T o p 10ish Wo me n s He a lth o r to pic s in the ne ws Mo stly - PDF document

Pre vie w  Artic le s tha t mig ht c ha ng e pra c tic e T o p 10ish Wo me n’ s He a lth o r to pic s in the ne ws  Mo stly g yn, a little o b Artic le s o f 2015-16  Bre a d a nd b utte r: me no pa use , dyspla sia , c o ntra c e ptio n, misc a rria g e Re b e c c a Ja c kso n, MD Ob ste tric s, Gyne c o lo g y a nd Re pro duc tive Sc ie nc e s UCSF Me no pa use : 3 studie s MHT (a ka HRT ) a nd CVD in yo ung e r me no pa usa l wo me n  Me ta -a na lysis o f RCT s lo o king a t sub g ro up in the subg roup of young e r wome n… . who sta rte d MHT le ss tha n 10 ye a rs a fte r me no pa use  Ora l o nly (tra nsde rma l no t e va lua te d)  5 tria ls a nd 9088 pa rtic ipa nts

NNH: 146 Summa ry o f b e ne fits a nd ha rms in yo ung e r Co ro na ry He a rt Dise a se : De c re a se d 48%, NNT 133 NNH: 133 wo me n De a th (a ll c a use ): De c re a se d 30%, NNT 146 NNH: 214 SWAN: Stud y o f Wo me n’ s He a lth Ac ro ss the Na tio n 17yr c o ho rt o f 3300 multi-ra c ia l/ e thnic wo me n e nro lle d a t 42-52 yo , e xc luding me no pa usa l, o n o c p o r hrt, hyste re c to my  Bo tto m L ine : HRT in yo ung e r po stme no pa usa l wo me n a ppe a rs to re duc e mo rta lity a nd  80% o f wo me n e xpe rie nc e va so mo to r sx (VMS), CVD b ut with a n inc re a se in VT E a nd stro ke . mo st ra te the m mo de ra te to se ve re  No t re c o mme nde d fo r pre ve ntio n o f he a rt  Olde r studie s a nd g uide line s re po rte d VMS dise a se due to risks c o ntinue 6 mo s to 2 yrs a fte r L MP  2 o utc o me s: to ta l dura tio n o f fre q ue nt VMS  Ca ve a t: T he fo llo w-up time is lumpe d (ra the r (pe rime no pa use inc lude d) a nd dura tio n a fte r tha n ye a r b y ye a r). So me e vide nc e sug g e sts me no pa use .  F a n e a rly inc re a se in CVD in pre dispo se d re q ue nt VMS= 6 o r mo re da ys in 2 wk pe rio d; ho t fla she s o r nig ht swe a ts wo me n. VMS=va so mo to r sympto ms

