PROVERA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Provera: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84056-3 1. Provera-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Provera. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PROVERA ................................................................................................... 3 Overview........................................................................................................................................ 3 Federally Funded Research on Provera.......................................................................................... 3 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND PROVERA ......................................................................................... 19 Overview...................................................................................................................................... 19 Finding Nutrition Studies on Provera......................................................................................... 19 Federal Resources on Nutrition ................................................................................................... 21 Additional Web Resources ........................................................................................................... 21 CHAPTER 3. ALTERNATIVE MEDICINE AND PROVERA................................................................... 23 Overview...................................................................................................................................... 23 National Center for Complementary and Alternative Medicine.................................................. 23 Additional Web Resources ........................................................................................................... 28 General References ....................................................................................................................... 29 CHAPTER 4. CLINICAL TRIALS AND PROVERA ............................................................................... 31 Overview...................................................................................................................................... 31 Recent Trials on Provera.............................................................................................................. 31 Keeping Current on Clinical Trials ............................................................................................. 32 CHAPTER 5. BOOKS ON PROVERA ................................................................................................... 35 Overview...................................................................................................................................... 35 Book Summaries: Online Booksellers........................................................................................... 35 The National Library of Medicine Book Index ............................................................................. 36 Chapters on Provera..................................................................................................................... 37 CHAPTER 6. PERIODICALS AND NEWS ON PROVERA ..................................................................... 39 Overview...................................................................................................................................... 39 News Services and Press Releases................................................................................................ 39 Academic Periodicals covering Provera ....................................................................................... 41 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 45 Overview...................................................................................................................................... 45 NIH Guidelines............................................................................................................................ 45 NIH Databases............................................................................................................................. 47 Other Commercial Databases....................................................................................................... 49 APPENDIX B. PATIENT RESOURCES ................................................................................................. 51 Overview...................................................................................................................................... 51 Patient Guideline Sources............................................................................................................ 51 Finding Associations.................................................................................................................... 53 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 55 Overview...................................................................................................................................... 55 Preparation................................................................................................................................... 55 Finding a Local Medical Library.................................................................................................. 55 Medical Libraries in the U.S. and Canada ................................................................................... 55 ONLINE GLOSSARIES.................................................................................................................. 61 Online Dictionary Directories ..................................................................................................... 61 PROVERA DICTIONARY ............................................................................................................. 63 INDEX ................................................................................................................................................ 83
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Provera is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Provera, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Provera, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Provera. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Provera, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Provera. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON PROVERA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Provera.
Federally Funded Research on Provera The U.S. Government supports a variety of research studies relating to Provera. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Provera. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Provera. The following is typical of the type of information found when searching the CRISP database for Provera: •
Project Title: ADOLESCENT CONTRACEPTION
MISCONCEPTIONS
ABOUT
HORMONAL
Principal Investigator & Institution: Clark, Liana R.; Assistant Professor; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 15-JUL-1999; Project End 30-JUN-2004
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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Summary: PROFESSIONAL GOAL: The overall goal of this patient-oriented research career development award proposal is to contribute to the professional, academic, and research development of Dr. Liana Clark. In addition to the proposed project exploring the concerns and misconceptions about hormonal contraception, Dr. Clark will also pursue research training at the University of Pennsylvania. She will take courses toward the Master's degree in Clinical Epidemiology and Biostatistics, as well as courses in bioethics and financial issues in medicine. Under the mentorship of Dr. Loretta Jemmott, Dr. Clark hopes to use this award to establish herself as an academic leader in the area of adolescent sexual risk behaviors. SPECIFIC AIMS OF CONTRACEPTION PROJECT: This project will use both cross sectional and longitudinal study design to: a) identify the attitudes, concerns and misconceptions of adolescents regarding hormonal methods of contraception (Norplant, Depo-Provera and the oral contraceptive pill); b) determine the gender, racial/ethnic, sexual history, and sociodemographic factors associated with attitudes, concerns and misconceptions about hormonal contraception; and c) determine how strongly these attitudes, concerns and misconceptions predict nonuse of, or noncompliance with hormonal contraception. This study will have two parts: (1) a baseline component that includes three stages designed to identify adolescent attitudes, concerns and misconceptions about hormonal contraception and the gender, racial/ethnic, sexual history, sociodemographic features associated with holding such concerns; and (2) a follow-up component to determine whether hormonal contraceptive use and/or compliance is related to attitudes, concerns and misconceptions about these methods of contraception. HYPOTHESES: 1. The majority of adolescents studied will have concerns and misconceptions about hormonal contraception. 2. Minority adolescents (African-American and Hispanic) will have greater negative attitudes, concerns and misconceptions about hormonal contraception than will white nonHispanic adolescents. 3. Adolescents who have strongly negative attitudes, concerns and misconceptions about hormonal contraception will be less likely to choose to use these methods. 4. Adolescents who have negative attitudes, concerns and misconceptions about hormonal contraception will be less compliant with the use of these methods. CONCLUSIONS: By targeting the negative attitudes, concerns and misconceptions regarding hormonal contraception, we will be better able to encourage use of these highly effective methods by adolescents. Increased usage and improved compliance with Depo-Provera, Norplant and the oral contraceptive pill will result in an overall decrease in the rate of unintended adolescent pregnancy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEPO ADOLESCENTS
PROVERA
AND
BONE
MINERAL
DENSITY
IN
Principal Investigator & Institution: Cromer, Barbara A.; Frederick C. Robbins Professor of Child; Pediatrics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: (Adapted from Investigator's Abstract) The United States has one of the highest adolescent pregnancy rates among industrialized nations. One of the major contributing factors is inadequate contraception. A very effective contraceptive method is depot-medroxyprogesterone acetate (DMPA) which has become increasingly popular in this age group. Recent research in adults has suggested a negative effect of DMPA on bone mineral density (BMD). With decreased BMD, one's risk increases later for osteoporosis, a major public health problem affecting millions of postmenopausal women every year. Compromised BMD would appear to be a particular concern in
Studies
