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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Contraceptives for teenagers are discussed in detail by type and appropriateness for teenagers, the role of nurses, and the nature of and approach to the client. Contraceptives included are oral contraceptives currently available (24 kinds) and contraindications, condoms, barrier contraceptives such as the diaphragm and sponges, spermicides, IUDs, periodic abstinence, morning after pills, and other methods. Because of the high rates of sexually transmitted diseases (STDS), the method recommended is the condom. There are reservations, however, because some teenagers may lack the maturity to use the condom reliably. When used in conjunction with a sponge or vaginal spermicide, protection against unwanted pregnancy is improved. Females may prefer oral contraceptives, which have the disadvantage of not protecting against STDs. The choices are many, however, and can be tailored to the needs of the client. The role of the nurse practitioner or nurses providing contraceptive advice is important because the information provided by many parents and school-based sex education courses is too little too late. Clients tend to be female and are placed in the position of needing to be more responsible for sexual behavior because males do not take responsibility. The stigma attached to planned sex is a deterrent to using contraceptive protection. The media are partly responsible for enhancing the image of unplanned passionate sex as being the most desirable in relating to a teenaged client, the nurse needs to establish rapport and seek a health history which includes questions about sexual behavior and birth control. Provide guidance so that choice is given, but also state a preference and the justification for its selection. Oral contraceptives (OCs), for example, are 95% effective for 1st year users. The 28-day regimen increases compliance because there is a pill for every day. Consistent time of use (within 4 hours of the time taken the preceding day) is important information to be stressed with the low-dose OCs. Norinyl 1/35 or OrthoNovum 1/35 is recommended for teenagers because of the low dose of estrogen and the good balance. When side effects occur, the balance needs adjustment. Minipills are suggested for lactating mothers or those with headaches, edema, or breast tenderness, but are also less effective. On the other hand, condoms have a failure rate of 9-12% for 1st year use, but increased skill effectiveness is increased. Use instructions are given.
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PMID:Contraceptives for teenagers. 191 98

Many women seeking help from rural primary care providers are experiencing major or other types of depression. Women typically do not discuss their depression with their primary care providers although those who did reported finding it very helpful. Feeling understood and advice were particularly viewed as helpful. Major barriers to discussing depression with primary care providers include stigma about depression, lack of time, and perceptions that the primary care providers were not interested in these concerns. Depressed women tend to seek help for certain somatic problems, especially headaches, backaches, muscle pains, sleep problems, feeling tired, and abdominal pains.
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PMID:Challenges to identifying and treating women with depression in rural primary care. 886 16

Migraine is a significant women's health concern. Epidemiological research has demonstrated that migraine is one of the most common pain conditions and that women are disproportionately affected. Recent advances in pathophysiology highlight the hormonal antecedents of these sex differences in migraine and the potential influence of hormones on migraine pain pathways. Migraine spawns substantial suffering and disability and gives rise to great economic and personal burden. Despite the availability of effective pharmacological and nonpharmacological treatments, only a fraction of migraine sufferers receive state-of-the-art treatment. Access to effective treatment is limited by economic and social barriers to care, including the long-standing social stigma that trivializes headache. Although doubtless a women's health issue, migraine has been largely overlooked in the women's health initiatives. This paper argues that migraine is an important women's health concern and that greater attention to migraine promises to make a demonstrable improvement in the quality of life of many women.
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PMID:Migraine and women's health. 1199 24

There is emerging evidence that treatment of comorbid mood and anxiety disorders can improve headache treatment outcome when implemented within a comprehensive program. Effective treatment for comorbid mood and anxiety disorders requires screening headache patients and accurately diagnosing specific psychiatric disorders when present. Specific dual-action antidepressant, anticonvulsant, and atypical antipsychotic medications can serve as dual agents that simultaneously treat both headaches and a mood or anxiety disorder. Serotonin reuptake inhibitors and most other antidepressant, anxiolytic, and mood-stabilizing medications are generally ineffective for headache prophylaxis. However, they can be safely added to a headache regimen for treatment of a comorbid psychiatric disorder. Treatment of comorbid psychiatric disorders in headache patients requires patient education about the psychiatric disorder, its treatment, possible side-effects, and expected benefits. Clinicians need to be sensitive to possible stigma that some patients fear from a psychiatric diagnosis or its treatment.
Headache 2006 Oct
PMID:Pharmacological management of mood and anxiety disorders in headache patients. 1703 91

The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. Cancer was once an explosive, typically terminal disease and became the prototype for end-of-life opioid pain treatment. However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse.
Curr Pain Headache Rep 2007 Aug
PMID:Opioid misuse in oncology pain patients. 1768 91

This contribution concerns the experience of chronic diseases and how it disrupts the trajectory of a person's biography, undermining his/her identity, self-reliance and social relationships. The study focuses particular attention on those diseases which have not yet been fully acknowledged and can, therefore, be considered a socially invisible disease: chronic headache is one of these. Thirty-one life stories were collected from patients attending a specialized headache centre in Northern Italy, and selected in order to include all common varieties of chronic headache. Following the principles of grounded theory, interviews began by adopting a minimal theoretical framework which consisted of asking people how they became aware of the objective (disease), subjective (illness) and social (sickness) aspects of their condition. The analysis highlighted particular points in the patients' life trajectories: first, the biographical disruption that takes place because of the disease; second, how people succeed or fail in identity negotiation, which is vital for developing an acceptable social representation of the disease. Results show that patient's choices follow a vicious circle, where a partial social representation of the disease is produced. People who suffer from chronic headache face a dilemma in social relationships: should they conceal their disease, or make it evident? If they conceal, any possible social representation of the disease is denied, which could lead to carrying the burden of the disease alone, with no social support. On the other hand, making chronic headache visible could result in stigma.
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PMID:The passing dilemma in socially invisible diseases: narratives on chronic headache. 1771 94

