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Journal of women's health & gender-based medicine最新文献

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Times change: the public and government. 时代变了:公众和政府。
Pub Date : 2002-01-01 DOI: 10.1089/152460902753473372
F. Haseltine
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引用次数: 4
A survey of gynecologists concerning menorrhagia: perceptions of bleeding disorders as a possible cause. 一项关于月经过多的妇科医生的调查:对出血性疾病作为可能原因的看法。
Pub Date : 2002-01-01 DOI: 10.1089/152460902753473444
A. Dilley, C. Drews, C. Lally, H. Austin, Elizabeth R. Barnhart, B. Evatt
We sought to determine perceptions and practices of American gynecologists when treating with a woman complaining of menorrhagia, specifically with regard to an underlying bleeding disorder as a potential cause. A mail survey of Georgia members of the American College of Obstetricians and Gynecologists was conducted. The survey response was 52%, and the analysis includes 376 physicians who reported seeing at least one gynecological patient per week. On average, respondents were in practice 20 years and reported that 8% of their patient population complain of menorrhagia. Virtually all physicians reported employing a menstrual history as a starting point for the workup for menorrhagia, and 95% order a hemoglobin/hematocrit determination. About 50% of physicians considered saturating three tampons/pads per 4 hours as excessive, although the criterion varied widely (range 0-24 per 4 hours, SD = 3). The diagnoses considered most likely among reproductive age women were anovulatory bleeding or benign lesions or that the heavy bleeding was within normal limits. Only 4% of physicians would consider von Willebrand disease (VWD) for this age group (women of reproductive age). Among girls near menarche, physicians overwhelmingly consider anovulatory bleeding or bleeding within normal limits the likely diagnoses, and 16% would consider VWD in this age group. Only rarely (3%) do surveyed physicians refer menorrhagia patients to other specialists. Most respondents believe that most menorrhagia is caused by anovulation or is within normal limits. Bleeding disorders are believed to be a rare cause of menorrhagia.
我们试图确定美国妇科医生在治疗抱怨月经过多的女性时的看法和做法,特别是关于潜在的出血性疾病作为潜在原因。对乔治亚州的美国妇产科医师学会成员进行了一项邮件调查。调查的回复率为52%,该分析包括376名医生,他们报告每周至少看一名妇科病人。平均而言,应答者在实践20年,并报告说,他们的患者人口的8%抱怨月经过多。几乎所有的医生都报告将月经史作为月经过多检查的起点,95%的医生要求进行血红蛋白/红细胞压积测定。大约50%的医生认为每4小时饱和3条卫生棉条/卫生巾是过量的,尽管标准差异很大(范围0-24 / 4小时,SD = 3)。在育龄妇女中,最可能的诊断是无排卵性出血或良性病变,或者大出血在正常范围内。只有4%的医生认为这个年龄组(育龄妇女)患有血管性血友病。在接近初潮的女孩中,医生绝大多数认为无排卵性出血或正常范围内出血是可能的诊断,16%的人会考虑该年龄组的VWD。只有很少(3%)的受访医生将月经过多患者转介给其他专科医生。大多数受访者认为大多数月经过多是由无排卵引起的或在正常范围内。出血性疾病被认为是月经过多的罕见原因。
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引用次数: 70
Phytoestrogen and multiple vitamin/mineral effects on bone mineral density in early postmenopausal women: a pilot study. 植物雌激素和多种维生素/矿物质对早期绝经后妇女骨密度的影响:一项初步研究。
Pub Date : 2002-01-01 DOI: 10.1089/152460902753473462
A. Cook, Gena Pennington
The purpose of the study was to assess the effect of a combination regimen of herbs, vitamins, and minerals on bone mineral density (BMD) in early postmenopausal women via a 2-year, single-blind, uncontrolled, prospective trial. BMD was measured by dual energy x-ray absorptiometry (DEXA) at baseline and at 6, 12, and 24 months. Results of lumbar spine, hip, and forearm densities did not differ significantly from historical controls derived from other recent trials using a similar patient population. Bone mineral losses are reported on an annualized basis over the 2 years for the 12 women who completed the trial: spine (-1.42% per year), hip (-0.43% per year), forearm (-1.42% per year). Six women were withdrawn from the trial by the investigators because of excessive losses of bone mineral, and 1 of these women was diagnosed with hyperparathyroidism. There were no metabolic diseases to explain the losses in the remaining 5 withdrawn subjects. Four of 21 subjects experienced adverse side effects, necessitating dropping out by 3 of these women. In conclusion, the combined treatment regimen of a menopause symptom-oriented herbal blend plus a high potency vitamin/mineral was unsuccessful in protecting women against the predictable acceleration of bone mineral losses associated with early postmenopause.