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adolescents, as they normally accrue up to 40% of their total bone mineral content during this period. In preliminary work, the investigators demonstrated a 3.0% decrease in BMD in adolescent DMPA users over 2 years, compared with a 9.0% increase in untreated controls (p<0.0001). A prospective cohort study of the effects of DMPA on adolescent BMD, which will also include a double-blinded randomized prevention component, is proposed. Bone density in 400 adolescent DMPA initiators will be compared to their baseline values and to that of 300 and 120, oral and barrier contraceptive initiators, respectively, frequency matched on age and race. Bone density will be measured every six months for a maximum of two years. Bone density will also be measured at the time of discontinuation of contraceptive method. To evaluate the protective effects of estrogen on bone density, females in the DMPA treatment arm will be randomly assigned to DMPA with estradiol (n=200) and DMPA without estradiol (n=200). To examine the question of whether age modifies the effect of DMPA on bone density, the investigators will evaluate the age-treatment interaction between DMPA use and bone density among females of varying gynecologic ages. Finally, sex hormone levels and indices of calcium metabolism will be compared among the treatment groups in order to explore the biologic mechanisms underlying BMD changes. The statistical analysis will estimate the effect of DMPA on bone density while taking account of constant treatment discontinuation throughout the study period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEPO-PROVERA AND BONE DENSITY IN PREMENOPAUSAL WOMEN Principal Investigator & Institution: Clark, M Kathleen.; Associate Professor; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2004 Summary: (Adapted from abstract): Registered nurses (RNs) and advanced practice nurses (APNs) play an important role in providing contraceptive services to women of reproductive age. Education and counseling regarding use, risks, and benefits of contraceptive choices are long-standing nursing interventions. With prescriptive authority, APNs are additionally responsible for providing safe, effective pharmacological interventions for preventing pregnancy. DMPA is a progestin only injectable contraception, approved for use in the US in 1992. Of concern is a potential adverse effect of DMPA on bone mineral density. Because DMPA disrupts the hypothalamic-pituitary-ovarian-axis (HPO), it theoretically will suppress estrogen production causing a relative estrogen deficiency, and corresponding loss of bone mineral density. The overall goals of this study are to determine the effect of DMPA on bone mineral density in women aged 18 to 30 years and to determine whether the effect can be modified by calcium intake or predicted by, baseline estradiol levels, irregular vaginal bleeding or weight gain. A two-year prospective longitudinal study of 275 women, 160 who are receiving their first DMPA injection, and 115 control subjects who are not using any hormonal method of contraception, will be completed. All participants will receive a baseline evaluation, and follow-up evaluations every three months for two years. At baseline, participants will have their bone mineral density of the femoral neck, lumbar spine and total body measured using dual energy x-ray densitometry (DEXA). Blood will be drawn for estradiol levels and other physical measurements completed. Participants will complete nutritional and physical activity assessments, as well as a comprehensive interview detailing demographic, medical reproductive and lifestyle behaviors that may influence bone mineral density. All participants will be given one 90-day menstrual calendar for the daily recording of vaginal bleeding. At each follow-
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Provera
up evaluation bone mineral density and body composition will be measured, nutrition and physical activity reassessed and components of the interview updated. The menstrual calendar will be collected, reviewed and new calendars provided. Random coefficient regression (RCR) analysis will be the major analytic strategy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEPO-PROVERA USE AND BONE MINERAL DENSITY IN YOUNG WOMEN Principal Investigator & Institution: Scholes, Delia; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2001; Project Start 15-JUL-1994; Project End 31-JAN-2003 Summary: Osteoporosis and related fractures are growing public health problems. Factors affecting bone loss in later life and those affecting peak bone mass attainment are key to prevention of this condition. Several small studies suggest that depot medroxyprogesterone acetate (Depo-Provera, DMPA), an injectable progesterone-based contraceptive, decreases bone density and may thus increase a woman's later risk of osteoporosis. However, our ongoing evaluation of this association in a large study group provides evidence that DMPA's effects may be more complex, varying by age, duration of use, and anatomic site. In particular, effects on bone may be greater in younger age groups. Preliminary studies also suggest that discontinuation may favorably impact bone mass, but whether any effects are completely reversed and what roles age, duration of prior DMPA use, time since discontinuation, and other covariates may play is, as yet, unclear. We propose to continue our prospective epidemiologic evaluation of the effects of DMPA use on bone mineral density (BMD) in reproductiveage women. The primary aims are: to attain longer-term BMD evaluations in women who continue to use this contraceptive method; to assess the effects of discontinuation in women of varying age and durations of use; and to evaluate DMPA's effects on bone density in adolescents. Members of our established cohort of 457 women 18-39 years of age will be followed to evaluate more fully the effects of continued DMPA use on bone density and to assess changes in BMD after discontinuation. We propose to enrich our cohort with an additional group of adolescent participants. This group will be recruited from the same defined HMO population as our ongoing study group, using automated databases to select DMPA users and randomly-selected age-comparable women not using DMPA. Adolescent women will be followed for 24 to 36 months. For all participants the primary outcome, bone mineral density, will be measured every 6 months at various anatomic sites (hip, spine, and whole body) using dual-energy x-ray absorptiometry. This proposal addresses an area designated as a priority for research by the NIH/NICHD and incorporates a group (adolescents) deemed to be in critical need of adequate study. Moreover, DMPA is an increasingly popular contraceptive among young contracepting women. The size, diversity, and range of DMPA exposure in this study group allow for comprehensive evaluation of the possibly complex association between this effective, convenient and economical contraceptive and bone mass. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PROGESTERONE IMPLANTS TRANSMISSION & EARLY VIRUS LOAD
ENHANCE
SIV
VAGINAL
Principal Investigator & Institution: Veazey, Ronald S.; Assistant Professor; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2002
Studies
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Summary: Previously we demonstrated that administration of synthetic progesterone to macaques resulted in thinning of the vaginal epithelium and increased susceptibility to SIV infection following atraumatic vaginal inoculation The objective of this study was to determine whether administration of progestin-only contraceptives also induced thinning of the vaginal epithelium in macaques Eight intact rhesus monkeys (4/group) were treated with either a single intramuscular injection of 30 mg Depo-Provera _ or subcutaneous insertion of Norplant-II _ (2x75 mg rods; day 0) Norplant-II _ rods were removed 90 days after insertion Vaginal biopsies were obtained during a pretreatment menstrual cycle and following treatment on days 10, 30, 60, 118, and 146 Formalin-fixed vaginal biopsies were evaluated for epithelial thickness and the degree of keratinization Circulating levels of estradiol and progesterone confirmed the stage of the menstrual cycle in which pretreatment bi opsi es were obtained A pronounced effect of progestin treatment was observed on the vaginal epithelium Compared to pretreatment menstrual cycle controls, the vaginal epithelial thickness was decreased (p<0 05) by day 30 or 60 following Norplant-II _ insertion or Depo-Provera _ injection, respectively The number of epithelial cell layers was also decreased (p0 05) from the pretreatment control cycle These data demonstrate that progestin-only contraceptives induced thinning of the vaginal epithelium in rhesus monkeys, and this effect was rapidly reversible following physical or metabolic removal of the progestin Publication Hild-Petito S, Veazey RS, Larner JM, Reel JR, Blye RP Effects of two progestin-only contraceptives, Depo-Provera and Norplant-II on the vaginal epithelium of rhesus monkeys AIDS Res Hum Retro, 14:S1:S125-S130, 1998 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Provera, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Provera” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Provera (hyperlinks lead to article summaries): •
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A multicentered clinical trial of the long-acting injectable contraceptive Depo Provera in Chinese women. Author(s): Danli S, Qingxiang S, Guowei S. Source: Contraception. 2000 July; 62(1): 15-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11024223&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Provera
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A process model of Depo-Provera use in Canadian women. Author(s): Hampton M, McWatters B. Source: Health Care for Women International. 2003 March; 24(3): 193-208. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746011&dopt=Abstract
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A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (Depo-Provera), levonorgestrel (Norplant), or oral contraceptives. Author(s): Cromer BA, Blair JM, Mahan JD, Zibners L, Naumovski Z. Source: The Journal of Pediatrics. 1996 November; 129(5): 671-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8917232&dopt=Abstract
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A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception. Author(s): Cromer BA, Smith RD, Blair JM, Dwyer J, Brown RT. Source: Pediatrics. 1994 November; 94(5): 687-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7936897&dopt=Abstract
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Acceptability and discontinuation of Depo-Provera, IUCD and combined pill in Kenya. Author(s): Sekadde-Kigondu C, Mwathe EG, Ruminjo JK, Nichols D, Katz K, Jessencky K, Liku J. Source: East Afr Med J. 1996 December; 73(12): 786-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9103686&dopt=Abstract
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Acute necrotic skin reaction to intramuscular Depo-Provera. Author(s): Clark SM, Lanigan SW. Source: The British Journal of Dermatology. 2000 December; 143(6): 1356-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11122072&dopt=Abstract
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Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives Depo-Provera and Norplant. Author(s): Harel Z, Biro FM, Kollar LM, Rauh JL. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1996 August; 19(2): 118-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8863083&dopt=Abstract
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Anaphylaxis to Depo-Provera? Author(s): Rajapaksa DS. Source: Ceylon Med J. 1993 September; 38(3): 158-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7828243&dopt=Abstract
Studies
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Beliefs about Depo-Provera among three groups of contraceptors. Author(s): Cushman LF, Kalmuss D, Davidson AR, Heartwell S, Rulin M. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1996 March; 12(1): 43-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8739515&dopt=Abstract
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Bleeding pattern and endometrial changes during continuous combined hormone replacement therapy. The Ogen/Provera Study Group. Author(s): Nand SL, Webster MA, Baber R, O'Connor V. Source: Obstetrics and Gynecology. 1998 May; 91(5 Pt 1): 678-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9572210&dopt=Abstract
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Bone density effects of continuous estrone sulfate and varying doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Author(s): Nand SL, Wren BG, Gross BA, Heller GZ. Source: Obstetrics and Gynecology. 1999 June; 93(6): 1009-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10362172&dopt=Abstract
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Bone loss in adolescents using Depo-Provera. Author(s): Kass-Wolff JH. Source: Journal of the Society of Pediatric Nurses : Jspn. 2001 January-March; 6(1): 21-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11288500&dopt=Abstract
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By the way, doctor. I've been taking hormone replacement with Premarin and Provera for 12 years. Now that I'm 68 years old, I'd like to stop taking the hormones, but I don't know how. What is the best way to get off HRT? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2001 February; 8(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11175470&dopt=Abstract
