Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) affecting up to 7% of reproductive age women. Women with PMDD are of reproductive age; therefore, contraception and treatment of PMDD are important considerations. The disorder as described in the DSM-V is characterized by moderate to severe psychological, behavioral and physical symptoms beginning up to two weeks prior to menses, resolving soon after the onset of menstruation and significantly interfering with daily functioning. PMDD develops in predisposed individuals after they are exposed to progesterone at the time of ovulation. It has been hypothesized that PMDD is in part attributable to luteal phase abnormalities in serotonergic activity and to altered configuration of ℽ-aminobutyric acid subunit A (GABA_A) receptors in the brain triggered by the exposure to the neuroactive steroid progesterone metabolite, allopregnanolone (Allo). A large body of evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can be effective in the treatment of PMDD. Combined hormonal contraceptive (CHC) pills, specifically the 20 mcg ethinyl estradiol/3mg drospirenone in a 24/4 extended cycle regimen has been shown to significantly improve the emotional and physical symptoms of PMDD. Other combined monophasic, extended cycle hormonal contraceptive pills with less androgenic progestins may also be helpful, although not well studied. Copper intrauterine devices (IUDs) are recommended for those not seeking hormonal contraceptives. Progestin-only methods including the progestin-only pill (POP), levonorgestrel (LNG) IUD, etonorgestrel implant or depot medroxyprogesterone acetate (DMPA) have the potential to negatively affect mood symptoms for women with or without baseline mood disorders, including PMDD. Careful counseling and close follow-up is recommended for patients with PMDD seeking these contraceptive methods.

Is outdoor recreational activity an independent predictor of cardiovascular disease mortality - NHANES III?

BACKGROUND AND AIMS

To investigate if frequency of outdoor recreational activity (ORA) predicts cardiovascular disease (CVD) mortality, independent of serum 25(OH)D concentration.

METHODS AND RESULTS

Baseline data on ORA and serum 25(OH)D, collected from 11,746 participants aged 30-90 years in the Third National Health and Nutrition Examination Survey during 1988-1994, were linked to the National Death Index for assessment of CVD deaths from baseline through December 2006. CVD mortality as a primary cause of death was assessed during a mean follow up of 12.9 (SD, 4.2) years. There were 1519 CVD deaths during follow up. A strong positive association was observed between frequency of ORA in the last month and serum 25(OH)D (p < 0.001). Compared to participants who did no ORA in the last month, the hazard ratio (HR) of CVD mortality was 0.72 (95% confidence interval 0.58-0.90) for those doing ORA 1-4 times, 0.64 (0.47-0.89) for 5-12 times, 0.70 (0.56-0.89) for 13-30 times and 0.63 (0.47-0.84) for ≥30 times (p-trend < 0.001), in a Cox proportional hazards regression model which included 25(OH)D and CVD risk factors. Serum 25(OH)D was inversely associated with CVD mortality (p-trend, 0.01) in this same model.

CONCLUSIONS

An inverse association between ORA and CVD mortality was observed independent of 25(OH)D. The underlying mechanism for this association may not involve 25(OH)D hence, further studies are warranted to confirm and investigate the underlying mechanism.

Examination of reproductive aging milestones among women who carry the FMR1 premutation

BACKGROUND

The fragile X premutation is characterized by a large CGG repeat track (55-199 repeats) in the 5' UTR of the FMR1 gene. This X-linked mutation leads to an increased risk for premature ovarian failure; interestingly, the association of repeat size with risk is non-linear. We hypothesize that the premutation-associated ovarian insufficiency is due to a diminished oocyte pool and examined reproductive aging milestones by repeat size group to determine if the same non-linear association is observed.

METHODS

We analyzed cross-sectional reproductive history questionnaire data from 948 women with a wide range of repeat sizes.

RESULTS

We have confirmed the non-linear relationship among premutation carriers for ovarian insufficiency. The mid-range repeat size group (80-100 repeats), not the highest group, had an increased risk for: altered cycle traits (shortened cycle length, irregular cycles and skipped cycles), subfertility and dizygotic twinning. Smoking, a modifiable risk, decreased the reproductive lifespan of women with the premutation by about 1 year, similar to its effect on non-carriers. As expected, premutation carriers were found to be at an increased risk for osteoporosis.

