Harnessing hormonal signaling for cardioprotection

Cardiovascular disease is the leading cause of death in women in the Western world and is predominant among the elderly. A large body of evidence suggests that hormonal signaling plays a critical role in the regulation of cardioprotective mechanisms, as premenopausal women are at significantly lower risk of heart disease compared with men, but the risk greatly increases with the onset of menopause. This association indicates that estrogen may protect the heart from cardiovascular disease. Whereas a number of analyses of the effects of hormone replacement therapy (HRT) on postmenopausal women supported the idea that estrogen is a cardioprotective factor, the findings of the more recent Women's Health Initiative (WHI) study suggested that HRT may actually increase the risk of cardiovascular events. These conflicting reports have left both patients and clinicians reluctant to continue using current HRT regimes. The WHI findings do not, however, negate the epidemiological link between menopause and increased cardiovascular risk. Hence, the identification of the specific actions of estrogen that promote cardioprotective pathways without enhancing deleterious vascular mechanisms may provide novel estrogen-based alternatives to current HRT strategies. In this Review, we outline the known actions of estrogen on the cardiovascular system, focusing on cardioprotective mechanisms that may be targeted for the development of new therapeutic approaches.     

National Osteoporosis Society's Position statement on hormone replacement therapy in the prevention and treatment of osteoporosis

Hormone replacement therapy (HRT) has been shown to increase bone density, reduce the risk of fracture and can successfully relieve menopausal symptoms. From a time when HRT was the major therapeutic option for the management of osteoporosis, women and their clinicians now have a range of treatments available. Following the publication of the Women's Health Initiative (WHI) and the Million Women Study highlighting potential side-effects, such as breast cancer, heart disease and stroke, many doctors and women are now reluctant to use HRT. The National Osteoporosis Society felt that the role of HRT in the management of osteoporosis needed to be clarified. Using the Charity's expert clinical and scientific advisers, and through public consultation with members and key stakeholders, a Position Statement has been published. We conclude that HRT has a role to play in the management of osteoporosis in postmenopausal women below the age of 60 years. The key recommendations of the Position Statement are presented in this paper.     

Physical activity and hormone-replacement therapy: interactive effects on cognition?

The purpose of this study was to examine the interactive effects of hormone-replacement therapy (HRT) and physical activity (PA) on the cognitive performance of older women. Postmenopausal women (n = 101) were recruited to complete a PA questionnaire, provide demographic information, and perform the digit-symbol substitution task (DSST) and the trail-making tests (TMT). Regression analyses were conducted for participants with complete data for each cognitive test (DSST n = 62; TMT n = 69). For both tasks, results indicated that PA and education were positively related and age was negatively related to cognitive performance. The interaction of HRT with PA did not add to the predicted variance of either measure of cognitive performance. This was true even after limiting the HRT users to women using unopposed estrogen. It is concluded that the beneficial relationship between PA and these two measures of cognitive performance in postmenopausal women exists irrespective of HRT use.     

Management of premature menopause

There has been some confusion among women and health professionals since the publication of the Women's Health Initiative and Million Women studies about the management of premature ovarian failure (POF). Both studies were undertaken in women aged 50 and over, and cannot be extrapolated to their younger counterparts, who would normally be producing their endogenous estrogen, since they have functioning ovaries. Estrogen-based replacement therapy is the main stay of treatment for women with POF and is recommended at least until the average age of natural menopause (52 years in the UK). This view is endorsed by regulatory bodies such as the Committee on Safety of Medicines (now the Commission on Human Medicines) in the UK. No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women, and women with POF do not need to start mammographic screening early unless other risk factors are present, such as family history.     

Homocysteine, menopause and cardiovascular disease

A high plasma concentration of total homocysteine (tHcy) and a deficiency of vitamins related to its metabolism, such as vitamin B12 and folate, have been associated with cardiovascular disease. Postmenopausal women have higher concentrations than age-matched premenopausal women, and plasma concentrations of homocysteine in postmenopausal women taking hormone replacement therapy are significantly lower than they are in those who do not take estrogen supplements. Because of the possible mixed effects of HRT on cardiovascular events, surrogate end-points must be evaluated with caution. While measuring homocysteine levels is relatively simple, evidence from well designed trials is awaited before population screening can be advocated. Also, the benefits of reducing homocysteine levels with folic acid and vitamin B6 and B12 supplements are highly debated.     

Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.     

Gender-based health interventions in the United States: An overview of the coalition for healthier community initiative

Health disparities by gender constitute an important yet often overlooked aspect of health around the globe. Within the United States, there is both a paucity of research as well as planned programs that take into account how socio-cultural roles and expectations for men and women may differentially affect symptoms, access to care, and treatment. Viewing women's health exclusively as a function of sex (i.e., biological) differences represents a narrow understanding that does not fully explain gaps in health disparities between men and women. In September 2010, the U.S. Department of Health and Human Services (DHHS) launched a national initiative entitled the Coalition for a Healthier Community (CHC) to employ a gender-based framework in several urban, suburban and rural communities across the nation. The Office on Women's Health (OWH) within the DHHS funded 10 coalitions to ultimately improve the health of women and girls utilizing a gender-based approach. This article provides an overview of the initiative and the focus of the special issue.     

Enhanced rate of resting energy expenditure in women using hormone-replacement therapy: preliminary results

Hormone-replacement therapy (HRT) attenuates the menopause-associated alterations in body composition. It is not known, however, whether this effect is a result of a concomitant increase in energy expenditure. The authors examined whether women submitted to a long-term HRT treatment presented greater energy expenditure than women who had never used HRT. We compared 13 postmenopausal women using HRT (>1 yr) with 13 age- (+/-2 yr) and body-mass-index-matched (BMI; +/-1.5 kg/m2) postmenopausal women not using HRT. Resting energy expenditure (REE; indirect calorimetry), body composition, and daily (DEE) and physical activity (PAEE) energy expenditure (accelerometry) were obtained. Although BMI, fat mass, fat-free mass, DEE, and PAEE were similar between groups, the HRT group displayed a significantly greater REE than the no-HRT group (Delta +222 kcal/day). In conclusion, the authors observed that a long-term treatment with HRT is associated with a greater REE in postmenopausal women. These results need to be confirmed.     

The use of selective estrogen receptor modulators on bone health in men

Selective estrogen receptor modulators (SERMs) represent a class of drugs that act as agonist or antagonist for estrogen receptor in a tissue-specific manner. The SERMs drugs are initially used for the prevention and treatment of osteoporosis in postmenopausal women. Bone health in prostate cancer patients has become a significant concern, whereby patients undergo androgen deprivation therapy is often associated with deleterious effects on bone. Previous preclinical and epidemiological findings showed that estrogens play a dominant role in improving bone health as compared to testosterone in men. Therefore, this evidence-based review aims to assess the available evidence derived from animal and human studies on the effects of SERMs on the male skeletal system. The effects of SERMs on bone mineral density (BMD)/content (BMC), bone histomorphometry, bone turnover, bone strength and fracture risk have been summarized in this review.     

Gender,interaction and intonational variation: The discourse functions of High Rising Terminals in London

In this paper, I examine the different conversational and interactional functions that High Rising Terminals (HRT) fulfil among young, White, middle‐class speakers of London English. Data are drawn from sixteen small‐group interviews with forty‐two individuals (28 women and 14 men) aged 18–25. From this corpus, 7351 declarative Intonation Phrases were extracted, and auditorily coded for the presence/absence of HRT as well as for a variety of social, interactional and pragmatic factors. I combine quantitative and qualitative methods to demonstrate that while all of the speakers investigated use HRT to accomplish relational work in conversation, the specific interactional strategies that the feature is recruited to perform differ markedly across genders. I consider the ramifications of this finding for our understanding of ‘politeness’ as a gendered practice, and illustrate the importance of examining a variable like HRT in its discourse‐functional context.     

Older Women:

This paper addresses one of the challenges that older women face-poor health. The focus of this paper is the extent to which health status affects the political behavior of older women. To enrich the analysis, the relationship between health status for older males is examined as well. Health status has modest effects on both sexes. Most interesting, better health directly affects greater political participation among older women. It has only an indirect effect on older males political activism. Implications of these findings are discussed.     

Prevention of osteoporosis: one step forward, two steps back

For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.     

