Page 9 – Womens Health Polylang

Parathyroid diseases are uncommon in pregnancy, may produce significant perinatal and maternal morbidity and mortality if not diagnosed and properly managed. It reviews calcium homeostasis, primary hyperparathyroidism, hypoparathyroidism, and osteoporosis during pregnancy. PTH promotes resorption of calcium from the bones. Thus, all events of PTH action are directed at increasing serum calcium levels. The successful treatment of maternal PHP may transiently improve some of the clinical findings of preeclampsia and preterm labor.

Breast Cancer Risk Assessment

May 10, 2010

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Breast cancer biology is a topic of intensive research, and there have been huge breakthroughs in recent years. Scientific insight into estrogen-receptor biology has led to major advances in estrogen-targeted prevention and chemotherapy. Increased breast density has emerged as a dominant, detectable, and modifiable risk factor for subsequent development of breast cancer in women. The purpose of this document is to discuss clinical application of the various tools available to assess a woman’s risk for breast cancer and apply in clinical practice. This review also provides a comprehensive examination of the importance of breast density as a dominant risk factor for the development of breast cancer, highlighting the role that genetics and hormones play in maintaining breast density in postmenopausal women. Future research can be directed toward the detection of preexisting conditions (such as gene mutations) that put women at risk for highly aggressive cancers. Recommendations for genetic testing are reviewed here, with a particular focus on the components of genetic counseling, identifying individuals for testing, and interpreting test results.

Domestic Violence: Screening And Intervention

June 8, 2010

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Domestic violence continues to be a prevalent problem in the United States. In order to prevent domestic violence and promote the well-being of their patients, healthcare professionals in all settings must take the initiative to properly assess all women for abuse during each visit and, for those women who are or may be victims, to offer education, counseling, and referral information. A tremendous barrier to diagnosing and treating domestic violence is a lack of knowledge and training. It is imperative that healthcare professionals work together to establish specific guidelines that will facilitate identification of batterers and their victims. During the assessment process, a practitioner must be open and sensitive to the client’s/patient’s worldview, cultural belief systems. The long-term focus on domestic violence is responsible for major reforms on multiple levels within various systemic functions related to criminal prosecution, legislative views and actions, and healthcare protocols. Encouraging health care providers to address overall preventive health care may also improve screening for this important public health issue.

Psycho-Oncology Services for Gynecologic Cancer

February 17, 2015

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The purpose of this document is to begin to bridge the gap between clinicians’ and patients’ expectations of how psychosocial services should be used in response to distress screening. The Women’s Health and Education Center (WHEC) supports professional organizations with the mission to improve survival and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive quality care. In 2014, the WHEC approved new standards to promote patient-centered care, an exciting shift driven by research over the past decade showing that patient-centered services improve outcomes. Patient-centered standards include the provision of treatment and survivorship plans, palliative care services, genetic services, navigation programs, and psychosocial distress screening. Given that the popularity of distress screening is increasing exponentially, and begins to bridge the gap between clinicians’ and patients’ expectations of how psychosocial services should be used in response to distress screening. Key findings and implications for service delivery were: 1) receptivity to referral is a separate issue from that of distress level, 2) strong preference among those who declined psycho-oncology referral to cope on their own emphasized the potential role of self-management interventions, and 3) low social support was a major theme among those accepting referral, suggesting that assessing family support might further contribute to identifying patients in need of additional psychological assessment. Additional studies are needed to further examine, on a large scale, patients’ preferences for follow-up care after distress screening. Several different approaches to distress screening are discussed above, and additional studies should examine their comparative acceptability and efficacy.

Urodynamic Assessment: Voiding Studies

February 9, 2009

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Uroflowmetry is an electronic measure of urine flow rate and pattern. Combined with assessment of postvoid residual urine volume (PVR), it is a screening test for voiding dysfunction. If the uroflowmetry and postvoid residual volume (PVR) are normal, voiding function is probably normal; however, if the uroflowmetry or postvoid residual volume (PVR) or both are abnormal, further testing is necessary to determine the cause. More sophisticated measures of voiding function include a pressure-flow voiding study with or without videofluoroscopy. Electromyography of the striated urethral sphincter may be useful to assess neurogenic voiding dysfunction.

Preeclampsia and Eclampsia

August 6, 2009

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Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States. However, there is confusion about the terminology and classification of these disorders. We hope to provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (preeclampsia and eclampsia), as well as the various associated complications. The purpose this document is to provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy — preeclampsia and eclampsia. Various associated complications are also discussed. Expectant management should be considered for women remote from term who have mild preeclampsia. For the prevention and treatment of seizures in women with severe preeclampsia or eclampsia magnesium sulfate is the drug of choice. Practitioners should be aware that various laboratory tests may be useful in the management of women with preeclampsia. The differential diagnosis is also discussed. It is important that clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different.

Menopause: A Close-Up Look

September 23, 2009

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As the life expectancy has increased markedly, more and more women are living longer after menopause. In western society, women can anticipate living for approximately 80 years, spending more than one third of their lives in the postmenopausal period. Menopause refers to the complete or permanent cessation of menstruation; an interval of 6 to 12 months of amenorrhea is usually necessary to establish the diagnosis of menopause. The biologic event of menopause marks a meaningful life passage for every woman. It is a transition made from the reproductive stage of life to the non-reproductive stage. This transition is the period of declining ovarian function, which usually becomes apparent clinically over the 2 to 5 years around menopause. The population of postmenopausal women continues to rise; currently approximately 470 million women in the world are of age 50 and older- a figure that is projected to increase to 1.2 billion by 2030. It is estimated that 25 million women each year pass into menopause. Several studies have shown that both the number of cigarettes smoked and the duration of smoking affects the onset of menopause and it induces earlier menopause.

Domestic Violence During Pregnancy

October 13, 2009

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Intimate partner violence affects 1 out of 4 women in the US and has a tremendous effect on the health and well-being of female patients. The medical community is uniquely positioned to lessen this impact, at the very least by alleviating the isolation that is often integral to victimization. In accordance with expert guidelines, clinicians should screen all women for partner abuse and provide support and information about available resources for patient identified as victims of violence. Domestic violence is a multifaceted problem with high prevalence and substantial costs to society. Using these time-saving screening tools can facilitate discussion of abuse. However, it is important to note that a positive screen with any of the tools demands further evaluation. The military environment possesses a unique set of circumstances and stressors that may directly affect family violence. These include periods of family separation, tensions between the demands of duty and the demands of family life, stress related to the military mission, frequent relocation, perceived dangers associated with military training and combat, as well as financial stressors. Screening for a controlling or threatening partner among women with even mild postpartum depression may identify those who are at higher risk for long-term depression.

Breast Cancer: Early Detection

November 6, 2009

gyno

It is estimated that 217,640 new cases of breast cancer will be diagnosed in United States this year; more than 99% of these breast cancers occur in women. Breast cancer is the most common malignancy among U.S. women and it is the second leading cause of death from cancer among American women (lung cancer is first). A woman’s lifetime risk (80-year life-span) of developing breast cancer is 12.5%, or 1 in 8. Early detection of breast cancer has been shown to decrease the mortality rate. Technology continues to evolve to improve the accuracy of detection. The review also focuses on mammography and other detection techniques as screening tools to identify non-palpable lesions. This information is designed to aid practitioners in making decisions about appropriate care. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institutions or type of practices.

Health Care Patents and The Interests of Patients

December 7, 2009

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Discussions of intellectual property are very complex and involve knowledge of convoluted laws, legal decisions, economic and business analyses. This forum attempts to present and evaluate the arguments on all sides and suggests a possible way out of the current impasse. It attempts to determine the ethical responsibility of the drug industry in making drugs available to the needy, while at the same time developing the parallel responsibilities of individuals, governments, and NGOs. It concludes with the suggestions and areas for future development of mutual interests (continuing medical education initiatives).