Journal of the American Medical Women's Association (1972)最新文献

Coronary heart disease is the leading cause of death in women older than 50. This article will discuss the role of modifiable risk factors for the primary prevention of heart disease in women, including hypertension, smoking, obesity, and exercise. We will also address what is known about the role of psychological factors in the development of heart disease in women. Cholesterol and diabetes are discussed only in the context of obesity because both are addressed elsewhere in this issue. Finally, this article will review the evidence on the use of low-dose aspirin and antioxidants in the primary prevention of heart disease in women.

Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians' moral values take on special significance, however, when considering services patients may request but that contradict that physician's moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician's freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient's right to full disclosure of options and informed consent is not compromised by the physician's personal moral stance.

Objective: In the wake of the premature end of the Women's Health Initiative (WHI) study, we sought to assess women's knowledge of and attitudes about hormone therapy (HT) study findings and to appraise women's responses and intentions.

Methods: Between July 26 and August 6, 2002 a national random-digit-dialing telephone survey was conducted in a sample of households that included women 40 to 79 years old.

Results: Sixty-four percent of the 819 women interviewed had heard something about HT study results from the media or from talking with others, and 74% were confused about HT use. Another 57% were worried about how the findings might affect them, and 79% were interested in obtaining additional information about HT Only 24% of those who had heard something had actually sought additional information. Logistic regression findings suggested that women currently taking HT were most likely to be aware and informed. They also were more likely to be confused, worried, or to need or to seek additional information. Older women were less likely to be confused or worried or to need or seek additional information. More highly educated women were more likely to be aware and less likely to be confused or uninformed, but were more likely to have sought additional information.

Conclusion: The Women's Health Initiative study provided a clear message about health risks and benefits of HT use. An important next step is to continue to convey accurate information to women, health providers, and the media so that women can make informed decisions about HT.

Objective: To assess the knowledge of the risks and benefits of oral contraceptives (OCs) in a heterogeneous group of women and to identify their sources of information.

Methods: A self-administered questionnaire assessing demographics, contraception history, knowledge of risks and benefits of OCs, and information sources was given to literate English- and Spanish-speaking women waiting for appointments at 4 clinics serving distinct populations in Portland, Oregon.

Results: Approximately half of the 211 women studied were of the opinion that OCs decreased the risk of acne, dysmenorrhea, and menorrhagia and increased the risk of weight gain, headaches, and thrombosis. Less than 15% knew of the decreased risk of anemia, endometrial cancer, colon cancer and pelvic inflammatory disease, but 28% understood the decreased risk of ovarian cancer. Seven percent to 36% of women used their own experiences in assessing the effect of OCs on a variety of general and reproductive factors. Women relied primarily on printed information for knowledge of OCs' effects on cardiovascular health and cancer.

Conclusion: Women in this heterogeneous population of women were unaware of several benefits of OCs. Women relied heavily on their own experiences in assessing the risks and benefits of OCs. Women cited printed information more frequently than medical personnel as major sources of information on cardiovascular and oncological risks and benefits of OCs. The Internet, however, played a minimal, if any role in educating women about OCs.

As the proportion of women physicians in the United States increases, patients have increased access to physicians of either sex, and some patients express a clear preference for female providers. This is especially true in obstetrics/gynecology, where patients may have a variety of reasons for requesting female physicians. This column presents a case in which the patient not only expressed a preference for a female physician, but also, in fact, refused care from any male obstetrician/gynecologist. Possible responses to such a request are examined, with consideration of the competing priorities involved.

Objectives: To identify the characteristics of older women who sought Jack Kevorkian's assistance in dying and to compare them with those of an age-matched sample who committed suicide.

Method: This retrospective case-control study compared all 18 women age 55 and older who died with the assistance of Jack Kevorkian and whose deaths were investigated in Oakland County, Michigan from 1995 to 1997 with all 15 women age 55 and older who committed suicide in the same county during the same time period. We coded 203 variables in 7 domains from medical examiner files, including autopsy findings.

Results: Significantly more of Kevorkian's cases had amyotrophic lateral sclerosis or multiple sclerosis (p = .018), a recent decline in health (p = .031), or inadequately controlled pain (p = .041). Women who committed suicide had more prevalent chronic illnesses and were more likely to have been diagnosed with clinically significant depression or other psychiatric disorders (p = .023). Both groups were significantly less likely to be married (p < .001) and more likely to be divorced (p < .001) than US Census data would predict.

