Healthcare News and Research

*Anya* · 02-21-2012, 05:32 PM

Better Pain Control by...Cutting Back on Opioids?
Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York.

Posted: 02/13/2012
I want to talk about a new approach to chronic pain care, based on a recent, exciting study.[1] I certainly see many people with chronic pain in my role as director of a pain center in an academic institution. Many patients do not respond to typically prescribed medications for osteoarthritis and for various neuropathic pain states. I am certain that those of you who are not working at pain centers also see patients who do not respond to available treatments that provide pain relief for other patients.
We are all concerned that sometimes we do not always have a treatment for each individual patient. We need new and improved analgesics and, absent those, at least a more creative way to benefit from what we have.

One approach to this quest has been to try to capitalize on the endocannabinoid system through the use of cannabinoids in various oral pharmacologic tactics. Some cannabinoid agents are available, but with marginal benefit. A second approach has been to develop a better, more effective, and safer way of using opioid analgesics.

The study I want to discuss, "Cannabinoid-Opioid Interaction in Chronic Pain," by Abrams and colleagues,[1] demonstrates how combining the 2 agents may provide promise. I live in New York State, where using marijuana is illegal, medically or otherwise; I am not speaking for or against this. I am merely reporting this particular study.

This study involved individuals with various chronic pain states, including musculoskeletal pain from osteoarthritis and other causes, neuropathic pain, sickle cell disease, and others. These patients were already using long-acting opioids: either time-released oxycodone twice daily at mean doses of 100 mg/day or time-released morphine twice daily at mean doses of about 120 mg/ day. More than 300 individuals were screened, and ultimately 21 of these participated in the study. Participants had to be stable on their opioid regimens before they were enrolled.

The 21 participants were managed as inpatients over 5 days. On the first day, they received 1 evening dose of vaporized cannabis; on days 2-4, they received 3 doses; and on day 5, they received a morning dose, in addition to their typical opioid regimens.

On average, these participants experienced an added 27% reduction in pain with the addition of vaporized cannabis. Pharmacokinetic studies demonstrated that although there was an effect on reducing absorption of morphine by the addition of vaporized cannabis, there was no change in the area under the curve. Therefore, the patients were exposed to a similar amount of morphine, although the peak concentration of morphine was also slightly reduced. Adding vaporized cannabis seemed to independently magnify the response the person was experiencing to the analgesia.

This brings to mind a couple of things. First, this was a limited, 5-day study; the investigators recognized this limitation. However, this shows a new and potentially very helpful combined approach to treatment that comes at an important time when we are searching for improved and novel analgesics that can provide us with additional relief for our patients, and also could spare opioid dosing.

Most important, we're looking for ways to safely treat patients who have chronic pain. This study of vaporized cannabis in addition to long-acting opioid found no significant changes in the plasma opioid level with the combination, even though it proved more effective than the opioid alone. This may be a gateway to future studies using lower doses of opioids in combinations with endocannabinoids or other agents that act on cannabinoid receptors -- or, in certain settings, use of cannabis itself.

Ultimately, this may point to a new way we can effectively treat outpatients.

References

1. Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011;90:844-851. Abstract
Medscape Neurology © 2012 WebMD, LLC

Corkey · 02-21-2012, 05:42 PM

Wouldn't mind a pill form, as a reformed smoker just not gonna inhale.

Rockinonahigh · 02-21-2012, 05:50 PM

I quit smoking nearly a year and ahalf ago,if this came in pill form I could do that just not smokeing it cause I know it will put me on the path to ciggies again.Currently im takeing tramadole and useing flexerill to relax my back,recently ive been up in the amount of tramadols I can take a day but I ony take the extra pill if I really need it.I am so tired of floating thrue most of the day I just dont take anything at all dureing the day,just at bed time.

Greyson · 02-21-2012, 05:53 PM

You know, I am sure there are medical merits to using canabus. Personally, I am tired of the scamming encouraged by greed and for some addiciton in this medical marijuana wars.

Why don't the States that allow the sale of medical marijuana put it in a pharmacy? All of these "dispensarys" popping up under the planning/land use decisions and local (city) ordinances are not working. Make it accountable to the State, legalize it as a medical drug and sell it out of the Pharmacy. This is how it is done with other medical prescriptions.

Toughy · 02-21-2012, 06:18 PM

There is a pharmaceutical version of cannabinoids. It is FDA approved for treatment of nausea and vomiting during chemotherapy. It was approved in the early 90s. The generic name is 'dronabinol' and the brand name is 'marinol'. There are some other approved versions.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000403/

I tried it. Did not like it at all. Gave me a headache and I had no way to control how much I was taking. I think it came in 2 different doses. With smoked cannabinoids, I had control. I can take 1 or 2 tokes or smoke the whole joint depending on pain severity. I did not get the relaxed 'oh I feel better now' that I got by smoking. It didn't really get me loaded.....just a headache and maybe a tiny bit of pain relief.

Vaporized cannabis is very very different than smoking cannabis. It doesn't feel like smoke going in your lungs. I can't tell if I have actually had a dose. It has none of the problems with smoked cannabis. No tars, none of the evil nasty crap smoking gives you, no apparent risk for developing lung disease down the road.

*Anya* · 02-23-2012, 03:10 PM

Women at Midlife and Beyond Have Unique Health Needs

An Expert Interview With Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN

"Hot Flashes and More: Midlife Women's Health and Beyond" was presented at the 14th Annual Nurse Practitioners in Women's Healthcare (NPWH) Premier Women's Healthcare Conference. We spoke with one of the presenters, Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN.

Medscape: What percentage of women in midlife is living with symptoms related to menopause?

Dr. Alexander: Every single woman who lives long enough will experience menopause, and all of us will have some kind of symptoms; the biggest question is whether or not it is bothersome to them. All women experience vaginal atrophy over time. There are certain different symptoms that affect everybody; whether or not it is bothersome is a separate question.

Medscape: Do vasomotor symptoms associated with menopause consist only of hot flashes, or are there other symptoms as well?

Dr. Alexander: Some women get sweats and some women get chills. In Europe they call it 'hot flushes' instead of hot flashes, because their faces turn very red.

Medscape: What are some other consequences related to loss of estrogen?

Dr. Alexander: People can have psychosomatic symptoms, like mood swings, or they can have neurological symptoms like formication, where there's a sensation of bugs picking over the skin. Women sometimes have disbalance.

They can have genitourinary symptoms; they can have musculoskeletal symptoms; some women have gastrointestinal symptoms. The receptors for estrogen and progestogen are all over the body, and so symptoms can occur anyplace, in areas where those receptors become unbalanced, during and after menopause.

There are other physiologic changes that aren't so much symptoms as they are physiologic changes like loss of bone mass and increase of cardiovascular disease, although that's not really related directly to loss of estrogen — it's probably more related to estrogen-testosterone balance, or imbalance.

Medscape: What are some of the risks and benefits associated with use of hormone therapy, and which women would be considered the best candidates for it?

Dr. Alexander: We talked a lot during the session about the history of hormone therapy, and how it has swung like a pendulum over time: first it was in favor, then swung out of favor, then swung into favor, and then swung out of favor.

The most recent evidence-based (data) that we are working with include the HERS study and the WHI study. These studies have indicated that contrary to what was suggested in prior population-based observational studies, hormone therapy, estrogen therapy, or estrogen plus progesterone therapy do not confer cardiac protection, especially if taken a chunk of time after menopause.

We don't really have good data yet whether or not there might be any kind of benefit toward that if hormone therapy is started at the time of the woman transitioning towards menopause. It looks like there are a couple of theories that are evolving, if you look at one more data and start to analyze subgroups. That has suggested 2 different theories related to when one should initiate using hormone therapy; one of them was the "gap" theory, which looks at breast cancer risk, and there's some question about whether there might be a decrease in breast cancer risk if a woman holds off on starting hormone therapy for that 5 years post menopause.

The news is starting to suggest that if we start hormone therapy right at the time when a woman becomes postmenopausal, it helps to decrease, delay, or put off their risk of developing cardiovascular disease.

Now, it is very controversial; there's a lot of good data that's available. Some of the results from various different studies are rather controversial and confusing, and so it's important for people to really look hard to make sure they remain abreast of these developments.

The most immediate information that we have is what I've just described, and it's looking more and more like we really need to individualize care…if the greatest risk for her is related to heart disease, you might want to think about hormone care sooner than later if in fact she's a good candidate. If the risk factors are higher for breast cancer, you might want to wait.

Medscape: Are there any alternative therapies that you currently favor, and what are some of the risks and benefits of those, particularly when compared to hormone therapy?

Dr. Alexander: There are some alternative therapies, and nonhormonal prescription medications that can be used to try to allay symptoms related to menopause: selective serotonin reuptake inhibitors (SSRIs), selective neurotonin reuptake inhibitors (SNRIs), and the like.

The good thing is that we really have a lot of choices and we're learning a lot more about potential risks and benefits, and I think that's incredibly important. We do know that hormone therapy, estrogen therapy, or estrogen plus progesterone therapy are the single most effective for menopause-related symptoms, but it's not a good choice for every person, and it's not something that every woman feels comfortable taking because of some of the risk factors that we're learning about.

Some of the things that might be most beneficial [with hormone replacement therapy] are things like: A) when a hot flash is coming on, the woman can try to decrease its intensity, or B) possibly stop it from happening.

There are a couple of different products on the market that are available, and some of them suggest benefits that may not be borne out when we do larger head-to-head clinical trials. The other thing is that there are many different things that can trigger hot flashes, and it is really important for women to recognize that there are triggers, and if something is coming on, that they might be able to stop it…if they start to feel that hot flash, by using paced breathing.

The data [related to acupuncture] is kind of all over the place. I think the most recent meta-analysis suggested that it probably didn't have a very strong effect… The benefit of acupuncture is that it's a very well-known, well-proven, safe alternative therapy and it certainly increases relaxation and decreases pain, so if it helps lower someone's stress level and anxiety, it may help to decrease hot flashes — not so much because it's having an impact on the hot flashes directly, but more because it is decreasing some things that are possibly triggering the hot flashes to begin with.

Medscape: Which women would be considered good candidates for alternative therapies?

Dr. Alexander: Anybody.

Medscape: What screening tests should be done on all women at midlife and beyond, regardless of whether they are experiencing symptoms of menopause?

Dr. Alexander: We recommend colonoscopy for women starting at age 50 or younger if there's a family history of colon cancer that is identified before the age of 50; regular female Pap smears and annual internal exams; clinical breast exams and mammography; blood sugar and lipid screening at least every 5 years or more frequently in women at risk; PSA [prostate-specific antigen] sometime around age 40 or 50; hemoglobin around age 50; flu shots annually, pneumothorax depending on their health risk at 65, herpes zoster vaccine every 10 years; tetanus vaccine, and if there's any travel, they should have appropriate immunizations for that.

Osteoporosis is very important; some women need to be measured on a stadiometer every single year to be sure that you actually have an accurate height. Bone density screening should be done at the age of 65, unless experiencing other risk factors earlier.

For women who are experiencing menopause-related symptoms and for whom various different therapies might be being considered, there are some screenings that we do that are separate from that: clotting factor, blood cancer risk, heart disease risk, and so forth.

Medscape: Do you have any special tips for examining women at midlife and beyond?

Dr. Alexander: It's important that you maintain an open differential because even though a woman is 52 and hasn't had a menstrual period in 8 months, and has symptoms that sound like they are related to menopause, it doesn't behoove the patient or the clinic to just decide, "Those are menopause-related symptoms." You need to really make sure you go through an appropriate history and a complete physical exam and really maintain your open mind to a broad differential and potential basis for the symptoms.

Women who are at midlife are at higher risk for diabetes, just like men are, and the waxing and waning of blood sugar levels can sometimes mimic menopause-related symptoms such as hot flashes, and it's important to make sure that you screen for those other health conditions.

Dr. Alexander disclosed that she is on the speaker's bureau for Amgen.

National Association of Nurse Practitioners in Women's Healthcare (NPWH) 2011 Annual Meeting. October 12-15, 2011.

Medscape Medical News © 2012 WebMD, LLC

Slowpurr · 02-23-2012, 06:46 PM

Available at: http://www.medscape.com/viewarticle/408896.

Can Exercise Offset Impact of Estrogen Loss?

Physical activity, so vital to good health and well being, takes on even greater importance at menopause; as the ovaries shut down, a woman loses estrogen's protective effects against bone loss. The years surrounding the menopause, which occurs at an average age of 52, when a woman undergoes the transition from a reproductive to a postreproductive state, are termed the climacteric period. Regular exercise can prevent or lessen the impact of many of the changes women experience at this time. Exercise also can decrease morbidity and mortality after menopause by lowering a woman's risk of bone fracture.

Exercise can attenuate some of the effects of aging as well as the physical changes linked to a sedentary lifestyle. Regular physical activity can reduce the symptoms and risks of cardiovascular disease, osteoporosis, obesity, and other chronic diseases such as diabetes, which become more prevalent in the postmenopausal period.[1] There is some evidence that symptoms often associated with the hormonal changes of menopause, such as hot flashes, insomnia, and depression, can also be alleviated by exercise.[2] Despite the growing body of evidence for the benefits of exercise at any age, it is estimated that only 38% of females over the age of 19 exercise regularly.[3] The public health burden of inactivity, with its associations to coronary heart disease (CHD) and all-cause mortality, is high. All women should be encouraged to exercise regularly, and clinicians should reinforce the particular benefits of exercise to patients in their menopausal and postmenopausal years.

Authors and Disclosures

Margaret Burghardt is Staff Physician at the Fowler-Kennedy Sports Medicine Clinic, University of Western Ontario Faculty of Medicine, London, Ontario, Canada. She holds a diploma in sports medicine from the Canadian Academy of Sports Medicine (CASM).

Burghardt M. Exercise at Menopause: A Critical Difference. MedGenMed 1(3), 1999. [formerly published in Medscape Women's Health eJournal 4(1), 1999].

*Anya* · 02-24-2012, 02:02 PM

SAMHSA News Release
Date: 2/16/2012 12:05 AM
From: Substance Abuse and Mental Health Services Administration (SAMHSA)
Telephone: 240-276-2130

A new report shows 7.5 million children under age 18 (10.5 percent of this population) lived with a parent who has experienced an alcohol use disorder in the past year. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA) 6.1 million of these children live with two parents—with either one or both parents experiencing an alcohol use disorder in the past year.
The remaining 1.4 million of these children live in a single-parent house with a parent who has experienced an alcohol use disorder in the past year. Of these children 1.1 million lived in a single mother household and 0.3 million lived in a single father household. This study is done in conjunction with Children of Alcoholics Week, February 12-18, 2012.

“The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems later in their lives,” said SAMHSA Administrator Pamela S. Hyde. “SAMHSA and others are promoting programs that can help those with alcohol disorders find recovery – not only for themselves, but for the sake of their children. SAMHSA is also playing a key role in national efforts to prevent underage drinking and other forms of alcohol abuse.”

SAMHSA offers an on-line treatment locator service that can be accessed at www.samhsa.gov/treatment or by calling 1-800-662-HELP (4357).

There are many resources available to help children with a parent who has an alcohol problem. The National Association for Children of Alcoholics ( http://www.nacoa.org ) provides information and resources for professionals who may be in a position to help these children and their families. More resources are available at: http://www.samhsa.gov/prevention .

The report entitled, Data Spotlight: Over 7 Million Children Live with a Parent with Alcohol Problems, is based on data analyzed from SAMHSA’s 2005-2010 National Survey on Drug Use and Health (NSDUH). NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many substance abuse and behavioral health issues affecting the nation. http://www.samhsa.gov/data/spotlight...holics2012.pdf .

For more information about SAMHSA visit: http://www.samhsa.gov.

SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Last updated: 2/15/2012 4:16 PM

*Anya* · 02-24-2012, 02:06 PM

Joanna Broder
February 17, 2012 — Strong social support may help protect gay, lesbian, bisexual, and transgender (LGBT) youth against suicidal thoughts, new research suggests.

The first longitudinal prospective study to examine factors predictive of suicidal ideation and self-harm in this vulnerable, high-risk population indicates that support from friends and family may offer the greatest protection.

"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," senior author Brian Mustanski, PhD, a clinical psychologist and associate professor of medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, Illinois, said in a release.

"I think it really informs us as to what sort of avenues we can take to help reduce suicide in gay youth," he told Medscape Medical News.

The study is published in the March issue of the American Journal of Preventive Medicine.

