The impact of violence and abuse on women's physical health: Can trauma‐informed treatment make a difference?

A history of traumatic experiences has been associated with poor physical health. This study examined associations between trauma and physical health, as well as changes in physical health over time, in women with co‐occurring disorders and histories of violence who received either integrated trauma‐informed services or usual care. Results revealed that women who had experienced more severe trauma also suffered worse physical health and were more likely to engage in poor health behaviors. Receiving behavioral health care services was associated with improved physical health and health behaviors. Predictors of physical health improvements included reduced interpersonal abuse, reduced severity of posttraumatic symptoms, improved health behaviors, and adequate access to medical care. Implications for primary, secondary, and tertiary prevention are discussed.     

Initial clinical experiences with the Dresden 3D display in conjunction with the Heidelberg Retina Tomograph (HRT)]

BACKGROUND: For years the Heidelberg Retina Tomograph has been an established method to diagnose early glaucomatous damages at the optic nerve head. The major difficulty consists in defining the outlayer of the optic nerve head in a 2-dimensional reflective or topographic picture. A 3-dimensional presentation of the ocular fundus could ease the defining very much. The Dresden 3D-display tested provides a true 3-dimensional presentation of the HRT-values measured. METHODS: For the study 5 groups of prediagnosed follow-up examinations were formed, which in their course showed various progression. The examination firstly was carried out by manual defining of the papilla contour on the Dresden 3D-display and secondly by the new automatic contour-finding of the 3D-software. RESULTS: Through the 3-dimensional presentation a more correct position of the contour can be found when drawn manually. As a result some diagnoses of the 2-dimensional HRT-pictures had to be revised. The results proved considerable differences between the automatic outlayer-finding and the probably real position of the papilla borders. CONCLUSION: The 3-dimensional presentation of the HRT-pictures represents an subjective improvement regarding the accuracy of manual contour definition. In particular, the fact that it is feasible to make the pictures rotate around the axes offers completely new insights to the morphology of the disc.     

Metabolic and clinical effects of progestogens.

Synthetic progestogens differ not only in their hormonal potency, but also in their spectrum of hormonal activities. Beside their progestogenic and anti-oestrogenic effects, they may exert oestrogenic, androgenic, antiandrogenic, glucocorticoid and/or anti-mineralocorticoid activities. Consequently, progestogens may influence various metabolic parameters and modulate oestrogen-induced alterations in lipid metabolism, haemostasis, and various other factors. Progestogens with androgenic properties may counteract ethinyloestradiol (EE)-induced changes in lipoprotein metabolism, but do not cause atherosclerosis in the presence of EE. Oral contraceptives (OCs) containing androgenic progestogens which attenuate the EE-dependent changes in haemostasis, may be associated with a lower risk of venous thromboembolic disease than OCs whose progestogens have a less androgenic profile. Progestogens with androgenic activity may also antagonize oestrogen-induced alterations in various other hepatic proteins and modulate the effect of EE on growth factors. Progestogens with antiandrogenic activity may enhance the beneficial effect of EE in women with hyperandrogenic manifestations. Progestogens with glucocorticoid effects may increase procoagulatory activity in the vessel wall, while progestogens with anti-mineralocorticoid activity may reduce the aldosterone-induced water-retention in some women. For most women the differences in the hormonal pattern of progestogens used in OCs are without clinical relevance, but may be useful for women predisposed for the development of certain disorders.     

Perception of sexuality and fertility in women living with HIV: a questionnaire study from two Nordic countries

Introduction

As the human immunodeficiency virus (HIV)-positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire.

Methods

WLWH were recruited at their regular outpatient clinic visits, at the major Departments of Infectious Diseases in Denmark and Finland, from January 2012 to October 2013. A questionnaire was developed, study participants were informed of the nature of study and, if they agreed to participate and signed a consent form, they filled in the questionnaire. Demographic information on the participants was obtained from patient files (in Finland) or from a national HIV cohort (in Denmark). Statistical analysis was performed using STATA^®, version 11.

Results

In total, 560 women were included in the study. The median age was 44 years. The majority were of white European origin, with fully suppressed HIV viral load, CD4 cell count >350 µL and mild or no symptoms of their HIV infection. A total of 62% were sexually active, stating condom use as their sole form of contraception. Of the sexually inactive women, one-third were in steady relationships. Eighty percent reported prior pregnancies, of which the majority had one or more children. Most children were born prior to the women''s HIV diagnosis and the mode of conception was predominantly natural. One-quarter of the participating women desired pregnancy, while more than half did not. The remaining quarter either stated that they already had the desired number of children or chose not to answer the question. Fourteen percent stated that their HIV diagnosis ended their wish for children; of these women, the median time of diagnosis was between 1995 and 1996. Pregnancy had been attempted unsuccessfully in one-quarter of study participants. The final question inquired what the risk of mother-to-child transmission was, with all precautions taken. Fifteen percent estimated the risk to be above two percent.

Conclusions

In conclusion, the majority of WLWH in industrialized settings in Denmark and Finland have few HIV-related symptoms, are sexually active and have a strong desire for children.     

General Population Norms for the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale

Background

The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale is an internationally used validated measure. General population–based age- and sex-specific percentile norms are, however, not published to date, although these are needed as reference for the interpretation of clinical research data.