该研究的目的是通过一项为期2年、单盲、无控制、前瞻性试验,评估草药、维生素和矿物质联合治疗方案对早期绝经后妇女骨密度(BMD)的影响。在基线、6、12和24个月时,采用双能x线骨密度仪(DEXA)测量骨密度。腰椎、髋关节和前臂密度的结果与近期其他使用相似患者群体的试验得出的历史对照没有显著差异。在完成试验的12名妇女中,骨矿物质损失在2年的年化基础上报告:脊柱(每年-1.42%),髋关节(每年-0.43%),前臂(每年-1.42%)。6名妇女因骨矿物质过度流失而被研究人员退出试验,其中1名妇女被诊断为甲状旁腺功能亢进。没有代谢性疾病可以解释其余5名受试者的损失。21名受试者中有4名出现了不良副作用,其中3名女性不得不退出。总之,以更年期症状为导向的草药混合物加上高效维生素/矿物质的联合治疗方案在保护妇女免受与绝经后早期相关的可预测的骨矿物质流失加速方面是不成功的。
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引用次数: 15
Are mammography and palpation sufficient for breast cancer screening? A dissenting opinion. 乳房x光检查和触诊是否足以进行乳腺癌筛查?反对意见。
Pub Date : 2002-01-01 DOI: 10.1089/152460902753473417
L. Keith, J. Oleszczuk, M. Laguens
Breast cancer is an equal opportunity killer in that as many as 60%-70% of breast cancer patients have no obvious risk factor(s). Thus, the continued reliance on the importance of risk factors to initiate screening programs may inhibit further inquiry into better diagnostic and prognostic indicators. An extensive review of past and recent literature reveals that mammography is not an objective examination. Its use as a screening tool is facilitated among women 40 years old and older whose breast tissue is primarily fatty and provides better visualization. Younger women are not generally advised to use mammography because of its potentially hazardous effects associated with repeated use of radiation. More importantly, regardless of patient age, radiologists interpret mammograms, and different degrees of interpretation error exist for different radiologists as well as for the same radiologist performing the analysis after a period of time. Thus, the use of mammography as the sole screening tool does not provide patients or physicians with a sense of confidence about sensitivity and specificity. Further, recent enthusiasm to promote mammography screening may give women unrealistic expectations, leading them to falsely believe that a negative examination is assurance that cancer is not present in its earliest detectable stage. We propose to supplement the physical examination and mammography with a third screening modality based on thermal detection monitors. This is a noninvasive and nonradiogenic tool and might enable clinicians to provide patients with every opportunity for early diagnosis.