Suicide More Common in Gay Youth

Suicide is the third-leading cause of death among adolescents. However, LGBT youth are at least twice as likely to attempt suicide as their heterosexual counterparts. Contemplating suicide is a precursor of suicide attempts, prior research shows.

Understanding the risk factors for suicidal ideation is "crucial for improving prevention and treatment strategies," the authors write.

The investigators examined suicide risk factors such as depression and feelings of hopelessness in a general adolescent population along with a variety of LGBT-specific risk factors such as gay-specific victimization and gender nonconformity.

The study followed an ethnically diverse cohort of 246 Chicago-area LGBT youth aged 16 to 20 years at baseline for 2.5 years. The study population was not randomized. Participants self-identified their sexual orientation; they were recruited from a variety of sources, including flyers distributed in LGBT-identified neighborhoods and group listservs. Each participant completed a baseline interview, then 4 follow-up interviews were conducted 6 months apart.

Researchers chose to focus on suicidal ideation and self-harm as the main outcome measures, rather than suicide attempts, because different people mean different things by the phrase "suicide attempt," Dr. Mustanski said.

"By focusing specifically on these precursors that we can define much more clearly, it really gives us a much better window into what the risk and protective factors are," he said.

Self-Harm Risk

At baseline, participants were asked whether they had ever attempted suicide. They were also asked about their level of gender nonconformity, impulsivity, and sensation seeking.

During follow-up interviews, participants were asked about suicidal ideation, feelings of hopelessness, self-harm, bullying due to their sexual orientation, and level of support from family and friends.

Hierarchic linear modeling was used to examine between-person differences and within-person changes in suicidal ideation and self-harm over time.

Results showed that a history of attempted suicide (P = .05), impulsivity (P = .01), prospective LGBT victimization (P = .03), and low social support (P = .02) were all associated with an increased risk for suicidal ideation.

Prior suicide attempts (P < .01), sensation seeking (P = .04), female gender (P < .01), childhood gender nonconformity (P < .01), prospective hopelessness (P < .01), and victimization (P < .01) were all associated with greater self-harm.

On average, each experience of LGBT victimization was associated with a 2.5-fold increased risk for self-harm behavior.

"Well Done"

Commenting on the findings for Medscape Medical News, Anthony D’Augelli, PhD, a clinical and community psychologist and professor of human development and family studies at Pennsylvania State University in University Park, Pennsylvania, described the study as "extremely well done."

"There are a few longitudinal studies of this population, but none that have studied the issue of suicidality over time, so it makes it quite distinctive in that sense," said Dr. D'Augelli.

"Being LGBT as a young person is extremely stressful...the need for support is pretty intense," he added.

The other message for mental health professionals, said Dr. D'Augelli, is not to be judgmental and to use gender-neutral language when engaging with LGBT patients.

The authors and Dr. D'Augelli have disclosed no relevant financial relationships.

Am J Prev Med. 2012;42:221-228. Full article

Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to news@medscape.net.

*Anya* · 02-27-2012, 11:27 AM

Norgestimate and Ethinyl Estradiol Tablets: Recall - Packaging Error, Potential for Incorrect Dosing Regimen

AUDIENCE: OB/GYN, Pharmacy, Patient

ISSUE: Glenmark Generics Inc. issued a nationwide, consumer-level recall of seven (7) lots of Norgestimate and Ethinyl Estradiol Tablets USP (0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg), because of a packaging error where select blisters were rotated 180 degrees within the card, reversing the weekly tablet orientation and making the lot number and expiry date visible only on the outer pouch. As a result of this packaging error, the daily regimen for these oral contraceptives may be incorrect and could leave women without adequate contraception, and at risk for unintended pregnancy.

BACKGROUND: Norgestimate and Ethinyl Estradiol Tablets are used as an oral contraceptive, indicated for the prevention of pregnancy in women. The product was distributed to wholesalers and retail pharmacies nationwide between September 21, 2011 and December 30, 2011.

RECOMMENDATION: Consumers exposed to affected packaging should begin using a non-hormonal form of contraception immediately. Patients who have the affected product should notify their physician and return the product to the pharmacy. See the Press Release for a listing of affected lot numbers, expiration dates, and product photos.

Read the MedWatch safety alert, including a link to the Press Release, at:

http://www.fda.gov/Safety/MedWatch/S.../ucm293385.htm

You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.ht

*Anya* · 02-28-2012, 05:44 PM

Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. Based primarily on recent Medscape News coverage, the following slideshow collects some of the more prominent investigations on nutrition and the brain into a single resource to aid in counseling your patients.

Make for Malta in Depression, Stroke, and Dementia

A 2009 study published in Archives of General Psychiatry found that people who follow Mediterranean dietary patterns -- that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat (common in olive and other plan oils) -- are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare.[1]The olive oil-inclined also show a lower risk for ischemic stroke[2,3] and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.[4,5]

Fat: The Good and the Bad

A study conducted in Spain[6,7] reported that consumption of both polyunsaturated fatty acids (found in nuts, seeds, fish, and leafy green vegetables) and monounsaturated fatty acids (found in olive oil, avocados, and nuts) decreases the risk for depression over time. However, there were clear dose-response relationships between dietary intake of trans fats and depression risk, whereas other data support an association between trans fats and ischemic stroke risk.[8] Trans fats are found extensively in processed foods.

Fish Oil to Fend Off Psychosis?

Thanks to their high levels of polyunsaturated fatty acids, namely omega-3 fatty acids, fish can help fend off numerous diseases of the brain. A 2010 study correlated fish consumption with a lower risk for psychotic symptoms,[10] and concurrent work suggested that fish oil may help prevent psychosis in high-risk individuals.[11] Although data are conflicting, new research shows that the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid are beneficial in depression and postpartum depression, respectively, and other research suggests that omega-3 deficiency may be a risk factor for suicide.[12-16] Oily, cold-water fish, such as salmon, herring, and mackerel, have the highest omega-3 levels.

Berries for Oxidative Stress

Polyphenols, namely anthocyanins, found in berries and other darkly pigmented fruits and vegetables may slow cognitive decline through antioxidant and anti-inflammatory properties. A study in rats from 2010 showed that a diet high in strawberry, blueberry, or blackberry extract leads to a "reversal of age-related deficits in nerve function and behavior involving learning and memory."[17] In vitro work by the same group found that strawberry, blueberry, and acai berry extracts -- albeit in very high concentrations -- can induce autophagy, a means by which cells clear debris, such as proteins linked to mental decline and memory loss.[18] Berry anthocyanins may also reduce cardiovascular disease risk by reducing oxidative stress and attenuating inflammatory gene expression.

What Not to Eat?

Saturated fats and refined carbohydrates have highly detrimental effects on the immune system, oxidative stress, and neurotrophins, all factors that are known to play a role in depression. The study by Akbaraly and colleagues cited previously[22] showed that a diet rich in high-fat dairy foods and fried, refined, and sugary foods significantly increases risk for depression. Similar findings were seen in another study from Spain,[7] showing that intake of such foods as pizza and hamburgers increased the risk for depression over time, and in another study, women with a diet higher in processed foods were more likely to have clinical major depression or dysthymia.[17] Research published last year[37] also showed for the first time that quality of adolescents' diets was linked to mental health: Healthier diets were associated with reduced mental health symptoms and unhealthy diets with increased mental health symptoms over time. Excess salt intake has been long known to increase blood pressure and stroke risk[38,39]; however, recent data also correlate high salt intake, as well as diets high in trans or saturated fats, with impaired cognition.[40,41]

PLEASE NOTE:

**Studies and references available if interested. Did not list as there are 41 separate citations!

*Anya* · 02-29-2012, 07:08 PM

From Pharmacotherapy

Comparison of Prescription Drug Costs in the United States and the United Kingdom: Statins

Hershel Jick, M.D.; Andrew Wilson, M.P.H.; Peter Wiggins, M.B.; Douglas P. Chamberlin, B.A.

Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts (Dr. Jick and Mr. Chamberlin); the Tufts Center for the Study of Drug Development, Boston, Massachusetts (Mr. Wilson); and Castlemilk Group Practice, Glasgow, UK (Dr. Wiggins).

Posted: 02/19/2012; Pharmacotherapy. 2012; 32(1):1-6. © 2012 Pharmacotherapy Publications

Abstract

Study Objective To compare the annual cost of statins in the United States and in the United Kingdom.

Design Matched-cohort cost analysis.

Data Sources U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database.

Study Population We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55–64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries.

Measurements and Main Results Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic Lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric Atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%.

Conclusion The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries.

For reprints, visit http://caesar.sheridan.com/reprints/...0089&acro=PHAR. For questions or comments, contact Hershel Jick, M.D., Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: hjick@bu.edu.

*Anya* · 03-02-2012, 11:34 AM

New Position Statement from NAMS on Hormone Therapy
Reassuring News for Many Women
JoAnn E. Manson, MD, DrPH

This Dr. JoAnn Manson, Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School. I would like to talk with you today about a new position statement on hormone therapy from the North American Menopause Society (NAMS) that was just published in the journal Menopause.[1] This position statement is freely available on the NAMS Website, and it also is accompanied by a patient education handout that can be downloaded and may be very helpful for patient care. I would like to acknowledge that I served in the writing group for this position statement and also that I am currently serving as president of NAMS.

What is new in this 2012 position statement? First, the statement does reaffirm that hormone therapy is the most effective treatment for vasomotor symptoms and other symptoms of menopause. However, now with a decade of research findings since publication of the first results from the Women's Health Initiative (WHI), it has become clear that there are important distinctions between estrogen plus progestin and estrogen alone in terms of benefits and risks. Furthermore, the benefit/risk profile of hormone therapy can vary by a woman's age, time since menopause and her personal risk-factor profile.

One of the reasons that previous guidelines have recommended avoiding treatment with hormones for more than 5 years is that estrogen plus progestin is linked to an increased risk for breast cancer after 3-5 years. This has been seen in many types of studies. Estrogen therapy alone was associated with no increase in the risk for breast cancer in the WHI Estrogen-Alone Trial, with an average of 7 years of treatment and up to 11 years of follow-up. These findings suggest that there may be more flexibility in terms of the duration of treatment of women with hysterectomy who are taking estrogen alone.

Overall, it is suggested that treatment with hormone therapy should be individualized -- that it will depend on the severity of a woman's symptoms, impairment of quality of life, her personal risk-factor status, and her personal preferences. Women who have early surgical or natural menopause may be treated until the average age of natural menopause, around age 51, in the absence of contraindications, and even longer if necessary for symptoms. This is also highlighted in the position statement.

Evidence has been increasing that different formulations and routes of delivery (for example, transdermal or low-dose estrogen) may have different benefits and risks. Overall, we need much more research on the role of formulation and route of delivery of estrogen, but we have some evidence that the transdermal route of delivery may have some advantages, especially for women who are at increased risk for thrombosis.

The NAMS statement reaffirms that estrogen therapy (ET) represents the most effective treatment for the dryness and dyspareunia caused by genital atrophy. When the only indication for use of HT is genital atrophy, vaginal ET, including 2 marketed creams, the 2-mg estradiol 3-month ring, and 10-µg estradiol slow-release tablets, represent appropriate therapy and can be used safely as long as needed to relieve symptoms.

Vaginal ET is approved to treat genital atrophy only; however, vaginal ET also helps to prevent recurrent urinary tract infections, and the 2-mg estradiol vaginal ring in particular has been noted to benefit women with overactive bladder. Although use of a progestin to protect the endometrium is, in general, not recommended while vaginal ET is used, any bleeding that occurs during use should be evaluated.

http://www.menopause.org/psht12.pdf

http://www.medscape.com/viewarticle/759409

Menopause: The Journal of The North American Menopause Society
Vol. 19, No. 3, pp. 257/271
DOI: 10.1097/gme.0b013e31824b970a
* 2012 by The North American Menopause Society

Kobi · 07-03-2012, 07:44 AM

Study Links Cat Litter Box to Increased Suicide Risk

A common parasite that can lurk in the cat litter box may cause undetected brain changes in women that make them more prone to suicide, according to an international study.

Scientists have long known that pregnant women infected with the toxoplasma gondii parasite -- spread through cat feces, undercooked meat or unwashed vegetables -- could risk still birth or brain damage if transmitted to an unborn infant.

But a new study of more than 45,000 women in Denmark shows changes in their own brains after being infected by the common parasite.

The study, authored by University of Maryland School of Medicine psychiatrist and suicide neuroimmunology expert Dr. Teodor T. Postolache, was published online today in the Archives of General Psychiatry.

The study found that women infected with T. gondii were one and a half times more likely to attempt suicide than those who were not infected. As the level of antibodies in the blood rose, so did the suicide risk. The relative risk was even higher for violent suicide attempts.

"We can't say with certainty that T. gondii caused the women to try to kill themselves, but we did find a predictive association between the infection and suicide attempts later in life that warrants additional studies," said Postolache, who is director of the university's Mood and Anxiety Program and is a senior consultant on suicide prevention.

"There is still a lot we don't know," he told ABCNews.com. "We need a larger cohort and need a better understanding of the vulnerabilities that certain people have to the parasite."

Suicide is a global public health problem. An estimated 10 million attempt suicide and 1 million are successful, according to Postlache's work.

More than 60 million men, women, and children in the United States carry the toxoplasma parasite, according to the Centers for Disease Control and Prevention, but very few have symptoms.

Toxoplasmosis is considered one of the "neglected parasitic infections," a group of five parasitic diseases that have been targeted by CDC for public health action.

About one-third of the world is exposed to T. gondii, and most never experience symptoms and therefore don't know they have been infected. When humans ingest the parasite, the organism spreads from the intestine to the muscles and the brain.

Previous research on rodents shows that the parasite can reside in multiple brain structures, including the amygdala and the prefrontal cortex, which are responsible for emotional and behavioral regulation.

Rat Study Showed Parasite Changes the Brain
A 2011 study on rats infected by the parasite showed that their fear of cats disappeared. Instead, the parts of their brains associated with sexual arousal were activated. Researchers theorized that the mind-manipulating T. gondii ensures that the parasite will reach and reproduce in the gut of a cat, which it depends upon for its survival.

"The parasite does actually alter the brain of its host," Stanford University study co-author Patrick House told ABCNews.com last year. "The fact that a parasite can get into an organism, target its brain, stay there without killing the host and alter the circuitry of the brain -- we've seen this is insects and fungi, but it's the first time we've seen it in a mammalian host."

It was this and other research that led Postolache to investigate the relationship between the parasite and biological changes in the brain that might lead to suicide. He was also intrigued by studies on allergies and research that showed a connection between toxoplasmosis and schizophrenia.

"I was interested in the neuron aspects of suicide and intrigued by low-grade activation in patients who attempted suicide, as well as victims," he said. "Other studies had looked at the brain and suicide risk and impulsivity. The next question was, what could be the triggers that perpetuate this level of heightened activation in the brain?"

Postolache collaborated with Danish, German and Swedish researchers, using the Danish Cause of Death Register, which logs the causes of all deaths, including suicide. The Danish National Hospital Register was also a source of medical histories on those subjects.

They analyzed data from women who gave birth between 1992 and 1995 and whose babies were screened for T. gondii antibodies. It takes three months for antibodies to develop in babies, so when they were present, it meant their mothers had been infected.

The scientists then cross-checked the death registry to see if these women later killed themselves. They used psychiatric records to rule out women with histories of mental illness.

Postolache said there were limitations to the study and further research is needed, particularly with a larger subject group.

Dr. J. John Mann, a psychiatrist from Columbia University, said Postolache's research mirrors his work in the field of suicidal behavior.

"The relationship of the brain to the immune system is more complex than it may appear," said Mann. "The brain regulates the stress response system, which impacts the immune response."

Scientists already know that steroids like cortisone can affect the immune response. Some antibodies whose goal is to kill off cancer can also affect the brain. Oftentimes the first symptom of pancreatic cancer is depression, he said.

Research also shows that streptococcus bacteria can trigger obsessive-compulsive disorder (OCD) in some children. Sydenham's chorea, the loss of motor control that can occur after acute rheumatic fever, may also be an immune response affecting the brain, according to Mann.

Maryland researcher Postolache suspects that some individuals have a predisposition to these neurological changes.

He speculates that the parasite may disrupt neurological pathways in those who are vulnerable, so that projections of fear and depression from the amygdala are not tempered or controlled by the "braking" function of the prefrontal cortex.

