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University of Kent, Canterbury, Kent CT2 7NF Telephone: 01227 764000 Fax: 01227 764327 Established in 1974 at the University of Kent at Canterbury, the Personal Social Services Research Unit is now the largest social care research unit in the UK, with some 40 staff members. Its work is funded by the Department of Health, and other government departments, the Economic and Social Research Council, charitable trusts and international social welfare organisations. PSSRU research focuses on needs, resources and outcomes in social care and mental health care: its concerns are resourcing, equity and efficiency from the perspective of users, agencies and others. A distinctive analytical framework called the `production of welfare approach' has been developed by the Unit to illuminate such research. The PSSRU applies the approach in studies of a wide range of areas. Most of its work has been on what is loosely described as `community care', but it has also worked on other areas such as in-patient health care, housing, income maintenance, criminal justice services, and the voluntary sector. The PSSRU Bulletin is available free from Maureen Weir 01227 827555 ; at the Unit, who will also be glad to send lists of PSSRU books, monographs and discussion papers, for example, rxlist.

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Associations with COCs, either second or third generation progestins can be used.2 It is more important to ensure that larger risk factors for morbidity are reduced e.g. avoid use in women 35 y.o. who smoke heavily ; .2 This will be more important as women use COCs into their perimenpausal years. "Quick Start" initiation of therapy: The COC is traditionally initiated within the first 5 days of the menstrual cycle, or on the first Sunday after menses begins backup contraception is not required if started within the first 5 days of menstruation ; . To promote compliance and avoid confusion, the first COC dose can now be initiated during the office visit regardless of the patient's cycle.2, 12 This "QuickStart" method will require backup contraception during the first 7 days of initiation unless within the first 5 days of menstruation ; . Extended use of COC, "bicycling", "tricycling": COCs can now be used consecutively for 3 months 4 packages x 21s ; before allowing for a 7-day pill free interval. This method may help alleviate some the symptoms associated with menstruation, and postpone menstrual bleeding e.g. for vacation, wedding ; . Although there is a marketed product in the U.S. that results in 1 period each season Seasonale ; , any monophasic COC can be used consecutively to achieve a similar effect. Little information on long-term safety is available, but it is not expected that extended use would increase side-effects compared to the traditional 21-days-on and 7-days-pill-free regimens.13 Endometrial hyperplasia should not occur because progestin is available to oppose estrogen. Drug interactions: Although not well studied, the clinical significance of many interactions is questionable with COCs, and 5% of drug interactions result in pregnancy.2 Table 3 lists drug interactions from the Canadian guidelines. Table 1. Non-contraceptive benefits of COCs: * 2 cycle regulation BMD endometrial cancer menstrual flow acne ovarian cancer dysmenorrhea hirsutism risk fibroids perimenopausal salpingitis possibly colorectal symptoms carcinoma premenstrual mood possibly possibly benign changes bloating, ovarian cysts breast disease breast tenderness and ddavp.
This last point is downright scary. All women with PCOS need to take extra good care of themselves and work to get lifestyle issues such as diet and exercise under control as quickly as possible. Diabetes is preventable in many cases. Even when it is not preventable, diabetics who learn to manage their disease have much longer and healthier lives and are less likely to become insulin-dependent. What causes PCOS? There are a number of theories about what causes PCOS. The most commonly held theory right now is that insulin resistance is at the root of PCOS. While it is true that many women control their PCOS symptoms by controlling insulin resistance, many other women with PCOS do not have insulin resistance and have no symptom improvement from the standard insulin medications or diet and exercise treatment. Other theories include: An underlying neuroendocrine defect that causes high luteinizing hormone LH ; levels. One recent study University of Virginia study confirmed that provoking high LH levels lead to PCOS symptoms. A defect in androgen production that results in excessive ovarian androgen production. A problem with cortisol metabolism leading to enhanced adrenal androgen production.
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TENSION PNEUMOTHORAX 253. Tension pneumothorax time for a rethink? S. Leigh-Smith; T. Harris In Emergency Medicine Journal Vol. 22 1 ; Jan. '05 pp 8-16.
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