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

Objective: We conducted a cross-sectional study to determine the prevalence of asymptomatic Clostridium difficile in a nursing home population.

Methods: Inclusion criteria for the study required that the subjects be residents of the facility for more than 1 month. Exclusion criteria included: (1) patients who developed C. difficile infection within 2 months prior to stool collection; (2) metronidazole or vancomycin therapy within 2 months prior to stool collection; (3) past surgical history of colectomy; and (4) possible signs and symptoms of active C. difficile infection.

Results: The prevalence of asymptomatic C. difficile infection in this population was 5%. There was no significantly higher prevalence of asymptomatic C. difficile based on age, race, length of stay, gender, diabetes, renal failure, history of cancer, recent antibiotic use, gastric tube, histamine2 blocker/proton pump inhibitor use, Foley catheter, or dementia.

Conclusions: The prevalence of asymptomatic C. difficile in this population is similar to previously studied populations. Further research should follow a cohort of asymptomatic individuals with C. difficile to determine if colonization may be protective against symptomatic infection.

Objective: To present gender comparisons of residents with multiple sclerosis (MS) at admission to nursing facilities, including demographic characteristics, health measures, and treatments.

Methods: We analyzed 13,998 admission assessments in the Minimum Data Set for residents with MS recorded between June 23, 1998 and December 31, 2000.

Results: Although both male and female residents with MS tended to have severe disability, there were significant gender differences in measures of activities of daily living (ADL) dependency and disability, with males slightly more likely to exhibit total ADL dependence and greater loss of voluntary movement. Females with MS tended to have significantly better cognitive performance and better communication abilities than males with MS. There were significant gender differences in pain symptoms among residents, with one-third of females and one-fifth of males experiencing daily pain. Depression was the most common comorbidity among residents with MS, with females significantly more likely to have this diagnosis. Although females with MS were slightly more likely to have depression or anxiety disorder, males with MS were slightly more likely to receive mental health services.

Conclusions: These analyses demonstrate that many nursing facilities need to improve pain management and mental health care provided to residents with MS, especially to females.

Objective: The Bcl-2 family mediates erythropoietin-dependent survival of erythroid progenitor cells and regulates erythropoiesis. We assessed for any association between Bcl-2 family nucleotide variation and hematocrit (HCT) in healthy blood donors.

Methods: We screened Bcl-w, Bcl-x, and Bax (members of Bcl-2 family) using polymerase chain reaction and singlestrand conformation polymorphism analysis. One polymorphism each was found in Bax and Bcl-w. Using these markers, we genotyped the 100 males and 100 females with the highest or lowest HCT in a population of 819 healthy people in Iowa. A comparison of the allelic frequencies and distribution of each polymorphism was made in males versus females, individuals with low versus high HCT, and other subgroups.

Results: One sequence-based polymorphism was found in Bax and Bcl-w having three and two alleles, respectively. No polymorphism was found for Bcl-x. The Bax polymorphism is caused by variation in nucleotide A repeat number (19, 25, 27) at position 360 in 5'-region of Bax. The Bcl-w polymorphism is a G to A transition at 123. The allelic frequencies of Bax polymorphism were significantly different between males and females (P = 0.004). There were no significant associations for Bcl-w polymorphism by gender or HCT level (P > 0.05).

Conclusions: Polymorphism in the 5'-region of Bax was associated with gender-based HCT differences. This is theoretically due to gender-based hormonal effects on gene transcription mediated by the different polymorphisms.

The prevalence of depression, erectile dysfunction (ED), and coronary heart disease (CHD) increases with age, and the symptoms related to these three illnesses are closely interlinked. The term "DEC syndrome" is introduced to refer to this triad of comorbid conditions. When a patient presents with one component of the DEC syndrome, physicians should also screen for the other two components. Studies have shown that depression may predispose an individual to an increased risk of developing CHD, and older men with CHD are more likely to be depressed. Likewise, patients with ED are more likely to be clinically depressed, and patients with clinical depression often have ED. Furthermore, patients presenting with ED are often hypertensive, and thus have a significantly higher prevalence of cardiovascular complications. Multifactorial problems require multifactorial approaches, and the care of older men can improve if physicians are aware of this interlinked syndrome.