乳腺癌是一个机会均等的杀手,多达60%-70%的乳腺癌患者没有明显的危险因素。因此,继续依赖风险因素的重要性来启动筛查计划可能会阻碍对更好的诊断和预后指标的进一步研究。一个广泛的回顾过去和最近的文献表明,乳房x光检查不是一个客观的检查。它作为一种筛查工具,在40岁及以上的女性中使用,这些女性的乳房组织主要是脂肪,可以提供更好的可视化。年轻女性通常不建议使用乳房x光检查,因为它与重复使用辐射有关的潜在危险影响。更重要的是,无论患者的年龄如何,放射科医生对乳房x光片的解读,不同的放射科医生以及同一放射科医生在一段时间后进行分析,都存在不同程度的解读误差。因此,使用乳房x光检查作为唯一的筛查工具并不能给患者或医生提供对敏感性和特异性的信心。此外,最近提倡乳房x光检查的热情可能会给女性带来不切实际的期望,导致她们错误地认为阴性检查可以确保癌症没有出现在最早可检测到的阶段。我们建议用基于热检测监视器的第三种筛查方式来补充体格检查和乳房x光检查。这是一种非侵入性和非放射性基因的工具,可能使临床医生为患者提供早期诊断的每一个机会。
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引用次数: 15
News from the Society for Women's Health Research: subgroup analysis in clinical trials: detecting sex differences. 来自妇女健康研究协会的消息:临床试验中的亚组分析:检测性别差异。
Pub Date : 2002-01-01 DOI: 10.1089/152460902753473390
P. Greenberger, S. Knab
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引用次数: 1
Possible beneficial effect of exercise, by reducing oxidative stress, on the incidence of preeclampsia. 通过减少氧化应激,运动可能对子痫前期的发病率有有益的影响。
Pub Date : 2001-12-01 DOI: 10.1089/152460901317193558
SeonAe Yeo, S. Davidge
We hypothesize that regular exercise enhances antioxidative enzymes in pregnant women, which reduce oxidative stress and, thus, the incidence of preeclampsia. Oxidative stress with enhanced lipid peroxide formation could lead to endothelial dysfunction in preeclampsia. Other conditions, such as increased transferrin saturation and decreased iron-binding capacity, directly and indirectly promote the process of oxidative stress and subsequent endothelial dysfunction. Exercise increases oxidative metabolism and produces a prooxidant environment. This acidic environment during exercise (at or beyond anaerobic threshold) promotes oxygen release from hemoglobin and increases in PO(2) in tissues, as well as releases iron from transferrin. When exercise is repeated regularly, the body promptly adjusts so that oxidative stress is eliminated or reduced. The body's adaptations to a regular exercise habit seem to have an antioxidant effect. In humans, training effects have been identified with an enhanced activity of antioxidative enzymes. Another concerted adaptation that regular exercise brings to women's bodies is resistance against production of prooxidants by increasing the number of mitochondria. Equally important is a training effect that decreases susceptibility to lipid peroxidation. Evidence suggests that physically active women are less likely to develop preeclampsia. In theory, intracellular and extracellular conditions resulting from regular exercise should counteract the enhancement of oxidative stress, thus interfering with the process leading to endothelial dysfunction. This position paper describes a hypothesis and includes a brief review of exercise physiology and biochemical research in preeclampsia. Unlike other preventive treatments, such as aspirin or calcium supplements, a regular exercise habit leads to a positive and healthy lifestyle without concern of side effects.
我们假设有规律的运动可以增强孕妇体内的抗氧化酶,从而减少氧化应激,从而降低子痫前期的发病率。氧化应激与过氧化脂质形成增强可导致子痫前期内皮功能障碍。其他情况,如转铁蛋白饱和度升高和铁结合能力下降,直接或间接地促进氧化应激过程和随后的内皮功能障碍。运动可以增加氧化代谢,并产生促进氧化的环境。运动时的酸性环境(达到或超过无氧阈值)促进血红蛋白释放氧气,增加组织中PO(2),以及从转铁蛋白释放铁。当有规律地重复运动时,身体会迅速调整,从而消除或减少氧化应激。身体对有规律的运动习惯的适应似乎具有抗氧化作用。在人类中,训练的效果已被确定为增强抗氧化酶的活性。定期锻炼给女性身体带来的另一个协同适应是通过增加线粒体的数量来抵抗促氧化剂的产生。同样重要的是降低脂质过氧化易感性的训练效果。有证据表明,经常运动的女性患先兆子痫的可能性较小。从理论上讲,经常运动引起的细胞内和细胞外状况应该抵消氧化应激的增强,从而干扰导致内皮功能障碍的过程。这篇立场文件描述了一种假设,包括对先兆子痫的运动生理学和生化研究的简要回顾。不像其他预防治疗,如阿司匹林或补钙,有规律的运动习惯会带来积极健康的生活方式,而不用担心副作用。
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引用次数: 47
An open trial of mirtazapine in menopausal women with depression unresponsive to estrogen replacement therapy. 米氮平对雌激素替代疗法无反应的绝经期抑郁症妇女的公开试验。
Pub Date : 2001-12-01 DOI: 10.1089/152460901317193576
H. Joffe, Heather Groninger, C. Soares, R. Nonacs, L. Cohen