But, Postolache warns that even if a direct cause were found, no antibiotics for T. gondii yet exist and it could be a decade before effective vaccines or other agents that might stop the neurological damage are developed.

Right now, the most effective weapon against T. gondii is education about handwashing, the proper cooking of food, and not using a knife exposed to raw meat on cooked meat.

He also cautions against trendy food production techniques that let animals roam free. "The risk of infection could go up," he said, "and increase the rate of toxoplasmosis."

http://gma.yahoo.com/study-links-cat...ws-health.html

Kobi · 07-03-2012, 07:53 AM

Brian Kearney was an angry teenager.

"There were lots of holes in my bedroom wall," said 21-year-old Kearney, recalling the "superhuman strength" that sent his VCR clear across the room. "I would say I was a little on edge."

For Kearney, who also struggled with an eating disorder in his teens, anger was a way release the pressure of high school.

"I didn't develop appropriate coping mechanisms," Kearney said.

Nearly two-thirds of American teenagers admit to having "anger attacks" that that involve destroying property, threatening or engaging in violence, a new study found. And one in 12 has intermittent explosive disorder, characterized by chronic, uncontrollable fits of rage.

"It's an enormous problem that mental health professionals have not taken seriously," said Ronald Kessler, a psychiatric epidemiologist at Harvard Medical School in Boston and lead author of the study, published Monday in the journal Archives of General Psychiatry. "I think it's clear from this study that needs to change."

"Without a really good reason, people all of a sudden feel very fearful, or very angry, and do something excessive," he said. "It's either fight or flight."

For Kearney, one wrong look could trigger a "vicious" reaction.

"I can't explain how I felt when I was in one of those fits of rage," he said. "It's almost like I would black out."

Kessler said Kearney's situation is too common to ignore.

"One in 12 kids has this problem. And people very often continue to have this problem into adulthood, affecting their education, jobs and marriages," he said. "Not to mention the criminal implications."

Although IED is listed in the American Psychiatric Association's Diagnostic and Statistical Manual, its cause – and how best to treat it – remain unknown.

"It bears studying, because what we currently know remains speculative," said Dr. Bela Sood, chair of child and adolescent psychiatry at VCU Medical Center in Richmond, Va.

Sood said IED can be hard for patients – and their parents – to handle.

"During an episode, a person goes from zero to 60," she said. "Afterward they often feel remorseful, but the deed is done."

Kearney said he would apologize to his parents after an attack but admitted the anger took a heavy toll.

"It definitely affected our relationship," he said. "But in the end I'm closer to them than I ever was."

Kearney, now a junior at Rowan University in Glassboro, N.J., patched up his relationships – and the holes in his wall – and left his troubled teenage years behind. He credits talk therapy for his victory over anger, as well as Xanax that helps quell his anxiety.

"Everything I've gone through has shaped me into the person I am today," he said. "And I think I'm a pretty good person."

http://abcnews.go.com/Health/MindMoo...ry?id=16694231

*Anya* · 07-17-2012, 02:32 PM

References

1. Dean L, Meyer I, Robinson K, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101–151.
2. Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. J Adv Nurs. 2006;55(4):407–415.
3. Institute of Medicine. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academy Press; 1999. http://books.nap.edu/openbook.php?record_id_6109&page_1. Accessed April 3, 2012.
4. Hutchinson M, Thompson A, Cederbaum J. Multisystem factors contributing to disparities in preventive health care among lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(3):393–402.
5. Spinks VS, Andrews J, Boyle J. Providing health care for lesbian clients. J Transcult Nurs. 2000;11(2):137–143.
6. Mravcak S. Primary care for lesbians and bisexual women. Am Fam Physician. 2006;74(2):279–286.
7. O'Hanlan KA, Dibble SL, Hagan HJJ, Davids R. Advocacy for women's health should include lesbian health. J Womens Health (Larchmt). 2004;13(2):227–234.
8. Seaver MR, Freund KM, Wright LM, Tjia J, Frayne SM. Healthcare preferences among lesbians: a focus group analysis. J Womens Health (Larchmt). 2008;17(2):215–225.
9. Dibble SL, Roberts SA, Robertson PA, Paul SM. Risk factors for ovarian cancer: lesbian and heterosexual women. Oncol Nurs Forum. 2002;29(1):E1-E7.
10. The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. 2010. http://www.jointcommission.org/Advan..._Communication. Accessed April 3, 2012.
11. Gay and Lesbian Medical Association. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT) Health. 2001. http://www.nalgap.org/PDF/Resources/...LGBTHealth.pdf.
12. Gay and Lesbian Medical Association. Lesbian, gay, bisexual, and transgender health: overview. Healthy People 2020 Web site. http://healthypeople.gov/2020/topics...spx?topicid_25. Updated November 18, 2011. Accessed November 21, 2011.
13. Bjorkman M, Malterud K. Lesbian women's experience with health care: a qualitative study. Scand J Prim Health Care. 2009;27(4):238–243.
14. Platzer H, James T. Lesbians' experiences of healthcare. Nurs Times Res. 2000;5(3):194–202.
15. Nursing Council of New Zealand. Guidelines for cultural safety, the treaty of Waitangi, and Maori health in nursing education and practice. 2005. Amended and reprinted March 2009. http://www.nursingcouncil.org.nz/dow...l-safety09.pdf. Accessed February 5, 2011.
16. Roberts SJ. Health care recommendations for lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(5):583–591.
17. Boehmer U, Bowen DJ. Examining factors linked to overweight and obesity in women of different sexual orientations. Prev Med. 2009;48(4):357–361.
18. Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health. 2001;91(6):947–952.
19. Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol. 2009;118(3):647–658.
20. Matthews AK, Hughes TL, Johnson T, Razzano LA, Cassiday R. Prediction of depressive distress in a community sample of women: the role of sexual orientation. Am J Public Health. 2002;92(7):1131–1139.
21. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49(2):115–123.
22. Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health. 2010;100(12):2426–2432.
23. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10–51.
24. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79(2):159–170.
25. Blosnich JR, Horn K. Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation. Nicotine Tob Res. 2011;13(12):1284–1295.
26. Centers for Disease Control and Prevention. HIV/AIDS among women who have sex with women. 2006. http://www.cdc.gov/hiv/topics/women/...sheets/wsw.htm. Accessed March 1, 2011.
27. Marrazzo JM, Coffey P, Bingham A. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspect Sex Reprod Health. 2005;37(1):6–12.
28. O'Hanlan KA. Health policy considerations for our sexual minority patients. Obstet Gynecol. 2006;107(3):709–714.
29. Zeidenstein L. Health issues of lesbian and bisexual women. In: Varney's Midwifery. Varney H, Kriebs JM, Gegor CL, eds. 4th ed. Sudbury: Jones and Bartlett Publishers; 2004:299–311.
30. McManus A. Creating an LGBT-friendly practice: practical implications for NPs. Am J Nurse Pract. 2008;12(4):29–38.
31. Anderson T. Nursing profession development: scope and standards of practice (2010). Nebr Nurse. 2011;44(3):8–9.
32. Makadon HJ, Mayer KH, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia: American College of Physicians Press; 2007.

*Anya* · 07-17-2012, 02:40 PM

Part II

It is difficult to accurately capture the full effect of marginalization, discrimination, and stigmatization on the mental health of an individual or minority group. LGBT persons "are subject to unique social stressors such as prejudice, stigmatization, and antigay violence that may precipitate mental distress, mental disorders, suicidal ideation, and self-harm."[6] Matthews et al[20] studied the role of sexual orientation in predicting depressive distress in a sample of women. Their sample (N 5 829) showed "51% of lesbians and 38% of heterosexual women reported seriously considering suicide at some point in the past."[20] Also, "more than twice as many lesbians as heterosexual women in this age group (15–19) reported suicide attempts."[20]

Although research is limited, LGBT youth may also be at increased risk for suicide attempts compared to their heterosexual counterparts. Marshal et al[21] found that there is a higher rate of suicidality in sexual minority youth compared with heterosexual youth. However, in the study of LGBT youth by Mutanski et al,[22] there were similar rates of suicidality compared with youth of the same geographical areas. They also noted that mental health disorders were higher among the LGBT youth group compared with national data samples but similar when compared with ethnic/minority urban youth samples. Haas et al[23] said, "Over the last 2 decades, an increasing body of empirical research in the US and other countries has pointed to significantly elevated suicide risk among LGBT compared to heterosexual people."

Although there is limited research describing reasons for increased risk in the WSW population, it may be that many mental health issues are associated with the consequences of being a WSW living in a "heterosexual-oriented society."[7] "Heteronormativity denotes how the social life of Western culture is constructed on the assumption that all people are heterosexual, assuming the heterosexual nuclear family
norm to be natural and universal, and thereby making homosexuality socially invisible and second class."[13] It is important to understand that marginality of any kind can be a risk factor for mental health issues. Lehavot and Simoni[24] suggest screening (and referring as needed) for minority stress and the presence/absence of "coping resources" among sexual minority women.

Substance Abuse

Spinks et al[5] said, "Accurate estimates of the prevalence of substance abuse in lesbians are not available due to the marginalization and hidden nature of the population."[5] The rate of alcohol abuse in WSW is unclear and data are conflicting. Dean et al[1] identify that early studies on the gay and lesbian population recruited subjects in bars "which, not surprisingly, showed higher rates of heavy alcohol and drug use than the general population."

Many reports discussed by Roberts[16] indicate that there is more alcohol use in the lesbian community. "Data from the Women's Health Initiative study and other, smaller studies indicate that tobacco use is higher among lesbians than among the general female population."[6] This finding is in contrast with the Dibble study mentioned above. Roberts[16] said, "Reviews have concluded that smoking rates for adolescent and adult lesbians are higher than their national comparison groups, with adolescents being highest for both groups."

Blosnich and Horn[25] examined discrimination/violence and associated smoking among young adults and found that sexual minorities were more likely to experience discrimination and violence and are twice as likely to smoke when compared with heterosexuals in the same age group. It appears that there may be increased substance abuse among WSW in comparison to heterosexual women, but this, too, needs further research. Many factors may put WSW at higher risk for substance abuse or mental health issues, including social stigma, societal pressures, internalized homophobia, the "coming out" process, and discrimination.[5,6,16]

STDs and Reproductive Health/Services

Women who describe themselves as having same sex orientation may identify themselves as lesbian. However, sexual behavior is not the same as sexual orientation, and these should not be confused.[4] Obtaining an accurate sexual history is important to identify risk factors for STDs and safe sex practices. Sex practices of WSW vary widely and the most important thing a provider can do is refrain from making assumptions.

The risk for STD transmission in WSW changes based on sexual practices and the STD organism.[4] Little is known about transmission of STDs between 2 women. "Transmission of some STDs between women is known to occur; for other STDs, transmission between women is possible in theory but has not been proven."[6] Mravcak[6] provides a table in her article showing known transmission of STDs between women to include herpes simplex, genital warts associated with HPV, and trichomoniasis. Included in the table is the description of theoretical STD transmission between WSW: chlamydia, gonorrhea, syphilis, hepatitis B, and HIV.[6] Bacterial vaginosis, while not an STD, is commonly found in the WSW and their female partners[6,16] and is believed to be transmitted between women.[16]

As identified earlier in this article, most WSW have a history of male sexual partners. This fact increases STD risk for these women and their partners. However, Mravcak[6] said, "Lesbians are less likely than bisexual or heterosexual women to be tested regularly for STDs."[6] Many WSW may not believe that they are at risk for acquiring STDs and may even delay treatment when symptoms arise.[4] In addition, NPs may have inaccurate information about the risks of STDs for WSW and assume that they are not engaging in heterosexual intercourse.[4] This assumption may result in the provider choosing to omit needed routine screening for these patients.[4]

NPs need to teach safe sex practices for WSW. Some recommendations given by Mravcak[6] are to avoid contact with any visible genital lesions, cover sex toys that penetrate more than one person's vagina or anus with a new condom for each person, use a barrier during oral sex, and use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding. The Centers for Disease Control and Prevention[26] (CDC) determined, "No barrier methods for use during oral sex have been evaluated as effective by the Food and Drug Administration. However, natural rubber latex sheets, dental dams, condoms that have been cut and spread open, or plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission."

The CDC[26] also suggests the importance of knowing a partner's HIV status since there is a potential for HIV transmission through menstrual blood. For WSW at this time, oral sex does not require barrier methods if performed with a monogamous partner whose HIV status is negative and has no lesions or other risk factors.[26] Jeanne Marrazzo, MD, MPH, is a leader in infectious diseases and STD prevention and epidemiology. She and her colleagues[27] said WSW should be educated about possible STD transmission between women and education should be centered on common sex practices between WSW.

Reproductive health services are important topics to discuss with WSW patients. In the US, approximately 6 to 14 million children have parents who are lesbian or gay.[6] WSW may have children from previous relationships with men or may choose to become pregnant through a sperm bank, known donor, or heterosexual intercourse. Adoption and foster care are also options for WSW in many states. Other than dealing with societal stigma, studies have shown that children of lesbians have comparable development and life skills adjustment to children in heterosexual families.[16] "The American Psychological Association, the American Academy of Pediatricians, and the North American Council on Adoptable Children have each endorsed foster parenting, adoption, and parenting by same-gender couples, with the reassurance that their review of all the research on these children show that they develop normally."[28]

Even so, the process of starting a family can be emotionally, mentally, and financially challenging for WSW because of social stigma, discrimination, legal issues, and isolation. Zeidenstein[29] said the birth mother has unique challenges as she may have to "come out" again after becoming pregnant and once again as a lesbian mother. Zeidenstein[29] also identified that the comother can experience pain when her role as a parent is not recognized by the people in her life. Furthermore, state laws vary greatly. Legal action is required in most states for the nonbiological parent to be granted parental rights.[6] While legal implications are not within the scope of this article, it is important for NPs to encourage WSW to seek assistance from lawyers to ensure their wishes are granted and to ensure the comother has the rights of parenting she deserves. As an NP, referring WSW to agencies that are known to be nondiscriminatory can also be very helpful.[5]

Improving Practice Through Cultural Safety

NPs are responsible for creating a safe and caring atmosphere for each patient. A "safe" environment is defined by the patient. Key factors to a safe and caring context are reflection, environment, language, and knowledge. Context includes all the "in-betweens" of these 4 key factors. Most of context is made up of what is not said with words or language. A truly safe and caring health care context cannot be achieved by omitting any of the 4 elements. For example, a clinician who provides a safe environment but does not use inclusive language is not providing safe care.

Reflection of one's own feelings and possible biases about the WSW population is the first step in establishing a caring and safe patient-provider relationship. Acknowledging these feelings and examining personal biases is a necessary part of providing a safe and caring environment. McManus[30] said, "Awareness of how one's own attitudes affect clinical judgment and the development of a non-homophobic attitude are important steps in providing culturally competent care."[30] Reflection is an ongoing assessment of one's own feelings, reactions, and motivations. It cannot be done once as a single exercise; it is always evolving based on new experiences and interactions. The process of self-reflection is a personal mission of growth and development that requires continual self-evaluation.

Environment is the first factor that a WSW patient will experience. The waiting room can be a significant indicator of the level of acceptance a WSW patient can expect. The presence/absence of a posted nondiscriminatory policy, the art/pictures displayed, and the kinds of reading material available are all examples of environmental factors that a WSW patient will notice immediately. An example of a nondiscriminatory statement is: "This office appreciates the diversity of women [and men] and does not discriminate based on race, age, religion, ability, marital status, sexual orientation, gender, or perceived gender."[7]

The environment will likely affect the WSW patient's openness about her sexuality. "If the environment is perceived as completely unsafe, questioning by the provider will elicit an inaccurate history."[29] Many waiting rooms and clinics have brochures, posters, and educational materials that "reflect heterosexual experience."[29] Including posters or pictures depicting same-sex couples, brochures available that include same-sex experiences, a visible nondiscriminatory policy, and a visible symbol that the WSW population will recognize as a sign of safety are all ways to make an environment more welcoming to them.[4-6,16,30]

McManus[30] gives examples of symbols that health care providers can display to demonstrate a safe environment for the LGBT population:

**pink triangle (symbol of homosexuality in the concentration camps of Nazi Germany)
**A rainbow flag (an icon for the LGBT community since 1978, when it was first used in the San Francisco Gay Pride Parade)
**The Human Rights Campaign's equality symbol (a blue square with a yellow equal sign [5], which is well known to LGBT persons as a sign of acceptance)

Language used by the provider, staff, and in brochures and history/intake forms is also a strong indicator of safety for the WSW patient. Using inclusive, nonjudgmental, and open-ended questions are important to convey caring and safety. This provides a space for each patient to be as open as she chooses to be. A few examples of open-ended and nonjudgmental language include, "Do you have a partner or a spouse?" instead of "Do you have a husband?" or "Are you married?" Also asking, "Do you, or have you had, sexual relations with men, women, both, or none?"[4–6,16,30] This question is more likely to end with an honest response in comparison to simply asking the patient if she is sexually active.[30] "By taking a little time and asking a few sensitive questions, health care providers can create an environment of trust and inclusion."[5]

Knowledge and competency are associated with caring practice.[31] Understanding the health risks for WSW that are different than heterosexual women is valuable and necessary to provide quality care. The ability to refer patients to other providers who are known to be open and nondiscriminatory is helpful[6] and will enable patients to further trust their provider. The availability of information and resources ( Table 1 ) on WSW-specific health considerations is essential when providing care to this population.

