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

Exacerbation of certain medical conditions at specific phases of the menstrual cycle is a well-recognized phenomenon. We review the effects of the menstrual cycle on medical conditions, including menstrual migraine, epilepsy, asthma, rheumatoid arthritis, irritable bowel syndrome, and diabetes. We discuss the role of medical suppression of ovulation using gonadotropin-releasing hormone agonists in the evaluation and treatment of these disorders. Peer-reviewed publications from English-language literature were located via MEDLINE or from bibliographies of relevant articles. We reviewed all review articles, case reports and series, and therapeutic trials. Emphasis was placed on diagnosis and therapy of menstrual cycle-related exacerbations of disease processes. Abrupt changes in the concentrations of circulating ovarian steroids at ovulation and premenstrually may account for menstrual cycle-related changes in these chronic conditions. Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity. Medical suppression of ovulation using gonadotropin-releasing hormone agonists can be useful for both diagnosis and treatment of any severe, recurrent menstrual cycle-related disease exacerbations.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/208109/ira70759.pdf

Effects of the Menstrual Cycle on Medical Disorders

In postmenopausal women, the administration of β-endorphin in repeated pulses (1–2.5 mg) at 1- to 2-h intervals or constant infusion (1 mg/h) for 3–6 h elicited the prompt release of PRL without concomitant change in LH levels. Infusion of an opiate receptor antagonist, naloxone (1.6 mg/h), for 6–7 h also had no effect on LH levels. Since substantial evidence indicates that endogneous opioid peptides exert an inhibitory role on GnRH-LH secretion and that the functional activity of opiate receptors appears to be ovarian steroid dependent, the present observation suggests that the hypersecretion of gonadotropin in the absence of ovarian steroid feedback may, in part, be causally related to a reduced opioid inhibition of GnRH-LH release.

The Disappearance of Opioidergic Regulation of Gonadotropin Secretion in Postmenopausal Women

Induction of ovulation and pregnancy with pulsatile luteinizing hormone releasing factor: dosage and mode of delivery.

SUMMARY
The inhibitory role of the dopaminergic and opioidergic mechanisms in the control of LH secretion in patients with polycystic ovary syndrome (PCO) was evaluated. The administration of an opiate receptor antagonist, naloxone, of a dopamine receptor antagonist, metoclopramide, or of human synthetic βh-endorphin, were unable to alter LH secretory activity in patients with PCO. Since identical doses of these antagonists and the opiate agonist have elicited respectively a rise and fall of LH levels in normal cycling women, these findings suggest that an underlying hypothalamic component of defect in endogenous dopamine and opioid control may be responsible for the inappropriate gonadotrophin secretion in this syndrome.

Robert L. Reid

Papers

Effects of the Menstrual Cycle on Medical Disorders

The Disappearance of Opioidergic Regulation of Gonadotropin Secretion in Postmenopausal Women

Induction of ovulation and pregnancy with pulsatile luteinizing hormone releasing factor: dosage and mode of delivery.

Evidence for decreased endogenous dopamine and opioid inhibitory influences on LH secretion in polycystic ovary syndrome.

A double-blind placebo-controlled trial of progesterone vaginal suppositories in the treatment of premenstrual syndrome