Obstetrics and Gynecology Clinics RSS feed: Current Issue. Obstetrics and Gynecology Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in obstetrics and gynecology and is presented under the direction of an experienced guest editor.http://www.obgyn.theclinics.com/?rss=yesElsevier Inc.en © 2009 Elsevier Inc. All rights reserved. Obstetrics and Gynecology Clinics0889-8545364December 2009 © 2009 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.obgyn.theclinics.com/article/PIIS0889854509001193/abstract?rss=yesCME Accreditation Page and Author Disclosure10.1016/j.ogc.2009.11.001Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7iiiiiihttp://www.obgyn.theclinics.com/article/PIIS0889854509001120/abstract?rss=yesTable of Contents10.1016/S0889-8545(09)00112-0Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7ixxiihttp://www.obgyn.theclinics.com/article/PIIS0889854509001132/abstract?rss=yesForthcoming Issues10.1016/S0889-8545(09)00113-2Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7xiiixiiihttp://www.obgyn.theclinics.com/article/PIIS0889854509001041/abstract?rss=yes “Challenging Issues in Women's Health Care,” guest edited by Kathleen Kennedy, MD, reflects the expanding role of obstetrician-gynecologists in optimizing women's health. Dr. Kennedy and I reviewed all of the other Clinics to identify papers of interest relating to psychosocial challenges we often encounter that, while not related directly to obstetrics and gynecology, are linked to the needs of many patients. Given the outstanding quality of those authors' recent manuscripts and their importance to obstetrics and gynecology, Dr. Kennedy and I believe that these select articles could be combined and presented here for the benefit of our readership.ForewordWilliam F. Rayburn10.1016/j.ogc.2009.10.012Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7xvxvihttp://www.obgyn.theclinics.com/article/PIIS0889854509001053/abstract?rss=yes Women's health care embraces the entire spectrum of a woman's life. Over the past century, women have been impacted most dramatically by changes in work, personal, and family life. Women's mental and psychosocial health and well-being must take into account the social, economic, and political issues surrounding women. Personal problems and stress often affect a woman's life and the social roles she plays. For this reason, challenging issues often arise in women's health care as a result of a woman's unique physiology and response to personal concerns.PrefaceKathleen Kennedy10.1016/j.ogc.2009.10.013Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7xviixviiihttp://www.obgyn.theclinics.com/article/PIIS0889854509000850/abstract?rss=yesThe recognition that women have different health care needs than men has enabled changes to take place in clinical care, research, and education of women's health. Providing health care coverage to all women must be a high priority. Research must address the differences between men and women and how they respond to disease and treatment. The physician workforce needs to be expanded; physicians should be well trained to provide comprehensive health care to women. Strategies, such as those used in comprehensive centers of women's health and women's health residencies, can improve education and increase the number of women in academia.Barriers to Women's Health: Why is It So Hard for Women to Stay Healthy?Tony Ogburn, Carolyn Voss, Eve Espey10.1016/j.ogc.2009.10.007Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7737752http://www.obgyn.theclinics.com/article/PIIS0889854509000874/abstract?rss=yesBeginning in the past century and continuing to evolve into the twenty-first century, there have been dramatic changes in women's work and personal/family lives within the United States. These changes have particularly affected white, middle-class women and women in medicine and other professions. Physicians in fields whose practitioners are predominantly female and/or who treat primarily women and families need to be aware of the scope and nature of these changes and to recognize that their own personal experiences and values might differ from those of women of different generations as well as different socioeconomic and cultural backgrounds.Psychosocial Aspects of Women's Lives: Work and Family/Personal Life and Life Cycle IssuesDiane K. Shrier, Lydia A. Shrier10.1016/j.ogc.2009.10.009Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7753769http://www.obgyn.theclinics.com/article/PIIS0889854509000849/abstract?rss=yesPrevalence studies show that 1 in 5 women experience an episode of major depressive disorder during their lifetime. The peripartum period is a prime time for symptom exacerbation and relapse of depressive episodes. Health care providers, specifically those in obstetric care, should be aware of: (1) the frequency of depression in pregnant and postpartum women; (2) signs, symptoms, and appropriate screening methods; and (3) the health risks for the mother and growing fetus if depression is undetected or untreated. Because management of depressed peripartum women also includes care of a growing fetus or breastfeeding infant, treatment may be complex and requires input from a multidisciplinary team, including an obstetrician, psychiatrist, and pediatrician, to provide optimal care.When Depression Complicates Childbearing: Guidelines for Screening and Treatment During Antenatal and Postpartum Obstetric CareMaria Muzik, Sheila M. Marcus, Julie E. Heringhausen, Heather Flynn10.1016/j.ogc.2009.10.006Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7771788http://www.obgyn.theclinics.com/article/PIIS0889854509000837/abstract?rss=yesThe popularity of natural or “alternative” remedies to treat medical and psychiatric disorders has accelerated dramatically over the past decade, in the United States and worldwide. This article reviews the evidence for clinical efficacy, active ingredients, mechanisms of action, recommended dosages, and toxicities of the 3 best-studied putative natural antidepressants, St. John's wort (hypericum), S-adenosyl methionine, and the Ω-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. Despite growing evidence for efficacy and safety, more comprehensive studies are required before these remedies can be recommended as safe and effective alternatives or adjuncts to conventional psychotropic agents. There are limited data regarding safety in pregnancy and during lactation, and caution is therefore recommended in women who are pregnant or breastfeeding.Update and Critique of Natural Remedies as Antidepressant TreatmentsDavid