Conclusions: The different vulnerabilities of older women who want to die and either commit suicide or seek assistance deserve continued careful research. Poorly controlled pain was a factor in seeking assistance in dying, and depression and psychiatric disorders characterized older women who committed suicide in our study. Not having a spouse may increase isolation and reinforce the hopelessness of women who are living with catastrophic illness.

Objective: To examine the prevalence of vitamin-mineral supplement use and its association with sociodemographic, health status, and health behavior characteristics in a nationally representative sample of US women.

Methods: We analyzed the cancer supplement file of the 2000 National Health Interview Survey, which included 11,888 non-Hispanic white, 2866 non-Hispanic black, 3035 Hispanic, and 599 non-Hispanic other women. Bivariate and multivariate analyses were conducted to examine the relationships between sociodemographic, health status, and health behavior characteristics and the use of selected vitamin-mineral supplements.

Results: Nearly 60% of US women took at least one supplement in 2000. Logistic regression showed that women who were non-Hispanic white, married, older, more educated, not poor, former smokers, alcohol users, and regular exercisers were significantly more likely to take the most commonly reported vitamin-mineral supplements. Women who were obese or overweight and women who had not had contact with a health professional in the past 12 months were less likely to use supplements.

Conclusion: Our study suggests high levels of vitamin-mineral supplement use among US women. Supplement use was generally associated with a healthier lifestyle and more resources. Our data suggest the need for public health education on the benefits of age- and health-appropriate use of supplements.

Objective: The National Osteoporosis Foundation (NOF) practice guideline provides explicit recommendations for postmenopausal osteoporosis risk assessment and management. This study evaluated primary care adherence to the recommendations and factors associated with such adherence.

Method: Postmenopausal women 40 years old and older were sampled in the primary care clinic of a US tertiary hospital. We received 469 completed questionnaires that measured the respondent's demographics and osteoporosis risk factors; current and historical osteoporosis counseling, testing, and treatment; and whether or not she had a primary care clinician. Based on information provided, we determined whether each woman was receiving care that followed the NOF guideline. Univariate and multivariate analyses identified factors associated with guideline adherence.

Results: Mean age was 69 years; 53% were white and 38% black; 15% had prior fractures. Using NOF criteria, 19.8 % were at moderate risk and 80.2 % were at high risk for osteoporosis. Overall, 57.6% (95% confidence interval 53.1, 62.1) of patients received risk management in accordance with the NOF guideline. The adherence rate was higher in the high-risk group (60.9% v 44.1%, p=.003), in those who had primary care clinicians (62.0% v 43.5%, p=.006), and in nonblack patients (white v black 67.1% v 43.0%, p<.001; other v black 65.0% v 43.0%, p=.012). These associations remained statistically significant after multivariate adjustments. Adherence was not associated with the sex of the primary care clinician.

Conclusions: More than half of postmenopausal women in our study were receiving osteoporosis risk management that followed the NOF practice guideline. Those who were at higher risk, who were not black, or who had primary care clinicians were more likely to receive care in accordance with the NOF guideline, regardless of the sex of the clinician.

How can women physicians address the needs of those they serve until they meet their own needs for balance and fulfillment in their lives and careers? They can't, but there are sources of help. Women physicians can learn from consultants whose professional expertise can help them devise master plans to attain equilibrium, competence, and influence, and they can speak with other women physicians who share similar experiences and have succeeded in attaining stability, proficiency, and authority in their own lives. Career development coach and faculty career and diversity consultant Janet Bickel writes that seasoned professionals offer assistance in planning for productive careers that combine personal and professional goals. To find a coach, ask colleagues about their experiences and for recommendations. When selecting a coach, inquire about their training and credentials; ask for a free consultation and for references. Interview at least three coaches before making a selection. A coach with a similar background may provide the most comfortable working relationship. Ms. Bickel offers suggestions and programs to consider when seeking a career coach. Physicians Julia Files and Janis Blair address the multiple responsibilities of motherhood and medicine. Their experiences and tips from colleagues demonstrate that women in search of harmony benefit from others' knowledge and wise advice. Talking with colleagues lessens the feeling of isolation; all mothers who aspire to be the best at medicine and motherhood worry that achieving a healthy balance may be impossible. Drs. Files and Blair share strategies that worked for them and their colleagues at the Mayo Clinic.