Implications for NPS

In a qualitative study by Bjorkman and Malterud[13] on lesbian experiences with health care, 3 essential qualities were described as necessary for the health care provider: awareness, attitudes, and medical knowledge. This study reinforces the importance of personal attributes that play a role in developing a safe and caring patient-provider relationship.

Some suggestions given in the literature for providing a safe and caring health care context for the WSW population include health questionnaires that are inclusive of same-sex relationships or sexual practices, educational materials or brochures that are inclusive of same-sex relationships and sexual practices, open-ended questions from providers, a nonjudgmental approach to questions, images or posters with same-sex couples, and a nondiscriminatory statement.[6,16,30] While it is important to understand the common health disparities found in the WSW population, the population itself is full of unique individuals from every walk of life. Each individual will present a unique set of health issues and needs. Understanding the uniqueness and diversity of each woman allows the opportunity to provide individually tailored health care and best practices for this population.

In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

*Anya* · 07-17-2012, 02:44 PM

Part I

Creating a Safe and Caring Health Care Context for Women Who Have Sex with Women
Posted: 07/12/2012; Journal for Nurse Practitioners. 2012;8(6):464 © 2012 Elsevier Science, Inc.

The purpose of this article is to introduce the concept of cultural safety as it relates to women who have sex with women and offer nurse practitioners who work with this population an integrated literature review regarding relevant research and recommended practices.

Introduction

Women who have sex with women (WSW) are a population that has long been stigmatized and marginalized within our society. Commonly, WSW are referred to as lesbian or bisexual. However, many WSW do not self-identify this way, so using the term WSW is more inclusive. This article will use WSW and lesbian interchangeably and will mention people of other sexual minorities: lesbian, gay, bisexual, and transgender (LGBT) to be compatible with references and citations.

There has been incremental improvement in the United States toward societal acceptance of the LGBT population, yet there is still stigma associated with living anything other than a heterosexual lifestyle.[1,2] Neville and Henrickson[2] posit that consequences of these attitudes lead to violence, homophobia, and heterosexism that affect the mental and physical health of the LGBT population. "Although homosexuality has been removed from the list of diagnoses in the diagnostic manual of the American Psychiatric Association, the relationship between homosexuality and sickness has proved more enduring in the minds of many providers."[1]

It is difficult to accurately estimate the size of the LGBT or WSW populations because of poor research methods, nonstandardization of terms, and the historical invisibility of the population. Different estimates are given in the literature, all of which are relatively low. The Institute of Medicine[3] (IOM) sentinel report on lesbian health from 1999 lists the estimated percentage at 2%–10% of the population. The range of 1%–10% is reflected in other references.[4–8]

Dibble et al[9] said, "Lesbians are a diverse group of women from every ethnic, religious, economic, cultural, and age group." Some agencies have brought attention to the health disparities and consequent need for culturally safe care, including the Joint Commission,[10] Healthy People 2010 and 2020,[11,12] and the IOM.[3]

Many nurse practitioners (NPs) are educated in the specific health and cultural needs of the WSW population and provide exemplary care for this group. However, although many NPs provide culturally safe care for WSW, there are also accounts of discrimination, abuse, assumptions, voyeurism, lack of knowledge, and substandard care toward the WSW population in health care.[4,5,13,14] Some WSW report that, after coming out to their health care provider, they were treated with physical roughness during their exam.[13] Some women have been denied care after their providers found out about their sexual orientation.[5] According to Bjorkman and Malterud,[13] since many health care providers assume that women are heterosexual, a woman who self-identifies as lesbian has to "choose to actively intervene and inform the professional about her lesbian orientation or passively pass as heterosexual." They also point out that the pressure to disclose sexuality is particularly present during gynecologic exams, when the provider doesn't understand when the patient reports being sexually active but not using contraception and having no possibility of being pregnant.[13]

Much of the literature on WSW identifies gaps in providing culturally safe care for this population. Cultural safety is defined as "the effective nursing practice of a person or family from another culture, and is determined by that person or family."[15] The purpose of this article is to introduce the concept of cultural safety as it relates to WSW and offer NPs who work with this population an integrated literature review regarding relevant research and recommended practice.

Literature Review

The literature review is organized by common health issues found among WSW. The issues discussed are obesity and cardiovascular disease (CVD), cancer and screening, mental health and substance abuse, and sexually transmitted diseases (STDs) and reproductive health.

Obesity and Risk for Cardiovascular Disease

Many sources suggest that WSW may tend to have higher rates of obesity than heterosexual women.[6,9,16] "Lesbians are more likely than heterosexual women to have high body mass index, waist circumference, and waist-to-hip ratio; however, they are also more likely to engage in regular exercise."[6] Boehmer and Bowen[17] also found more obesity in women of sexual minority compared to women with a male partner.

There is conflicting information on the risk of CVD for the WSW population. Roberts[16] said, "Research has found increased risk for CVD in lesbians." On the other hand, Mravcak[6] said, "There is no proven increase in the risk of CVD among lesbians and bisexual women." Risk factors for CVD in the WSW population provided by Roberts include "higher rates of obesity, smoking, alcohol use, and less intake of fruits and vegetables."[16]

Cancer and Screening

Cervical Cancer and Dysplasia. Hutchinson et al[4] said, "All women, regardless of sexual preference, are at risk for cervical cancer." Many providers are under the assumption that WSW do not need regular Papanicolaou (Pap) smears because of perceived low risk of cervical dysplasia and cancer.[6,7] This belief may also be held by many WSW themselves.[16] However, human papillomavirus (HPV), the believed cause for 90% of cervical dysplasia, can be transmitted between women.[5] Cervical neoplasia has been found in WSW with no reported history of male partners.[18] In addition, most WSW do report a history of male sexual partners.[4-7]

There has been evidence that WSW have lower rates of cervical cancer screening than do heterosexual comparison groups.[16] One study of 7,000 lesbians cited by Hutchinson et al[4] reported, "Lesbians had higher rates of abnormal Pap results than rates reported in the general US population." Clearly, best practices suggest that WSW should not be excluded from regular cervical cancer screening. Moreover, NPs may need to educate WSW that they need this screening.

Breast Cancer. Several reasons are identified in the literature why WSW may be at a higher risk to develop breast cancer than heterosexual women. It is believed that WSW do not seek preventive mammograms as often as heterosexual women, citing reasons of mistrust of health care providers, negative past experiences, and perceived homophobia in the health care setting.[4] However, the data suggesting that WSW do not receive screening mammography as much as heterosexual women is not consistent. Mravcak[6] said, "Rates of mammogram screening in lesbians and bisexual women are similar to those in heterosexual women." Also discussed in the literature are lower rates of breast self-exam (BSE) among the lesbian population.[5]

It is commonly believed that many WSW are at a higher risk for developing some cancers as a result of higher rates of nulliparity, smoking, alcohol use, and obesity.[4,16] O'Hanlan et al[7] identify these risks and the use of menopausal hormone replacement therapy as a risk. This information is not well researched and needs further study. As Spinks et al[5] pointed out, "Current research has not accurately identified the incidence of breast cancer in lesbians; however, simply being female places lesbian clients at risk." NPs need to encourage WSW to perform monthly BSE, have regular cancer screening visits with a health care provider, and screening mammograms by following the guidelines for best practices as suggested for all women.

Ovarian Cancer. There is little research available about the occurrence of ovarian cancer in WSW compared to the general population of women. Dibble et al[9] performed a study on risk factors for ovarian cancer for lesbians and heterosexual women. This study of over 1,000 women found, "As expected from previous reports, the lesbians had significantly fewer pregnancies, miscarriages, and abortions and lower use of birth control pills. These variables place lesbians at a higher risk for developing ovarian cancer."[9] "Whether women are at increased risk for ovarian cancer secondary to exposure to HRT [hormone replacement therapy] is not clear. The prevalence of HRT usage among lesbians is unknown."[9] In addition, the authors suggest it would be helpful to include sexual orientation in tumor registry data.[9]

Mental Health

Mravcak[6] said, "Most lesbians and bisexual women are emotionally healthy and well-adjusted." However, mental illness, especially depression, occurs in the WSW population. Depression is the most common mental illness reported in WSW[16] and has shown in some studies to occur in higher rates in WSW than in heterosexual women.[19]

*Anya* · 07-19-2012, 10:15 PM

By Reshma Jagsi, MD, DPhil; Kent A. Griffith, MS; Abigail Stewart, PhD; Dana Sambuco, MPPA; Rochelle DeCastro, MS; Peter A. Ubel, MD
[+] Author Affiliations

JAMA. 2012;307(22):2410-2417. doi:10.1001/jama.2012.6183
ABSTRACT
Objectives: To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors.

Design and Setting: A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address.

Participants: The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary.

Main Outcome Measures A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research.

Results: The mean salary within our cohort was $167 669 ($158 417-$176 922) for women and $200 433 ( $194 249-$206 617) for men. Male gender was associated with higher salary (+$13 399) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12 194 higher than observed.

Conclusion: Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.

http://jama.jamanetwork.com/article....icleid=1182859

*Anya* · 07-23-2012, 12:29 PM

July 23, 2012

Robin W. Simon, PhD

Professor of Sociology, Wake Forest University, Winston-Salem, NC

First published in Psychiatry Weekly, Volume 7, Issue 14, July 23, 2012

Introduction
The connection between social relationships and mental health is a fundamental component of both the sociological and psychiatric literatures. Robin W. Simon, PhD, is a sociologist whose work has focused on social relationships—especially marriage—and mental health for 25 years.

Why is Marriage Associated with Mental Health?
“Sociologists have long been interested in the link between social relationships and mental health,” explains Dr. Simon. “Let’s take marriage as an example. At this point, hundreds of studies document a robust relationship between marriage and improved mental health: married people report significantly fewer symptoms of depression and are significantly less likely to abuse substances than their non-married counterparts. This is because marriage provides social support—including emotional, financial, and instrumental support. Also, married people have greater psychosocial (or coping) resources than the non-married—higher self-esteem and greater mastery. Social support and psychosocial resources not only increase emotional well-being but also buffer the negative emotional effects of stressors that people experience during the life course.”

There are, of course, many nuances in this narrative. For instance, poor marital quality can lead to lower levels of well-being among the married than the non-married, because marital conflict is highly stressful. However, although it was believed for decades that men derive greater benefit from marriage than women, Dr. Simon’s 2002 study1 and other sociological research show that the mental health advantage of marriage is evident among both genders. At the same time, it appears that marriage is less beneficial for individuals with a mentally ill than an emotionally healthy spouse.2

The Direction of the Relationship Between Marriage and Mental Health
The psychiatric literature recognizes the protective effects of marriage for mental illness. For example, among adults with schizophrenia, being in a marital or cohabiting relationship is associated with a 5-year delay in experiencing a first episode of psychosis (FEP) and higher quality of life, and is a significant predictor of symptom remission within 1 year of FEP.3,4

There is a debate about whether a person’s depression increases the risk of marital loss through divorce, or whether a marital loss itself (including cases where a spouse dies) is largely responsible for depression onset.

The former scenario fits into the hypothesis known as social selection, which states—to summarize it roughly—that healthy individuals gravitate toward intimate relationships and are seen as desirable partners. This view assumes that people who marry are more likely to have better mental health, anyway, and that “the healthiest, most robust people select into marriage,” says Dr. Simon. The alternative hypothesis—the perspective that most sociologists embrace—is social causation, which holds that marriage wards off mental illness and improves mental health by virtue of its built-in support system.

In a 2002 study1 Dr. Simon analyzed longitudinal data from a large nationally representative sample to examine, among other things, both the social causation and selection hypotheses of the relationship between marital status and mental health.

“In this study I examined whether a change in marital status between study onset and endpoint caused a change in mental health,” explains Dr. Simon. “I found that people who became divorced and widowed during the study experienced a significant decline in mental health between data points, which supports the social causation hypothesis. But those who divorced also reported more symptoms before the actual divorce. This latter finding could be interpreted as evidence that people who experience mental health problems are more likely to get divorced (in agreement with the social selection hypothesis). I argued, however, that some of these people might have been experiencing marital conflict at study onset, increasing symptoms of depression and alcohol abuse. In terms of marital gain, people who got married during the study reported a significant decrease in symptoms of depression and alcohol abuse, but there was no evidence that mentally robust people are more likely to marry than their less healthy peers.”

In an era where cohabitation and state-sanctioned same-sex marriage are increasingly common, do the mental health benefits of marriage apply exclusively to heterosexual marriages?

Unfortunately, there are no existing national data sets that would allow us to answer this question. Studies addressing this issue are underway, however, and Dr. Simon predicts that there would be no difference in the mental health benefits of marriage between individuals in heterosexual and same-sex marriages. “If anything,” she says, “marriage may be even more protective for people in same-sex marriages, because they fought long and hard for their partnerships to be recognized by the state.” As for cohabitation, Dr. Simon says that studies show that cohabitation, too, is good for mental health, “though not as good as marriage.”

“We still have much to learn about why marriage in particular, and social relationships in general, improve mental health,” concludes Dr. Simon, “but sociological research on this topic is clear; having a deep emotional connection with another person provides individuals with social support and coping resources, a sense of purpose and meaning in life, an important social identity, and feelings of social integration and mattering—which are all important for both the development and maintenance of mental health.”Disclosure: Dr. Simon reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.

References:

1. Simon RW. Revisiting the relationships among gender, marital status, and mental health. AJS. 2002;107:1065-1096.

2. Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord. 2005;7:431-440.

3. Nyer M, Kasckow J, Fellows I, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22:172-179.

4. Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42:595-606.

5. Bulloch AG, Williams JV, Lavorato DH, Patten SB. The relationship between major depression and marital disruption is bidirectional. Depress Anxiety. 2009;26:1172-1177.