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Can a woman breastfeed while using Depo-Provera as an agent for birth control? Author(s): Emery M. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 1993 September; 9(3): 187-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8260041&dopt=Abstract
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Change in mammographic breast density associated with the use of Depo-Provera. Author(s): Dillis CL, Schreiman JS. Source: The Breast Journal. 2003 July-August; 9(4): 312-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846867&dopt=Abstract
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Consumer-directed advertising of contraceptive drugs: the FDA, Depo-Provera, and product liability. Author(s): Green W. Source: Food Drug Law J. 1995; 50(4): 553-67. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10343019&dopt=Abstract
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Cyclofem/Cyclo-Provera: emerging countries' perspective. Author(s): Garza-Flores J. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 August; 62 Suppl 1: S31-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806236&dopt=Abstract
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Cytologic findings in cervical smears in patients using intramuscular medroxyprogesterone acetate (Depo-provera) for contraception. Author(s): Volk EE, Jax JM, Kuntzman TJ. Source: Diagnostic Cytopathology. 2000 September; 23(3): 161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10945902&dopt=Abstract
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Depo Provera and bone density. Author(s): Szarewski A, Mansour D, Hollingworth BA. Source: The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists. 2002 April; 28(2): 94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422861&dopt=Abstract
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Depo Provera and breast cancer. Author(s): McCowan L, Farquhar C, Roke C, Liddell H, Roberts H, Thakurdas N, Wilson J, Say PJ, McClure F. Source: N Z Med J. 1991 January 23; 104(904): 16-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1826144&dopt=Abstract
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Depo provera treatment for sex offending behavior: an evaluation of outcome. Author(s): Meyer WJ 3rd, Cole C, Emory E. Source: Bull Am Acad Psychiatry Law. 1992; 20(3): 249-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1421556&dopt=Abstract
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Depo Provera. Position paper on clinical use, effectiveness and side effects. Author(s): Bigrigg A, Evans M, Gbolade B, Newton J, Pollard L, Szarewski A, Thomas C, Walling M. Source: Br J Fam Plann. 1999 July; 25(2): 69-76. Review. Erratum In: Br J Fam Plann 2000 January; 26(1): 52-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10454658&dopt=Abstract
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Depo Provera--irregular bleeding management. Author(s): Hickey M, Paterson CM. Source: Br J Fam Plann. 2000 April; 26(2): 117. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896462&dopt=Abstract
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Depo-provera associated with weight gain in Navajo women. Author(s): Espey E, Steinhart J, Ogburn T, Qualls C. Source: Contraception. 2000 August; 62(2): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11102587&dopt=Abstract
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Depo-Provera contraceptive may increase risk of cardiovascular disease. Author(s): Cleve Clin J Med. 2002 Sep;69(9):680-1 Source: Bmj (Clinical Research Ed.). 2002 September 7; 325(7363): 513. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12222971
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Depo-Provera dilemmas. Author(s): Cayley J. Source: Br J Fam Plann. 1998 April; 24(1): 1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9719699&dopt=Abstract
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Depo-Provera in adolescents: effects of early second injection or prior oral contraception. Author(s): Harel Z, Biro FM, Kollar LM. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1995 May; 16(5): 379-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7662688&dopt=Abstract
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Depo-provera therapy as an alternative to imprisonment. Author(s): McFarland L. Source: Houst Law Rev. 1986 May; 23(3): 801-19. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11650759&dopt=Abstract
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Depo-Provera use in an Australian metropolitan practice. Author(s): Fraser IS, Dennerstein GJ. Source: The Medical Journal of Australia. 1994 May 2; 160(9): 553-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8164553&dopt=Abstract
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Depo-Provera. Author(s): Mesics S. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2002 April-May; 6(2): 93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975135&dopt=Abstract
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Depo-Provera. Author(s): McIntyre PS. Source: J Tenn Med Assoc. 1994 July; 87(7): 296. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8065137&dopt=Abstract
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Depo-Provera. Author(s): Sharts-Hopko NC. Source: Mcn. the American Journal of Maternal Child Nursing. 1993 March-April; 18(2): 128. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8492647&dopt=Abstract
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Depo-Provera. Controversial contraceptive wins approval from FDA panel. Author(s): Stone R. Source: Science. 1992 June 26; 256(5065): 1754. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1535454&dopt=Abstract
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Depo-Provera: an ideal contraceptive for adolescents? Author(s): Boroditsky RS. Source: Journal of Pediatric and Adolescent Gynecology. 1999 May; 12(2): 95-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10326195&dopt=Abstract
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Depo-Provera: an injectable contraceptive. Author(s): Earl DT, David DJ. Source: American Family Physician. 1994 March; 49(4): 891-4, 897-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8116522&dopt=Abstract
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Depot medroxyprogesterone acetate (Depo-Provera) and levonorgestrel (Norplant) use in adolescents among clinicians in Northern Europe and the United States. Author(s): Cromer BA, Berg-Kelly KS, Van Groningen JP, Seimer BS, Ruusuvaara L. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 August; 23(2): 74-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9714169&dopt=Abstract
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Depressive symptoms and Depo-Provera. Author(s): Westhoff C, Truman C, Kalmuss D, Cushman L, Davidson A, Rulin M, Heartwell S. Source: Contraception. 1998 April; 57(4): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9649914&dopt=Abstract
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Determining risk between Depo-Provera use and increased uterine bleeding in obese and overweight women. Author(s): Connor PD, Tavernier LA, Thomas SM, Gates D, Lytton SM. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2002 January-February; 15(1): 7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11841143&dopt=Abstract
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Drugs, science, and ethics; lessons from the Depo-provera story. Author(s): Parsons CD. Source: Issues Reprod Genet Eng. 1990; 3(2): 101-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11650915&dopt=Abstract
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Effect of Depo-Provera on the vaginal epithelium and cervical ectopy: report on a study in progress. Author(s): Mauck C. Source: Aids Research and Human Retroviruses. 1998 April; 14 Suppl 1: S131. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9581897&dopt=Abstract
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Effect of Depo-Provera or Microgynon on the painful crises of sickle cell anemia patients. Author(s): de Abood M, de Castillo Z, Guerrero F, Espino M, Austin KL. Source: Contraception. 1997 November; 56(5): 313-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9437560&dopt=Abstract
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Forearm bone density in users of Depo-Provera as a contraceptive method. Author(s): Bahamondes L, Perrotti M, Castro S, Faundes D, Petta C, Bedone A. Source: Fertility and Sterility. 1999 May; 71(5): 849-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10231044&dopt=Abstract
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Hormonal effects of Depo-Provera in cervical smears: a comparison with Triphasil and postmenopausal effects. Author(s): Kaptain S, Bloom LI, Weir MM. Source: Cancer. 2002 April 25; 96(2): 74-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11954024&dopt=Abstract
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Hormonal therapy for metastatic renal cell carcinoma combined androgen and provera followed by high dose tamoxifen. Author(s): Papac RJ, Keohane MF. Source: European Journal of Cancer (Oxford, England : 1990). 1993; 29A(7): 997-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8499154&dopt=Abstract
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Long-term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents. Author(s): Polaneczky M, Liblanc M. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 August; 23(2): 81-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9714170&dopt=Abstract
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Medroxyprogesterone (Depo Provera) and breast cancer. Author(s): McCowan L. Source: N Z Med J. 1990 May 9; 103(889): 225-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2140436&dopt=Abstract
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Menopausal symptom control and side-effects on continuous estrone sulfate and three doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Author(s): Nand SL, Webster MA, Baber R, Heller GZ. Source: Climacteric : the Journal of the International Menopause Society. 1998 September; 1(3): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913409&dopt=Abstract
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New once-a-month injectable contraceptives, with particular reference to Cyclofem/Cyclo-Provera. Author(s): Hall PE. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 August; 62 Suppl 1: S4356. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806239&dopt=Abstract
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Plasma concentrations of medroxyprogesterone acetate, estradiol and estrone following oral administration of Klimaxil, Trisequence/Provera and Divina. A randomized, single-blind, triple cross-over bioavailability study in menopausal women. Author(s): Svensson LO, Johnson SH, Olsson SE. Source: Maturitas. 1994 March; 18(3): 229-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8015506&dopt=Abstract
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Policing “perversions”: Depo-Provera and John Money's new sexual order. Author(s): Tsang DC. Source: Journal of Homosexuality. 1995; 28(3-4): 397-426. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7560938&dopt=Abstract
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Pregnancies diagnosed during Depo-Provera use. Author(s): Borgatta L, Murthy A, Chuang C, Beardsley L, Burnhill MS. Source: Contraception. 2002 September; 66(3): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384205&dopt=Abstract
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Prevalence of visible disruption of cervical epithelium and cervical ectopy in African women using Depo-Provera. Author(s): Kuhn L, Denny L, Pollack AE, Wright TC. Source: Contraception. 1999 June; 59(6): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10518230&dopt=Abstract
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Pseudocyesis in an adolescent using the long-acting contraceptive Depo-Provera. Author(s): Flanagan PJ, Harel Z. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1999 September; 25(3): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10475500&dopt=Abstract
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Recent clinical issues related to the use of depot medroxyprogesterone acetate (DepoProvera). Author(s): Cromer BA. Source: Current Opinion in Obstetrics & Gynecology. 1999 October; 11(5): 467-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10526923&dopt=Abstract
