The journal of gender-specific medicine : JGSM : the official journal of the Partnership for Women's Health at Columbia最新文献

Objective: To determine the prevalence and correlates of osteoporosis among middle-aged and elderly Jewish and Arab women in Israel.

Design: A cross-sectional study on a random sample of Israeli women, carried out through telephone interviews. Questions included physician-diagnosed osteoporosis, demographic and lifestyle variables, medical conditions, and present and past use of estrogen-containing medications. Body mass index (BMI) was calculated from reported height and weight.

Setting: A national population-based survey conducted from March through August 1998.

Participants: A national random sample of 888 women aged 45-74.

Main results: The overall prevalence of self-reported osteoporosis was estimated at 13.7%. The rates increased abruptly from about 5.8% at ages 45-59 to 19.6% at ages 60-64, and reached 27.7% at ages 70-74. Between ages 45-59, the rates were higher among Arab women, whereas in the older group they were higher among Jewish women. There was a marked increase following menopause. After adjustment for potential confounders, at ages 45-59, osteoporosis was positively associated with menopause and BMI, whereas at ages 60-74, it was positively associated with age and family history of osteoporosis, and negatively associated with BMI.

Conclusions: The prevalence of physician-diagnosed osteoporosis in Israel among women aged 45-74 is estimated to be 13.7%, which is similar to that for the United States. The association of osteoporosis with risk factors is age-dependent, and in particular, age-BMI interaction on osteoporosis requires further investigation.

Objective: To identify a possible gender bias in lipid assessment and treatment of patients following percutaneous coronary intervention (PCI).

Methods: Following PCI, patients were identified from a cardiology practice database, with retrospective follow-up achieved through medical record review in a private cardiology practice and in primary care physician practices. Patients were assessed for lipid measurement of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides, and for changes in these measures.

Results: A total of 356 patients were identified for analysis: 221 men (62%) and 135 women (38%). Mean post-PCI follow-up was 2.2 +/- 1.6 years. Among females, 80% had lipids measured, as compared with 87% of males (P = 0.07). At pre- and post-PCI, all fractions were significantly higher (P < 0.05) in women, except pre-PCI triglycerides, which were significantly lower in women. From pre- to post-PCI, HDL-C and triglycerides improved significantly more in males, while LDL-C improved significantly more in females. Target LDL-C levels (< 100 mg/dL) were achieved in 46.4% of the overall group. There were no significant gender-related differences in the number of patients treated with dyslipidemic medications or in patients achieving an LDL-C of < 100 mg/dL (P = 0.081).

Conclusion: Following PCI, a gender bias did not exist for lipid assessment, number of patients treated with pharmacotherapy, or achievement of target LDL-C (< 100 mg/dL). However, in terms of absolute levels achieved, women were treated less aggressively than men for all lipid fractions.

Background: Clinical studies have shown that the incidence of myocardial infarction is lower in women compared to men. However, following a myocardial infarct, women are at increased risk of developing ventricular dysfunction.

Objective: High levels of free fatty acids, observed in the clinical setting of ischemia, impair recovery of mechanical function during reperfusion of ischemic hearts. This study was designed to determine whether hearts from female rats are more sensitive to ischemia than male hearts when supplied with relevant levels of fatty acids.

Methods: Hearts from male and female Sprague-Dawley rats were isolated and perfused in the working mode with 5.5 mM glucose and 50 microU/mL insulin alone or in the presence of 1.2 mM palmitate. Cardiac function, expressed as heart rate-pressure product (RPP), was measured under preischemic conditions and during reperfusion following a period of transient global ischemia.

Results: Following the ischemic insult, RPP of male hearts returned to preischemic levels regardless of the substrates used. RPP of female hearts perfused with glucose alone also recovered to preischemic function. However, in female hearts perfused with the fatty acid, recovery of RPP was significantly lower compared to the female hearts perfused with glucose alone. In these hearts, recovery during reperfusion was only approximately 60% of preischemic function.