02-21-2012, 05:32 PM	#1
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Healthcare News and Research Better Pain Control by...Cutting Back on Opioids? Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York. Posted: 02/13/2012 I want to talk about a new approach to chronic pain care, based on a recent, exciting study.[1] I certainly see many people with chronic pain in my role as director of a pain center in an academic institution. Many patients do not respond to typically prescribed medications for osteoarthritis and for various neuropathic pain states. I am certain that those of you who are not working at pain centers also see patients who do not respond to available treatments that provide pain relief for other patients. We are all concerned that sometimes we do not always have a treatment for each individual patient. We need new and improved analgesics and, absent those, at least a more creative way to benefit from what we have. One approach to this quest has been to try to capitalize on the endocannabinoid system through the use of cannabinoids in various oral pharmacologic tactics. Some cannabinoid agents are available, but with marginal benefit. A second approach has been to develop a better, more effective, and safer way of using opioid analgesics. The study I want to discuss, "Cannabinoid-Opioid Interaction in Chronic Pain," by Abrams and colleagues,[1] demonstrates how combining the 2 agents may provide promise. I live in New York State, where using marijuana is illegal, medically or otherwise; I am not speaking for or against this. I am merely reporting this particular study. This study involved individuals with various chronic pain states, including musculoskeletal pain from osteoarthritis and other causes, neuropathic pain, sickle cell disease, and others. These patients were already using long-acting opioids: either time-released oxycodone twice daily at mean doses of 100 mg/day or time-released morphine twice daily at mean doses of about 120 mg/ day. More than 300 individuals were screened, and ultimately 21 of these participated in the study. Participants had to be stable on their opioid regimens before they were enrolled. The 21 participants were managed as inpatients over 5 days. On the first day, they received 1 evening dose of vaporized cannabis; on days 2-4, they received 3 doses; and on day 5, they received a morning dose, in addition to their typical opioid regimens. On average, these participants experienced an added 27% reduction in pain with the addition of vaporized cannabis. Pharmacokinetic studies demonstrated that although there was an effect on reducing absorption of morphine by the addition of vaporized cannabis, there was no change in the area under the curve. Therefore, the patients were exposed to a similar amount of morphine, although the peak concentration of morphine was also slightly reduced. Adding vaporized cannabis seemed to independently magnify the response the person was experiencing to the analgesia. This brings to mind a couple of things. First, this was a limited, 5-day study; the investigators recognized this limitation. However, this shows a new and potentially very helpful combined approach to treatment that comes at an important time when we are searching for improved and novel analgesics that can provide us with additional relief for our patients, and also could spare opioid dosing. Most important, we're looking for ways to safely treat patients who have chronic pain. This study of vaporized cannabis in addition to long-acting opioid found no significant changes in the plasma opioid level with the combination, even though it proved more effective than the opioid alone. This may be a gateway to future studies using lower doses of opioids in combinations with endocannabinoids or other agents that act on cannabinoid receptors -- or, in certain settings, use of cannabis itself. Ultimately, this may point to a new way we can effectively treat outpatients. References 1. Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011;90:844-851. Abstract Medscape Neurology © 2012 WebMD, LLC __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-21-2012, 05:42 PM	#2
Corkey Infamous Member How Do You Identify?: Human Preferred Pronoun?: He Relationship Status: Very Married Join Date: Dec 2009 Location: Where I want to be Posts: 8,155 My Photo Gallery Thanks: 47,491 Thanked 29,268 Times in 6,637 Posts Rep Power: 21474859	Wouldn't mind a pill form, as a reformed smoker just not gonna inhale. __________________ "Many proposals have been made to us to adopt your laws, your religion, your manners and your customs. We would be better pleased with beholding the good effects of these doctrines in your own practices, than with hearing you talk about them". ~Old Tassel, Chief of the Tsalagi (Cherokee)

02-21-2012, 05:53 PM	#4
Greyson Infamous Member How Do You Identify?: Transmasculine/Non-Binary Preferred Pronoun?: Hy (Pronounced He) Relationship Status: Married Join Date: Nov 2009 Location: SF Bay Area Posts: 6,589 My Photo Gallery Thanks: 21,132 Thanked 8,146 Times in 2,005 Posts Rep Power: 21474858	You know, I am sure there are medical merits to using canabus. Personally, I am tired of the scamming encouraged by greed and for some addiciton in this medical marijuana wars. Why don't the States that allow the sale of medical marijuana put it in a pharmacy? All of these "dispensarys" popping up under the planning/land use decisions and local (city) ordinances are not working. Make it accountable to the State, legalize it as a medical drug and sell it out of the Pharmacy. This is how it is done with other medical prescriptions. __________________ Sometimes you don't realize your own strength until you come face to face with your greatest weakness. - Susan Gale Last edited by Greyson; 02-21-2012 at 06:08 PM.

02-21-2012, 06:18 PM	#5
Toughy Senior Member How Do You Identify?: pervert butch feminist woman Preferred Pronoun?: see above Relationship Status: independent entity Join Date: Nov 2009 Location: Oakland Posts: 1,826 My Photo Gallery Thanks: 4,068 Thanked 7,654 Times in 1,523 Posts Rep Power: 21474853	There is a pharmaceutical version of cannabinoids. It is FDA approved for treatment of nausea and vomiting during chemotherapy. It was approved in the early 90s. The generic name is 'dronabinol' and the brand name is 'marinol'. There are some other approved versions. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000403/ I tried it. Did not like it at all. Gave me a headache and I had no way to control how much I was taking. I think it came in 2 different doses. With smoked cannabinoids, I had control. I can take 1 or 2 tokes or smoke the whole joint depending on pain severity. I did not get the relaxed 'oh I feel better now' that I got by smoking. It didn't really get me loaded.....just a headache and maybe a tiny bit of pain relief. Vaporized cannabis is very very different than smoking cannabis. It doesn't feel like smoke going in your lungs. I can't tell if I have actually had a dose. It has none of the problems with smoked cannabis. No tars, none of the evil nasty crap smoking gives you, no apparent risk for developing lung disease down the road. __________________ We are everywhere We are different I do not care if resistance is futile I will not assimilate www.butchfemmesocials.com/

02-23-2012, 03:10 PM	#6
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Women at Midlife and Beyond Have Unique Health Needs An Expert Interview With Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN "Hot Flashes and More: Midlife Women's Health and Beyond" was presented at the 14th Annual Nurse Practitioners in Women's Healthcare (NPWH) Premier Women's Healthcare Conference. We spoke with one of the presenters, Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN. Medscape: What percentage of women in midlife is living with symptoms related to menopause? Dr. Alexander: Every single woman who lives long enough will experience menopause, and all of us will have some kind of symptoms; the biggest question is whether or not it is bothersome to them. All women experience vaginal atrophy over time. There are certain different symptoms that affect everybody; whether or not it is bothersome is a separate question. Medscape: Do vasomotor symptoms associated with menopause consist only of hot flashes, or are there other symptoms as well? Dr. Alexander: Some women get sweats and some women get chills. In Europe they call it 'hot flushes' instead of hot flashes, because their faces turn very red. Medscape: What are some other consequences related to loss of estrogen? Dr. Alexander: People can have psychosomatic symptoms, like mood swings, or they can have neurological symptoms like formication, where there's a sensation of bugs picking over the skin. Women sometimes have disbalance. They can have genitourinary symptoms; they can have musculoskeletal symptoms; some women have gastrointestinal symptoms. The receptors for estrogen and progestogen are all over the body, and so symptoms can occur anyplace, in areas where those receptors become unbalanced, during and after menopause. There are other physiologic changes that aren't so much symptoms as they are physiologic changes like loss of bone mass and increase of cardiovascular disease, although that's not really related directly to loss of estrogen — it's probably more related to estrogen-testosterone balance, or imbalance. Medscape: What are some of the risks and benefits associated with use of hormone therapy, and which women would be considered the best candidates for it? Dr. Alexander: We talked a lot during the session about the history of hormone therapy, and how it has swung like a pendulum over time: first it was in favor, then swung out of favor, then swung into favor, and then swung out of favor. The most recent evidence-based (data) that we are working with include the HERS study and the WHI study. These studies have indicated that contrary to what was suggested in prior population-based observational studies, hormone therapy, estrogen therapy, or estrogen plus progesterone therapy do not confer cardiac protection, especially if taken a chunk of time after menopause. We don't really have good data yet whether or not there might be any kind of benefit toward that if hormone therapy is started at the time of the woman transitioning towards menopause. It looks like there are a couple of theories that are evolving, if you look at one more data and start to analyze subgroups. That has suggested 2 different theories related to when one should initiate using hormone therapy; one of them was the "gap" theory, which looks at breast cancer risk, and there's some question about whether there might be a decrease in breast cancer risk if a woman holds off on starting hormone therapy for that 5 years post menopause. The news is starting to suggest that if we start hormone therapy right at the time when a woman becomes postmenopausal, it helps to decrease, delay, or put off their risk of developing cardiovascular disease. Now, it is very controversial; there's a lot of good data that's available. Some of the results from various different studies are rather controversial and confusing, and so it's important for people to really look hard to make sure they remain abreast of these developments. The most immediate information that we have is what I've just described, and it's looking more and more like we really need to individualize care…if the greatest risk for her is related to heart disease, you might want to think about hormone care sooner than later if in fact she's a good candidate. If the risk factors are higher for breast cancer, you might want to wait. Medscape: Are there any alternative therapies that you currently favor, and what are some of the risks and benefits of those, particularly when compared to hormone therapy? Dr. Alexander: There are some alternative therapies, and nonhormonal prescription medications that can be used to try to allay symptoms related to menopause: selective serotonin reuptake inhibitors (SSRIs), selective neurotonin reuptake inhibitors (SNRIs), and the like. The good thing is that we really have a lot of choices and we're learning a lot more about potential risks and benefits, and I think that's incredibly important. We do know that hormone therapy, estrogen therapy, or estrogen plus progesterone therapy are the single most effective for menopause-related symptoms, but it's not a good choice for every person, and it's not something that every woman feels comfortable taking because of some of the risk factors that we're learning about. Some of the things that might be most beneficial [with hormone replacement therapy] are things like: A) when a hot flash is coming on, the woman can try to decrease its intensity, or B) possibly stop it from happening. There are a couple of different products on the market that are available, and some of them suggest benefits that may not be borne out when we do larger head-to-head clinical trials. The other thing is that there are many different things that can trigger hot flashes, and it is really important for women to recognize that there are triggers, and if something is coming on, that they might be able to stop it…if they start to feel that hot flash, by using paced breathing. The data [related to acupuncture] is kind of all over the place. I think the most recent meta-analysis suggested that it probably didn't have a very strong effect… The benefit of acupuncture is that it's a very well-known, well-proven, safe alternative therapy and it certainly increases relaxation and decreases pain, so if it helps lower someone's stress level and anxiety, it may help to decrease hot flashes — not so much because it's having an impact on the hot flashes directly, but more because it is decreasing some things that are possibly triggering the hot flashes to begin with. Medscape: Which women would be considered good candidates for alternative therapies? Dr. Alexander: Anybody. Medscape: What screening tests should be done on all women at midlife and beyond, regardless of whether they are experiencing symptoms of menopause? Dr. Alexander: We recommend colonoscopy for women starting at age 50 or younger if there's a family history of colon cancer that is identified before the age of 50; regular female Pap smears and annual internal exams; clinical breast exams and mammography; blood sugar and lipid screening at least every 5 years or more frequently in women at risk; PSA [prostate-specific antigen] sometime around age 40 or 50; hemoglobin around age 50; flu shots annually, pneumothorax depending on their health risk at 65, herpes zoster vaccine every 10 years; tetanus vaccine, and if there's any travel, they should have appropriate immunizations for that. Osteoporosis is very important; some women need to be measured on a stadiometer every single year to be sure that you actually have an accurate height. Bone density screening should be done at the age of 65, unless experiencing other risk factors earlier. For women who are experiencing menopause-related symptoms and for whom various different therapies might be being considered, there are some screenings that we do that are separate from that: clotting factor, blood cancer risk, heart disease risk, and so forth. Medscape: Do you have any special tips for examining women at midlife and beyond? Dr. Alexander: It's important that you maintain an open differential because even though a woman is 52 and hasn't had a menstrual period in 8 months, and has symptoms that sound like they are related to menopause, it doesn't behoove the patient or the clinic to just decide, "Those are menopause-related symptoms." You need to really make sure you go through an appropriate history and a complete physical exam and really maintain your open mind to a broad differential and potential basis for the symptoms. Women who are at midlife are at higher risk for diabetes, just like men are, and the waxing and waning of blood sugar levels can sometimes mimic menopause-related symptoms such as hot flashes, and it's important to make sure that you screen for those other health conditions. Dr. Alexander disclosed that she is on the speaker's bureau for Amgen. National Association of Nurse Practitioners in Women's Healthcare (NPWH) 2011 Annual Meeting. October 12-15, 2011. Medscape Medical News © 2012 WebMD, LLC __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-21-2012, 05:50 PM	#3
Rockinonahigh Senior Member How Do You Identify?: stone butch Preferred Pronoun?: makes no diffrence,I know who I am. Relationship Status: single,maybe looking if the right person comes along. Join Date: Dec 2009 Location: shreveport,Louisiana Posts: 4,907 My Photo Gallery Thanks: 4,682 Thanked 14,933 Times in 3,938 Posts Rep Power: 21474856	I quit smoking nearly a year and ahalf ago,if this came in pill form I could do that just not smokeing it cause I know it will put me on the path to ciggies again.Currently im takeing tramadole and useing flexerill to relax my back,recently ive been up in the amount of tramadols I can take a day but I ony take the extra pill if I really need it.I am so tired of floating thrue most of the day I just dont take anything at all dureing the day,just at bed time.

02-23-2012, 06:46 PM	#7
Slowpurr Member How Do You Identify?: Stone femme Relationship Status: ** Join Date: Dec 2011 Location: Posts: 286 My Photo Gallery Thanks: 833 Thanked 587 Times in 209 Posts Rep Power**: 21474849	Available at: http://www.medscape.com/viewarticle/408896. Can Exercise Offset Impact of Estrogen Loss? Physical activity, so vital to good health and well being, takes on even greater importance at menopause; as the ovaries shut down, a woman loses estrogen's protective effects against bone loss. The years surrounding the menopause, which occurs at an average age of 52, when a woman undergoes the transition from a reproductive to a postreproductive state, are termed the climacteric period. Regular exercise can prevent or lessen the impact of many of the changes women experience at this time. Exercise also can decrease morbidity and mortality after menopause by lowering a woman's risk of bone fracture. Exercise can attenuate some of the effects of aging as well as the physical changes linked to a sedentary lifestyle. Regular physical activity can reduce the symptoms and risks of cardiovascular disease, osteoporosis, obesity, and other chronic diseases such as diabetes, which become more prevalent in the postmenopausal period.[1] There is some evidence that symptoms often associated with the hormonal changes of menopause, such as hot flashes, insomnia, and depression, can also be alleviated by exercise.[2] Despite the growing body of evidence for the benefits of exercise at any age, it is estimated that only 38% of females over the age of 19 exercise regularly.[3] The public health burden of inactivity, with its associations to coronary heart disease (CHD) and all-cause mortality, is high. All women should be encouraged to exercise regularly, and clinicians should reinforce the particular benefits of exercise to patients in their menopausal and postmenopausal years. Authors and Disclosures Margaret Burghardt is Staff Physician at the Fowler-Kennedy Sports Medicine Clinic, University of Western Ontario Faculty of Medicine, London, Ontario, Canada. She holds a diploma in sports medicine from the Canadian Academy of Sports Medicine (CASM). Burghardt M. Exercise at Menopause: A Critical Difference. MedGenMed 1(3), 1999. [formerly published in Medscape Women's Health eJournal 4(1), 1999].