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State also pays for Depo-Provera. Author(s): Hanson MS. Source: Minn Med. 1991 June; 74(6): 7-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1830920&dopt=Abstract
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Striae from DEPO-PROVERA injections. Author(s): Harris D, Ridley CM. Source: Clinical and Experimental Dermatology. 1996 March; 21(2): 172. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8759213&dopt=Abstract
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Supplementation with vitamin C and/or vitamin B(6) in the prevention of DepoProvera side effects in adolescents. Author(s): Harel Z, Biro F, Kollar L, Riggs S, Flanagan P, Vaz R. Source: Journal of Pediatric and Adolescent Gynecology. 2002 June; 15(3): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12106752&dopt=Abstract
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The contraceptive use of Depo-Provera in U.S. adolescents. Author(s): Pinkston Koenigs LM, Miller NH. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1995 May; 16(5): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7662682&dopt=Abstract
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The effect of low-dose combined oral contraceptive pills versus injectable contraceptive (Depot Provera) on liver function tests of women with compensated bilharzial liver fibrosis. Author(s): Tagy AH, Saker ME, Moussa AA, Kolgah A. Source: Contraception. 2001 September; 64(3): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704097&dopt=Abstract
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The effect of one injection of Depo-Provera on the human vaginal epithelium and cervical ectopy. Author(s): Mauck CK, Callahan MM, Baker J, Arbogast K, Veazey R, Stock R, Pan Z, Morrison CS, Chen-Mok M, Archer DF, Gabelnick HL. Source: Contraception. 1999 July; 60(1): 15-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10549448&dopt=Abstract
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The effect upon the human vaginal histology of the long-term use of the injectable contraceptive Depo-Provera. Author(s): Bahamondes L, Trevisan M, Andrade L, Marchi NM, Castro S, Diaz J, Faundes A. Source: Contraception. 2000 July; 62(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11024225&dopt=Abstract
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The effects of Provera on chemotherapy of uterine cancer cell lines. Author(s): Nguyen HN, Sevin BU, Averette HE, Perras J, Ramos R, Penalver M, Donato D. Source: Gynecologic Oncology. 1991 August; 42(2): 165-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1832652&dopt=Abstract
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The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation. Author(s): Pardthaisong T, Yenchit C, Gray R. Source: Contraception. 1992 April; 45(4): 313-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1387602&dopt=Abstract
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The use of Depo-provera for treating male sex offenders: a review of the constitutional and medical issues. Author(s): Rainear DH. Source: Univ Toledo Law Rev. 1984 Fall; 16(1): 181-230. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11650761&dopt=Abstract
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The use of Norplant and Depo Provera in adolescents. Author(s): Ammerman SD. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1995 May; 16(5): 343-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7662681&dopt=Abstract
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Timing of onset of contraceptive effectiveness in Depo-Provera users. II. Effects on ovarian function. Author(s): Petta CA, Faundes A, Dunson TR, Ramos M, DeLucio M, Faundes D, Bahamondes L. Source: Fertility and Sterility. 1998 November; 70(5): 817-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806559&dopt=Abstract
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Timing of onset of contraceptive effectiveness in Depo-Provera users: Part I. Changes in cervical mucus. Author(s): Petta CA, Faundes A, Dunson TR, Ramos M, DeLucio M, Faundes D, Bahamondes L. Source: Fertility and Sterility. 1998 February; 69(2): 252-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9496338&dopt=Abstract
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Update on Depo-Provera. Author(s): Sapire KE. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1992 May 2; 81(9): 444-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1533472&dopt=Abstract
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Use of depo-provera in teens. Author(s): Khoiny FE. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1996 September-October; 10(5): 195-201. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8920351&dopt=Abstract
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Why women quit using Depo-Provera? Author(s): Tinkle M, Reifsnider E, Ransom SP. Source: Awhonn Lifelines / Association of Women's Health, Obstetric and Neonatal Nurses. 2001 December-2002 January; 5(6): 36-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11778463&dopt=Abstract
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Women's responses to Depo-Provera. Author(s): Freda MC, Abruzzo-Fogarassy M, Adams NV, Davini D, DeVore N, Merkatz IR. Source: Mcn. the American Journal of Maternal Child Nursing. 1996 July-August; 21(4): 183-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8754434&dopt=Abstract
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CHAPTER 2. NUTRITION AND PROVERA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Provera.
Finding Nutrition Studies on Provera The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Provera” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
4
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “Provera” (or a synonym): •
Bleeding pattern and endometrial changes during continuous combined hormone replacement therapy. The Ogen/Provera Study Group. Author(s): School of Obstetrics and Gynaecology and the Sydney Menopause Centre, Royal Hospital for Women, Randwick, NSW, Australia. Source: Nand, S L Webster, M A Baber, R O'Connor, V Obstet-Gynecol. 1998 May; 91(5 Pt 1): 678-84 0029-7844
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Bone density effects of continuous estrone sulfate and varying doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Author(s): School of Obstetrics & Gynaecology, and Sydney Menopause Centre, Royal Hospital for Women, Randwick, NSW, Australia.
[email protected] Source: Nand, S L Wren, B G Gross, B A Heller, G Z Obstet-Gynecol. 1999 June; 93(6): 1009-13 0029-7844
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By the way, doctor. I've been taking hormone replacement with Premarin and Provera for 12 years. Now that I'm 68 years old, I'd like to stop taking the hormones, but I don't know how. What is the best way to get off HRT? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 2001 February; 8(6): 8 1070910X
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Hormonal therapy for metastatic renal cell carcinoma combined androgen and provera followed by high dose tamoxifen. Author(s): Section of Oncology, Yale University School of Medicine, New Haven, Connecticut 06510. Source: Papac, R J Keohane, M F Eur-J-Cancer. 1993; 29A(7): 997-9 0959-8049
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Medroxyprogesterone acetate [Depo Provera] injections. Development of striae. Author(s): Bedfordshire and Luton Community NHS Trust, Luton, UK. Source: Gupta, M Br-J-Fam-Plann. 2000 April; 26(2): 104-5 0144-8625
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Menopausal symptom control and side-effects on continuous estrone sulfate and three doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Author(s): School of Obstetrics and Gynaecology, Royal Hospital for Women, Barker Street, Randwick, NSW, 2031, Australia. Source: Nand, S L Webster, M A Baber, R Heller, G Z Climacteric. 1998 September; 1(3): 211-8 1369-7137
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Plasma concentrations of medroxyprogesterone acetate, estradiol and estrone following oral administration of Klimaxil, Trisequence/Provera and Divina. A randomized, single-blind, triple cross-over bioavailability study in menopausal women. Author(s): Department of Obstetrics and Gynecology, Central Hospital, Vasteras, Sweden. Source: Svensson, L O Johnson, S H Olsson, S E Maturitas. 1994 March; 18(3): 229-38 0378-5122
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The effect of low-dose combined oral contraceptive pills versus injectable contraceptive (Depot Provera) on liver function tests of women with compensated bilharzial liver fibrosis. Author(s): Department of Obstetrics and Gynecology, Al-Azhar School of Medicine, 28 Kabal St., Nasr City, 11371 Cairo, Egypt Source: Tagy, A H Saker, M E Moussa, A A Kolgah, A Contraception. 2001 September; 64(3): 173-6 0010-7824
Nutrition
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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CHAPTER 3. ALTERNATIVE MEDICINE AND PROVERA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Provera. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Provera and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Provera” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Provera: •
A 2-year prospective study on the effects of depot medroxyprogesterone acetate on bone mass-response to estrogen and calcium therapy in individual users. Author(s): Merki-Feld GS, Neff M, Keller PJ. Source: Contraception. 2003 February; 67(2): 79-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12586317&dopt=Abstract
•
A phase II trial of mitomycin C, 5'-deoxy-5-fluorouridine, etoposide and medroxyprogesterone acetate (McVD-MPA) as a salvage chemotherapy to anthracycline-resistant tumor in relapsed breast cancer and its mechanism(s) of antitumor action. Author(s): Kim R, Osaki A, Tanabe K, Kojima J, Toge T. Source: Oncol Rep. 2001 May-June; 8(3): 597-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295087&dopt=Abstract
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•
A randomised controlled trial of medroxyprogesterone acetate in mastalgia. Author(s): Serewel A, Haggie JA, Cade D. Source: Annals of the Royal College of Surgeons of England. 1990 July; 72(4): 273. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2143365&dopt=Abstract
•
Actions of medroxyprogesterone acetate on the efficacy of cytotoxic drugs: studies with human breast cancer cells in culture. Author(s): Shaikh N, Owen AM, Ghilchik MW, Braunsberg H. Source: International Journal of Cancer. Journal International Du Cancer. 1989 March 15; 43(3): 458-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2522422&dopt=Abstract
•
Advanced adenocarcinoma of the kidney: therapy with lomustine, vinblastine, hydroxyurea, and medroxyprogesterone acetate and regression analysis of factors relating to survival. Author(s): Brubaker LH, Troner MB, Birch R. Source: Cancer Treat Rep. 1983 July-August; 67(7-8): 741-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6223695&dopt=Abstract
•
Bioidentical hormone replacement therapy. Customizing care for perimenopausal and menopausal women. Author(s): Romero M. Source: Adv Nurse Pract. 2002 November; 10(11): 47-8, 51-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12478948&dopt=Abstract
•
Chemotherapy with or without high-dose medroxyprogesterone acetate in oestrogenreceptor-negative advanced breast cancer. Norwegian Breast Cancer Group. Author(s): Gundersen S, Kvinnsland S, Klepp O, Lund E, Hannisdal E, Host H. Source: European Journal of Cancer (Oxford, England : 1990). 1992; 28(2-3): 390-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1534248&dopt=Abstract
•
Cisplatin, adriamycin, etoposide, megestrol acetate versus melphalan, 5-fluorouracil, medroxyprogesterone acetate in the treatment of endometrial carcinoma. Author(s): Cornelison TL, Baker TR, Piver MS, Driscoll DL. Source: Gynecologic Oncology. 1995 November; 59(2): 243-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7590480&dopt=Abstract
•
Clinical and laboratory evaluation of the myeloprotective effect of medroxyprogesterone acetate in head and neck cancer. Author(s): Amadori D, Frassineti GL, Flamini E, Falcini F, Maltoni M, Nanni O, Riccobon A, Piccinini C.
