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

Evidence of lasting functional destruction of the rat en dometrium after 5-aminolevulinic acid—induced photodynamic ablation: Prevention of implantation

To gain insights into the neuroendocrine basis for the initiation of folliculogenesis, the hormonal dynamics during the period from the late luteal to the early follicular phase of the menstrual cycle (the luteal-follicular transition) were examined. Blood samples were obtained at 2-h intervals for 5 consecutive days in seven women and at 15-min intervals for 8 h on each of 4 consecutive days in five women. The results indicate that the luteolytic process, as reflected by an exponential decline of both serum estradiol and progesterone levels, began at least 64 h before the onset of menses. During estradiol and progesterone withdrawal, there was a selective increase in mean serum FSH levels (P less than 0.001) beginning 24 h before and reaching a peak 24 h after the onset of menses. The frequency of LH pulses increased slightly but not significantly during this period, with a significant rise in mean serum LH levels on the day of menses. Thus, an acute rise in FSH concentrations the day before and in LH concentrations the day after the onset of menses occurs during luteal-follicular transition. The dissociation of FSH and LH secretion observed suggests that additional neuroendocrine events other than changes in pulsatile GnRH secretion may be operative during this period. These findings indicate that the initiation of folliculogenesis for the ensuing cycle occurs during the late luteal phase by a process of selective augmentation in FSH secretion independent of hypothalamic GnRH secretion. This event may ultimately prove to be a manifestation of the action of recently characterized ovarian peptides on FSH secretion.

Hormonal Dynamics During Luteal-Follicular Transition

Objective To serve as a guideline for health care providers on the use of continuous and extended combined hormonal contraception regimens, to prevent pregnancy, and to delay menses that affect health-related quality of life. Options All combined hormonal contraceptive methods available in Canada that may be used in a continuous or extended regimen are reviewed, and the implications are discussed. Outcomes Efficacy of cited regimens and assessment of their side effects, patient safety, medical usage and non-contraceptive benefits, cost-effectiveness, and availability in Canada. Indications for patient counselling are also provided Evidence Medline, PubMed, and Cochrane Database were searched for articles published in English between 1977 and May 2007. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. Values The quality of evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs The guideline is intended to help reduce unintended pregnancies and improve health-related quality of life in women who find their menses problematic. Increased awareness and empowerment of women, their partners, and health care professionals will improve their ability to make appropriate choices between continuous or extended and cyclic usage of these regimens. Sponsors The development of this guideline has been supported by unrestricted grants from Bayer HealthCare Pharmaceuticals, Janssen Ortho, Organon Canada Ltd., Paladin Labs Inc., Pfizer Canada Inc., and Wyeth Pharmaceuticals.

Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception, 2007

Pneumococcal meningitis during therapy of otitis media with clarithromycin.

A role for endogenous opioid peptides in stress-induced inhibition of LH secretion has been suggested based on the observation in rats, humans, and nonhuman primates that LH inhibition in response to a variety of different stresses could be blocked by the administration of opiate antagonists. In the present study, we have examined in rhesus monkeys whether suppression of LH secretion by insulin-induced hypoglycemia is prevented by administration of the opiate antagonist naloxone. The administration of 1.0 U insulin/kg to chair-restrained ovariectomized monkeys (n = 6) decreased blood glucose levels from 4.98 +/- 0.17 to 2.08 +/- 0.05 mmol/L and increased cortisol levels from 1279 +/- 205 to 2191 +/- 475 nmol/L. LH levels declined to 62% of the levels observed in the pretreatment control period (P < 0.05). Infusion of naloxone (2-mg bolus plus 2 mg/h or 10-mg bolus plus 10 mg/h) did not reverse the effects of insulin-induced hypoglycemia on LH concentrations. The administration of 1.0 U insulin/kg to nonre...

Robert L. Reid

Papers

Evidence of lasting functional destruction of the rat en dometrium after 5-aminolevulinic acid—induced photodynamic ablation: Prevention of implantation

Hormonal Dynamics During Luteal-Follicular Transition

Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception, 2007

Pneumococcal meningitis during therapy of otitis media with clarithromycin.

Hypoglycemia-induced inhibition of luteinizing hormone secretion in the rhesus monkey is not mediated by endogenous opioid peptides.