02-24-2012, 02:02 PM	#8
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Report shows 7.5 million children live with a parent with an alcohol use disorder SAMHSA News Release Date: 2/16/2012 12:05 AM From: Substance Abuse and Mental Health Services Administration (SAMHSA) Telephone: 240-276-2130 A new report shows 7.5 million children under age 18 (10.5 percent of this population) lived with a parent who has experienced an alcohol use disorder in the past year. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA) 6.1 million of these children live with two parents—with either one or both parents experiencing an alcohol use disorder in the past year. The remaining 1.4 million of these children live in a single-parent house with a parent who has experienced an alcohol use disorder in the past year. Of these children 1.1 million lived in a single mother household and 0.3 million lived in a single father household. This study is done in conjunction with Children of Alcoholics Week, February 12-18, 2012. “The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems later in their lives,” said SAMHSA Administrator Pamela S. Hyde. “SAMHSA and others are promoting programs that can help those with alcohol disorders find recovery – not only for themselves, but for the sake of their children. SAMHSA is also playing a key role in national efforts to prevent underage drinking and other forms of alcohol abuse.” SAMHSA offers an on-line treatment locator service that can be accessed at www.samhsa.gov/treatment or by calling 1-800-662-HELP (4357). There are many resources available to help children with a parent who has an alcohol problem. The National Association for Children of Alcoholics ( http://www.nacoa.org ) provides information and resources for professionals who may be in a position to help these children and their families. More resources are available at: http://www.samhsa.gov/prevention . The report entitled, Data Spotlight: Over 7 Million Children Live with a Parent with Alcohol Problems, is based on data analyzed from SAMHSA’s 2005-2010 National Survey on Drug Use and Health (NSDUH). NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many substance abuse and behavioral health issues affecting the nation. http://www.samhsa.gov/data/spotlight...holics2012.pdf . For more information about SAMHSA visit: http://www.samhsa.gov. SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Last updated: 2/15/2012 4:16 PM __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-24-2012, 02:06 PM	#9
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Strong Support May Protect Gay Youth From Suicide Joanna Broder February 17, 2012 — Strong social support may help protect gay, lesbian, bisexual, and transgender (LGBT) youth against suicidal thoughts, new research suggests. The first longitudinal prospective study to examine factors predictive of suicidal ideation and self-harm in this vulnerable, high-risk population indicates that support from friends and family may offer the greatest protection. "Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," senior author Brian Mustanski, PhD, a clinical psychologist and associate professor of medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, Illinois, said in a release. "I think it really informs us as to what sort of avenues we can take to help reduce suicide in gay youth," he told Medscape Medical News. The study is published in the March issue of the American Journal of Preventive Medicine. Suicide More Common in Gay Youth Suicide is the third-leading cause of death among adolescents. However, LGBT youth are at least twice as likely to attempt suicide as their heterosexual counterparts. Contemplating suicide is a precursor of suicide attempts, prior research shows. Understanding the risk factors for suicidal ideation is "crucial for improving prevention and treatment strategies," the authors write. The investigators examined suicide risk factors such as depression and feelings of hopelessness in a general adolescent population along with a variety of LGBT-specific risk factors such as gay-specific victimization and gender nonconformity. The study followed an ethnically diverse cohort of 246 Chicago-area LGBT youth aged 16 to 20 years at baseline for 2.5 years. The study population was not randomized. Participants self-identified their sexual orientation; they were recruited from a variety of sources, including flyers distributed in LGBT-identified neighborhoods and group listservs. Each participant completed a baseline interview, then 4 follow-up interviews were conducted 6 months apart. Researchers chose to focus on suicidal ideation and self-harm as the main outcome measures, rather than suicide attempts, because different people mean different things by the phrase "suicide attempt," Dr. Mustanski said. "By focusing specifically on these precursors that we can define much more clearly, it really gives us a much better window into what the risk and protective factors are," he said. Self-Harm Risk At baseline, participants were asked whether they had ever attempted suicide. They were also asked about their level of gender nonconformity, impulsivity, and sensation seeking. During follow-up interviews, participants were asked about suicidal ideation, feelings of hopelessness, self-harm, bullying due to their sexual orientation, and level of support from family and friends. Hierarchic linear modeling was used to examine between-person differences and within-person changes in suicidal ideation and self-harm over time. Results showed that a history of attempted suicide (P = .05), impulsivity (P = .01), prospective LGBT victimization (P = .03), and low social support (P = .02) were all associated with an increased risk for suicidal ideation. Prior suicide attempts (P < .01), sensation seeking (P = .04), female gender (P < .01), childhood gender nonconformity (P < .01), prospective hopelessness (P < .01), and victimization (P < .01) were all associated with greater self-harm. On average, each experience of LGBT victimization was associated with a 2.5-fold increased risk for self-harm behavior. "Well Done" Commenting on the findings for Medscape Medical News, Anthony D’Augelli, PhD, a clinical and community psychologist and professor of human development and family studies at Pennsylvania State University in University Park, Pennsylvania, described the study as "extremely well done." "There are a few longitudinal studies of this population, but none that have studied the issue of suicidality over time, so it makes it quite distinctive in that sense," said Dr. D'Augelli. "Being LGBT as a young person is extremely stressful...the need for support is pretty intense," he added. The other message for mental health professionals, said Dr. D'Augelli, is not to be judgmental and to use gender-neutral language when engaging with LGBT patients. The authors and Dr. D'Augelli have disclosed no relevant financial relationships. Am J Prev Med. 2012;42:221-228. Full article Medscape Medical News © 2012 WebMD, LLC Send comments and news tips to news@medscape.net. __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-27-2012, 11:27 AM	#10
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	FDA Safety and Adverse Event Reporting Norgestimate and Ethinyl Estradiol Tablets: Recall - Packaging Error, Potential for Incorrect Dosing Regimen AUDIENCE: OB/GYN, Pharmacy, Patient ISSUE: Glenmark Generics Inc. issued a nationwide, consumer-level recall of seven (7) lots of Norgestimate and Ethinyl Estradiol Tablets USP (0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg), because of a packaging error where select blisters were rotated 180 degrees within the card, reversing the weekly tablet orientation and making the lot number and expiry date visible only on the outer pouch. As a result of this packaging error, the daily regimen for these oral contraceptives may be incorrect and could leave women without adequate contraception, and at risk for unintended pregnancy. BACKGROUND: Norgestimate and Ethinyl Estradiol Tablets are used as an oral contraceptive, indicated for the prevention of pregnancy in women. The product was distributed to wholesalers and retail pharmacies nationwide between September 21, 2011 and December 30, 2011. RECOMMENDATION: Consumers exposed to affected packaging should begin using a non-hormonal form of contraception immediately. Patients who have the affected product should notify their physician and return the product to the pharmacy. See the Press Release for a listing of affected lot numbers, expiration dates, and product photos. Read the MedWatch safety alert, including a link to the Press Release, at: http://www.fda.gov/Safety/MedWatch/S.../ucm293385.htm You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.ht __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-28-2012, 05:44 PM	#11
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Which foods are better for the brain? Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. Based primarily on recent Medscape News coverage, the following slideshow collects some of the more prominent investigations on nutrition and the brain into a single resource to aid in counseling your patients. Make for Malta in Depression, Stroke, and Dementia A 2009 study published in Archives of General Psychiatry found that people who follow Mediterranean dietary patterns -- that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat (common in olive and other plan oils) -- are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare.[1]The olive oil-inclined also show a lower risk for ischemic stroke[2,3] and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.[4,5] Fat: The Good and the Bad A study conducted in Spain[6,7] reported that consumption of both polyunsaturated fatty acids (found in nuts, seeds, fish, and leafy green vegetables) and monounsaturated fatty acids (found in olive oil, avocados, and nuts) decreases the risk for depression over time. However, there were clear dose-response relationships between dietary intake of trans fats and depression risk, whereas other data support an association between trans fats and ischemic stroke risk.[8] Trans fats are found extensively in processed foods. Fish Oil to Fend Off Psychosis? Thanks to their high levels of polyunsaturated fatty acids, namely omega-3 fatty acids, fish can help fend off numerous diseases of the brain. A 2010 study correlated fish consumption with a lower risk for psychotic symptoms,[10] and concurrent work suggested that fish oil may help prevent psychosis in high-risk individuals.[11] Although data are conflicting, new research shows that the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid are beneficial in depression and postpartum depression, respectively, and other research suggests that omega-3 deficiency may be a risk factor for suicide.[12-16] Oily, cold-water fish, such as salmon, herring, and mackerel, have the highest omega-3 levels. Berries for Oxidative Stress Polyphenols, namely anthocyanins, found in berries and other darkly pigmented fruits and vegetables may slow cognitive decline through antioxidant and anti-inflammatory properties. A study in rats from 2010 showed that a diet high in strawberry, blueberry, or blackberry extract leads to a "reversal of age-related deficits in nerve function and behavior involving learning and memory."[17] In vitro work by the same group found that strawberry, blueberry, and acai berry extracts -- albeit in very high concentrations -- can induce autophagy, a means by which cells clear debris, such as proteins linked to mental decline and memory loss.[18] Berry anthocyanins may also reduce cardiovascular disease risk by reducing oxidative stress and attenuating inflammatory gene expression. What Not to Eat? Saturated fats and refined carbohydrates have highly detrimental effects on the immune system, oxidative stress, and neurotrophins, all factors that are known to play a role in depression. The study by Akbaraly and colleagues cited previously[22] showed that a diet rich in high-fat dairy foods and fried, refined, and sugary foods significantly increases risk for depression. Similar findings were seen in another study from Spain,[7] showing that intake of such foods as pizza and hamburgers increased the risk for depression over time, and in another study, women with a diet higher in processed foods were more likely to have clinical major depression or dysthymia.[17] Research published last year[37] also showed for the first time that quality of adolescents' diets was linked to mental health: Healthier diets were associated with reduced mental health symptoms and unhealthy diets with increased mental health symptoms over time. Excess salt intake has been long known to increase blood pressure and stroke risk[38,39]; however, recent data also correlate high salt intake, as well as diets high in trans or saturated fats, with impaired cognition.[40,41] PLEASE NOTE: **Studies and references available if interested. Did not list as there are 41 separate citations! __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

02-29-2012, 07:08 PM	#12
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Let's File this under: Gee What a Surprise! From Pharmacotherapy Comparison of Prescription Drug Costs in the United States and the United Kingdom: Statins Hershel Jick, M.D.; Andrew Wilson, M.P.H.; Peter Wiggins, M.B.; Douglas P. Chamberlin, B.A. Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts (Dr. Jick and Mr. Chamberlin); the Tufts Center for the Study of Drug Development, Boston, Massachusetts (Mr. Wilson); and Castlemilk Group Practice, Glasgow, UK (Dr. Wiggins). Posted: 02/19/2012; Pharmacotherapy. 2012; 32(1):1-6. © 2012 Pharmacotherapy Publications Abstract Study Objective To compare the annual cost of statins in the United States and in the United Kingdom. Design Matched-cohort cost analysis. Data Sources U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database. Study Population We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55–64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries. Measurements and Main Results Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic Lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric Atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%. Conclusion The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries. For reprints, visit http://caesar.sheridan.com/reprints/...0089&acro=PHAR. For questions or comments, contact Hershel Jick, M.D., Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: hjick@bu.edu. __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

03-02-2012, 11:34 AM	#13
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Latest research hormones and women New Position Statement from NAMS on Hormone Therapy Reassuring News for Many Women JoAnn E. Manson, MD, DrPH This Dr. JoAnn Manson, Professor of Medicine at Brigham and Women's Hospital and Harvard Medical School. I would like to talk with you today about a new position statement on hormone therapy from the North American Menopause Society (NAMS) that was just published in the journal Menopause.[1] This position statement is freely available on the NAMS Website, and it also is accompanied by a patient education handout that can be downloaded and may be very helpful for patient care. I would like to acknowledge that I served in the writing group for this position statement and also that I am currently serving as president of NAMS. What is new in this 2012 position statement? First, the statement does reaffirm that hormone therapy is the most effective treatment for vasomotor symptoms and other symptoms of menopause. However, now with a decade of research findings since publication of the first results from the Women's Health Initiative (WHI), it has become clear that there are important distinctions between estrogen plus progestin and estrogen alone in terms of benefits and risks. Furthermore, the benefit/risk profile of hormone therapy can vary by a woman's age, time since menopause and her personal risk-factor profile. One of the reasons that previous guidelines have recommended avoiding treatment with hormones for more than 5 years is that estrogen plus progestin is linked to an increased risk for breast cancer after 3-5 years. This has been seen in many types of studies. Estrogen therapy alone was associated with no increase in the risk for breast cancer in the WHI Estrogen-Alone Trial, with an average of 7 years of treatment and up to 11 years of follow-up. These findings suggest that there may be more flexibility in terms of the duration of treatment of women with hysterectomy who are taking estrogen alone. Overall, it is suggested that treatment with hormone therapy should be individualized -- that it will depend on the severity of a woman's symptoms, impairment of quality of life, her personal risk-factor status, and her personal preferences. Women who have early surgical or natural menopause may be treated until the average age of natural menopause, around age 51, in the absence of contraindications, and even longer if necessary for symptoms. This is also highlighted in the position statement. Evidence has been increasing that different formulations and routes of delivery (for example, transdermal or low-dose estrogen) may have different benefits and risks. Overall, we need much more research on the role of formulation and route of delivery of estrogen, but we have some evidence that the transdermal route of delivery may have some advantages, especially for women who are at increased risk for thrombosis. The NAMS statement reaffirms that estrogen therapy (ET) represents the most effective treatment for the dryness and dyspareunia caused by genital atrophy. When the only indication for use of HT is genital atrophy, vaginal ET, including 2 marketed creams, the 2-mg estradiol 3-month ring, and 10-µg estradiol slow-release tablets, represent appropriate therapy and can be used safely as long as needed to relieve symptoms. Vaginal ET is approved to treat genital atrophy only; however, vaginal ET also helps to prevent recurrent urinary tract infections, and the 2-mg estradiol vaginal ring in particular has been noted to benefit women with overactive bladder. Although use of a progestin to protect the endometrium is, in general, not recommended while vaginal ET is used, any bleeding that occurs during use should be evaluated. http://www.menopause.org/psht12.pdf http://www.medscape.com/viewarticle/759409 Menopause: The Journal of The North American Menopause Society Vol. 19, No. 3, pp. 257/271 DOI: 10.1097/gme.0b013e31824b970a * 2012 by The North American Menopause Society __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

07-03-2012, 07:44 AM	#14
Kobi Infamous Member How Do You Identify?: Biological female. Lesbian. Relationship Status: Happy Join Date: Feb 2010 Location: Hanging out in the Atlantic. Posts: 9,234 My Photo Gallery Thanks: 9,840 Thanked 34,617 Times in 7,640 Posts Rep Power: 21474860	As if women didnt have enough to worry about r.e. their health.... Study Links Cat Litter Box to Increased Suicide Risk A common parasite that can lurk in the cat litter box may cause undetected brain changes in women that make them more prone to suicide, according to an international study. Scientists have long known that pregnant women infected with the toxoplasma gondii parasite -- spread through cat feces, undercooked meat or unwashed vegetables -- could risk still birth or brain damage if transmitted to an unborn infant. But a new study of more than 45,000 women in Denmark shows changes in their own brains after being infected by the common parasite. The study, authored by University of Maryland School of Medicine psychiatrist and suicide neuroimmunology expert Dr. Teodor T. Postolache, was published online today in the Archives of General Psychiatry. The study found that women infected with T. gondii were one and a half times more likely to attempt suicide than those who were not infected. As the level of antibodies in the blood rose, so did the suicide risk. The relative risk was even higher for violent suicide attempts. "We can't say with certainty that T. gondii caused the women to try to kill themselves, but we did find a predictive association between the infection and suicide attempts later in life that warrants additional studies," said Postolache, who is director of the university's Mood and Anxiety Program and is a senior consultant on suicide prevention. "There is still a lot we don't know," he told ABCNews.com. "We need a larger cohort and need a better understanding of the vulnerabilities that certain people have to the parasite." Suicide is a global public health problem. An estimated 10 million attempt suicide and 1 million are successful, according to Postlache's work. More than 60 million men, women, and children in the United States carry the toxoplasma parasite, according to the Centers for Disease Control and Prevention, but very few have symptoms. Toxoplasmosis is considered one of the "neglected parasitic infections," a group of five parasitic diseases that have been targeted by CDC for public health action. About one-third of the world is exposed to T. gondii, and most never experience symptoms and therefore don't know they have been infected. When humans ingest the parasite, the organism spreads from the intestine to the muscles and the brain. Previous research on rodents shows that the parasite can reside in multiple brain structures, including the amygdala and the prefrontal cortex, which are responsible for emotional and behavioral regulation. Rat Study Showed Parasite Changes the Brain A 2011 study on rats infected by the parasite showed that their fear of cats disappeared. Instead, the parts of their brains associated with sexual arousal were activated. Researchers theorized that the mind-manipulating T. gondii ensures that the parasite will reach and reproduce in the gut of a cat, which it depends upon for its survival. "The parasite does actually alter the brain of its host," Stanford University study co-author Patrick House told ABCNews.com last year. "The fact that a parasite can get into an organism, target its brain, stay there without killing the host and alter the circuitry of the brain -- we've seen this is insects and fungi, but it's the first time we've seen it in a mammalian host." It was this and other research that led Postolache to investigate the relationship between the parasite and biological changes in the brain that might lead to suicide. He was also intrigued by studies on allergies and research that showed a connection between toxoplasmosis and schizophrenia. "I was interested in the neuron aspects of suicide and intrigued by low-grade activation in patients who attempted suicide, as well as victims," he said. "Other studies had looked at the brain and suicide risk and impulsivity. The next question was, what could be the triggers that perpetuate this level of heightened activation in the brain?" Postolache collaborated with Danish, German and Swedish researchers, using the Danish Cause of Death Register, which logs the causes of all deaths, including suicide. The Danish National Hospital Register was also a source of medical histories on those subjects. They analyzed data from women who gave birth between 1992 and 1995 and whose babies were screened for T. gondii antibodies. It takes three months for antibodies to develop in babies, so when they were present, it meant their mothers had been infected. The scientists then cross-checked the death registry to see if these women later killed themselves. They used psychiatric records to rule out women with histories of mental illness. Postolache said there were limitations to the study and further research is needed, particularly with a larger subject group. Dr. J. John Mann, a psychiatrist from Columbia University, said Postolache's research mirrors his work in the field of suicidal behavior. "The relationship of the brain to the immune system is more complex than it may appear," said Mann. "The brain regulates the stress response system, which impacts the immune response." Scientists already know that steroids like cortisone can affect the immune response. Some antibodies whose goal is to kill off cancer can also affect the brain. Oftentimes the first symptom of pancreatic cancer is depression, he said. Research also shows that streptococcus bacteria can trigger obsessive-compulsive disorder (OCD) in some children. Sydenham's chorea, the loss of motor control that can occur after acute rheumatic fever, may also be an immune response affecting the brain, according to Mann. Maryland researcher Postolache suspects that some individuals have a predisposition to these neurological changes. He speculates that the parasite may disrupt neurological pathways in those who are vulnerable, so that projections of fear and depression from the amygdala are not tempered or controlled by the "braking" function of the prefrontal cortex. But, Postolache warns that even if a direct cause were found, no antibiotics for T. gondii yet exist and it could be a decade before effective vaccines or other agents that might stop the neurological damage are developed. Right now, the most effective weapon against T. gondii is education about handwashing, the proper cooking of food, and not using a knife exposed to raw meat on cooked meat. He also cautions against trendy food production techniques that let animals roam free. "The risk of infection could go up," he said, "and increase the rate of toxoplasmosis." http://gma.yahoo.com/study-links-cat...ws-health.html __________________