Alternative Medicine 25
Source: European Journal of Cancer (Oxford, England : 1990). 1992; 28A(8-9): 1331-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1381210&dopt=Abstract •
Combined chemo-immuno-hormonotherapy of advanced renal cell carcinoma. Author(s): Panetta A, Martoni A, Guaraldi M, Tamberi S, Casadio M, Lelli G, Pannuti F. Source: Journal of Chemotherapy (Florence, Italy). 1994 October; 6(5): 349-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7861200&dopt=Abstract
•
Combined effect of navelbine with medroxyprogesterone acetate against human breast carcinoma MCF-7 cells in vitro. Author(s): Sugiyama K, Shimizu M, Akiyama T, Ishida H, Okabe M, Tamaoki T, Akinaga S. Source: British Journal of Cancer. 1998 June; 77(11): 1737-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9667641&dopt=Abstract
•
Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause. Author(s): Woo J, Lau E, Ho SC, Cheng F, Chan C, Chan AS, Haines CJ, Chan TY, Li M, Sham A. Source: Menopause (New York, N.Y.). 2003 July-August; 10(4): 352-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851519&dopt=Abstract
•
Connexin 43 expression in rat aortic smooth muscle after ovariectomy and hormonal replacement. Author(s): Hortovanyi E, Varbiro S, Tokes AM, Illyes G, Szekacs B, Paku S, Kerenyi T, Kadar A. Source: Pathology, Research and Practice. 2001; 197(2): 109-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261814&dopt=Abstract
•
Contraception with progestogens and progesterone during lactation. Author(s): Shaaban MM. Source: The Journal of Steroid Biochemistry and Molecular Biology. 1991; 40(4-6): 70510. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1835650&dopt=Abstract
•
Cytochemical examinations of Ca, cytochrome oxidase and succinate dehydrogenase enzymes in endometrium carcinomatous tissue after high dose progestogen treatment. Author(s): Szarvas Z, Balogh I, Patai K. Source: Acta Morphol Hung. 1988; 36(3-4): 177-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2855777&dopt=Abstract
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Dietary genistein increased DMBA-induced mammary adenocarcinoma in wild-type, but not ER alpha KO, mice. Author(s): Day JK, Besch-Williford C, McMann TR, Hufford MG, Lubahn DB, MacDonald RS. Source: Nutrition and Cancer. 2001; 39(2): 226-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759285&dopt=Abstract
•
Discontinuation of HRT, memory disorder and cerebral blood flow. Author(s): Ohkura T. Source: Climacteric : the Journal of the International Menopause Society. 1999 September; 2(3): 232-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910602&dopt=Abstract
•
Effects of hormonal therapies and dietary soy phytoestrogens on vaginal cytology in surgically postmenopausal macaques. Author(s): Cline JM, Paschold JC, Anthony MS, Obasanjo IO, Adams MR. Source: Fertility and Sterility. 1996 May; 65(5): 1031-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8612830&dopt=Abstract
•
Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. Author(s): Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, Ouyang P, Thompson P, Tardif JC, Higginson L, Bittner V, Steffes M, Gordon DJ, Proschan M, Younes N, Verter JI. Source: Jama : the Journal of the American Medical Association. 2002 November 20; 288(19): 2432-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435256&dopt=Abstract
•
Estrogens, progestins, and coronary artery reactivity in atherosclerotic monkeys. Author(s): Williams JK, Delansorne R, Paris J. Source: The Journal of Steroid Biochemistry and Molecular Biology. 1998 April; 65(1-6): 219-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9699876&dopt=Abstract
•
European Organization for Research and Treatment of Cancer (EORTC) prostate cancer trials, 1976-1996. Author(s): Denis L. Source: Urology. 1998 May; 51(5A Suppl): 50-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9610558&dopt=Abstract
•
Evaluating therapeutic modalities for prevention and treatment of postmenopausal osteoporosis. Author(s): Sagraves R.
Alternative Medicine 27
Source: The Annals of Pharmacotherapy. 2003 May; 37(5): 744-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708956&dopt=Abstract •
Good science or good marketing? Author(s): Head K. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2002 August; 7(4): 274-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197780&dopt=Abstract
•
High-dose medroxyprogesterone acetate in combination with vindesine in advanced breast cancer. Author(s): Falkson HC, Falkson G. Source: Eur J Cancer Clin Oncol. 1986 December; 22(12): 1511-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2954823&dopt=Abstract
•
High-dose medroxyprogesterone acetate plus mitomycin-C or vindesine in the treatment of advanced breast cancer. Author(s): Falkson CI, Falkson HC, Falkson G. Source: American Journal of Clinical Oncology : the Official Publication of the American Radium Society. 1988 August; 11(4): 431-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2970218&dopt=Abstract
•
Hormone and cytotoxic drug responsiveness of cultured human breast cancer cells resistant to specific hormones. Author(s): Coldham NG, Patel K, Braunsberg H. Source: International Journal of Cancer. Journal International Du Cancer. 1990 April 15; 45(4): 712-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2139015&dopt=Abstract
•
How to improve adjuvant treatment results in postmenopausal patients. Author(s): Mouridsen HT. Source: Recent Results Cancer Res. 1989; 115: 144-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2533698&dopt=Abstract
•
Intensive short-term chemotherapy in patients with advanced breast cancer. Author(s): Wander HE, Nagel GA, Luig H, Emrich D. Source: Klin Wochenschr. 1987 April 1; 65(7): 317-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2953934&dopt=Abstract
•
Supplementation with vitamin C and/or vitamin B(6) in the prevention of DepoProvera side effects in adolescents. Author(s): Harel Z, Biro F, Kollar L, Riggs S, Flanagan P, Vaz R.
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Source: Journal of Pediatric and Adolescent Gynecology. 2002 June; 15(3): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12106752&dopt=Abstract •
The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation. Author(s): Pardthaisong T, Yenchit C, Gray R. Source: Contraception. 1992 April; 45(4): 313-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1387602&dopt=Abstract
•
Vitamin fluctuations in the blood of female baboons in relation to normal menstrual cycles, treatments with Lo-Ovral or Depo-Provera and a selected vitamin supplement. Author(s): Boots LR, Cornwell PE, Donahue MA, Bradley EL Jr. Source: The American Journal of Clinical Nutrition. 1983 April; 37(4): 518-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6220598&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
Alternative Medicine 29
The following is a specific Web list relating to Provera; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Menopause Source: Healthnotes, Inc.; www.healthnotes.com Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. CLINICAL TRIALS AND PROVERA Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning Provera.
Recent Trials on Provera The following is a list of recent trials dedicated to Provera.5 Further information on a trial is available at the Web site indicated. •
Depo-Medroxyprogesterone Acetate (DMPA, Depo-Provera) Use with Certain AntiHIV Drugs in HIV-Infected Women Condition(s): HIV Infections Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: The purpose of this study is to look at the level of depomedroxyprogesterone acetate (DMPA or Depo-Provera) in the blood to see if is affected by certain anti-HIV drugs (nelfinavir [NFV], efavirenz [EFV], indinavir [IDV] in combination with ritonavir [RTV], and nevirapine [NVP]). This study will also look at the levels of these anti-HIV drugs to see if they are affected by DMPA. DMPA is a hormonal birth control method that is given as an injection. It is not known if taking DMPA together with anti-HIV drugs changes the amount of DMPA and/or the amount of anti-HIV drugs in the blood. If higher levels of DMPA occur, side effects may increase. If lower levels of anti-HIV drugs occur, the drugs may become less effective against HIV. This study will look at the levels of anti-HIV drugs and DMPA in the blood when these medications are used together. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016601
5
These are listed at www.ClinicalTrials.gov.
