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

Though commonly seen as a disease afflicting only women, osteoporosis affects more than 5 million men in the United States with significant morbidity and mortality. Alcohol abuse, glucocorticoid excess, and hypogonadism are the principle risk factors for osteoporosis in men. Radiographs alone are insufficient in detecting the presence of the disease. Examining bone mineral density is the diagnostic standard used to detect the disease in both men and women. Unfortunately, diagnostic parameters and screening recommendations for bone mineral density testing have not been firmly established in men. The treatment and prevention of osteoporosis has been well studied in women, thus many of the treatments for men with the disease were extrapolated from studies predominantly involving women. Prevention of osteoporosis in men is best directed toward risk-factor modification and supplementation with calcium and vitamin D. The mainstay of treatment is bisphosphonates such as alendronate that have demonstrated both efficacy and safety in studies. Vitamin D and calcium supplementation also has some benefit in treating men with osteoporosis. Parathyroid hormone, thiazide diuretics, and calcitonin may also have a role in the prevention and treatment of osteoporosis in men, although this is not yet firmly established.

Hirsuties is an androgen-dependent differentiation and growth of hair in females in the same pattern and sequence as that which develops in the normal postpubertal male, but of less quantity and varying in severity. The clinical diagnosis implies underlying pathology and necessitates systematic consideration. The assessment must be adequate to distinguish between causes that are "dangerous" and those that are relatively trivial to life and health, and to determine whether the condition has consequences for well-being over the short term or may incur some significant health risks over the long term. The physiologic mechanisms for androgenic activity may be considered in three stages: (1) the production of androgens by the ovaries and adrenal glands; (2) their transport in the blood on carrier proteins, principally SHBG (sex hormone-binding globulin); and (3) their intracellular modification and binding to the androgen receptor. Causes may include polycystic ovary syndrome, congenital adrenal hyperplasia, androgen-secreting tumors, Cushing's syndrome, hyperprolactinemia, and menopause. There is a genuine need for accurate anthropologic and racial data in relation to female hair patterns.

Despite an ever-growing body of medical literature on epilepsy and its treatment, there are many clinical situations in which the best approach is unclear. In these situations, physicians may turn to expert opinion for guidance. Several methods exist for summarizing expert opinion. The least biased method is also the newest: the expert consensus method. When this method is used to analyze opinion regarding the treatment of women with epilepsy, it is clear that the selection of therapy is influenced by the sex of the patient.

Obesity is a major health problem in U.S. adults. Most successful weight loss programs have multiple components, including lifestyle modifications, reduced caloric intake, and exercise. Short-term use of medications for weight loss may be a part of such a plan. Currently, most medications are adrenergic stimulants and can produce adverse CNS and cardiovascular effects. Antiabsorptive agents appear to be safer but have significant GI side effects. An important finding is the potential for adverse life-threatening effects with over-the-counter products and dietary supplements that do not undergo evaluation similar to prescription drugs. The search continues for safe and effective pharmacologic agents to assist in weight loss.

An examination of coronary heart disease in women over the past two decades in the United States reveals a disturbing gender difference that points to more treatment success in men than in women, which raises the question as to whether women have been as aggressively evaluated and treated. It is only over the last several years that evidence from randomized clinical trials on coronary heart disease etiology and treatment in women has become available. In addition, the previous widely held viewpoint that estrogen is cardioprotective and should be an integral part of pharmacologic therapy has been abandoned. Triglycerides and their very important influence on lipoproteins have emerged as a critical part of the pathobiological forces related to atherothrombosis in women.

Urinary incontinence in the elderly will continue to grow as a health and lifestyle issue as this population expands. Additionally, as older Americans seek to remain active in their careers and recreational pursuits, they are likely to be more intensive in seeking consultation for this condition. Evaluation of incontinence has become simpler and more focused to allow for an earlier and more precise diagnosis, which in turn expedites therapy. In the past, surgery was often thought of as the sole modality, which likely prevented larger numbers of patients from seeking relief. Today, more conservative treatments tend to bring more patient referrals to physicians' offices. Incontinence affects 15-30% of older patients living at home, one-third of those in acute care hospitals, and half of those in nursing homes. It is responsible in part for up to half of all nursing home admissions. Because of the diagnostic and therapeutic variability between men and women, a gender-specific discussion is called for. Catheter care is sufficiently challenging so as to merit a specific tutorial.