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.

/pdf/guidelines-for-the-prevention-of-stroke-in-patients-with-4s66xf1dte.pdf

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 provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Outcomes Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general wellbeing; contraceptive counselling methods; and access to and availability of cited contraceptive methods in Canada. Evidence Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).

Canadian Contraception Consensus (Part 1 of 4) Abstract and Summary Statement

Objective To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Outcomes Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Evidence Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).

Canadian Contraception Consensus (Part 2 of 4) Abstract and Summary Statement

Implicit in this statement is the fact that we may devise efficacious forms of menopausal hormone replacement therapy (HRT) and yet the desired benefits may not be achieved because other factors result in noncompliance. Although the magnitude and pervasiveness of noncompliance with menopausal HRT has generally been acknowledged, this issue has played a limited role in assessment, decision making, policy setting, and individual patient care.1 This chapter examines the range of issues that may have an impact upon the two components of compliance—commencement and maintenance. In general, these can be divided into three major categories: physicians’ concerns, patients’ concerns, and third party concerns. The current state of compliance with available menopausal HRT regimens will be reviewed and recommendations given that may lead to improvement of utilization for those in whom HRT is deemed appropriate.

Compliance with Menopausal Hormone Replacement Therapy

Canada’s Generation X is now entering the menopausal transition and pursuing effective therapy for bothersome vasomotor symptoms. They do so at a time when confusion about the safe and appropriate use of menopausal hormone therapy (MHT) has never been greater. Misplaced fears among women and their health care providers about MHT have, in many circumstances, led them to abandon this most effective therapy. This review discusses the physiology of the menopausal transition, the nature of symptoms related to withdrawal of ovarian estrogen production, and the potential benefits and risks of MHT. It is now clear that for most recently menopausal women the benefits of MHT outweigh the risks. The rationale for choosing different dosages, formulations, and regimens is reviewed.

/pdf/confronting-the-challenges-of-the-menopausal-transition-zc0pz15eep.pdf

Confronting the challenges of the menopausal transition

Objective Anecdotal reports suggest that application of a cool device to the back of the neck at the onset of a hot flush can afford symptomatic relief. The effects of a novel handheld mechanical cooling device in a population of perimenopausal women with moderate-to-severe vasomotor symptoms were evaluated.Methods In this randomized, double-blind, sham-controlled pilot study, 40 perimenopausal women experiencing ≥ 7 moderate-to-severe hot flushes per day were recruited at a single university site. Women were randomized to the active (n = 20) or sham (n = 20) device, which was applied to the back of the neck with each hot flush over the 4-week treatment period. Hot flush scores were calculated based on frequency and severity of symptoms. The Carpenter Hot Flash Related Daily Interference Scale and Zung Anxiety Scale were used to evaluate impact on quality of life. At study end, participants completed an open-ended questionnaire to assess the degree of unblinding and overall subjective improvement ...

Robert L. Reid

Papers

Canadian Contraception Consensus (Part 1 of 4) Abstract and Summary Statement

Canadian Contraception Consensus (Part 2 of 4) Abstract and Summary Statement

Compliance with Menopausal Hormone Replacement Therapy

Confronting the challenges of the menopausal transition

Randomized clinical trial of a handheld cooling device (Menopod ® ) for relief of menopausal vasomotor symptoms