The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

A large body of evidence indicates that women are more likely than men to show unipolar depression. Five classes of explanations for these sex differences are examined and the evidence for each class is reviewed. Not one of these explanations adequately accounts for the magnitude of the sex differences in depression. Finally, a response set explanation for the sex differences in depression is proposed. According to this explanation, men are more likely to engage in distracting behaviors that dampen their mood when depressed, but women are more likely to amplify their moods by ruminating about their depressed states and the possible causes of these states. Regardless of the initial source of a depressive episode (i.e., biological or psychological) men's more active responses to their negative moods may be more adaptive on average than women's less active, more ruminative responses. The epidemiology of a disorder can provide important clues to its etiology. When a disorder only strikes persons from one geographical region, one social class, or one gender, we can ask what characteristics of the vulnerable group might be making its members vulnerable. A frequent finding in epidemiological studies of mental disorders is that women are more prone to unipolar affective disorders than are men (Boyd & Weissman, 1981; Weissman & Klerman, 1977). A number of different explanations have been proposed to account for women's greater vulnerability to depression. Previous reviews of these explanations (e.g., Weissman & Klerman, 1977) have been quite brief and uncritical. In this article, the evidence for sex differences in unipolar depression first is summarized, then the most prominent explanations proposed for these sex differences are discussed in detail. These explanations include those attributing the differences to the response biases of subjects, as well as biological, psychoanalytic, sex role, and learned helplessness explanations. Although most of the proposed explanations for sex differences in depression have received some empirical support, not one of them has been definitively supported and not one as yet accounts for the magnitude of sex differences in depression. In the final section of this article it is suggested that differences in the ways that men and women respond to their own depressive episodes, whatever the origin of these episodes, may be an important source of the sex differences observed in depression.

Sex differences in unipolar depression: evidence and theory.

In this innovative book, a well-known feminist and sociologist-who is also the founding editor of Gender & Society-challenges our most basic assumptions about gender. Judith Lorber argues that gender is wholly a product of socialization, subject to human agency, organization, and interpretation, and that it is a social institution comparable to the economy, the family, and religion in its significance and consequences. Calling into question the inevitability and necessity of gender, she envisions a society structured for equality, where no gender, racial ethnic, or social class group is allowed to monopolize positions of power.

Paradoxes of gender

Central mechanisms of stress integration: hierarchical circuitry controlling hypothalamo-pituitary-adrenocortical responsiveness.

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations.

Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack

Objective To obtain information on women's attitudes and opinions about participation in vaccine and medication trials during pregnancy. Methods A quantitative, cross-sectional survey was administered to 110 consenting women over a four-week period in the waiting room of an ambulatory obstetrics and gynaecology clinic in Ontario. Results The final response rate was 74.8%, with the majority of participants agreeing with statements about the importance of obtaining safety data about products in pregnancy and the importance of a woman having the ability to choose whether to participate in such research. Of all participants, 16.3% indicated they would consider participating in vaccine research during pregnancy and 20.0% would consider participating in medication research during pregnancy. Factors relating to maternal or fetal/child health were the most frequently cited factors influencing willingness to participate, with lack of trust in researchers and pharmaceutical companies as factors that would discourage participation. Conclusion A minority of pregnant women were willing to consider participating in medication or vaccine research during pregnancy. Optimizing participation requires providing women (and if appropriate, their partners) with detailed, multidisciplinary education about the maternal and fetal benefits and risks of such trials. Education about the principles of research ethics, including the limits of involvement of pharmaceutical companies, would be beneficial.

https://www.jogc.com/article/S1701-2163(16)39308-2/pdf

Optimizing Participation of Pregnant Women in Clinical Trials: Factors Influencing Decisions About Participation in Medication and Vaccine Trials

Objective To provide updated guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease, breast cancer, urogynaecology, and sexuality. Outcomes Lifestyle interventions, prescription medications, and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms. Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are reviewed. Approaches to the identification and evaluation of women at high risk of osteoporosis, along with options for prevention and treatment, are presented in the companion osteoporosis guideline. Evidence Published literature was retrieved through searches of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary (e.g., hormone therapy, menopause, cardiovascular diseases, and sexual function) and key words (e.g., hormone therapy, perimenopause, heart disease, and sexuality). Results were restricted to clinical practice guidelines, systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to publication dates of 2009 onwards and to material in English or French. Searches were updated on a regular basis and incorporated in the guideline until January 5, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, national and international medical specialty societies, and clinical practice guideline collections. Values The quality of the evidence in this document was rated using the criteria described by the Report of the Canadian Task Force on Preventive Health Care (Table 1).

https://www.jogc.com/article/S1701-2163(15)30456-4/pdf

Managing Menopause Abstract and Summary Statement

Objective To determine whether demographic or patient factors contribute to later presentation (10 to 12weeks' gestational age) for induced abortion in a Canadian abortion clinic. Methods Women attending a hospital-based abortion clinic between April and September 2012 were asked to complete a survey. The characteristics of women who presented early (EPs; gestational age t tests for means and Fisher exact tests for rates. Results Among women referred to the clinic by a primary care provider, LPs were more likely than EPs to report "a delay in obtaining a referral" (20.8% vs. 6.1%; P =0.007). While there was no significant difference between the groups in reporting that "someone tried to discourage [them] from having an abortion" (26.45% for EPs, 32.4% for LPs; P =0.421), LPs were more likely to report that discouragement "caused a delay in making arrangements" (45.5% vs. 16.7%; P =0.019). Of women who had access to a primary care provider, it was more common for the primary care provider to be aware of the pregnancy among LPs than among EPs (80.6% vs. 63.1%; P =0.015). Conclusion Some women delay presenting for abortion because of discouragement from friends and family. It is unclear whether there are educational or policy interventions that can have an impact on this delay, and this warrants further study. There may be ways of addressing the delay in referral by primary care providers. Further study into the causes for delay in referral for abortion is warranted.

https://www.jogc.com/article/S1701-2163(15)30361-3/pdf

Robert L. Reid

Papers

Optimizing Participation of Pregnant Women in Clinical Trials: Factors Influencing Decisions About Participation in Medication and Vaccine Trials

Managing Menopause Abstract and Summary Statement

Determinants of Late Presentation for Induced Abortion Care

Heavy menstrual bleeding: is tranexamic acid a safe adjunct to combined hormonal contraception?

Safety and bleeding profile of continuous levonorgestrel 90 mcg/ethinyl estradiol 20 mcg based on 2 years of clinical trial data in Canada