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J A Lamont

Publications and source records attributed to J A Lamont.

13 recordsLinked to original sources
PubMed1996

Late luteal phase dysphoric disorder and the thyroid axis revisited.

Late luteal phase dysphoric disorder (LLPDD), also known as premenstrual dysphoria, has been etiologically linked to both depression and thyroid disease. We examined baseline and TRH-stimulated thyroid function in 45 otherwise healthy women with prospectively confirmed LLPDD during the follicular and luteal phases of their menstrual cycles. The means of all thyroid variables were normal. Three (6.8%) subjects had elevated baseline TSH (mild hypothyroidism), and 6 (13.3%) had an exaggerated TSH response (delta max TSH) to TRH (subclinical hypothyroidism). A blunted delta max TSH (< 5 mU/L) was found in only 4.4% of the subjects. History of a past major psychiatric diagnosis (mostly depression) or a current personality disorder correlated with a lower delta max TSH. As baseline TSH, using the new ultrasensitive radioimmunometric assay, correlated strongly with delta max TSH, the utility of the TRH challenge is questioned. Our findings suggest that LLPDD is not related to depression on the basis of this marker and that hypothyroidism is not the cause of LLPDD.

Adolescent↗
PubMed1994

Patient-physician sexual involvement: a Canadian survey of obstetrician-gynecologists.

OBJECTIVE: To determine obstetrician-gynecologists' (ob-gyns') awareness of and experience with sexual abuse of patients and former patients and their opinions about appropriate consequences. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: All 792 members of the Society of Obstetricians and Gynaecologists of Canada (SOGC); 618 (78%) responded. Approximately half of all ob-gyns in Canada belong to the SOGC. MAIN OUTCOME MEASURES: Knowledge of sexual involvement by an ob-gyn colleague with a patient or former patient (as defined by the respondents and by the College of Physicians and Surgeons of Ontario [CPSO]), self-report of such involvement, attitudes toward physician sexual abuse, desirable length of time a physician should wait before seeing a former patient in a situation that could lead to a sexual encounter, suggested consequences of sexual abuse. RESULTS: Overall, 10% of the respondents indicated that they knew about another ob-gyn who at some time had been sexually involved with a patient. In all, 3% of the male respondents and 1% of the female respondents reported sexual involvement with a patient; the corresponding proportions of those who reported having been accused of sexual abuse by a patient were 4% and 2%. Significantly more of the female ob-gyns than of their male counterparts (37% v. 19%) reported awareness of a colleague's sexual involvement with a patient that would meet the CPSO's definition of sexual impropriety, transgression or violation. Most of the respondents felt that the consequence of proven sexual impropriety should be reprimand and fine (chosen by 33%) or rehabilitation without loss of licence (28%). Most of the physicians supported loss of licence for proven sexual transgression (57%) or proven sexual violation (74%), but fewer felt that loss of licence should be permanent for these types of abuse (4% and 24% respectively). The female ob-gyns supported stronger sanctions against sexual transgression and sexual violation than the male ob-gyns. A wide range of opinion was seen regarding the propriety of sexual relationships with former patients. CONCLUSIONS: Ob-gyns have varied opinions about how sexual abuse of patients should be defined and how it should be sanctioned. There is a discrepancy between proposed public policy and the beliefs of physicians to whom the policy is to be applied.

Canada↗
PubMed1994

Cervicovaginal screening in women with HIV infection: a need for increased vigilance?

OBJECTIVE: To review the current literature on cervical disease (dysplasia, cervical intraepithelial neoplasia [CIN] or carcinoma) in women with HIV infection and to assess recommendations for cervicovaginal screening in these patients. DATA SOURCES: MEDLINE and AIDSLINE were searched for relevant articles published in English or French between January 1987 and February 1993, abstracts presented at international AIDS conferences from 1989 to 1993 were evaluated, and pertinent agencies and organizations were consulted. STUDY SELECTION: A total of 92 reports of gynecologic disease in women with HIV infection were examined; 32 studies were retained that reported pertinent findings on cervical dysplasia, CIN or cervical carcinoma. DATA EXTRACTION: The following criteria were used to extract data: study design (descriptive v. comparative), sample size, heterogeneity of the study population, presence of immunodeficiency indicators (i.e., absolute CD4+ lymphocyte count) and presence of concomitant vaginal infections. Recommendations were assessed for their specific application to women with HIV infection. DATA SYNTHESIS: Data on the associations between stage of cervical disease and response to treatment at varying levels of CD4+ lymphocyte depletion were incomplete. Recommendations by official bodies for cervicovaginal screening in women with HIV infection differed little from recommendations for standard care of all women of reproductive age. CONCLUSIONS: The consequences of a missed or delayed diagnosis of cervical disease for women with HIV infection can be severe. Pending further research, more frequent cervicovaginal screening through Papanicolaou testing and colposcopy in women with HIV infection is warranted.

