Women's Health Medicine最新文献

The epidemiology of STIs in the UK has undergone marked changes over the last century. After two major peaks in syphilis and gonorrhoea coinciding with the two World Wars, the incidence of these STIs decreased dramatically after World War II, with the advent of penicillin. The 1960s and 1970s saw a resurgence of gonorrhoea and syphilis, and the male:female ratio of reported syphilis cases increased, suggesting that transmission among men who have sex with men (MSM) was increasing. STI incidence again declined in the 1980s with the advent of the HIV/AIDS epidemic, suggesting that widespread changes in sexual risk behaviour patterns were occurring. These decreases were not sustained, however, and during the mid-to-late 1990s both viral and bacterial acute STIs increased substantially. This trend has been most marked in young people and MSM. Numbers of reported gonococcal infections more than doubled to between 1995 and 2003, to 24,157 cases in England, Wales and Northern Ireland; syphilis increased more than tenfold to 1580 cases as a consequence of localised outbreaks, particularly in MSM. Data from 2003 compared with 2002 indicate stabilization or slowing of some STIs, including gonorrhoea and genital herpes, numbers of which decreased by 4% and 3% respectively. Rates of genital warts, chlamydial infection and syphilis continued to increase. Delivery of appropriate, effective STI preventive interventions targeted to those at highest risk, including young people and MSM, continues to be a public health priority.

This article assesses how the thalidomide disaster has caused GPs to have a difficult approach to prescribing in pregnancy. It notes how medical opinion might look towards changing attitudes to prescribing for hypertension, diabetes, depression, thyroid disorders and epilepsy.

For many women, a rewarding sex life is an important part of life. The loss of the enjoyment and satisfaction a good sex life brings has many knock-on effects, including poor self-esteem and relationship difficulties. These, in turn, affect women’s home and work life. Although, for many women, a lack of libido is often a temporary problem, for others it can be long term, unless medical or psychosexual advice and help are provided. This article investigates the presentation, diagnosis and support for women experiencing a loss of libido.

Bones provide mechanical support for joints, tendons and ligaments, protect vital organs, and act as a reservoir for calcium and phosphate in the preservation of normal mineral homeostasis. Bone is a complex and dynamic tissue that undergoes renewal and repair throughout life as the result of bone remodelling. Most diseases of bone result from abnormalities in bone remodelling that compromise the architecture, structure and mechanical strength of bone, leading to clinical symptoms such as pain, deformity, fracture and abnormalities of calcium and phosphate homeostasis. This contribution offers an overview of: the growth of bone, peak bone mass, the composition of bone, bone remodelling, the regulation of bone remodelling and resulting bone disease.

Osteomalacia is characterized by defective mineralization of bone, leading to an accumulation of unmineralized bone matrix (osteoid). Rickets represents the occurrence of this defect in growing children before the closure of epiphysis. In osteomalacia, there is a reduction in the mineralized bone:matrix ratio, unlike osteoporosis, where this ratio remains normal. There is sufficient bone volume, but the bone has reduced calcification. This contribution discusses the: aetiology, clinical features, investigations and management of osteomalacia.

Regular exercise and physical activity have many health benefits for both females and males. In particular, weight-bearing exercise has a protective effect on the skeleton, and can even be osteogenic (stimulating to bone formation). However, achievement of optimal bone mineral density and regulation of bone maintenance depend upon a combination of mechanical, hormonal and dietary factors. Adequate hormonal status (oestrogen and progesterone), and sufficient nutrition (calcium, protein, and other bone-building materials) are essential. For young women with components of the Female Athlete Triad (such as disordered eating, amenorrhea and other forms of menstrual dysfunction), one or more of these may be lacking, and decreased bone density can result. With an effort to maximize peak bone mineral density in the young athlete and to preserve or restore gonadal function during the reproductive years, the complications of altered bone mineral density and frank osteoporosis can be avoided.

Thirty per cent of people aged over 65 fall each year in the UK. This number increases to more than 60% in those in care homes, illustrating the contextual nature of falls. The social consequences (apart from any injury) are considerable, with fear of falling among the most common. Fear of falls reduces the patient's quality of life and increases dependency. This has a significant knock-on effect for social and community care. For GPs, the frequency of falls presenting depends on the nature of the practice and the environment. But if you ask patients, you will find falls. As a consequence, they form part of the single assessment process (SAP) introduced in the national service framework for older people, which is used to determine a patient's health and social care needs. To manage falls more effectively, this contribution assesses how Southwark and Lambeth Integrated care pathway for older people with falls (SLIPS Project) has been developed as a fully integrated pathway linking acute care with primary, community and social care.

Providing practical advice on the prevention of osteoporosis in childhood, adolescence and adulthood, this contribution offers a number of useful suggestions in calcium intake, vitamin D supply, exercise, prevention and protection against falls, early diagnosis and effective medication. The prevention of osteoporosis begins with optimal bone mass acquisition during growth. Bones are living tissue, and the skeleton grows continually from birth to the end of the teen years, reaching a maximum strength and size (peak bone mass) in early adulthood. An efficient way of preventing osteoporotic fractures is to build up the strongest bones possible during childhood and adolescence. In adulthood, there are also necessary steps to take in the prevention of osteoporosis building strong bones in youths is also applicable to adults to prevent excessive bone loss.

One may suspect osteoporosis for many reasons. One may identify a woman who has had a fracture that has resulted from minimal trauma; she may have had a radiograph that raises the issue of vertebral fracture or osteopenia; she may have a strong family history of osteoporosis; she may have a disease (such as premature ovarian failure) or be taking drugs (such as glucocorticoids) that are strongly associated with osteoporosis. In all of these situations, it is important to consider the possibility of osteoporosis and to refer for bone densitometry. A common form of presentation of more severe osteoporosis is a woman presenting with vertebral fracture - the paper begins by considering this clinical presentation. It then assesses the types of deformity, followed by the deformities that mimic fractures. Finally, the review article considers the use of vertebral morphometry in the clinic.

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