Subject(s)
Health , Women , Breast Neoplasms/prevention & control , Contraceptives, Oral , Coronary Disease/mortality , Domestic Violence/prevention & control , Female , Hormone Replacement Therapy , Humans , Male , Obesity/prevention & control , Osteoporosis, Postmenopausal/drug therapy , Sexual Dysfunction, Physiological/epidemiology , United States/epidemiologyABSTRACT
CONTEXT: Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. OBJECTIVE: To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. DESIGN: Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. SETTING: Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. PARTICIPANTS: Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation. MAIN OUTCOME MEASURES: Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire. RESULTS: Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups. CONCLUSIONS: This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.
Subject(s)
Health Behavior , Homosexuality, Female , Sexual Behavior , Women's Health , Adaptation, Psychological , Aged , Female , Health Services Accessibility , Health Status , Homosexuality, Female/statistics & numerical data , Humans , Life Style , Middle Aged , Multivariate Analysis , Preventive Health Services/statistics & numerical data , United StatesSubject(s)
Coronary Disease/epidemiology , Health Services Accessibility/statistics & numerical data , Kidney Failure, Chronic/epidemiology , Women's Health Services/statistics & numerical data , Coronary Disease/therapy , Female , Humans , Kidney Failure, Chronic/therapy , Male , Myocardial Revascularization/statistics & numerical data , Sex Factors , Treatment Outcome , United StatesSubject(s)
Curriculum , Domestic Violence , Internal Medicine/education , Internship and Residency , Humans , New YorkABSTRACT
This review addresses some of the challenges confronting the modern nutrition support clinician in developing protocols for nutrition assessment. While it is generally agreed upon that patients who are malnourished are at greater risk for development of complications during hospitalization, there is no consensus on the best method for assessment of nutritional status. Assessment parameters currently available include clinical, biochemical, anthropometric, and functional tests designed to evaluate nutrition status as well as estimate body composition. As some of these parameters are expensive or not practical for routine clinical use, they should be evaluated carefully when a nutrition assessment protocol is designed.
Subject(s)
Nutrition Assessment , Nutrition Disorders/diagnosis , Clinical Protocols , Humans , Nutrition Disorders/metabolism , Nutritional Status , Risk FactorsABSTRACT
PURPOSE: To determine whether there is sufficient information in the medical literature to guide appropriate treatment of hypertensive women. DATA IDENTIFICATION: Epidemiologic surveys of hypertension, clinical trials of antihypertensive therapy, and studies of selected adverse effects of antihypertensive agents were identified through a computerized search using MEDLINE and by identifying all studies cited in current medical textbooks as supporting evidence for the guidelines for the treatment of hypertensive individuals. All epidemiologic studies selected were cross-sectional or longitudinal, multicenter, population-based surveys. All clinical trials were large, randomized studies comparing one or more antihypertensive agents with a placebo or nonplacebo control group. Epidemiologic studies and clinical trials were reviewed to assess the quantity and quality of information available regarding important aspects of hypertension in women. Data pertaining to epidemiology, natural history, results of treatment, and two significant side effects of antihypertensive treatment were examined. RESULTS OF DATA ANALYSIS: The prevalence of hypertension is greater in black women than in black men and is about equal in white women and men. Because women outnumber men in the population, there are more hypertensive women than men. The attributable risk percent (the proportion of end points that could be eliminated by removing hypertension) for cardiovascular complications of hypertension is higher for women than men. Clinical trials show clear benefit of therapy for black women but no clear benefit for white women; some studies suggest that treatment of white women is harmful. Lipid profiles and their relation to ischemic heart disease differ for women and men; there is currently no information on the effects of antihypertensive agents on serum lipids in women. Few data have been published on the frequency of sexual dysfunction in treated hypertensive women. CONCLUSIONS: Hypertension in women and its related cardiovascular outcomes are a major public health problem. Clinical trials of antihypertensive therapy do not fully support current guidelines for the treatment of hypertensive women. Research concerning adverse effects of antihypertensive agents has largely excluded women from consideration; further studies are required to guide appropriate treatment.
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Women's Health , Black or African American , Antihypertensive Agents/adverse effects , Epidemiologic Methods , Female , Humans , Hypertension/epidemiology , Lipids/blood , Male , Randomized Controlled Trials as Topic , Sex Factors , Sexual Dysfunction, Physiological/chemically induced , United States/epidemiology , White PeopleABSTRACT
A double-blind, controlled study was performed in which eight investigators treated a total of 180 psoriasis patients with either betamethasone dipropionate cream or fluocinolone acetonide cream for four weeks. Betamethasone dipropionate cream was clearly superior to the control preparation in the degree of improvement effected and rapidity of action.