Conclusion: Our results indicate that the sensitivity of the female myocardium to postischemic dysfunction is enhanced in the presence of fatty acids, suggesting that a gender effect on recovery of cardiac function following ischemia exists.

Urinary incontinence is a major medical problem that affects people worldwide. More than 17 million people in the United States are affected by the disorder, with billions of dollars in annual costs. The overactive bladder is a major cause of incontinence. The symptoms of frequent urination, pain, and leakage of urine range in severity and debilitation. Overactive bladder produces significant social and physical ramifications that if left untreated result in a dismal quality of life. Newer medications that have been developed allow simple oral treatment. Most patients can now be treated successfully and compassionately.

The paucity of research on gender-specific differences related to antidepressants is a significant public health deficiency and represents an understudied and necessary research area. The current data suggest that the pharmacokinetics of antidepressant drugs can be substantially different between men and women as a result of differences in both the metabolizing enzymes and the expression of P-glycoprotein MDR1. The data suggest that different pharmacodynamic responses are observed between premenopausal women and men. Women are more likely to respond better to an MAOI antidepressant compared to men. In addition, men respond better to TCAs than women in this age group, but differences diminish after menopause. Given the evidence of distinct gender-specific differences, it is critical that these differences be addressed more widely in research evaluating the administration of antidepressants in women.

Background: Menopause is a significant biological event in the life of every woman, including women with mental disorders. This brief report describes the results of a survey of 39 patients with mental illness and their family members regarding perceived effects of menopause on mental illness.

Methods: The survey was distributed to participants attending a National Alliance for the Mentally Ill educational presentation on menopause and mental health.

Results: Most participants (15/39; 38.5%) had depression or had a family member with depression. Groups with other mental disorders were less represented, with 8/39 (20.5%) having schizophrenia, 6/39 (15.4%) having bipolar illness, and 10/39 (25.6%) having other disorders such as anxiety disorders or personality disorders. The mean age of the individuals/family members with mental illness was 51.2 years. Most participants (21/39; 53.8%) felt that menopause might be affecting their emotional symptoms or those of their family members, while 11/39 (28.2%) felt that their illness or their family member's illness was worse because of menopause or approaching menopause. There was a trend for perception of menopause affecting mental illness to be stronger among individuals with bipolar illness and depression, as compared to individuals with schizophrenia and other disorders (P = .052).

Conclusions: Menopause is a significant life event among women with mental illness. Nearly 30% of individuals affected by mental illness perceive menopause to worsen symptoms of mental illness.

Objectives: To determine whether impaired reactivity to dilatory agonists could contribute to pulmonary hypertension, and whether there are gender differences in pulmonary vasodilator reactivity.

Methods: Pulmonary arterial rings from monocrotaline (MCT)-induced pulmonary hypertensive and control rats were isolated. At the peaks of submaximal contractions to norepinephrine (NE) or endothelin (ET-1), rings were exposed to 5 x 10(-6) M acetylcholine (ACh) or 9 x 10(-9) M adrenomedullin (ADM) or 1.3 x 10(-8) M calcitonin gene-related peptide (CGRP).

Results: Relaxation to ACh, ADM, and CGRP was endothelium-dependent. Hypertensive pulmonary arterial rings relaxed less to ACh and CGRP than controls in both genders. Female pulmonary hypertensive muscle was more rather than less reactive to ADM compared with controls. ADM-induced relaxation of NE contractions was 2.4 times greater in female compared with male control rings and 5.5 times greater in female compared with male hypertensive preparations. Gender differences in relaxation responses were similar for CGRP. MCT-treated female arterial rings relaxed more than did MCT-treated male arterial muscle in response to ACh. No difference in ACh relaxation was found between genders for controls.

Conclusions: Pulmonary arterial relaxation to endothelium-dependent vasodilators is impaired in MCT-induced pulmonary hypertension with the exception of ADM in females. Vasodilators may be more effective in reducing pulmonary hypertension in females than in males.