OBJECTIVE: To determine the characteristics of menopause in Aboriginal women, in particular Canadian Aboriginal women. METHODS: An extensive review of articles extracted from both medical and non-medical databases was undertaken. The search strategy combined the key word "menopause" with any of the following terms: Aboriginals, Native Americans, Natives, Indians, Métis, Inuit, Eskimo, and Indigenous people. RESULTS: A total of 29 records were found, 13 of which had results relevant to the objective of the study. These articles suggest that menopause may have a positive effect on the lives of Aboriginal women with respect to increasing their freedom within the community. Aboriginal women appear to experience fewer vasomotor symptoms than other North American women. CONCLUSION: More research needs to be done to determine the effect menopause has on Canadian Aboriginal women and their coexisting diseases such as cardiovascular disease, hypertension, and diabetes mellitus. This work will allow health care providers to make more informed decisions on managing Aboriginal women's transition through menopause in areas such as hormone replacement therapy.
To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management, and to review investigations in the assessment of ovarian aging.
This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility.
The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility.
Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010.
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table).
Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology.
1. Women in their 20s and 30s should be counselled about the age-related risk of infertility when other reproductive health issues, such as sexual health or contraception, are addressed as part of their primary well-woman care. Reproductive-age women should be aware that natural fertility and assisted reproductive technology success (except with egg donation) is significantly lower for women in their late 30s and 40s. (II-2A) 2. Because of the decline in fertility and the increased time to conception that occurs after the age of 35, women > 35 years of age should be referred for infertility work-up after 6 months of trying to conceive. (III-B) 3. Ovarian reserve testing may be considered for women = 35 years of age or for women 40 years of age. Women > 40 years should consider IVF if they do not conceive within 1 to 2 cycles of controlled ovarian hyperstimulation. (II-2B) 6. The only effective treatment for ovarian aging is oocyte donation. A woman with decreased ovarian reserve should be offered oocyte donation as an option, as pregnancy rates associated with this treatment are significantly higher than those associated with controlled ovarian hyperstimulation or in vitro fertilization with a woman's own eggs. (II-2B) 7. Women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age. Women should be counselled about and offered appropriate prenatal screening once pregnancy is established. (II-2A) 8. Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes should be considered for women > age 40. (III-B) 9. Advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions, autism spectrum disorders, and schizophrenia. Men > age 40 and their partners should be counselled about these potential risks when they are seeking pregnancy, although the risks remain small. (II-2C).
To review the risk of in utero infection through amniocentesis in women with hepatitis B, hepatitis C, or human immunodeficiency virus (HIV).
Fetal and neonatal morbidity and mortality.
Review articles, meta-analyses, and MEDLINE searches from 1966 to 2002 for English-language articles related to amniocentesis, fetal and neonatal infection, and hepatitis B, hepatitis C, or HIV.
The evidence collected was reviewed by the Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the Evaluation of Evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam.
1. The risk of fetal hepatitis B infection through amniocentesis is low. However, knowledge of the maternal hepatitis B e antigen status is valuable in the counselling of risks associated with amniocentesis. (II-1C) 2. Amniocentesis in women infected with hepatitis C does not appear to significantly increase the risk of vertical transmission, but women should be counselled that very few studies have properly addressed this possibility. (II-2C) 3. In HIV-positive women all noninvasive screening tools should be used prior to considering amniocentesis. (II-2D) 4. For women infected with hepatitis B, hepatitis C, or HIV, the addition of noninvasive methods of prenatal risk screening, such as nuchal translucency, triple screening, and anatomic ultrasound, may help in reducing the age-related risk to a level below the threshold for genetic amniocentesis. (II-2C) 5. For those women infected with hepatitis B, hepatitis C, or HIV who insist on amniocentesis, every effort should be made to avoid inserting the needle through the placenta. (II-1B) VALIDATION: These guidelines have been approved by the SOGC Genetics Committee, SOGC Executive, and SOGC Council.
The Society of Obstetricians and Gynaecologists of Canada.
Arthrosis and back troubles together account for at least a third of all rheumatic suffering, and they are much the commonest rheumatological causes of impairment and disability. In contrast to the inflammatory arthropathies, one cannot help but be struck by the fact that research endeavour has not been commensurate with the burden that has to be endured.
A bibliometric analysis was employed to objectively assess scientific studies published between 1966 and 1993 which have described cancer among American Indians and Alaska Natives. Searches of the MEDLINE (1966-1993) and CANCERLIT data bases (1983-1994) were used to identify relevant publications. In addition to examining publication sources and quantitative temporal trends, further bibliometric analyses were completed by considering a subset of papers published between 1982 and 1992. A total of 128 studies of cancer among American Indians and Alaska Natives were published between 1966 and 1993; 62 of these articles (48%) appeared between 1988 and 1993. Nine journals accounted for 53% of the total publications. The subset of 68 papers published between 1982 and 1992 were cited a total of 388 times in 136 different journals; the median number of citations was 2. Results demonstrate a limited number of published papers on cancer among American Indians and Alaska Natives. It is hoped that this paper will increase the awareness of cancer as an important health problem among American Indian and Alaska Natives and thereby serve to stimulate additional cancer-related research activities involving these groups.
Demographic changes likely to occur in the near future and the need for planning to address them are behind the urgent drive to assess present-day provision and utilization of low-vision rehabilitation (LVR) services in the community. Perhaps even more important is the assessment of supporting research work in this field of health care. The purpose of this study, therefore, was to investigate the current involvement of researchers in Canada in the elucidation of the LVR sciences.
A PubMed search of the MEDLINE database was performed. Publications were identified according to preset criteria and search key words pertinent to various aspects of LVR sciences. Data were collected on the corresponding authors and their affiliations, type of journal and type of study performed, and reported outcome measures.
Approximately 1500 papers were reviewed, and 131 that met the preset criteria were included in the study. Medical doctors published most papers (48.1%), followed by optometrists, those with PhDs, occupational therapists, and others; most of the papers (44.3%) were published in ophthalmology journals. Research was performed mainly at Canadian universities (84%), and the findings were published in the last 3 decades. The studies largely concentrated on rehabilitation services and other aspects of vision rehabilitation (55%), whereas studies focusing on the evaluation of tools used for assessment of either visual functions or functional vision were in the minority (45%).
The majority of research activity in Canada is university based and involves the medical profession in a leading role, thus affording LVR the appropriate medium for promotion and development of a multidisciplinary approach to outstanding research issues. Only a fraction of current research in LVR (12.2%) deals with outcome measures of the therapeutic interventions aimed at restoring functional vision.
Comment In: Can J Ophthalmol. 2009 Aug;44(4):464; author reply 46419606175