K E E PS: K ro no s E a rly E stro g e n Pre ve ntio n Study  T RCT o f o ra l o r ota l VMS dura tion: 7.4 ye a rs , a fte r L MP 4.5 ye a rs SWAN: Study o f tra nsd e rma l E +P vs (ie 2 yrs VMS while pe rime no pa usa l, 5 mo re ye a rs a fte r  Ho w o fte n do yo ur pa tie nts c o mpla in Wo me n’ s He a lth pla c e b o in re c e ntly me no pa use ) Ac ro ss the Na tio n: tha t me no pa use is c a using mo o dine ss, me no pa usa l wo me n,  Onse t o f VMS: I 17yr c o ho rt o f multi- f VMS sta rt during pre o r e a rly de pre ssio n, irrita b ility o r de c re a se d a b ility n=693, 4 yrs f/ u ra c ia l& e thnic pe rime no pa use —lo ng e r o ve ra ll dura tio n (>11.8 yrs!); wo me n e nro lle d a t if sta rt a fte r me no pa use , sho rte r dura tio n (3.4 yrs) to c o nc e ntra te o r pe rfo rm? 42-52 yo  Ra c e / E thnic ity: AA wo me n ha d lo ng e st dura tio n (10  Is HRT the a nswe r? yrs); Ja pa ne se a nd Chine se wo me n ha d the sho rte st  F 4.8 a nd 5.4 ye a rs, re spe c tive ly). No n-Hispa nic o r Co g nitio n: No . (no sig diff in a ny White =6.5; Hispa nic =8.9 c o g nitive o utc o me )  Dura tio n inc re a se d with stre ss, de pre ssio n/ a nxie ty,  F o r Mo o d: Ma yb e , mo de st impro ve me nt yo ung e r a g e , lo we r e duc in so me sx, fo r o ra l E +P o nly (impro ve d sx o f a nxie ty, de pre ssio n, a ng e r) VMS=va so mo to r sympto ms Ala K a ha ka i T ra il  Anc ie nt Ha wa iia n T ra il  Ac c e ss it a t le ft side o f b e a c h—wa lk inla nd  ~20% o f tho se infe c te d b e c o me ill. a lo ng ro c ks a nd yo u will  Inc ub a tio n fe w da ys to 2 wks. (4-10 da ys) se e it  Co mmo n Sx: a c ute o nse t o f fe ve r, ma c ulo pa pula r  Go e s to Be a c h 69 (25 ra sh, a rthra lg ia , c o njunc tivitis (50%); L e ss c o mmo n: min) a nd b e yo nd to mya lg ia , he a da c he , re tro o rb ita l pa in, pruritus, a nd Pua ko (1 hr) vo miting  Ho t, ro c ky, lo o k fo r  T ypic a lly mild a nd la sts se ve ra l da ys to 1 we e k. c a irns to find tra il in  Guilla in-Ba rre -po ssib le b ut ra re . (<<1% o f infe c te d) pla c e s

As o f july 6  Othe r mo de s o f tra nsmissio n= ma te rna l-fe ta l, b lo o d tra nsfusio n, se xua l (ma le to fe ma le o nly)  Re ma ins a live in se me n up to 62 da ys  De te c tio n: RT -PCR fo r vira l RNA, a ntig e n o r a ntib o die s  T e st within 1 wk o f sx (vira l c le a ra nc e c a n o c c ur in 7 da ys)  T e sts pe rfo rme d a t CDC a nd limite d sta te DPH’ s.  Up to da te info a t CDC we b site Ra pidly c ha ng ing re c o mme nda tio ns: g o to CDC fo r la te st info Ge t upda te a t CDC: http:/ / www.c d c .g o v/ zika / g e o / a c tive -c o untrie s.html

Wha t’ s missing in the CDC a dvic e ? Pre g na nt wo me n a nd Zika ……Ro le o f a b o rtio n  No t a t inc re a se d risk o r se ve rity whe n pre g na nt  Ma te rna l-fe ta l tra nsmissio n c a n o c c ur a ny time “How would the re sults of a mniotic fluid te sting for Zika NEJM July 7  F Risk o f virus inform c linic a l ma na g e me nt of pre g na nt wome n? e ta l e ffe c ts: mic ro c e pha ly, b ra in a tro phy, mic ro c e pha ly ve ntric ula r e nla rg e me nt, intra c ra nia l g re a te st with infx a t <18wks, c a lc ific a tio ns. ( Po ssib le : o c ula r de fe c ts, sc a lp rug a e , A po sitive Zika virus RT -PCR re sult fro m a mnio tic fluid Risk o f jo int c o ntra c ture s.) wo uld b e sug g e stive o f intra ute rine infe c tio n. T his mic ro c e pha ly 1-  Usua lly c a nnot dia g nose until a fte r la te 2 nd T 13% ri info rma tio n wo uld b e use ful fo r pre g na nt wo me n a nd  DE E T & pic a ridin sa fe thro ug ho ut pre g na nc y the ir he a lth c a re pro vide rs to a ssist in de te rmining  If ma le pa rtne r po te ntia lly e xpo se d  c o ndo ms c linic a l ma na g e me nt (e .g ., a nte pa rtum te sting , sc he duling se ria l ultra so unds, de live ry pla nning ).“ thro ug ho ut pre g na nc y (a nd 6 mo nths prio r to c o nc e ptio n) Wha t’ s missing in the CDC a dvic e ? ……Ro le o f a b o rtio n  So no g ra phic e vide nc e o f fe ta l tra nsmissio n Just this we e k… A Why isn’ t o c c urs la te in 2 nd trime ste r, e a rly 3 rd trime ste r. link o n ACOG’ s a nyo ne  T o o la te fo r le g a l a b o rtio n in mo st sta te s we b site (b ut its ta lking a b o ut  No std de finitio n o f mic ro c e pha ly, unc le a r a b o ut a b o rtio n in a b o rtio n? ne uro c o g nitive o utc o me b a se d o n he a d size o the r c o untrie s).  T he re fo re , diffic ult to c o unse l wo me n o r Still no thing a b o ut re c o mme nd a b o rtio n  None the le ss, in US, a bortion should be it in the ir disc usse d a s a n option (no t re c o mme nde d , a lg o rithms just disc usse d) a fte r suspe c te d Zika e xpo sure e ve n witho ut c o nfirma to ry te sting o r wa iting to ha ve so no e vide nc e o f fe tus b e ing a ffe c te d

