, the Gladiator Mk I, was delivered from July 1936, becoming operational in January 1937. The Mk II soon followed, the main differences being a slightly more powerful Mercury VIIIAS engine with Hobson mixture control boxes and a partly automatic boost-control carburettor, driving a Fairey fixed-pitch three-blade metal propeller, instead of the two-blade wooden one of the Mark I. All MK II Gladiators also carried Browning 0.303-inch machine guns (licence-manufactured by the BSA company in Birmingham) in place of the Vickers-Lewis combination of the MK I. A modified Mk II, the Sea Gladiator, was developed for the Fleet Air Arm, with an arrestor hook, catapult attachment points, a strengthened airframe, and an underbelly fairing for a dinghy lifeboat, all for operations aboard aircraft carriers. Of the 98 aircraft built as, or converted to, Sea Gladiators, 54 were still in service by the outbreak of the Second World War.


title: Gloster Gladiator

text: The Gladiator was the last British biplane fighter to be manufactured, and the first to feature an enclosed cockpit. It possessed a top speed of about , yet even as the Gladiator was introduced, it was already being eclipsed by new-generation monoplane fighters, such as the RAF Hawker Hurricane and Supermarine Spitfire, and the "Luftwaffe" Messerschmitt Bf 109. In total, 747 aircraft were built (483 RAF, 98 RN), with 216 being exported to 13 countries, some of which were from the total allotted to the RAF. Gladiators were sold to Belgium, China, Egypt, Finland, Free France, Greece, Iraq, Ireland, Latvia, Lithuania, Norway, Portugal, South Africa, and Sweden.


title: Gloster Gladiator

text: In February 1937, No. 72 Squadron, based at Tangmere, became the first squadron to be equipped with the Gladiator; No. 72 operated the type until April 1939, longer than any other home-based frontline unit. Between March and April 1937, No. 3 Squadron at Kenley also received Gladiators from the remainder of the first production batch, replacing their obsolete Bristol Bulldogs. Initial service with the type proved the Vickers guns to be problematical; the Gladiator was quickly armed with .303 in (7.7 mm) Browning machine guns, which were substantially more popular, leading to the other guns often only being resorted to if deemed necessary. On 27 March 1937, No. 54 Squadron at Hornchurch became the first unit to receive Browning-armed Gladiators.


title: Gloster Gladiator

text: By September 1937, all eight Gladiator squadrons had achieved operational status and had formed the spearhead of London's air defences. Difficulties with introducing the type had been experienced. Although the Gladiator was typically well-liked by pilots, the accident rate during operational training on the type was so high that a small replacement batch of 28 Gladiator Mk IIs was hurriedly produced. Most accidents were caused by pilots being caught out by the fighter's increased wing loading, and many aviators had little experience in landing aircraft with such a wide flap area. The aircraft had a tendency to stall more abruptly, frequently dropping a wing while doing so. The Gladiator very easily entered a flat spin, and great skill was needed to recover.


title: Gloster Gladiator

text: During 1938, the RAF had begun to receive its first deliveries of the Hurricane and Spitfire monoplanes; an emphasis was soon placed on quickly re-equipping half of the Gladiator squadrons with either of these monoplane types. By the outbreak of the Second World War, the Gladiator had largely been replaced by the Hurricane and Spitfire in front-line RAF service. The introduction of these aircraft had been eased by the presence of the Gladiator, squadrons that had operated Gladiators prior to converting to the monoplane types experienced a noticeably improved accident record than those who converted from older types such as the Gauntlet. Experiences such as operating the Gladiator's landing flaps and familiarisation with its sliding hood have been attributed to having favourably impacted pilot conversion.


title: Gloster Gladiator

text: Although by 1941, all Gladiators had been withdrawn from front-line duties defending the British Isles, a need to defend Britain's trade routes throughout the overseas territories of the British Empire had been recognised, so the RAF redeployed many of its Gladiators to the Middle East to defend the theatre and the crucial Suez Canal. The Gladiator saw considerable action during early stages of the war, including participating in the action in the French and Norwegian campaigns, in addition to various peripheral campaigns.


title: Gloster Gladiator

text: In October 1937, the Chinese Central Government ordered 36 Gladiator Is, which were delivered in two crated batches to Guangzhou via Hong Kong. The Chinese Gladiators used the American M1919 Browning machine gun to fire American .30-06 Springfield ammunition, the main ammunition of the new Chinese Nationalist Air Force. By February 1938, these aircraft had been assembled into two squadrons and the Chinese pilots familiarised themselves with them. The Gloster Gladiator had its combat début on 24 February 1938. That day, in the Nanking area, Chinese-American Capt John Wong Sun-Shui (nicknamed 'Buffalo') shot down an Mitsubishi A5M "Claude" naval fighter, the first victim of a Gladiator. Wong is believed to have shot down a second A5M as the wrecks of two Japanese fighters were found. During that clash, Chinese Gladiators lost two of their number.


title: Gloster Gladiator

text: Chinese Gladiators scored several more victories over Japanese aircraft from 1938 to 1940 during the Second Sino-Japanese War. In China, Gladiators were used extensively before the start of 1940 by the 28th, 29th, and 32nd squadrons of the 3rd Group. Chinese aviators considered the Gladiator an excellent fighter in its class, but pilots soon found it increasingly difficult to hold their own against the modern A5M, and because of a lack of spare parts due to an arms embargo, the surviving Gladiators were mostly relegated to training. When newer Japanese aircraft such as the Mitsubishi A6M Zero entered the theatre, the Gladiators' days were numbered. "Buffalo" Wong, the first Gladiator flying ace and first American fighter ace of the war, was eventually shot down in combat with A6M Zeros on 14 March 1941 and died two days later from his injuries. Arthur Chin and he were among a group of 15 Chinese Americans who formed the original group of American volunteer combat aviators in China.


title: Gloster Gladiator

text: During the Winter War, the Finnish Air Force (FAF) obtained 30 Mk II fighters from the UK. Ten of the aircraft were donated, while the other 20 were bought by the FAF; all were delivered between 18 January and 16 February 1940, the first entering service on 2 February 1940. The Finnish Gladiators served until 1945, but they were outclassed by modern Soviet fighters during the Continuation War, and the aircraft was mostly used for reconnaissance from 1941. The Finnish Air Force obtained 45 aerial victories by 22 pilots with the aircraft during the Winter War and one victory during the Continuation War. Twelve Gladiators were lost in combat during the Winter War and three during the Continuation War. Two pilots became aces with this aircraft: Oiva Tuominen (6.5 victories with Gladiators) and Paavo Berg (five victories).


title: Gloster Gladiator

text: Besides the FAF Gladiators, the Swedish Voluntary Air Force, responsible for the air defence of northernmost Finland during the later part of the Winter War, was also equipped with Gladiator fighters, known as J8s (Mk Is) and J8As (Mk IIs). The Flying Regiment F 19 arrived in Finnish Lapland on 10 January 1940 and remained there until the end of hostilities. It fielded 12 Gladiator Mk II fighters, two of which were lost during the fighting and five Hawker Hart dive bombers, plus a Raab-Katzenstein RK-26 liaison aircraft and a Junkers F.13 transport aircraft. The aircraft belonged to and were crewed by the Swedish Air Force but flew with Finnish nationality markings. The Swedish Gladiators scored eight aerial victories and destroyed four aircraft on the ground. One concern was expressed when F 19's executive officer Captain Björn Bjuggren wrote in his memoirs, that the tracer rounds of the Gladiator's machine guns would not ignite the gasoline when penetrating the fuel tanks of Soviet bombers.