Since 1960, there has been a remarkable increase in the number of women graduating from United States medical schools. Concurrent with this increase, a large body of research has emerged on whether patient gender has an impact on disease diagnosis and therapy. From that research, a related question has emerged: Do patients receive different treatment based on the gender of their physician? In this article, we review the current literature regarding the effects of the gender of the primary care physician on patient care. Our purpose is to understand the potential implications of the changing demographics in the primary care specialties, and to propose a framework for further investigation.

Background: Estrogen receptors have been located in the human spinal cord and the dorsal root ganglia. The location of these receptors may allow them to participate in motoneuron regulation. Estrogen has the capability to exhibit a strong influence on cells of the nervous system.

Objective: To determine whether differences exist in spinal reflex profiles between early postmenopausal women taking hormone replacement therapy and those who are not.

Methods: Spinal reflex profiles (maximum H-reflex/maximum M-wave) provide insight into the connectiveness of the sensory and motor components of the reflex loop. The maximum H-reflex/maximum M-wave ratios were assessed in 40 early postmenopausal women divided into two groups--hormone replacement therapy and no hormone replacement therapy.

Results: Our results indicate that no group differences in spinal reflex profiles existed between women in this study who were taking hormone replacement therapy and those who were not taking hormone replacement therapy.

Conclusion: These results lead to the conclusion that a woman's choice regarding hormone replacement therapy did not affect the connections of the components of the spinal reflex loop in the women in this study.

Background: The adipocyte-derived hormone leptin regulates food intake by stimulation of the long leptin receptor isoform in the hypothalamus. The long leptin receptor is also expressed in the piriform cortex, an area involved in the relay of olfactory cues. In rodents, both olfaction and leptin influence food seeking.

Objective: To examine whether serum leptin levels are associated with olfaction in humans.

Subjects: Two distinct samples were analyzed. The population-based sample, 60 men and 61 women, was randomly selected from a population living in Mölndal, Sweden. The obese sample, 31 men and 27 women, was from the ongoing Swedish Obese Subjects (SOS) study.

Methods: Olfactory function was assessed with a two-part test used at Connecticut Chemosensory Clinical Research Center.

Results: In the population-based sample, multiple regression analysis revealed a gender difference (interaction gender x leptin; P = .016) between the association of odor identification and logarithmically transformed (log) leptin when adjusting for smoking and log body mass index (BMI). In men the association was positive (beta = 13.2; P = .0026), whereas in women it was negative (beta = -11.4; P = .050). When further adjusting for the influence of menopause and estrogen treatment, the negative association between odor identification and leptin became stronger for women in the population-based sample (beta = -13.7; P = .027). In the obese sample, the associations were similar in direction to those observed in the population-based sample, although nonsignificant.

Conclusion: Serum leptin levels were associated with odor identification in a randomly selected population. The association was gender-specific and independent of BMI. High odor identification scores were associated with high serum leptin levels in men and low serum leptin levels in women. This provides further support for previously recognized gender differences in the leptin system and suggests alternative ways for leptin to modulate its effects.

Objective: Thirty million men in the United States may have erectile dysfunction, and coronary artery disease (CAD) is the major cause of death in men over 55 years old. Several studies have shown a correlation between erectile dysfunction and risk factors for coronary artery disease. Hyperlipidemia plays a pivotal role in CAD, and obesity is now considered an independent risk factor for CAD. Therefore, we attempted to determine the prevalence of obesity and hyperlipidemia, along with other established risk factors such as diabetes, hypertension, and tobacco use, in men with erectile dysfunction.

Methods: Men who had had symptoms of erectile dysfunction for at least six months were recruited from the Center for Sexual Function. Participants underwent detailed clinical interviews, blood analyses, and physical examinations including calculation of body mass index, and they completed a questionnaire on sexual function.

Results: Of the 154 men evaluated, 44% had hypertension; 23% had diabetes mellitus; 16% used tobacco; 79% had a body mass index of > 26 kg/m2; and 74% had a low-density lipoprotein cholesterol level of > 120 mg/dL.

Conclusion: Impotence is an important symptom, and its presence should instigate assessment and aggressive management of coexistent risk factors for CAD. Intervention could restore sexual function and ultimately improve cardiovascular health.