Adult↗
PubMed1985

An assessment approach to couples with sexual problems.

We have described the assessment approach to couples with sexual complaints used in the McMaster Human Sexuality Clinic. Our approach takes into account a number of individual factors including intrapersonal and biological ones as well as issues of sexual socialization, gender role socialization and sexual orientation. Couple factors include relationship factors as well as factors dealing with sexual behaviours, attitudes and responses. In our view, the issues of sexual socialization and gender role socialization needs special emphasis in assessing such couples. We stress as well that the dichotomy between organic and functional is a misleading one and that for each individual and couple, any biological factors and the many supra-biological factors listed above, must be prioritized in terms of their role in symptom production. Such a priority list can then be used to map out treatment strategies.

Female↗
PubMed1982

Twin pregnancies following induction of ovulation: a literature review.

A literature review of the occurrence of multiple pregnancies associated with artificial induction of ovulation is reported. This report considers three treatment schedules: (1) clomiphene citrate; (2) human pituitary gonadotrophin with human chorionic gonadotrophin; and (3) human menopausal gonadotrophin with human chorionic gonadotrophin. The majority of the increase in twinning is related to hyperstimulation of the ovary by these medications, resulting in dizygotic twinning. The true incidence of twin pregnancy cannot be calculated because the vital statistics of all nations report live birth rates. Increased rates of fetal wastage, late abortion and prematurity associated with the occurrence of multiple pregnancies are overlooked by these statistics. The increased incidence of twinning appears to be related to the type and dosage of medication used, and the patient's underlying problem.

Chorionic Gonadotropin↗
PubMed1980

Female dyspareunia.

This descriptive study presents 230 women with the chief or major complaint of pain during intercourse. The patients were assessed according to the medical model with careful screening for intrapersonal (intrapsychic), interpersonal (relationship), and physical factors that contributed to the patient's discomfort. Each patient had a careful pelvic examination to clarify the physical and physiologic factors which contributed to the patient's discomfort. Each total assessment attempted to identify the primary source of the patient's complaint. Sixty-two patients were seen as primarily having an interpersonal problem; 100 had intrapersonal problems, and 68 primarily had a physical problem. Secondary physical problems were identified in 22 patients from the first two of these three groups. Factors which highlight each group are presented. Standard treatment techniques were employed for each group. Treatment successes are discussed briefly for each of the three groups.

Adolescent↗
PubMed1978

Vaginismus.

Eighty patients with vaginismus were seen in the Human Sexuality Clinic, McMaster University Medical Center, between 1972 and 1976. The diagnosis was made based on history and physical demonstration of perineal muscular spasm. The patients were classified according to the presenting complaint as well as to the degree of muscle spasm experienced at the time of physical examination. In the management of these patients, relaxation, self and mutual pleasuring exercises, Kegel exercises, and physical examination played an important role in successful treatment. Certain male problems were identified during treatment, including situational impotence and premature ejaculation. In our series the women who chose to be treated without an involved partner had comparable success rates to those choosing conjoint therapy. With the use of the combination of available techniques with special emphasis on the pelvic assessment as an educational experience for the patient, good success can be obtained in treating vaginismus with the conjoint approach or office management of the woman alone.

Adolescent↗
PubMed1975

Dyspareunia: a symptom of female sexual dysfunction.

Dyspareunia is one of the most common sexual symptoms that carries wide-ranging potential foor emotional and physical pain. Informed therapeutic intervention can be useful in helping a person with sexual problems. Organic causes underlying dyspareunia are usually temporary and easily correctable. They are rare as a cause of a continuing problem, compared to issues of intrapersonal and interpersonal conflict. One of the keys to achieving a satisfying relationship on an adult-to-adult basis requires that each partner assume responsibility for his/her own sexual pleasure. The woman who withdraws into the assumption that she has an organic problem in the absence of abnormal findings, or that her partner or therapist must find a solution, abdicates responsibility for her own sexual pleasure. Although few of us will be therapists in the sense that the role is generally understood, indentifying and responding to sexual concerns of patients is part of the professional's commitment. Ultimately, our goal is the same for any problem of human development-- to facilitate the realization of the potentialities of the person.

Adult↗