NE L HA: Na tura l E ne rg y L a b o f Ha wa ii Zika virus outbre a k: re pr oduc tive he a lth a nd rig hts in L a tin Ame ric a . Mo nic a Ro a , L a nc e t, 2016 Just pa st a irpo rt L a tin Ame ric a n he a lth ministe rs re c o mme nde d po stpo ning Re se a rc h a nd pre g na nc y fo r 6 mo nths to 2 ye a rs inc ub a to r fa c ility  56% o f pre g na nc ie s in the re g io n a re uninte nde d T o urs: 10:00a m M-F  L a rg e g ro ups o f wo me n do no t ha ve c o ntro l o ve r the ir se xua l a nd re pro duc tive live s due to …“ Po o r q ua lity o f se x Buy tix o nline e d uc a tio n, po o r a c c e ss to c o ntra c e ptio n, hig h pre va le nc e o f ra pe , a nd c ultura l b a rrie rs tha t ma ke it d iffic ult fo r wo me n to ne g o tia te the use o f c o ntra c e ptio n with the ir pa rtne rs.”  …”a nd the ir ho using a nd lo c a l e nviro nme nts dispro po rtio na te ly e xpo se the m to a re a s tha t a re b re e ding g ro unds fo r mo sq uito e s.  “If g o ve rnme nts d o no t ta ke this o ppo rtunity [to impro ve a c c e ss to c o ntra c e ptio n], the Zika virus will no t o nly b e a pub lic he a lth issue , b ut a lso e xa c e rb a te e xisting g e nde r ine q ua litie s a nd so c ia l injustic e .  L inka g e s o f Swe dish na tio nwide he a lth re g iste rs o f  Ne w pa tho lo g ic a nd limite d e pide mio lo g ic a ll re side nts b e twe e n ho spita l a dmissio ns, o pe ra tio ns, c a nc e r re g istry, de a th re g istry e vide nc e sug g e sts e pithe lia l o va ria n c a nc e r  Surg e ry fro m1973 to 1997 a rise s fro m the F a llo pia n tub e , no t the o va ry  251,500 wo me n with surg e ry, 5.5M witho ut  Ob se rva tio na l studie s sho w de c re a se d o va ria n  81,658 ste riliza tio n c a nc e r in wo me n who ’ ve ha d prio r tub a l lig a tio n  34,400 with sa lping e c to my, o nly 3051 b ila te ra l  T his is a ve ry la rg e , po pula tio n-b a se d study in  Numb e rs do n’ t a dd up: “3051 wo me n we re ide ntifie d with Swe de n fro m 1973-2009 to e va lua te g yn surg e ry two -side d sa lping e c to my a nd 19552 with o ne -side d sa lping e c to my” fo r b e nig n re a so ns a nd risk o f o va ria n c a nc e r