Spontaneous intracranial hypotension typically results from spontaneous cerebrospinal fluid (CSF) leak, often at spine level and only rarely from skull base. Once considered rare, it is now diagnosed far more commonly than before and is recognized as an important cause of headaches. CSF leak leads to loss of CSF volume. Considering that the skull is a rigid noncollapsible container, loss of CSF volume is typically compensated by subdural fluid collections and by increase in intracranial venous blood which, in turn, causes pachymeningeal thickening, enlarged pituitary, and engorgement of cerebral venous sinuses on magnetic resonance imaging (MRI). Another consequence of CSF hypovolemia is sinking of the brain, with descent of the cerebellar tonsils and brainstem as well as crowding of the posterior fossa noted on head MRI. The clinical consequences of these changes include headaches that are often but not always orthostatic, nausea, occasional emesis, neck and interscapular pain, cochleovestibular manifestations, cranial nerve palsies, and several other manifestations attributed to pressure upon or stretching of the cranial nerves or brain or brainstem structures. CSF lymphocytic pleocytosis or increase in CSF protein concentration is not uncommon. CSF opening pressure is often low but can be within normal limits. Stigmata of disorders of connective tissue matrix are seen in some of the patients. An epidural blood patch, once or more, targeted or distant, at one site or bilevel, has emerged as the treatment of choice for those who have failed the conservative measures. Epidural injection of fibrin glue of both blood and fibrin glue can be considered in selected cases. Surgery to stop the leak is considered when the exact site of the leak has been determined by neurodiagnostic studies and when less invasive measures have failed. Subdural hematomas sometimes complicate the CSF leaks; a rebound intracranial hypertension after successful treatment of a leak is not rare. Cerebral venous sinus thrombosis as a complication is fortunately less common, and superficial siderosis and bibrachial amyotrophy are rare. Short-term recurrences are not uncommon, and long-term recurrences are not rare.
Headache
PMID:Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. 2380 30

Epilepsy, a spectrum disorder characterized by recurring seizures, affects approximately 2.3 million U.S. adults. Epilepsy poses challenges because of uncontrolled seizures, treatment complexity, social disadvantages (e.g., unemployment), and stigma. Persons with epilepsy are at increased risk for early mortality and for comorbidities that can complicate epilepsy management, increase health-care costs, and shorten the lifespan. Numerous studies have described higher rates of psychiatric comorbidity (e.g., depression and anxiety) in persons with epilepsy. However, fewer studies have examined nonpsychiatric comorbidity in a nationally representative U.S. sample of adults with epilepsy. To assess the prevalence of nonpsychiatric comorbidities, CDC analyzed data from the 2010 National Health Interview Survey (NHIS). Adults with epilepsy had a higher prevalence of cardiovascular, respiratory, some inflammatory, and other disorders (e.g., headache, migraine, and various other types of pain) than adults without epilepsy. Public health agencies can work with health-care providers, the Epilepsy Foundation, and other partners to ensure that adults with epilepsy have access to health promotion resources and chronic disease self-management programs.
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PMID:Comorbidity in adults with epilepsy--United States, 2010. 2417 78

In an effort to support mental health policy planning efforts in conjunction with the reconstruction of Iraq, a nationally representative face-to-face household survey was carried out that assessed the prevalence and correlates of common mental disorders in the Iraqi population. A total of 4332 adult (ages 18+) respondents were interviewed (95.2% response rate). The current report presents data on the role impairments (number of days out-of-role in the past 30 days) associated with the nine mental disorders assessed in the survey in comparison to the impairments associated with ten chronic physical disorders also assessed in the survey. These disorders were all assessed with the WHO Composite International Diagnostic Interview. Days out-of-role were assessed with the WHO Disability Assessment Schedule. Both individual-level and societal-level effects of the disorders were estimated. Strongest individual-level predictors were bipolar and drug abuse disorders (176-195 days per year), with mental disorders making up five of the seven strongest predictors. The strongest population-level predictors were headache/migraine and arthritis (22-12% population proportions). Overall population proportions were 57% of days out-of-role due to the chronic physical disorders considered here and 18% for the mental disorders. Despite commonly-occurring mental disorders accounting for more individual-level days out-of-role than the physical disorders, mental disorders are much less likely to receive treatment in Iraq (e.g., due to stigma). These results highlight the need for culturally tailored mental health prevention and treatment programs in Iraq.
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PMID:The role of common mental and physical disorders in days out of role in the Iraqi general population: results from the WHO World Mental Health Surveys. 2458 72

Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a 'permanent disease of the brain', and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study's genealogical lens examines one white settler male patient's experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry's 'case' interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of 'patient' and 'family' in colonial life, c.1888-1918, and considers the calamity, uncertainty, stigma and silences of mental illness.
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PMID:Reconstructing Harry: a genealogical study of a colonial family 'inside' and 'outside' the Grahamstown Asylum, 1888-1918. 2477 28


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