Treatment of major depression in menopausal women is controversial. Estrogen replacement therapy (ERT) treats mild depression but may not treat more severe depression in this population. Antidepressants are recommended as treatment for major depression in menopausal women, but the specific efficacy of antidepressants has not been examined in menopause-associated depression. Twenty-two perimenopausal and postmenopausal women aged 40-61 taking stable doses of ERT who met Structured Clinical Interview for DSM-IV (SCID-IV) criteria for major depression were accessioned into an open-label clinical trial of mirtazapine. Subjects were treated with 30-45 mg/day mirtazapine for 8 weeks and were assessed every 2 weeks with the Hamilton Depression Rating Scale-17 (HDRS-17), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI) Scale. Remission of depression was defined as an HDRS-17 score < or =7 at the week 8 study visit. Sixteen (73%) of the enrolled subjects completed the 8-week study. The median HDRS-17 score declined from 20.5 (range 12-37) at baseline to 2 (range 0-9) at week 8 (Wilcoxon signed-rank test, p < 0.001). Remission of depression was achieved by 14 of 16 (87.5%) study completers. Subjects responded well to mirtazapine regardless of whether their depression preceded ERT use or developed after ERT was initiated. Therapeutic response also appeared independent of menopausal status (perimenopausal vs. postmenopausal), ERT preparation, and concomitant use of medroxyprogesterone. Mirtazapine is an effective treatment for major depression in perimenopausal and postmenopausal women whose depression precedes ERT use and does not respond to ERT or whose depression develops after ERT is initiated.
更年期妇女重度抑郁症的治疗是有争议的。雌激素替代疗法(ERT)治疗轻度抑郁症,但可能不能治疗更严重的抑郁症。抗抑郁药被推荐用于治疗更年期妇女的重度抑郁症,但抗抑郁药在更年期相关抑郁症中的具体疗效尚未得到检验。22名年龄在40-61岁的围绝经期和绝经后妇女服用稳定剂量的ERT,符合DSM-IV (SCID-IV)重度抑郁症的结构化临床访谈标准,加入米氮平的开放标签临床试验。受试者服用30- 45mg /天的米氮平治疗8周,每2周用汉密尔顿抑郁评定量表-17 (HDRS-17)、贝克抑郁量表(BDI)和临床总体印象量表(CGI)进行评估。在第8周的研究访问中,HDRS-17评分<或=7,抑郁缓解被定义为。16名(73%)入组受试者完成了为期8周的研究。HDRS-17评分中位数从基线时的20.5(范围12-37)下降到第8周时的2(范围0-9)(Wilcoxon sign -rank检验,p < 0.001)。16名研究完成者中有14名(87.5%)达到抑郁缓解。受试者对米氮平反应良好,无论他们的抑郁是在ERT使用之前还是在ERT开始后发展。治疗效果也与绝经状态(围绝经期和绝经后)、ERT制剂和同时使用甲羟孕酮无关。米氮平是围绝经期和绝经后妇女重度抑郁症的有效治疗方法,这些妇女在使用ERT之前出现抑郁症,对ERT没有反应,或者在ERT开始后出现抑郁症。
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引用次数: 57
Identifying and caring for underserved populations: experience of the National Centers of Excellence in Women's Health. 确定和照顾服务不足的人口:国家妇女健康卓越中心的经验。
Pub Date : 2001-12-01 DOI: 10.1089/152460901317193521
T. Weitz, K. Freund, L. Wright
From 1996 through 1998, 18 National Centers of Excellence in Women's Health (CoEs) were designated by the Office on Women's Health (OWH) of the U.S. Department of Health and Human Services (DHHS). These CoEs were charged with developing standards for comprehensive, multidisciplinary, and culturally competent approaches to women's health. One specific mandate to the CoEs was to address the needs of underserved women. This paper presents the efforts of the CoE Racial and Ethnic Minority and Underserved Women Working Group to describe the work done within the CoEs to meet this mandate. One method of defining underserved populations is the seven-point definition used in the current "Index for Primary Care Shortage," which categorizes underserved populations based on characteristics including race, ethnicity, geography, and health outcomes. The definition allows the local identification of underserved communities based on this group of variables. The analysis included in this paper focuses specifically on the CoEs' efforts to operationalize this definition in order to meet the clinical care needs of women who are of low socioeconomic status (SES), racial or ethnic minorities, or non-English speaking. A brief review of the literature linking these characteristics to being underserved is provided, followed by examples of ongoing activities at the 15 currently funded CoEs, to understand the needs of diverse women, to improve the quality of care provided to women, and to address healthcare needs of underserved women who meet this definition. Efforts to serve three additional underserved populations defined by age, sexual orientation, and disability status are also presented.