07-03-2012, 07:53 AM	#15
Kobi Infamous Member How Do You Identify?: Biological female. Lesbian. Relationship Status: Happy Join Date: Feb 2010 Location: Hanging out in the Atlantic. Posts: 9,234 My Photo Gallery Thanks: 9,840 Thanked 34,617 Times in 7,640 Posts Rep Power: 21474860	Anger Attacks Rampant Among U.S. Teens Brian Kearney was an angry teenager. "There were lots of holes in my bedroom wall," said 21-year-old Kearney, recalling the "superhuman strength" that sent his VCR clear across the room. "I would say I was a little on edge." For Kearney, who also struggled with an eating disorder in his teens, anger was a way release the pressure of high school. "I didn't develop appropriate coping mechanisms," Kearney said. Nearly two-thirds of American teenagers admit to having "anger attacks" that that involve destroying property, threatening or engaging in violence, a new study found. And one in 12 has intermittent explosive disorder, characterized by chronic, uncontrollable fits of rage. "It's an enormous problem that mental health professionals have not taken seriously," said Ronald Kessler, a psychiatric epidemiologist at Harvard Medical School in Boston and lead author of the study, published Monday in the journal Archives of General Psychiatry. "I think it's clear from this study that needs to change." "Without a really good reason, people all of a sudden feel very fearful, or very angry, and do something excessive," he said. "It's either fight or flight." For Kearney, one wrong look could trigger a "vicious" reaction. "I can't explain how I felt when I was in one of those fits of rage," he said. "It's almost like I would black out." Kessler said Kearney's situation is too common to ignore. "One in 12 kids has this problem. And people very often continue to have this problem into adulthood, affecting their education, jobs and marriages," he said. "Not to mention the criminal implications." Although IED is listed in the American Psychiatric Association's Diagnostic and Statistical Manual, its cause – and how best to treat it – remain unknown. "It bears studying, because what we currently know remains speculative," said Dr. Bela Sood, chair of child and adolescent psychiatry at VCU Medical Center in Richmond, Va. Sood said IED can be hard for patients – and their parents – to handle. "During an episode, a person goes from zero to 60," she said. "Afterward they often feel remorseful, but the deed is done." Kearney said he would apologize to his parents after an attack but admitted the anger took a heavy toll. "It definitely affected our relationship," he said. "But in the end I'm closer to them than I ever was." Kearney, now a junior at Rowan University in Glassboro, N.J., patched up his relationships – and the holes in his wall – and left his troubled teenage years behind. He credits talk therapy for his victory over anger, as well as Xanax that helps quell his anxiety. "Everything I've gone through has shaped me into the person I am today," he said. "And I think I'm a pretty good person." http://abcnews.go.com/Health/MindMoo...ry?id=16694231 __________________

07-17-2012, 02:32 PM	#16
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Journal for Nurse Practitioners References 1. Dean L, Meyer I, Robinson K, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101–151. 2. Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. J Adv Nurs. 2006;55(4):407–415. 3. Institute of Medicine. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academy Press; 1999. http://books.nap.edu/openbook.php?record_id_6109&page_1. Accessed April 3, 2012. 4. Hutchinson M, Thompson A, Cederbaum J. Multisystem factors contributing to disparities in preventive health care among lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(3):393–402. 5. Spinks VS, Andrews J, Boyle J. Providing health care for lesbian clients. J Transcult Nurs. 2000;11(2):137–143. 6. Mravcak S. Primary care for lesbians and bisexual women. Am Fam Physician. 2006;74(2):279–286. 7. O'Hanlan KA, Dibble SL, Hagan HJJ, Davids R. Advocacy for women's health should include lesbian health. J Womens Health (Larchmt). 2004;13(2):227–234. 8. Seaver MR, Freund KM, Wright LM, Tjia J, Frayne SM. Healthcare preferences among lesbians: a focus group analysis. J Womens Health (Larchmt). 2008;17(2):215–225. 9. Dibble SL, Roberts SA, Robertson PA, Paul SM. Risk factors for ovarian cancer: lesbian and heterosexual women. Oncol Nurs Forum. 2002;29(1):E1-E7. 10. The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. 2010. http://www.jointcommission.org/Advan..._Communication. Accessed April 3, 2012. 11. Gay and Lesbian Medical Association. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT) Health. 2001. http://www.nalgap.org/PDF/Resources/...LGBTHealth.pdf. 12. Gay and Lesbian Medical Association. Lesbian, gay, bisexual, and transgender health: overview. Healthy People 2020 Web site. http://healthypeople.gov/2020/topics...spx?topicid_25. Updated November 18, 2011. Accessed November 21, 2011. 13. Bjorkman M, Malterud K. Lesbian women's experience with health care: a qualitative study. Scand J Prim Health Care. 2009;27(4):238–243. 14. Platzer H, James T. Lesbians' experiences of healthcare. Nurs Times Res. 2000;5(3):194–202. 15. Nursing Council of New Zealand. Guidelines for cultural safety, the treaty of Waitangi, and Maori health in nursing education and practice. 2005. Amended and reprinted March 2009. http://www.nursingcouncil.org.nz/dow...l-safety09.pdf. Accessed February 5, 2011. 16. Roberts SJ. Health care recommendations for lesbian women. J Obstet Gynecol Neonatal Nurs. 2006;35(5):583–591. 17. Boehmer U, Bowen DJ. Examining factors linked to overweight and obesity in women of different sexual orientations. Prev Med. 2009;48(4):357–361. 18. Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health. 2001;91(6):947–952. 19. Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol. 2009;118(3):647–658. 20. Matthews AK, Hughes TL, Johnson T, Razzano LA, Cassiday R. Prediction of depressive distress in a community sample of women: the role of sexual orientation. Am J Public Health. 2002;92(7):1131–1139. 21. Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49(2):115–123. 22. Mustanski BS, Garofalo R, Emerson EM. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health. 2010;100(12):2426–2432. 23. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10–51. 24. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79(2):159–170. 25. Blosnich JR, Horn K. Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation. Nicotine Tob Res. 2011;13(12):1284–1295. 26. Centers for Disease Control and Prevention. HIV/AIDS among women who have sex with women. 2006. http://www.cdc.gov/hiv/topics/women/...sheets/wsw.htm. Accessed March 1, 2011. 27. Marrazzo JM, Coffey P, Bingham A. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspect Sex Reprod Health. 2005;37(1):6–12. 28. O'Hanlan KA. Health policy considerations for our sexual minority patients. Obstet Gynecol. 2006;107(3):709–714. 29. Zeidenstein L. Health issues of lesbian and bisexual women. In: Varney's Midwifery. Varney H, Kriebs JM, Gegor CL, eds. 4th ed. Sudbury: Jones and Bartlett Publishers; 2004:299–311. 30. McManus A. Creating an LGBT-friendly practice: practical implications for NPs. Am J Nurse Pract. 2008;12(4):29–38. 31. Anderson T. Nursing profession development: scope and standards of practice (2010). Nebr Nurse. 2011;44(3):8–9. 32. Makadon HJ, Mayer KH, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia: American College of Physicians Press; 2007. __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

07-17-2012, 02:40 PM	#17
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Good journal article from: Journal for Nurse Practitioners Part II It is difficult to accurately capture the full effect of marginalization, discrimination, and stigmatization on the mental health of an individual or minority group. LGBT persons "are subject to unique social stressors such as prejudice, stigmatization, and antigay violence that may precipitate mental distress, mental disorders, suicidal ideation, and self-harm."[6] Matthews et al[20] studied the role of sexual orientation in predicting depressive distress in a sample of women. Their sample (N 5 829) showed "51% of lesbians and 38% of heterosexual women reported seriously considering suicide at some point in the past."[20] Also, "more than twice as many lesbians as heterosexual women in this age group (15–19) reported suicide attempts."[20] Although research is limited, LGBT youth may also be at increased risk for suicide attempts compared to their heterosexual counterparts. Marshal et al[21] found that there is a higher rate of suicidality in sexual minority youth compared with heterosexual youth. However, in the study of LGBT youth by Mutanski et al,[22] there were similar rates of suicidality compared with youth of the same geographical areas. They also noted that mental health disorders were higher among the LGBT youth group compared with national data samples but similar when compared with ethnic/minority urban youth samples. Haas et al[23] said, "Over the last 2 decades, an increasing body of empirical research in the US and other countries has pointed to significantly elevated suicide risk among LGBT compared to heterosexual people." Although there is limited research describing reasons for increased risk in the WSW population, it may be that many mental health issues are associated with the consequences of being a WSW living in a "heterosexual-oriented society."[7] "Heteronormativity denotes how the social life of Western culture is constructed on the assumption that all people are heterosexual, assuming the heterosexual nuclear family norm to be natural and universal, and thereby making homosexuality socially invisible and second class."[13] It is important to understand that marginality of any kind can be a risk factor for mental health issues. Lehavot and Simoni[24] suggest screening (and referring as needed) for minority stress and the presence/absence of "coping resources" among sexual minority women. Substance Abuse Spinks et al[5] said, "Accurate estimates of the prevalence of substance abuse in lesbians are not available due to the marginalization and hidden nature of the population."[5] The rate of alcohol abuse in WSW is unclear and data are conflicting. Dean et al[1] identify that early studies on the gay and lesbian population recruited subjects in bars "which, not surprisingly, showed higher rates of heavy alcohol and drug use than the general population." Many reports discussed by Roberts[16] indicate that there is more alcohol use in the lesbian community. "Data from the Women's Health Initiative study and other, smaller studies indicate that tobacco use is higher among lesbians than among the general female population."[6] This finding is in contrast with the Dibble study mentioned above. Roberts[16] said, "Reviews have concluded that smoking rates for adolescent and adult lesbians are higher than their national comparison groups, with adolescents being highest for both groups." Blosnich and Horn[25] examined discrimination/violence and associated smoking among young adults and found that sexual minorities were more likely to experience discrimination and violence and are twice as likely to smoke when compared with heterosexuals in the same age group. It appears that there may be increased substance abuse among WSW in comparison to heterosexual women, but this, too, needs further research. Many factors may put WSW at higher risk for substance abuse or mental health issues, including social stigma, societal pressures, internalized homophobia, the "coming out" process, and discrimination.[5,6,16] STDs and Reproductive Health/Services Women who describe themselves as having same sex orientation may identify themselves as lesbian. However, sexual behavior is not the same as sexual orientation, and these should not be confused.[4] Obtaining an accurate sexual history is important to identify risk factors for STDs and safe sex practices. Sex practices of WSW vary widely and the most important thing a provider can do is refrain from making assumptions. The risk for STD transmission in WSW changes based on sexual practices and the STD organism.[4] Little is known about transmission of STDs between 2 women. "Transmission of some STDs between women is known to occur; for other STDs, transmission between women is possible in theory but has not been proven."[6] Mravcak[6] provides a table in her article showing known transmission of STDs between women to include herpes simplex, genital warts associated with HPV, and trichomoniasis. Included in the table is the description of theoretical STD transmission between WSW: chlamydia, gonorrhea, syphilis, hepatitis B, and HIV.[6] Bacterial vaginosis, while not an STD, is commonly found in the WSW and their female partners[6,16] and is believed to be transmitted between women.[16] As identified earlier in this article, most WSW have a history of male sexual partners. This fact increases STD risk for these women and their partners. However, Mravcak[6] said, "Lesbians are less likely than bisexual or heterosexual women to be tested regularly for STDs."[6] Many WSW may not believe that they are at risk for acquiring STDs and may even delay treatment when symptoms arise.[4] In addition, NPs may have inaccurate information about the risks of STDs for WSW and assume that they are not engaging in heterosexual intercourse.[4] This assumption may result in the provider choosing to omit needed routine screening for these patients.[4] NPs need to teach safe sex practices for WSW. Some recommendations given by Mravcak[6] are to avoid contact with any visible genital lesions, cover sex toys that penetrate more than one person's vagina or anus with a new condom for each person, use a barrier during oral sex, and use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding. The Centers for Disease Control and Prevention[26] (CDC) determined, "No barrier methods for use during oral sex have been evaluated as effective by the Food and Drug Administration. However, natural rubber latex sheets, dental dams, condoms that have been cut and spread open, or plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission." The CDC[26] also suggests the importance of knowing a partner's HIV status since there is a potential for HIV transmission through menstrual blood. For WSW at this time, oral sex does not require barrier methods if performed with a monogamous partner whose HIV status is negative and has no lesions or other risk factors.[26] Jeanne Marrazzo, MD, MPH, is a leader in infectious diseases and STD prevention and epidemiology. She and her colleagues[27] said WSW should be educated about possible STD transmission between women and education should be centered on common sex practices between WSW. Reproductive health services are important topics to discuss with WSW patients. In the US, approximately 6 to 14 million children have parents who are lesbian or gay.[6] WSW may have children from previous relationships with men or may choose to become pregnant through a sperm bank, known donor, or heterosexual intercourse. Adoption and foster care are also options for WSW in many states. Other than dealing with societal stigma, studies have shown that children of lesbians have comparable development and life skills adjustment to children in heterosexual families.[16] "The American Psychological Association, the American Academy of Pediatricians, and the North American Council on Adoptable Children have each endorsed foster parenting, adoption, and parenting by same-gender couples, with the reassurance that their review of all the research on these children show that they develop normally."[28] Even so, the process of starting a family can be emotionally, mentally, and financially challenging for WSW because of social stigma, discrimination, legal issues, and isolation. Zeidenstein[29] said the birth mother has unique challenges as she may have to "come out" again after becoming pregnant and once again as a lesbian mother. Zeidenstein[29] also identified that the comother can experience pain when her role as a parent is not recognized by the people in her life. Furthermore, state laws vary greatly. Legal action is required in most states for the nonbiological parent to be granted parental rights.[6] While legal implications are not within the scope of this article, it is important for NPs to encourage WSW to seek assistance from lawyers to ensure their wishes are granted and to ensure the comother has the rights of parenting she deserves. As an NP, referring WSW to agencies that are known to be nondiscriminatory can also be very helpful.[5] Improving Practice Through Cultural Safety NPs are responsible for creating a safe and caring atmosphere for each patient. A "safe" environment is defined by the patient. Key factors to a safe and caring context are reflection, environment, language, and knowledge. Context includes all the "in-betweens" of these 4 key factors. Most of context is made up of what is not said with words or language. A truly safe and caring health care context cannot be achieved by omitting any of the 4 elements. For example, a clinician who provides a safe environment but does not use inclusive language is not providing safe care. Reflection of one's own feelings and possible biases about the WSW population is the first step in establishing a caring and safe patient-provider relationship. Acknowledging these feelings and examining personal biases is a necessary part of providing a safe and caring environment. McManus[30] said, "Awareness of how one's own attitudes affect clinical judgment and the development of a non-homophobic attitude are important steps in providing culturally competent care."[30] Reflection is an ongoing assessment of one's own feelings, reactions, and motivations. It cannot be done once as a single exercise; it is always evolving based on new experiences and interactions. The process of self-reflection is a personal mission of growth and development that requires continual self-evaluation. Environment is the first factor that a WSW patient will experience. The waiting room can be a significant indicator of the level of acceptance a WSW patient can expect. The presence/absence of a posted nondiscriminatory policy, the art/pictures displayed, and the kinds of reading material available are all examples of environmental factors that a WSW patient will notice immediately. An example of a nondiscriminatory statement is: "This office appreciates the diversity of women [and men] and does not discriminate based on race, age, religion, ability, marital status, sexual orientation, gender, or perceived gender."[7] The environment will likely affect the WSW patient's openness about her sexuality. "If the environment is perceived as completely unsafe, questioning by the provider will elicit an inaccurate history."[29] Many waiting rooms and clinics have brochures, posters, and educational materials that "reflect heterosexual experience."[29] Including posters or pictures depicting same-sex couples, brochures available that include same-sex experiences, a visible nondiscriminatory policy, and a visible symbol that the WSW population will recognize as a sign of safety are all ways to make an environment more welcoming to them.[4-6,16,30] McManus[30] gives examples of symbols that health care providers can display to demonstrate a safe environment for the LGBT population: pink triangle (symbol of homosexuality in the concentration camps of Nazi Germany) A rainbow flag (an icon for the LGBT community since 1978, when it was first used in the San Francisco Gay Pride Parade) **The Human Rights Campaign's equality symbol (a blue square with a yellow equal sign [5], which is well known to LGBT persons as a sign of acceptance) Language used by the provider, staff, and in brochures and history/intake forms is also a strong indicator of safety for the WSW patient. Using inclusive, nonjudgmental, and open-ended questions are important to convey caring and safety. This provides a space for each patient to be as open as she chooses to be. A few examples of open-ended and nonjudgmental language include, "Do you have a partner or a spouse?" instead of "Do you have a husband?" or "Are you married?" Also asking, "Do you, or have you had, sexual relations with men, women, both, or none?"[4–6,16,30] This question is more likely to end with an honest response in comparison to simply asking the patient if she is sexually active.[30] "By taking a little time and asking a few sensitive questions, health care providers can create an environment of trust and inclusion."[5] Knowledge and competency are associated with caring practice.[31] Understanding the health risks for WSW that are different than heterosexual women is valuable and necessary to provide quality care. The ability to refer patients to other providers who are known to be open and nondiscriminatory is helpful[6] and will enable patients to further trust their provider. The availability of information and resources ( Table 1 ) on WSW-specific health considerations is essential when providing care to this population. Implications for NPS In a qualitative study by Bjorkman and Malterud[13] on lesbian experiences with health care, 3 essential qualities were described as necessary for the health care provider: awareness, attitudes, and medical knowledge. This study reinforces the importance of personal attributes that play a role in developing a safe and caring patient-provider relationship. Some suggestions given in the literature for providing a safe and caring health care context for the WSW population include health questionnaires that are inclusive of same-sex relationships or sexual practices, educational materials or brochures that are inclusive of same-sex relationships and sexual practices, open-ended questions from providers, a nonjudgmental approach to questions, images or posters with same-sex couples, and a nondiscriminatory statement.[6,16,30] While it is important to understand the common health disparities found in the WSW population, the population itself is full of unique individuals from every walk of life. Each individual will present a unique set of health issues and needs. Understanding the uniqueness and diversity of each woman allows the opportunity to provide individually tailored health care and best practices for this population. In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest. __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