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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “Provera” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
Clinical Trials 33
•
For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
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CHAPTER 5. BOOKS ON PROVERA Overview This chapter provides bibliographic book references relating to Provera. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Provera include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Provera” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “Provera” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Provera” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Birth Control by Injection: The Story of Depo-Provera by Thomas J., M.D. Vecchio; ISBN: 0533106958; http://www.amazon.com/exec/obidos/ASIN/0533106958/icongroupinterna
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Depo-provera : the quarterly contraceptive (SuDoc HE 20.4010/A:D 44) by Dori Stehlin; ISBN: B00010FWAC; http://www.amazon.com/exec/obidos/ASIN/B00010FWAC/icongroupinterna
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Provera by Mirko Miloradovic; ISBN: 8644102133; http://www.amazon.com/exec/obidos/ASIN/8644102133/icongroupinterna
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The Depo-Provera Story: A Continuing Controversy by I.S. Fraser; ISBN: 1850703744; http://www.amazon.com/exec/obidos/ASIN/1850703744/icongroupinterna
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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Provera” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:6 •
[Congressional interest in the Depo-Provera issue] Author: Camp, S. L.; Year: 1978; Legislative and Policy Update, Special Edition, 1981
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[The case for Depo-Provera] Author: Senanayake, P.; Year: 1975; 1980
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A study of 157 women who conceived after discontinuation of Depo Provera Author: Basnayake, Sriani.; Year: 1979; Colombo, Sri Lanka: [Family Planning Association of Sri Lanka], 1981
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Acceptance and use of Depo Provera in the model clinic Lahore Author: Chaudhry, I.; Year: 1978; Lahore, Family Planning Association of Pakistan, 1975?
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An International Experience on the Clinical Use of Depo-Provera: final report to the International Planned Parenthood Federation. Author: International Fertility Research Program.; Year: 1980; Research Triangle Park, N.C. International Fertility Research Program, 1980
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An overview of Depo-Provera Author: Schwallie, P. C.; Year: 1982; 1982
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Clinical experiences with Depo-provera: an injectable contraceptive. 1969 Author: Apelo, R.; Year: 1969; [1969]
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Commentary on Depo-Provera. Author: Upjohn Company.; Year: 1980; Kalamazoo, Michigan, Upjohn Company, 1980
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Comparative program demonstration of the use of Depo-provera by medical and paramedical personnel in Thailand (interim report). Author: Thailand. Ministry of Public Health. National Family Planning Program. Research and Evaluation Unit.; Year: 1981; Thailand, Ministry of Public Health, 1976
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Depo Provera approval Author: Nida, E.; Year: 1974; FDA Talk Paper, 1974
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Depo-provera: a critical analysis of published references Author: Hutton, J. D.; Year: 1981; 1981
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Depo-Provera: issue discussion paper Author: Clark, E. L.; Year: 1981; Kalamazoo, MIchigan, Upjohn Company, [1980]
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Depo-Provera: safety and efficacy issues Author: Duncan, G. W.; Year: 1980; 1980
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Depo-provera as an injectable female contraceptive agent Author: Vecchio, T. J.; Year: 1967; Paper presented to the Supreme Council for Family Planning, Cairo, Egypt, 1967
6
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
Books
37
•
Depo-Provera as long-acting injectable contraceptive Author: Khan, T.; Year: 1974; Proceedings of the Seventh Biannual Seminar on Research in Population Planning, Karachi, 1973
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Depo-Provera contraception: international experience in over 20,000 cases Author: Vecchio, T. J.; Year: 1973; 1972
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Depo-Provera Sterile Acqueous Suspension Author: Crout, J. R.; Year: 1975; 1978
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Hormone releasing silastic intrauterine devices: effect of provera releasing IUD's on two species of primate Author: Doyle, L. L.; Year: 1974; 1974
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Improving public confidence in Depo-Provera Author: Senanayake, P.; Year: 1982; London, International Planned Parenthood Federation, 1981
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Medroxyprogesterone acetate: a report on ten years of use of DEPO provera in family planning programme in Jamaica Author: Patterson, A. W.; Year: 1973; Paper presented at the International Family Planning Research Association Meeting, Palm Springs, California, 1974
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Provera-Provest bibliography, 1964. Author: Upjohn Company.; Year: 1981; Kalamazoo, Michigan, Upjohn, 1973
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Rebuttal to APHA resolution on Depo-Provera and Mother Jones article Author: Joseph, S. C.; Year: 1980; 1980
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Report on Depo Provera study of 50 women at Gokarna, Kathmandu Author: Gautam, L.; Year: 1973; 1973
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Report on our observation trip to Thailand about Depo-Provera and mini-lap Author: Van Der Blugt, G.; Year: 1978; 1975
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Report on the pilot study on Depo-Provera as a method of contraception in Kandnag Kerbau Family Planning Clinic and Queenstown Maternal and Child Health Clinic from February 15 1968 to February 14 1970 Author: Khim, S. S.; Year: 1970; Singapore, Singapore Family Planning and Population Board, (1970)
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Review of cervical carcinoma in-situ associated with the use of Depo-provera Author: Schwallie, P. C.; Year: 1974; Kalamazoo, Michigan, Upjohn Company, 1974
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The depo-provera debate. Author: United States. Congress. House. Select Committee on Population.; Year: 1981; Government Printing Office, Washington, D.C., United States, 1978
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The epidemiology of the acceptance and use of Depo-Provera in Chiang Mai, Northern Thailand Author: Pardthaisong, T.; Year: 1974; [1974]
Chapters on Provera In order to find chapters that specifically relate to Provera, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Provera using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Provera” (or synonyms) into the “For these words:” box.
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CHAPTER 6. PERIODICALS AND NEWS ON PROVERA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Provera.
News Services and Press Releases One of the simplest ways of tracking press releases on Provera is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Provera” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Provera. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Provera” (or synonyms). The following was recently listed in this archive for Provera: •
Estrogen therapy may arrest Depo-Provera-related bone loss Source: Reuters Medical News Date: February 12, 2003
•
Depo-Provera users can miss unplanned pregnancies Source: Reuters Health eLine Date: October 30, 2002
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Provera
•
Teens on Depo-Provera less likely to use condoms Source: Reuters Health eLine Date: March 28, 2001
•
Almost half of women discontinue Depo-Provera within 1 year Source: Reuters Medical News Date: May 21, 1998
•
Condom Use Patterns Vary Among Norplant And Depo-Provera Users Source: Reuters Medical News Date: November 11, 1997
•
Depo-Provera Shows Advantages Over Oral Contraceptives In Postpartum Adolescents Source: Reuters Medical News Date: March 10, 1997
•
Depo-Provera Reduces Bone Density In Adolescent Girls Source: Reuters Medical News Date: November 25, 1996 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “Provera” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.
Periodicals and News
41
Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Provera” (or synonyms). If you know the name of a company that is relevant to Provera, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Provera” (or synonyms).
Academic Periodicals covering Provera Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Provera. In addition to these sources, you can search for articles covering Provera that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
43
APPENDICES
45
APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
•
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
•
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
•
National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
•
National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
•
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
•
National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
•
National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
7
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
•
National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
•
National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
•
National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
•
National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
•
National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
•
Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
Physician Resources
47
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
•
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
•
Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
•
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
•
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
•
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
•
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
8
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.
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•
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Provera” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 3289 839 842 19 2 4991
HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “Provera” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
10
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
11
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
Physician Resources
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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
15 Adapted 16
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
51
APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Provera can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Provera. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Provera. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Provera”:
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•
Other guides Breast Cancer http://www.nlm.nih.gov/medlineplus/breastcancer.html Hormone Replacement Therapy http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html Uterine Cancer http://www.nlm.nih.gov/medlineplus/uterinecancer.html Uterine Fibroids http://www.nlm.nih.gov/medlineplus/uterinefibroids.html
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Provera. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Killer Sex Contact: Life Cycle Books, PO Box 420, Lewiston, NY, 14092-0420. Summary: This brochure, for college-age individuals, discusses sexual abstinence as a means to prevent unplanned pregnancies and sexually transmitted diseases (STDs). The brochure cites the example of an individual who had sex in college and contracted two STDs. The brochure provides statistical data on individuals infected with STDs (human papillomavirus (HPV), the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), herpes, and chlamydia). It discusses how contraceptive methods including the pill, Depo Provera shots, and Norplant do not protect individuals from STDs and identifies a number of sexual and emotional reasons for practicing sexual abstinence. Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:
Patient Resources
•
53
What You Should Know About Depo-Provera Source: Office of Population Affairs, U.S. Department of Health and Human Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5627 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Provera. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
•
WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Provera. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Provera. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Provera. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
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Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Provera” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Provera”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Provera” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Provera” (or a synonym) into the search box, and click “Submit Query.”
