Use of hormone replacement therapy by menopausal women in six family-practice teaching clinics in Israel.

BACKGROUND: The necessity of hormone replacement therapy (HRT) remains a controversial subject, but guidelines suggest that the subject be discussed with all menopausal women. AIM: To determine the rate of HRT use among women cared for in family-practice, university-affiliated teaching clinics. METHODS: Physicians from six family-practice teaching clinics enrolled all menopausal patients, aged between 50 and 70 years, registered in their practice. A detailed questionnaire was completed regarding demographic and health variables, gynecological history and the nature of HRT use. RESULTS: In total, 682 women were invited to participate in the study; 587 (86%) participated. Some 74% of the women were married, 64% were secular and 43% stated that they performed regular exercise. Current HRT use was reported by 156 women (26.6%). Most women (83%) had been treated for over 1 year. Common indications for starting treatment were hot flushes (75%), and routine recommendation by their physician (68%). Eighty-three (14%) women were past HRT users. It was stated by 45% of never-users that HRT had never been offered to them. Current users of HRT were found to be younger than non-users (mean age 58.2 years vs. 61.5 years, p < 0.0001), more secular than traditional or religious (p < 0.0001) with more years of formal education (p < 0.0001), and more likely to be of Western or European ("Ashkenazi") origin (p < 0.0001). Current HRT users reported fewer chronic illnesses than did non-users (p = 0.001); they were more likely to report being engaged in regular exercise (p < 0.002) and were less likely to be obese (p < 0.005). In a multiple regression model, HRT use was associated with more years of formal education and a secular identity. CONCLUSION: Our study found a higher proportion of women using HRT than in other Israeli studies. HRT use was more prevalent among women with improved health status and higher socioeconomic status. The most common reason given for not using HRT was that a physician had not raised the subject, indicating that physician-related factors might contribute to using HRT. Thus, comparing HRT prescribing rates in non-teaching clinics should clarify this factor.

Knowledge and attitudes of primary care physicians regarding battered women. Comparison between specialists in family medicine and GPs.

BACKGROUND: Domestic violence is a widespread public health problem and an important part of primary care practice. OBJECTIVE: To evaluate the approach of primary care physicians (family physicians and GPs) to the care of battered women. METHODS: A self-report questionnaire containing items about experience, knowledge and attitudes regarding the care of battered women was mailed to a random sample of 300 primary care physicians employed by the two major health management organizations in Israel. The population included family physicians, who have 4 years of residency training in primary care, and GPs, who do not undergo specialization after completing their medical studies. RESULTS: A total of 236 physicians (130 family physicians and 106 GPs) responded. In general, the physicians had had very little exposure to the problem and estimated its prevalence in the community as less than half that indicated in the medical literature. Compared with the GPs, however, the family physicians reported more exposure to the subject (P < 0.001) and had better knowledge of its prevalence and risk factors (P < 0.001). They also showed a greater tendency to view the problem as universal (P < 0.05) and as part of their professional responsibilities. However, both groups tended not to include the care of battered women with no physical injury within their professional duties. CONCLUSIONS: Physicians should be made more aware of the problem of battered women within the context of their routine professional practice and of the importance of keeping abreast of the subject. Educators should place more emphasis on imparting knowledge and skills in the management of battered women, especially for GPs.

Massive hemoptysis as a presenting sign of benign lymphocytic angiitis and granulomatosis.

We report a patient with massive hemoptysis due to benign lymphocytic angiitis and granulomatosis complicated by reactivated tuberculosis. There was remarkably good response to treatment with chlorambucil, corticosteroids and antituberculous drugs.