07-17-2012, 02:44 PM	#18
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Good journal article from: Journal for Nurse Practitioners Part I Creating a Safe and Caring Health Care Context for Women Who Have Sex with Women Posted: 07/12/2012; Journal for Nurse Practitioners. 2012;8(6):464 © 2012 Elsevier Science, Inc. The purpose of this article is to introduce the concept of cultural safety as it relates to women who have sex with women and offer nurse practitioners who work with this population an integrated literature review regarding relevant research and recommended practices. Introduction Women who have sex with women (WSW) are a population that has long been stigmatized and marginalized within our society. Commonly, WSW are referred to as lesbian or bisexual. However, many WSW do not self-identify this way, so using the term WSW is more inclusive. This article will use WSW and lesbian interchangeably and will mention people of other sexual minorities: lesbian, gay, bisexual, and transgender (LGBT) to be compatible with references and citations. There has been incremental improvement in the United States toward societal acceptance of the LGBT population, yet there is still stigma associated with living anything other than a heterosexual lifestyle.[1,2] Neville and Henrickson[2] posit that consequences of these attitudes lead to violence, homophobia, and heterosexism that affect the mental and physical health of the LGBT population. "Although homosexuality has been removed from the list of diagnoses in the diagnostic manual of the American Psychiatric Association, the relationship between homosexuality and sickness has proved more enduring in the minds of many providers."[1] It is difficult to accurately estimate the size of the LGBT or WSW populations because of poor research methods, nonstandardization of terms, and the historical invisibility of the population. Different estimates are given in the literature, all of which are relatively low. The Institute of Medicine[3] (IOM) sentinel report on lesbian health from 1999 lists the estimated percentage at 2%–10% of the population. The range of 1%–10% is reflected in other references.[4–8] Dibble et al[9] said, "Lesbians are a diverse group of women from every ethnic, religious, economic, cultural, and age group." Some agencies have brought attention to the health disparities and consequent need for culturally safe care, including the Joint Commission,[10] Healthy People 2010 and 2020,[11,12] and the IOM.[3] Many nurse practitioners (NPs) are educated in the specific health and cultural needs of the WSW population and provide exemplary care for this group. However, although many NPs provide culturally safe care for WSW, there are also accounts of discrimination, abuse, assumptions, voyeurism, lack of knowledge, and substandard care toward the WSW population in health care.[4,5,13,14] Some WSW report that, after coming out to their health care provider, they were treated with physical roughness during their exam.[13] Some women have been denied care after their providers found out about their sexual orientation.[5] According to Bjorkman and Malterud,[13] since many health care providers assume that women are heterosexual, a woman who self-identifies as lesbian has to "choose to actively intervene and inform the professional about her lesbian orientation or passively pass as heterosexual." They also point out that the pressure to disclose sexuality is particularly present during gynecologic exams, when the provider doesn't understand when the patient reports being sexually active but not using contraception and having no possibility of being pregnant.[13] Much of the literature on WSW identifies gaps in providing culturally safe care for this population. Cultural safety is defined as "the effective nursing practice of a person or family from another culture, and is determined by that person or family."[15] The purpose of this article is to introduce the concept of cultural safety as it relates to WSW and offer NPs who work with this population an integrated literature review regarding relevant research and recommended practice. Literature Review The literature review is organized by common health issues found among WSW. The issues discussed are obesity and cardiovascular disease (CVD), cancer and screening, mental health and substance abuse, and sexually transmitted diseases (STDs) and reproductive health. Obesity and Risk for Cardiovascular Disease Many sources suggest that WSW may tend to have higher rates of obesity than heterosexual women.[6,9,16] "Lesbians are more likely than heterosexual women to have high body mass index, waist circumference, and waist-to-hip ratio; however, they are also more likely to engage in regular exercise."[6] Boehmer and Bowen[17] also found more obesity in women of sexual minority compared to women with a male partner. There is conflicting information on the risk of CVD for the WSW population. Roberts[16] said, "Research has found increased risk for CVD in lesbians." On the other hand, Mravcak[6] said, "There is no proven increase in the risk of CVD among lesbians and bisexual women." Risk factors for CVD in the WSW population provided by Roberts include "higher rates of obesity, smoking, alcohol use, and less intake of fruits and vegetables."[16] Cancer and Screening Cervical Cancer and Dysplasia. Hutchinson et al[4] said, "All women, regardless of sexual preference, are at risk for cervical cancer." Many providers are under the assumption that WSW do not need regular Papanicolaou (Pap) smears because of perceived low risk of cervical dysplasia and cancer.[6,7] This belief may also be held by many WSW themselves.[16] However, human papillomavirus (HPV), the believed cause for 90% of cervical dysplasia, can be transmitted between women.[5] Cervical neoplasia has been found in WSW with no reported history of male partners.[18] In addition, most WSW do report a history of male sexual partners.[4-7] There has been evidence that WSW have lower rates of cervical cancer screening than do heterosexual comparison groups.[16] One study of 7,000 lesbians cited by Hutchinson et al[4] reported, "Lesbians had higher rates of abnormal Pap results than rates reported in the general US population." Clearly, best practices suggest that WSW should not be excluded from regular cervical cancer screening. Moreover, NPs may need to educate WSW that they need this screening. Breast Cancer. Several reasons are identified in the literature why WSW may be at a higher risk to develop breast cancer than heterosexual women. It is believed that WSW do not seek preventive mammograms as often as heterosexual women, citing reasons of mistrust of health care providers, negative past experiences, and perceived homophobia in the health care setting.[4] However, the data suggesting that WSW do not receive screening mammography as much as heterosexual women is not consistent. Mravcak[6] said, "Rates of mammogram screening in lesbians and bisexual women are similar to those in heterosexual women." Also discussed in the literature are lower rates of breast self-exam (BSE) among the lesbian population.[5] It is commonly believed that many WSW are at a higher risk for developing some cancers as a result of higher rates of nulliparity, smoking, alcohol use, and obesity.[4,16] O'Hanlan et al[7] identify these risks and the use of menopausal hormone replacement therapy as a risk. This information is not well researched and needs further study. As Spinks et al[5] pointed out, "Current research has not accurately identified the incidence of breast cancer in lesbians; however, simply being female places lesbian clients at risk." NPs need to encourage WSW to perform monthly BSE, have regular cancer screening visits with a health care provider, and screening mammograms by following the guidelines for best practices as suggested for all women. Ovarian Cancer. There is little research available about the occurrence of ovarian cancer in WSW compared to the general population of women. Dibble et al[9] performed a study on risk factors for ovarian cancer for lesbians and heterosexual women. This study of over 1,000 women found, "As expected from previous reports, the lesbians had significantly fewer pregnancies, miscarriages, and abortions and lower use of birth control pills. These variables place lesbians at a higher risk for developing ovarian cancer."[9] "Whether women are at increased risk for ovarian cancer secondary to exposure to HRT [hormone replacement therapy] is not clear. The prevalence of HRT usage among lesbians is unknown."[9] In addition, the authors suggest it would be helpful to include sexual orientation in tumor registry data.[9] Mental Health Mravcak[6] said, "Most lesbians and bisexual women are emotionally healthy and well-adjusted." However, mental illness, especially depression, occurs in the WSW population. Depression is the most common mental illness reported in WSW[16] and has shown in some studies to occur in higher rates in WSW than in heterosexual women.[19] __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

07-19-2012, 10:15 PM	#19
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	Sexism Everywhere: Gender Differences in Salaries of Physician Researchers By Reshma Jagsi, MD, DPhil; Kent A. Griffith, MS; Abigail Stewart, PhD; Dana Sambuco, MPPA; Rochelle DeCastro, MS; Peter A. Ubel, MD [+] Author Affiliations JAMA. 2012;307(22):2410-2417. doi:10.1001/jama.2012.6183 ABSTRACT Objectives: To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors. Design and Setting: A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address. Participants: The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary. Main Outcome Measures A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research. Results: The mean salary within our cohort was $167 669 ($158 417-$176 922) for women and $200 433 ( $194 249-$206 617) for men. Male gender was associated with higher salary (+$13 399) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12 194 higher than observed. Conclusion: Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors. http://jama.jamanetwork.com/article....icleid=1182859 __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner

07-23-2012, 12:29 PM	#20
Anya Infamous Member How Do You Identify?: Lesbian non-stone femme Preferred Pronoun?: She, her Relationship Status: Committed to being good to myself Join Date: Jun 2011 Location: West Coast Posts: 8,258 My Photo Gallery Thanks: 39,306 Thanked 40,449 Times in 7,285 Posts Rep Power: 21474858	The Relationship Between Marriage and Mental Health July 23, 2012 Robin W. Simon, PhD Professor of Sociology, Wake Forest University, Winston-Salem, NC First published in Psychiatry Weekly, Volume 7, Issue 14, July 23, 2012 Introduction The connection between social relationships and mental health is a fundamental component of both the sociological and psychiatric literatures. Robin W. Simon, PhD, is a sociologist whose work has focused on social relationships—especially marriage—and mental health for 25 years. Why is Marriage Associated with Mental Health? “Sociologists have long been interested in the link between social relationships and mental health,” explains Dr. Simon. “Let’s take marriage as an example. At this point, hundreds of studies document a robust relationship between marriage and improved mental health: married people report significantly fewer symptoms of depression and are significantly less likely to abuse substances than their non-married counterparts. This is because marriage provides social support—including emotional, financial, and instrumental support. Also, married people have greater psychosocial (or coping) resources than the non-married—higher self-esteem and greater mastery. Social support and psychosocial resources not only increase emotional well-being but also buffer the negative emotional effects of stressors that people experience during the life course.” There are, of course, many nuances in this narrative. For instance, poor marital quality can lead to lower levels of well-being among the married than the non-married, because marital conflict is highly stressful. However, although it was believed for decades that men derive greater benefit from marriage than women, Dr. Simon’s 2002 study1 and other sociological research show that the mental health advantage of marriage is evident among both genders. At the same time, it appears that marriage is less beneficial for individuals with a mentally ill than an emotionally healthy spouse.2 The Direction of the Relationship Between Marriage and Mental Health The psychiatric literature recognizes the protective effects of marriage for mental illness. For example, among adults with schizophrenia, being in a marital or cohabiting relationship is associated with a 5-year delay in experiencing a first episode of psychosis (FEP) and higher quality of life, and is a significant predictor of symptom remission within 1 year of FEP.3,4 There is a debate about whether a person’s depression increases the risk of marital loss through divorce, or whether a marital loss itself (including cases where a spouse dies) is largely responsible for depression onset. The former scenario fits into the hypothesis known as social selection, which states—to summarize it roughly—that healthy individuals gravitate toward intimate relationships and are seen as desirable partners. This view assumes that people who marry are more likely to have better mental health, anyway, and that “the healthiest, most robust people select into marriage,” says Dr. Simon. The alternative hypothesis—the perspective that most sociologists embrace—is social causation, which holds that marriage wards off mental illness and improves mental health by virtue of its built-in support system. In a 2002 study1 Dr. Simon analyzed longitudinal data from a large nationally representative sample to examine, among other things, both the social causation and selection hypotheses of the relationship between marital status and mental health. “In this study I examined whether a change in marital status between study onset and endpoint caused a change in mental health,” explains Dr. Simon. “I found that people who became divorced and widowed during the study experienced a significant decline in mental health between data points, which supports the social causation hypothesis. But those who divorced also reported more symptoms before the actual divorce. This latter finding could be interpreted as evidence that people who experience mental health problems are more likely to get divorced (in agreement with the social selection hypothesis). I argued, however, that some of these people might have been experiencing marital conflict at study onset, increasing symptoms of depression and alcohol abuse. In terms of marital gain, people who got married during the study reported a significant decrease in symptoms of depression and alcohol abuse, but there was no evidence that mentally robust people are more likely to marry than their less healthy peers.” In an era where cohabitation and state-sanctioned same-sex marriage are increasingly common, do the mental health benefits of marriage apply exclusively to heterosexual marriages? Unfortunately, there are no existing national data sets that would allow us to answer this question. Studies addressing this issue are underway, however, and Dr. Simon predicts that there would be no difference in the mental health benefits of marriage between individuals in heterosexual and same-sex marriages. “If anything,” she says, “marriage may be even more protective for people in same-sex marriages, because they fought long and hard for their partnerships to be recognized by the state.” As for cohabitation, Dr. Simon says that studies show that cohabitation, too, is good for mental health, “though not as good as marriage.” “We still have much to learn about why marriage in particular, and social relationships in general, improve mental health,” concludes Dr. Simon, “but sociological research on this topic is clear; having a deep emotional connection with another person provides individuals with social support and coping resources, a sense of purpose and meaning in life, an important social identity, and feelings of social integration and mattering—which are all important for both the development and maintenance of mental health.”Disclosure: Dr. Simon reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest. References: 1. Simon RW. Revisiting the relationships among gender, marital status, and mental health. AJS. 2002;107:1065-1096. 2. Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord. 2005;7:431-440. 3. Nyer M, Kasckow J, Fellows I, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22:172-179. 4. Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42:595-606. 5. Bulloch AG, Williams JV, Lavorato DH, Patten SB. The relationship between major depression and marital disruption is bidirectional. Depress Anxiety. 2009;26:1172-1177. __________________ ~Anya~ Democracy Dies in Darkness ~Washington Post "...I'm deeply concerned by recently adopted policies which punish children for their parents’ actions ... The thought that any State would seek to deter parents by inflicting such abuse on children is unconscionable." UN Human Rights commissioner