55
APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
18
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
19
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
57
•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
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•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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PROVERA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Acute leukemia: A rapidly progressing cancer of the blood-forming tissue (bone marrow). [NIH]
Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anthracycline: A member of a family of anticancer drugs that are also antibiotics. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a
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specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as
Dictionary 65
percent body fat. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Division: The fission of a cell. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and
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vagina. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements,
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megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH]
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Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytotoxic: Cell-killing. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the
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chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzymes: Biological molecules that possess catalytic activity. They may occur naturally or be synthetically created. Enzymes are usually proteins, however catalytic RNA and catalytic DNA molecules have also been identified. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrone: 3-Hydroxyestra-1,3,5(10)-trien-17-one. A metabolite of estradiol but possessing less biological activity. It is found in the urine of pregnant women and mares, in the human placenta, and in the urine of bulls and stallions. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), estrone may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] F Factor: A plasmid whose presence in the cell, either extrachromosomal or integrated into the bacterial chromosome, determines the "sex" of the bacterium, host chromosome mobilization, transfer via conjugation of genetic material, and the formation of sex pili. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU]
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Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematologic malignancies: Cancers of the blood or bone marrow, including leukemia and lymphoma. Also called hematologic cancers. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH]
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Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ida: An alkylating agent. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral
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bioavailability. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Levo: It is an experimental treatment for heroin addiction that was developed by German scientists around 1948 as an analgesic. Like methadone, it binds with opioid receptors, but it is longer acting. [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a
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factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Lomustine: An alkylating agent of value against both hematologic malignancies and solid tumors. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medroxyprogesterone Acetate: An injectable contraceptive, generally marketed under the name Depo-Provera. [NIH] Megestrol: 17-Hydroxy-6-methylpregna-3,6-diene-3,20-dione. A progestational hormone used most commonly as the acetate ester. As the acetate, it is more potent than progesterone both as a progestagen and as an ovulation inhibitor. It has also been used in the palliative treatment of breast cancer. [NIH] Megestrol Acetate: A drug that belongs to the group of hormones called progestins, used as hormone therapy to block estrogen and to suppress the effects of estrogen and androgens. [NIH]
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Melphalan: An alkylating nitrogen mustard that is used as an antineoplastic in the form of the levo isomer - melphalan, the racemic mixture - merphalan, and the dextro isomer medphalan; toxic to bone marrow, but little vesicant action; potential carcinogen. [NIH] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing cross-linking of DNA and inhibition of DNA synthesis. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Myelosuppression: A condition in which bone marrow activity is decreased, resulting in
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fewer red blood cells, white blood cells, and platelets. Myelosuppression is a side effect of some cancer treatments. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nelfinavir: A potent HIV protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]
Nevirapine: A potent, non-nucleoside reverse transcriptase inhibitor used in combination with nucleoside analogues for treatment of HIV infection and AIDS. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Non-nucleoside: A member of a class of compounds, including delavirdine, loviride and nevirapine, that acts to directly combine with and block the action of HIV's reverse transcriptase. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]
Opacity: Degree of density (area most dense taken for reading). [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH]
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Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photoreceptors: Cells specialized to detect and transduce light. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other
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nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH]
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Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Ribonucleoside Diphosphate Reductase: An enzyme of the oxidoreductase class that catalyzes the formation of 2'-deoxyribonucleotides from the corresponding ribonucleotides using NADPH as the ultimate electron donor. The deoxyribonucleoside diphosphates are used in DNA synthesis. (From Dorland, 27th ed) EC 1.17.4.1. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ritonavir: An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [NIH] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are
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SERMs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexual Abstinence: Refraining from sexual intercourse. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Squamous: Scaly, or platelike. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a
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smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Symphysis: A secondary cartilaginous joint. [NIH] Systemic: Affecting the entire body. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in
Dictionary 81
which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Venous: Of or pertaining to the veins. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vindesine: Vinblastine derivative with antineoplastic activity against acute leukemia, lung cancer, carcinoma of the breast, squamous cell carcinoma of the esophagus, head, and neck, and Hodgkin's and non-Hodgkin's lymphomas. Major side effects are myelosuppression and neurotoxicity. Vindesine is used extensively in chemotherapy protocols. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