Mischoulon10.1016/j.ogc.2009.10.005Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7789807http://www.obgyn.theclinics.com/article/PIIS0889854509000795/abstract?rss=yesNocturnal sleep is characterized by a unique pattern of endocrine activity, which comprises reciprocal influences on the hypothalamo-pituitary-adrenal (HPA) and the somatotropic system. During early sleep, when slow wave sleep (SWS) prevails, HPA secretory activity is suppressed whereas growth hormone (GH) release reaches a maximum; this pattern is reversed during late sleep when rapid eye movement (REM) sleep predominates. SWS benefits the consolidation of hippocampus-dependent declarative memories, whereas REM sleep improves amygdala-dependent emotional memories and procedural skill memories involving striato-cortical circuitry. Manipulation of plasma cortisol and GH concentration during sleep revealed a primary role of HPA activity for memory consolidation. Pituitary-adrenal inhibition during SWS sleep represents a prerequisite for efficient consolidation of declarative memory; increased cortisol during late REM sleep seems to protect from an overshooting consolidation of emotional memories.Sleep, Hormones, and MemoryJan Born, Ullrich Wagner10.1016/j.ogc.2009.10.001Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7809829http://www.obgyn.theclinics.com/article/PIIS0889854509000825/abstract?rss=yesThis article describes the circumstances under which women may develop insomnia and the various treatment options, including hypnotic medication and nonpharmacologic approaches. The efficacy and safety of these treatments are reviewed. The choice of treatment depends on the nature of the insomnia, the stage of a woman's life, the presence of medical or mental health conditions, the availability of treatments, and personal preference. For immediate, short-term relief of acute insomnia, hypnotic medication, especially the nonbenzodiazepines (zolpidem, zopiclone, eszopiclone) are options. For chronic insomnia, insomnia-specific cognitive and behavioral therapies are generally the interventions of choice.Insomnia Treatment Options for WomenJudith R. Davidson10.1016/j.ogc.2009.10.004Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7831846http://www.obgyn.theclinics.com/article/PIIS0889854509000898/abstract?rss=yesIntimate partner violence (IPV) is a common problem affecting many women who present to obstetrics and gynecology practices. It takes on many forms, including psychologic/emotional, physical, and sexual abuse, and its effects on the health of victims and their children vary. Although many women's health care professionals may be uncomfortable inquiring about IPV, a knowledge of patients' IPV victimization may help physicians develop a better understanding of patients' presenting symptoms and health risks, form more effective therapeutic relationships, and work toward reducing the myriad health risks associated with IPV.Intimate Partner ViolenceAdam J. Zolotor, Amy C. Denham, Amy Weil10.1016/j.ogc.2009.10.011Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7847860http://www.obgyn.theclinics.com/article/PIIS0889854509000801/abstract?rss=yesSexual dysfunctions diminish the quality of life for many women, frequently causing enough distress to warrant the diagnosis of a sexual disorder. Problems with sexual function can occur in any stage of the sexual response cycle. Dysfunction is further influenced by a variety of factors: medical, psychiatric, cultural, and stage of life. A variety of treatment modalities exist, though current research has not yet provided Food and Drug Administration approved therapies for sexual disorders in women.Female Sexual DysfunctionAnita H. Clayton, David V. Hamilton10.1016/j.ogc.2009.10.002Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7861876http://www.obgyn.theclinics.com/article/PIIS0889854509000813/abstract?rss=yesMillions of American girls and women have been drawn to smoking by an industry that has been clearly and systematically targeting women of all ages and life circumstances. Tobacco marketing strategies skillfully link cigarette use to typical female values. Biologically speaking, women are especially vulnerable to the legion of health problems of tobacco use. Smoking is a critical hazard for women in their reproductive years, particularly when they are pregnant.Women and Tobacco DependenceVirginia C. Reichert, Vicki Seltzer, Linda S. Efferen, Nina Kohn10.1016/j.ogc.2009.10.003Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7877890http://www.obgyn.theclinics.com/article/PIIS0889854509000862/abstract?rss=yesSubstance abuse poses significant health risks to reproductive age women in the United States and, for those who become pregnant, to their children. Substance abuse or dependence is defined as a maladaptive pattern of substance use marked by recurrent and significant negative consequences related to the repeated use of substances. Alcohol is the most prevalent substance consumed by childbearing-aged women, followed by tobacco and various illicit drugs. Substance use in the preconception period predicts continued but often limited substance use during the prenatal period. Providers must be aware of reproductive age women's unique physiologic, psychological, and social needs and the related legal and ethical ramifications surrounding substance abuse before referral to a community-based multidisciplinary team for often long-term treatment.Substance Abuse Among Reproductive Age WomenBrittany B. Albright, William F. Rayburn10.1016/j.ogc.2009.10.008Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7891906http://www.obgyn.theclinics.com/article/PIIS0889854509000886/abstract?rss=yesUp to 7% of women report premenstrual symptoms severe enough to impair daily function, and are said to suffer from premenstrual dysphoric disorder (PMDD). Although PMDD is predominately regarded as a biologically based condition, sociocultural factors, and particularly life stress, past sexual abuse, and cultural socialization, likely interact with hormonal changes. This integrative model has implications for etiology and treatment of PMDD.Understanding and Treating Premenstrual Dysphoric Disorder: An Update for the Women's Health PractitionerSimone N. Vigod, Lori E. Ross, Meir Steiner10.1016/j.ogc.2009.10.010Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7907924http://www.obgyn.theclinics.com/article/PIIS0889854509001144/abstract?rss=yesIndex10.1016/S0889-8545(09)00114-4Obstetrics and Gynecology Clinics 36, 4 (2009)2009-12-01Obstetrics and Gynecology Clinics2009-12-01364S0889-8545(09)X0005-7925933