CONCLUSIONS

Possible molecular mechanisms to explain the non-linear repeat size risk for ovarian insufficiency are discussed.

Examination of reproductive aging milestones among women who carry the FMR1 premutation

BACKGROUND

The fragile X premutation is characterized by a large CGG repeat track (55-199 repeats) in the 5' UTR of the FMR1 gene. This X-linked mutation leads to an increased risk for premature ovarian failure; interestingly, the association of repeat size with risk is non-linear. We hypothesize that the premutation-associated ovarian insufficiency is due to a diminished oocyte pool and examined reproductive aging milestones by repeat size group to determine if the same non-linear association is observed.

METHODS

We analyzed cross-sectional reproductive history questionnaire data from 948 women with a wide range of repeat sizes.

RESULTS

We have confirmed the non-linear relationship among premutation carriers for ovarian insufficiency. The mid-range repeat size group (80-100 repeats), not the highest group, had an increased risk for: altered cycle traits (shortened cycle length, irregular cycles and skipped cycles), subfertility and dizygotic twinning. Smoking, a modifiable risk, decreased the reproductive lifespan of women with the premutation by about 1 year, similar to its effect on non-carriers. As expected, premutation carriers were found to be at an increased risk for osteoporosis.

CONCLUSIONS

Possible molecular mechanisms to explain the non-linear repeat size risk for ovarian insufficiency are discussed.

Environmental impacts of the foot and mouth disease outbreak in Great Britain in 2001: the use of risk analysis to manage the risks in the countryside

Restrictions imposed for more than ten months throughout Great Britain in 2001 to control and eradicate foot and mouth disease (FMD) had a damaging effect on tourism and rural businesses. Risk assessment can play a valuable role in ensuring that the action taken is proportionate to the risk, and that countryside activities are allowed to resume when this can be done without compromising the objective of controlling and eradicating the disease. A risk assessment unit was established at the commencement of the epidemic to consider the risks posed by particular activities, to identify ways of managing those risks, and to make recommendations which could be used by policy makers when deciding what action to take. The assessments produced by the unit were published and the scientific rationale which supported policy and procedural changes was thereby exposed to public scrutiny and criticism. The author lists the activities subjected to veterinary risk assessments and describes how the process was used to consider public access to the countryside, leading to policy changes which within nine months resulted in the reopening of more than 96% of footpaths and bridleways without causing new outbreaks of FMD. A completed risk assessment is also included.

4-nitroimidazole binding to horse metmyoglobin: evidence for preferential anion binding

The ionization of 4-nitroimidazole to 4-nitroimidazolate was investigated as a function of ionic strength. The apparent pKa varies from 8.99 to 9.50 between 0.001 and 1.0 M ionic strength, respectively, at 25 degrees C. The ionic strength dependence of this ionization is anomalous. The binding of 4-nitroimidazole by horse metmyoglobin was studied between pH 5.0 and 11.5 and as a function of ionic strength between 0.01 and 1.0 M. The association rate constant is pH-dependent, varying from 24 M(-1)s(-1) at pH 5 to a maximum value of 280 M(-1)s(-1) at pH 9.5 and then decreasing to 10 M(-1)s(-1) at pH 11.5 in 0.1 M ionic strength buffers. The dissociation rate constant has a much smaller pH dependence, varying from 0.082 s(-1) at low pH to 0.035 s(-1) at high pH, with an apparent pKa of 6.5. The binding affinity of 4-nitroimidazole to horse metmyoglobin is about 2.5 orders of magnitude stronger than that for imidazole and this increased affinity is attributed to the much slower dissociation rate for 4-nitroimidazole compared to that of imidazole. Although the ionic strength dependence of the binding rate is small and secondary kinetic salt effects can account for the ionic strength dependence of the association rate constant, the pH dependence of the rate constants and microscopic reversibility arguments indicate that the anionic form of the ligand binds more rapidly to all forms of metmyoglobin than does the neutral form of the ligand. However, the spectrum of the complex is similar to model complexes involving neutral imidazole and not imidazolate. The latter observation suggests that the initial metmyoglobin/4-nitroimidazolate complex rapidly binds a proton and the neutral form of the bound ligand is stabilized, probably through hydrogen binding with the distal histidine.

