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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Obesity in Pregnancy

December 18, 2009

Obesity is now epidemic in many developed countries secondary to decreased physical activity combined with an abundance of cheap, high-caloric foods. Maternal obesity increases the risk of multiple adverse pregnancy outcomes including congenital anomalies, miscarriage, preeclampsia, gestational diabetes (GDM), fetal macrosomia, and stillbirth. Obesity also is associated with multiple labor abnormalities, including an increased risk of induction of labor, post-dates pregnancy, prolonged labor, labor augmentation with oxytocin, excessive blood loss at delivery, and cesarean delivery. Obese women who are delivered by cesarean are at greater risk of complications such as longer operative times, excessive blood loss, wound infections, and post-operative endometritis. Not only are large numbers of women overweight or obese prior to pregnancy, but many women gain an excessive amount of weight during pregnancy, thus compounding their obstetrical risks and making them more likely to retain weight postpartum.

The Diseases of Addiction: Opiate Use and Dependence

March 27, 2012

Dependence on opioids is associated with seri­ous morbidity and mortality, and advances in the understanding of the dependence have led to the development of effective treatments. A confusing aspect of the body of research on opi­ate abuse and dependence is the inconsistent use of important terminology that describes the nature and severity of involvement with therapeutic and illicit opiates. The purpose of this document is to provide the reader with a current, evidence-based overview of opiate abuse and dependence and its treatment. Topics covered in this review include the history and demographics of illicit and prescription opiate abuse; risk factors, background characteristics, and comorbid conditions of opiate abusers; the pharmacology of opiate drugs; the biological and behavioral characteristics of opiate dependence; and management of opiate dependence, including treatment of overdose, detoxification and with­drawal, agonist replacement therapy, and drug-free approaches. Additional areas of the course are devoted to the abuse liability of prescription opiates and the impact of abused opiates on the fetus.

Urodynamic Assessment: Leak Point Pressures and Urethral Pressure Profile

February 9, 2009

A review of the definitions, methodology, interpretation variables, and clinical applications of these tests. One of the most important concepts to be put forth in recent years is that “adequate storage at low intravesical pressure” will avoid deleterious upper urinary tract changes in patients with bladder outlet obstruction and/or neuromuscular lower urinary tract dysfunction. Application of this concept to patients with storage problems caused by decreased compliance has also resulted in the concept of the “leak point” as a significant piece of urodynamic data. This “detrusor leak point pressure” is not the same as the “abdominal/coughing Valsalva leak point pressure”. The latter parameter refers to the vesical pressure produced by straining, which is necessary to overcome sphincteric resistance and produce incontinence.

Mapping the Theories of Preeclampsia

March 12, 2009

Preeclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide. Its etiology is elusive and theories abound regarding its pathogenesis. Preeclampsia can cause changes in virtually all organ systems. Several organ systems are consistently and characteristically involved. The pathologic findings indicate that the pathogenetic factor of primary importance is not blood pressure elevation, but rather poor tissue perfusion. The histologic data support the clinical impression that the poor perfusion is secondary to profound vasospasm, which also increases total peripheral resistance and blood pressure. Preeclampsia is not merely an alternate form of malignant hypertension. Recently homocysteine, a metabolite of the essential amino acid methionine has been postulated to produce oxidative stress and endothelial cell dysfunction, alterations associated with preeclampsia. The studies examining the relationship between serum homocysteine concentrations and preeclampsia are also discussed.

Gestational Diabetes: A Comprehensive Review

June 8, 2009

The prevalence of gestational diabetes mellitus (GDM) continues to rise in the face of the obesity epidemic affecting up to 14% of the population. It is the most common clinical issues facing obstetricians and gynecologists and their patients. This document is to provide a comprehensive review of understanding of gestational diabetes mellitus (GDM) and provide management guidelines. Because the risk factors for GDM (particularly obesity) are independent risk factors for fetal macrosomia, the role of maternal hyperglycemia has been widely debated. Considerable controversy remains regarding the exact relationship of these complications to maternal hyperglycemia. Women with GDM are more likely to develop maternal and fetal complications. Whether the relationship with GDM is casual or not, clinicians should be aware of these risks. In addition, women with GDM have an increased risk of developing diabetes later in life.

Sexual Dysfunction in Postmenopausal Women

September 23, 2009

Sexual dysfunction is common in postmenopausal women and the rate can be well over 80%. Pain during intercourse, decreased arousal and response, decreased frequency of sex, and loss of sexual desire are the most frequently identified problems in this population. The primary care physicians and obstetricians and gynecologists are frequently the first-line in the management of these difficulties. The purpose of this document is to enhance the understanding of sexual dysfunction in postmenopausal women and the development of a strategy for treatment or referral. Sexual problems in postmenopausal women are often amenable to fairly simple interventions that are (or can and should be) within the competence of primary care professionals. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient’s individual need.

Assessment & Prognostic Factors In Breast Cancer

September 28, 2009

Few breast cancer risk factors are prevalent in more than 10% to 15% of the population, although some associated with very large relative risks (e.g., mutated genes, cellular atypia). Estimates of the summary population attributable risk for breast cancer range from only 21% to 55%, leaving most of the population attributable risk for the disease unexplained. Age is one of the most important risk factors for breast cancer. Although age-adjusted incidence rates continue to rise, breast cancer mortality has fallen in the past decade in the United States. It is useful for determining the extent of the disease, predicting overall survival, and providing guidance for therapy. Clinically established prognostic factors in breast cancer and concepts and mechanisms of breast cancer metastasis are also discussed. We hope our forums help the clinicians’ better understanding of the disease process and the patient management.

Childhood Injuries and Violence: Improving Care and Global Efforts

October 14, 2009

Injuries and violence are a significant cause of child death, physical and psychological disability. Increase attention to the field of injury control, the violence prevention and to stimulate research on what works to prevent and treat injuries, especially in low- and middle-income countries, as well as increased advocacy / partnership to confront child injury are of urgent need. Women’s Health and Education Center (WHEC) hopes our efforts encourage countries and governments to implement injury control policies and programs that will actually lower the currently unacceptable toll of child injury. While much remains to be learned about the effectiveness of rehabilitation approaches, they signal the potential to actualize the full and meaningful participation of young people who experience disability following an injury. Progress in child and adolescent health will be limited if child injuries are not addressed systematically.

Improving Maternal and Child Health: Towards Universal Access

December 7, 2009

Universal access for mothers and children requires health systems to be able to respond to the needs and demands of the population, and to offer them protection against the financial hardship that results from ill-health. Children are the future of society and their mothers are guardians of that future. To make this possible; investments in health systems and in the human resources for health need to be stepped up. Women’s Health and Education Center (WHEC) addresses through its publications the most pressing public health concerns of populations around the world. To ensure the widest possible availability of authoritative information and guidance on public health matters, WHEC encourages its translation and adaptation.

The Diseases of Addiction: Methamphetamine Abuse

August 20, 2010

The admissions rates for treatment of methamphetamine-related disorders have ballooned alarmingly in some areas, particularly in rural or frontier areas, causing public health concerns. As a result, it is important that healthcare professionals have a solid knowledge of the effects and appropriate treatment of methamphetamine abuse and dependence. Various programs addressing substance abuse and methamphetamine abuse are also discussed. The Fellowship of Crystal Meth Anonymous works a Twelve Step program of recovery. Crystal Meth Anonymous is a fellowship of men and women who share their experience, strength and hope with each other, so they may solve their common problem and help others to recover from addiction to crystal meth. The only requirement for membership is a desire to stop using.