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INDEX A Acute leukemia, 63, 81 Adenocarcinoma, 24, 26, 63 Adjuvant, 27, 63 Adrenal Cortex, 63, 69, 75, 77 Adverse Effect, 5, 63, 79 Age Groups, 6, 63 Aged, 80 and Over, 63 Agonist, 63, 80 Algorithms, 63, 64 Alkaline, 63, 65 Alternative medicine, 40, 63 Anal, 6, 63, 73 Analog, 63, 70 Androgens, 63, 73 Anemia, 13, 63 Anthracycline, 23, 63 Antibiotic, 63, 74 Antibody, 63, 64, 66, 72 Antigen, 63, 66, 72 Antimetabolite, 64, 70 Antineoplastic, 64, 70, 71, 74, 77, 81 Antioxidant, 26, 64 Antiviral, 64, 75 Anus, 63, 64, 65 Arterial, 64, 71, 77 Arteries, 64, 67, 74 ATP, 64, 68, 70, 76, 77, 80 B Bacterium, 64, 67, 69 Base, 64, 68, 72 Bile, 64, 70, 73, 79 Bioavailability, 14, 20, 64, 72 Biotechnology, 7, 36, 40, 47, 64 Bladder, 64, 77, 80 Blood Coagulation, 64, 65 Blood pressure, 64, 65, 71 Blood vessel, 64, 65, 79, 80, 81 Body Composition, 6, 64 Body Mass Index, 65, 76 Bone Density, 5, 6, 8, 10, 13, 40, 65 Bone Marrow, 63, 65, 70, 73, 74, 79 Bowel, 63, 65, 68 Bowel Movement, 65, 68 Branch, 59, 65, 76, 77, 79, 80 C Calcium, 5, 23, 65, 66 Carcinogen, 65, 69, 74
Carcinoma, 13, 20, 24, 25, 37, 65, 81 Cardiovascular, 11, 65 Cardiovascular disease, 11, 65 Cell, 7, 13, 16, 20, 25, 63, 64, 65, 66, 67, 68, 69, 70, 72, 74, 75, 76, 78, 81 Cell Cycle, 65, 69 Cell Division, 65, 69 Cerebral, 26, 65 Cerebrovascular, 65 Cerebrum, 65 Cervical, 10, 13, 15, 16, 17, 37, 65 Cervix, 65 Chemotherapy, 16, 23, 24, 25, 27, 66, 81 Chlamydia, 52, 66 Cholesterol, 64, 66, 67, 79, 80 Chromosome, 66, 67, 69 Chronic, 66, 72, 79 Clinical trial, 3, 7, 31, 32, 47, 66, 68, 78 Cloning, 64, 66 Cofactor, 66, 77 Complement, 66 Complementary and alternative medicine, 23, 29, 66 Complementary medicine, 23, 66 Computational Biology, 47, 67 Conception, 67 Condoms, 40, 67 Conjugated, 67, 68 Conjugation, 67, 69 Connective Tissue, 65, 67, 70, 73 Constitutional, 17, 67 Contraception, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 16, 20, 23, 25, 28, 37, 67, 72 Contraceptive, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15, 16, 17, 20, 35, 36, 37, 52, 67, 73, 75 Contraindications, ii, 67 Coronary, 26, 65, 67, 74 Coronary heart disease, 65, 67 Coronary Thrombosis, 67, 74 Corpus, 67, 68, 76, 77 Corpus Luteum, 68, 77 Cortex, 68 Curative, 68, 80 Cytochrome, 25, 68 Cytotoxic, 24, 27, 68 D Databases, Bibliographic, 47, 68 Density, 4, 5, 6, 9, 20, 65, 68, 75
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Diagnostic procedure, 40, 68 Digestion, 64, 65, 68, 73, 79 Digestive system, 32, 68 Direct, iii, 68, 78 DNA Topoisomerase, 68, 70 Double-blinded, 5, 68 Drug Interactions, 68 E Efficacy, 24, 36, 68 Electrons, 64, 68, 76, 78 Embryo, 69, 75 Endometrial, 9, 20, 24, 69 Endometriosis, 69, 72, 75 Endometrium, 25, 69, 74 Environmental Health, 46, 48, 69 Enzymatic, 65, 66, 69 Enzymes, 25, 69, 75, 76 Epithelial, 7, 63, 69 Epithelial Cells, 69 Epithelium, 7, 13, 15, 16, 69, 76 Erythrocytes, 63, 65, 69 Esophagus, 68, 69, 79, 81 Estradiol, 5, 7, 14, 20, 69 Estrogen, 5, 23, 39, 69, 73, 78, 80 Estrone, 9, 14, 20, 69 Etoposide, 23, 24, 69 F F Factor, 24, 69 Family Planning, 10, 36, 37, 47, 69 Fat, 65, 67, 69, 76 Femoral, 5, 69 Femur, 69, 70 Fibrosis, 16, 20, 70 Fluorouracil, 24, 70 Foetoplacental, 70, 75 G Gallbladder, 68, 70 Gas, 70, 75, 81 Gastrin, 70, 71 Gene, 36, 64, 70 Genistein, 26, 70 Gland, 63, 70, 73, 76, 77, 78 Glycogen, 66, 70 Governing Board, 70, 77 Gram-negative, 66, 70 Growth, 16, 28, 63, 70, 71, 73 H Heart attack, 65, 70 Hematologic malignancies, 70, 73 Heme, 68, 70 Hemoglobin, 63, 69, 70 Hemorrhage, 71, 79
Heredity, 70, 71 Herpes, 52, 71 Herpes Zoster, 71 Histology, 16, 71 Hormonal, 4, 5, 13, 20, 25, 26, 31, 71 Hormone, 5, 9, 20, 24, 25, 26, 27, 37, 52, 69, 70, 71, 72, 73, 77 Hormone Replacement Therapy, 9, 20, 24, 25, 26, 52, 71 Hormone therapy, 71, 73 Host, 24, 69, 71 Human papillomavirus, 52, 71 Hydroxyurea, 24, 71 Hypertension, 65, 71 Hypothalamic, 5, 71 Hypothalamus, 71 I Id, 21, 28, 53, 58, 60, 71 Ida, 71 Immune response, 63, 64, 71, 80, 81 Immunodeficiency, 52, 71 Immunology, 63, 71 Immunosuppressant, 70, 71 Impairment, 71, 74 Implantation, 67, 71, 75 In vitro, 25, 71 In vivo, 71 Indicative, 35, 71, 76, 81 Indinavir, 31, 71 Infant, Newborn, 63, 72 Infarction, 67, 72, 74 Infection, 7, 71, 72, 73, 75, 79, 81 Inflammation, 70, 71, 72 Inorganic, 72, 74 Intracellular, 72 Intramuscular, 7, 8, 10, 72 Intramuscular injection, 7, 72 K Kb, 46, 72 L Lactation, 9, 16, 25, 28, 72, 75 Large Intestine, 68, 72, 78, 79 Least-Squares Analysis, 72, 78 Levo, 72, 74, 75 Levonorgestrel, 8, 12, 72, 75 Library Services, 58, 72 Ligament, 72, 77 Likelihood Functions, 72, 78 Linear Models, 72, 78 Liver, 16, 20, 64, 68, 70, 73 Localized, 72, 73 Logistic Models, 73, 78
Index 85
Lomustine, 24, 73 Longitudinal study, 4, 5, 73 Lumbar, 5, 73 Lymph, 65, 73 Lymph node, 65, 73 Lymphatic, 72, 73, 79 M Malignant, 63, 64, 73 Mammary, 26, 73, 80 Medical Staff, 68, 73 MEDLINE, 47, 73 Medroxyprogesterone, 4, 6, 8, 9, 10, 12, 14, 15, 20, 23, 24, 25, 27, 31, 37, 73 Medroxyprogesterone Acetate, 4, 6, 8, 9, 10, 12, 14, 15, 20, 23, 24, 25, 27, 31, 73 Megestrol, 24, 73 Megestrol Acetate, 24, 73 Melphalan, 24, 74 Membranes, 74, 77 Memory, 26, 74 Menopause, 14, 20, 25, 26, 29, 74, 75, 76, 77 Menstrual Cycle, 7, 28, 74, 75, 77 Menstruation, 74 Mental Disorders, 33, 74 Mental Health, iv, 3, 33, 46, 48, 74, 77 Metabolite, 69, 74 Metastasis, 74 Metastatic, 13, 20, 74 MI, 61, 74 Milliliter, 65, 74 Mitomycin, 23, 27, 74 Mitotic, 69, 74, 81 Mobilization, 69, 74 Molecular, 25, 26, 47, 49, 64, 67, 74 Molecule, 64, 66, 74, 76, 77, 78, 80 Mucus, 17, 74 Myelosuppression, 74, 81 Myocardium, 74, 75 N NCI, 1, 32, 45, 75 Necrosis, 72, 74, 75 Need, 6, 37, 54, 70, 75 Nelfinavir, 31, 75 Neurotoxicity, 75, 81 Nevirapine, 31, 75 Nitrogen, 63, 74, 75 Non-nucleoside, 75 Norgestrel, 72, 75 O Oestrogen, 24, 75 Opacity, 68, 75 Osteoporosis, 4, 6, 26, 29, 75
Ovariectomy, 25, 75 Ovaries, 75, 79 Ovary, 68, 69, 75, 76 Overweight, 13, 21, 76 Ovulation, 73, 75, 76 Ovum, 68, 76, 77 Oxidation, 64, 68, 76 P Palliative, 73, 75, 76, 80 Pancreas, 68, 76 Papillomavirus, 76 Pathologic, 67, 76 Patient Education, 52, 56, 58, 61, 76 Pelvic, 69, 76, 77 Penis, 67, 76 Perimenopausal, 24, 76 PH, 65, 76 Pharmacologic, 76, 80 Phosphorus, 65, 76 Photoreceptors, 76, 78 Physiologic, 63, 74, 76, 78 Pilot study, 37, 76 Placenta, 69, 70, 76, 77 Plasmid, 69, 77 Podophyllotoxin, 69, 77 Posterior, 63, 76, 77 Postmenopausal, 4, 13, 26, 27, 75, 77 Practice Guidelines, 48, 77 Progesterone, 6, 7, 25, 72, 73, 75, 77, 79 Progestogen, 25, 77 Progressive, 70, 75, 77 Prospective study, 8, 23, 73, 77 Prostate, 26, 75, 77 Protease, 71, 75, 77, 78 Protein S, 36, 64, 77 Proteins, 64, 66, 69, 74, 75, 77, 80 Protein-Tyrosine Kinase, 70, 77 Public Health, 4, 6, 36, 48, 77 Public Policy, 47, 78 R Race, 5, 72, 74, 75, 78 Radiation, 78, 81 Randomized, 5, 14, 20, 26, 68, 78 Receptor, 24, 64, 78 Rectum, 64, 65, 68, 70, 72, 77, 78 Refer, 1, 66, 71, 78 Regimen, 68, 78 Regression Analysis, 24, 78 Retina, 78 Ribonucleoside Diphosphate Reductase, 71, 78 Risk factor, 73, 77, 78
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Ritonavir, 31, 78 Rods, 7, 78 S Salivary, 68, 78 Salivary glands, 68, 78 Screening, 66, 78 Secretion, 72, 74, 78, 79 Selective estrogen receptor modulator, 78, 80 Semen, 77, 79 Semisynthetic, 69, 79 Senile, 75, 79 Sex Characteristics, 63, 75, 79 Sexual Abstinence, 52, 79 Sexually Transmitted Diseases, 52, 79 Side effect, 10, 15, 27, 31, 63, 75, 79, 80, 81 Small intestine, 71, 79 Smooth muscle, 25, 79, 80 Solid tumor, 73, 79 Specialist, 53, 79 Species, 37, 66, 78, 79 Squamous, 79, 81 Steroid, 25, 26, 75, 79 Stomach, 68, 69, 70, 71, 79 Stroke, 33, 46, 65, 79 Subacute, 72, 79 Subclinical, 72, 79 Subcutaneous, 7, 79 Subspecies, 79 Substance P, 74, 77, 78, 80 Symphysis, 77, 80 Systemic, 64, 72, 80 T Tamoxifen, 13, 20, 78, 80 Testis, 69, 75, 80 Therapeutics, 80
Thigh, 69, 80 Thorax, 73, 80 Thrombosis, 77, 79, 80 Tissue, 25, 63, 64, 65, 67, 69, 71, 72, 73, 74, 75, 76, 78, 79, 80 Tomography, 65, 80 Toxic, iv, 67, 74, 77, 80 Toxicity, 68, 80 Toxicology, 48, 80 Toxins, 64, 72, 80 Transcriptase, 75, 80 Transfection, 64, 80 U Unconscious, 71, 80 Urethra, 76, 77, 80 Urine, 64, 69, 80 Uterus, 65, 67, 69, 74, 75, 77, 80, 81 V Vaccine, 63, 81 Vagina, 66, 74, 81 Vaginal, 5, 7, 13, 16, 26, 81 Vascular, 72, 76, 81 VE, 9, 20, 81 Venous, 77, 81 Veterinary Medicine, 47, 81 Vinblastine, 24, 81 Vinca Alkaloids, 81 Vindesine, 27, 81 Virus, 52, 71, 81 Vitro, 81 W Warts, 71, 77, 81 Weight Gain, 5, 11, 81 White blood cell, 63, 74, 75, 81 X X-ray, 5, 6, 65, 81
Index 87
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