Climate Change During the Last Deglaciation in Antarctica

Greenland ice core records provide clear evidence of rapid changes in climate in a variety of climate indicators. In this work, rapid climate change events in the Northern and Southern hemispheres are compared on the basis of an examination of changes in atmospheric circulation developed from two ice cores. High-resolution glaciochemical series, covering the period 10,000 to 16,000 years ago, from a central Greenland ice core and a new site in east Antarctica display similar variability. These findings suggest that rapid climate change events occur more frequently in Antarctica than previously demonstrated.

Purification of a Zn-binding phloem protein with sequence identity to chitin-binding proteins

In citrus blight, a decline disorder of unknown etiology, the tree canopy exhibits symptoms of Zn deficiency while Zn accumulates in the trunk phloem. We have purified a Zn-binding protein (ZBP) from phloem tissue of healthy and blight-affected citrus (Citrus sinensis [L.] Osbeck on Citrus jambhiri [L.]). The molecular weight of the ZBP was estimated to be 5000 by size-exclusion chromatography and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Ion-exchange chromatography at pH 8.0 demonstrated the 5-kD ZBP to be anionic. A partial N-terminal amino acid sequence revealed a cysteine-, glycine-rich domain with 45 to 80% identity with the chitin-binding domain of hevein, wheat germ agglutinin, and several class I chitinases. That the abundance of this protein increased 2.5-fold in association with Zn accumulation in the phloem is characteristic of citrus blight. Tissue mass changes of the phloem suggests that altered tissue structure accompanies blight. Phloem accumulation of the 5-kD ZBP may be in response to wounding or other stress of blight-affected citrus.

The Accumulation Record from the GISP2 Core as an Indicator of Climate Change Throughout the Holocene

A depth-age scale and an accumulation history for the Holocene have been established on the Greenland Ice Sheet Project 2 (GISP2) deep core, providing the most continuously dated record of annual layer accumulation currently available. The depth-age scale was obtained with the use of various independent techniques to count annual layers in the core. An annual record of surface accumulation during the Holocene was obtained by correcting the observed layer thicknesses for flow-thinning. Fluctuations in accumulation provide a continuous and detailed record of climate variability over central Greenland during the Holocene. Climate events, including "Little Ice Age" type events, are examined.

Changes in Atmospheric Circulation and Ocean Ice Cover over the North Atlantic During the Last 41,000 Years

High-resolution, continuous multivariate chemical records from a central Greenland ice core provide a sensitive measure of climate change and chemical composition of the atmosphere over the last 41,000 years. These chemical series reveal a record of change in the relative size and intensity of the circulation system that transported air masses to Greenland [defined here as the polar circulation index (PCI)] and in the extent of ocean ice cover. Massive iceberg discharge events previously defined from the marine record are correlated with notable expansions of ocean ice cover and increases in PCI. During stadials without discharge events, ocean ice cover appears to reach some common maximum level. The massive aerosol loadings and dramatic variations in ocean ice cover documented in ice cores should be included in climate modeling.

Provision of dental pensions

Compulsory financial commitments are seldom popular. Once one such expenditure, which has been required spending for those working in the NHS for up to 40 years, becomes no longer mandatory, it is hardly surprising that those who are suddenly presented with an opportunity to reconsider their position should seek to explore the alternatives. Indeed, it is wise to do so.

A review of some animal diseases encountered at meat inspections in England and Wales, 1969 to 1978

Condemnation of meat and offal in 65 selected abattoirs in England and Wales is reviewed. Returns cover about 14 per cent of animals slaughtered for food. In the decade under review, a marked reduction in losses caused by fascioliasis was noted in cattle and sheep, while other parasitic conditions show no decrease. Abscesses continue to be substantial cause of loss in cattle and pigs. Condemnation on account of bruising has increased.

Exhaust Catalysts: Appropriate Conditions for Comparing Platinum and Base Metal

There are fundamental differences in the behavior of alumina-supported samples of a platinum and a copper-chromium catalyst for oxidation of carbon monoxide in a simulated automotive exhaust stream. Ignoring such differences can result in inappropriate comparisons between oxidation catalysts for automotive application.