Seminars in reproductive medicine
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The connection between infection with the Zika virus (ZKV) and congenital anomalies such as microcephaly has been generally accepted. Although efforts are underway to develop preventive interventions such as vaccines, these are not yet available. Family planning is an effective preventive approach that has been underemphasized in many lists of research priorities. ⋯ Data on the impact of ZKV on contraceptive use and abortion are sparse, but a few studies have begun to address these questions. ZKV highlights the need to provide at-risk women and couples with effective means to prevent or postpone childbearing. Contraception, prenatal care, and safe abortion should be available to all women.
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Semin. Reprod. Med. · Sep 2016
ReviewEpidemiology, Virology, and Pathogenesis of the Zika Virus: From Neglected Tropical Disease to a Focal Point of International Attention.
Over the past year, the Zika virus, an arthropod-borne Flavivirus, has transitioned from a relatively unknown tropical disease to the cause of a public health emergency. The Zika virus is transmitted by the Aedes species of mosquito as well as by sexual intercourse. Although the symptoms of acute Zika virus infection are usually mild and self-limited, it causes fetal microcephaly in pregnant women, and is associated with an increased risk of Guillain-Barré syndrome. ⋯ The Zika virus has been shown to have significant neurotrophism in vivo and in vitro, although further study is needed to characterize its mechanisms of pathogenesis. Zika virus has previously caused two known outbreaks in the Pacific region prior to the current epidemic in South and Central America, and the current epidemic has affected at least 440,000 to 1,300,000 people. The population of the vector for the current epidemic, Aedes aegypti, varies seasonally in the United States, however there have been few documented cases of local spread of the Zika infection in the United States and it is unclear whether epidemic spread of Zika will occur within the United States.
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Semin. Reprod. Med. · Jul 2015
ReviewVulvodynia: The Role of Inflammation in the Etiology of Localized Provoked Pain of the Vulvar Vestibule (Vestibulodynia).
Vulvar pain affecting the vestibule (vestibulodynia) is an enigmatic pain disorder that greatly affects quality of life and sexual functioning. The most common form of the disorder (localized provoked vulvodynia) is initiated by genital contact but is otherwise asymptomatic. Findings on examination are limited to excessive tenderness of the vestibule with light touch with cotton swab but may also include localized erythema and pelvic floor muscle tightness and tenderness. ⋯ Abnormal inflammatory response and heightened sensitivity of the vaginal opening has been documented in a murine model of vaginal infection with Candida albicans. In vitro studies of fibroblasts from the vestibule of affected women with vestibulodynia demonstrate a proinflammatory response to C albicans that may be important in the initiation of pain. However, thus far none of the findings have led to adequate treatments.
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Noncommunicable diseases (NCDs), long considered diseases of little significance to global health, represent the greatest threat to economic development and human health. The main NCDs-diabetes, cancer, cardiovascular disease, and chronic respiratory disease-are the world's number one killer and bear the greatest burden on the poor. ⋯ The 2011 HLM for NCDs did not measure up to the previous meeting in funding, targets, or advocacy but gave birth to a series of commitments in the form of a political declaration. In this article, we discuss the extent to which NCD is effecting the global population, what has and has not transpired since the 2011 HLM, and what lies ahead if we are to successfully tackle this growing burden of disease before it grows beyond our reach.
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Semin. Reprod. Med. · Jan 2015
The health of women and girls: how can we address gender equality and gender equity?
This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. ⋯ These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policy arenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy.