The Medical clinics of North America
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Several key points are addressed in this article including the following: 1. Most women with HIV are of reproductive age (20 to 44 years of age), acquire their HIV infection through heterosexual contact, and are women of color (African American or Latina). 2. Sex does not seem to alter substantially the presentation or natural history of HIV with the exception of unique gynecologic manifestations. 3. ⋯ The risk of perinatal transmission has dramatically dropped to 1% to 2% with the advent of potent ARV therapy. 5. Several potent ARV therapies are now available and have greatly prolonged and enhanced the quality of life among persons with HIV. 6. New approaches to prevention of HIV transmission include use of topical microbicides, vaccines, and use of potent ARV therapies following exposure to HIV.
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Med. Clin. North Am. · Sep 2003
ReviewBeyond women's health the new discipline of gender-specific medicine.
At its best, women's health is not something to be developed as an isolated discipline. If instead biologic sex is used as an important variable in research protocols, studying and comparing men and women directly, the data prompt the formulation of questions that never otherwise would be asked. In answering those questions, one can fashion more accurate and complete models not only of human physiology, but also of the pathophysiology of disease.
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For many years, women have sought alternative therapies for menopausal symptoms and for general health overall. The highly publicized findings from the Women's Health Initiative have led to an increased pressure on the medical community to find safe and alternative medications for female health. This article reviews the challenges and problems with the use of alternative medicines, and the clinical trials that prove their efficacy, and discusses the safety issues that may occur with these types of products.
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Med. Clin. North Am. · Sep 2003
ReviewGonadal steroids, selective serotonin reuptake inhibitors, and mood disorders in women.
That gonadal steroids influence the limbic system and that they affect neurotransmitter activity is undisputed. Because of these known actions, and because ET and HT alleviate hot flushes and resultant sleep disturbances, they may improve mood and sense of well-being in healthy climacteric women. However, estrogen plus progestin did not decrease depressive symptoms in the WHI, the largest double-blind, placebo-controlled trial of hormone replacement yet performed. ⋯ If major depression is to be addressed in this way, SSRIs become first-line therapy, with TCAs considered second-line because of reduced tolerability. ET and HT may be added separately as appropriate, and may be helpful on an individual basis. Indeed, treatment for major depression in any person, male or female, at any age, is best chosen based on life situation and the neuropsychology of the condition, and not based on gender alone.
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Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. ⋯ Patients are advising each other to "educate yourself and ask questions". Patient satisfaction with their care, rests heavily on how successfully this transition is accomplished. Ready access to quality information and thoughtful patient-doctor discussions is at the fulcrum of this revolution.