从1996年到1998年,美国卫生与公众服务部妇女健康办公室(OWH)指定了18个国家妇女健康卓越中心(coe)。这些妇女保健委员会负责制定全面、多学科和具有文化竞争力的妇女保健办法的标准。行政中心的一项具体任务是解决得不到充分服务的妇女的需要。本文介绍了CoE种族和少数民族和服务不足妇女工作组的努力,以描述CoE为完成这一任务所做的工作。定义服务不足人口的一种方法是目前“初级保健短缺指数”中使用的七点定义,它根据种族、民族、地理和健康结果等特征对服务不足人口进行分类。该定义允许基于这组变量对服务不足的社区进行本地识别。本文中包含的分析特别侧重于CoEs为实现这一定义所做的努力,以满足社会经济地位低(SES)、种族或少数民族或非英语妇女的临床护理需求。本文简要回顾了将这些特征与得不到充分服务联系起来的文献,然后列举了15个目前获得资助的妇女保健中心正在开展的活动,以了解不同妇女的需求,提高向妇女提供的保健质量,并满足满足这一定义的得不到充分服务的妇女的保健需求。此外,还介绍了为另外三种按年龄、性取向和残疾状况定义的服务不足人群提供服务的努力。
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引用次数: 22
Observations from the CDC. Community Prevention Study: contributions to women's health and prevention research. 来自疾病预防控制中心的观察。社区预防研究:对妇女健康和预防研究的贡献。
Pub Date : 2001-12-01 DOI: 10.1089/152460901317193495
B. Ainsworth, L. Anderson, D. Becker, S. Blalock, D. Brown, R. Brownson, N. Brownstein, C. Cornell, B. Devellis, L. Finnegan, S. Folger, J. Fulton, J. Groff, C. Herman, D. Jones, T. Keyserling, D. M. Matson Koffman, C. Lewis, L. Mâsse, R. Mckeown, D. Orenstein, A. J. Spadaro
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引用次数: 7
Training programs for healthcare professionals in domestic violence. 为医疗保健专业人员提供家庭暴力方面的培训方案。
Pub Date : 2001-12-01 DOI: 10.1089/152460901317193530
L. Davidson, J. Grisso, C. Garcia-Moreno, J. Garcia, V. King, S. Marchant
Although women who experience domestic violence seek healthcare services frequently, screening and counseling rates remain low, and healthcare professionals report feeling inadequately trained to care for abused women. The English language literature from 1989 to 1999 was searched to identify and evaluate published assessments of the education of healthcare providers in domestic violence toward women. Major deficiencies in program evaluation were found. They included the use of a historical comparison group, lack of an experimental design, selection of nonstandardized outcomes without clinical performance measures, short-term follow-up, limited documentation of course content and theory, and lack of focus on the impact of programs on abused women. Educational programs generally consisted of a single session of limited duration (1-3 hours). Based on published reports, it appears that few rigorously designed evaluations have been conducted of training programs for healthcare providers in the detection and treatment of women affected by domestic violence.
虽然遭受家庭暴力的妇女经常寻求保健服务,但筛查和咨询的比率仍然很低,保健专业人员报告说,他们感到没有得到足够的培训来照顾受虐待的妇女。检索了1989年至1999年的英语文献,以确定和评价已发表的对保健提供者进行关于对妇女的家庭暴力教育的评估。发现了项目评估的主要缺陷。其中包括使用历史比较组,缺乏实验设计,选择没有临床表现衡量的非标准化结果,短期随访,课程内容和理论文件有限,以及缺乏对受虐妇女项目影响的关注。教育项目一般由一节课组成,时间有限(1-3小时)。根据已发表的报告,似乎很少对保健提供者在发现和治疗受家庭暴力影响的妇女方面的培训方案进行严格设计的评估。
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引用次数: 71
期刊
Journal of women's health & gender-based medicine
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