College students with congenital heart disease: A critical time for transition

As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. Participants: A case of a male with CHD presenting to the college health clinic with a new onset headache. Methods: The authors discuss some of the unique challenges that college health practitioners may face when caring for students with CHD. In addition, they make recommendations on how best to care for these patients and how best to coordinate care with CHD students other care providers. Results: This student with a history of coarctation of the aorta presented with new onset headaches and was found to have high blood pressure. He was diagnosed with recurrent coarctation, underwent percutaneous treatment with stenting and quickly resumed classes. Conclusions: As more students with CHD enter college, college health providers will need to understand some of the health risks that CHD students face. In addition, understanding some of the optimal ways to coordinate care with CHD providers can ease the transition that CHD students face as they enter college.     

Poverty and health: older minority women and the rise of the female-headed household

This analysis uses the 1984 Survey on Aging (SOA) supplement to the National Health Interview Survey (NHIS) to compare the relative impacts of poverty and health on the propensity of unmarried older black, Hispanic, and non-Hispanic white women to live with family. The results reveal that for blacks and Hispanics, economics are more significant than health in determining whether a woman lives with her children. Our findings also show that black unmarried elderly females are more likely than similar non-Hispanic white women to head their households. The literature and our findings suggest that black and Hispanic older women have fewer options in living arrangements than non-Hispanic older women in the event of diminished health.     

Sexual Violence and the MDGs

ABSTRACT

Sexual violence is multi-faceted. Three (overlapping) categories can be distinguished: violence that is sexual in nature, gender-based violence, and sexuality-based violence. The latter refers to violence against persons because of their sexuality and/or their (presumed) sexual behavior. Being female, young, poor, and living in a sexually conservative culture and/or in conflict areas appear to be important risk factors for sexual violence. Sexual violence is widespread (one in five girls worldwide are sexually abused in childhood and up to three-quarters of women in some countries have been victimized by a partner), but prevalence figures around the globe are hard to compare. Both the individual and society suffer from sexual violence. The eradication of sexual violence is directly relevant to achieving the Millennium Development Goals (MDGs) related to infant and maternal health and mortality, and combating HIV/AIDS. And certainly no less important, it is very closely linked to the MDGs related to gender equality and the empowerment of women, poverty, and primary education for all. Campaigning against sexual violence against women has been presented as one of the ‘quick wins’ in progress towards achieving the MDGs by the UN Millennium Project. Many good practices have been employed in political-legal, awareness raising, prevention, and health care domains, but important setbacks are noteworthy as well. Priority number one for the World Association for Sexual Health now seems to be to adequately and strategically contribute to the continuous efforts to integrate sexual health into the Millennium Development framework.     

Boundary-spanning work demands and their consequences for guilt and psychological distress

Using data from a national survey of working Americans (Work, Stress, and Health Survey; N = 1,042), the authors examine the associations between boundary-spanning work demands and self-reported feelings of guilt and distress. The authors document gender differences in the emotional and mental health consequences of boundary-spanning work demands, as indexed by the frequency of receiving work-related contact outside of normal work hours. Specifically, the authors observe that frequent work contact is associated with more feelings of guilt and distress among women only. Analyses also demonstrate that guilt accounts for the positive association between the frequency of work contact and distress among women. Statistical adjustments for levels of guilt reduce the positive association between frequent work contact and distress among women to nonsignificance. The findings underscore the importance of focusing on gender and emotions in work-family interface processes, as well as their implications for psychological health.     

Gender and the 'New Paradigm' of Health

This article provides a critical review of literature on the relationship between gender and the 'new paradigm' of health. An overview of the feminist critique of health is given, from the Women's Health Movement of the late 1960s and early feminist debates about medicalisation, to more recent discussions about structural inequalities between men and women, eating disorders, and AIDS. I then go on to explore the feminist response to the so-called 'new paradigm' of health (an approach that emphasises health promotion, individual responsibility for health, and body-monitoring). Arguments that health promotion initiatives target women and confirm their position as principal guardians of health within the family are considered, as well as literature on the breast cancer awareness campaign. I then explore the growing body of literature on masculinity and health, and its account of the relationship between gender and current ideas about healthiness. Finally, I offer up some suggestions for the direction a new feminist critique of health might take.     

Socioeconomic and Gender Health Disparities in Diabetes: The Lower Middle Income Case of Ghana

While literature theorizing the relationship between socioeconomic status (SES), gender, and health outcomes is robust in high‐income countries, there is less scholarship examining how SES affects men and women in lower middle income countries (LMICs). Focusing on the LMIC case of Ghana, I use Wave 1 of the World Health Organization Study on Global Aging and Adult Health (SAGE) to examine the relationship between SES and diabetes among Ghanaian women and men. Specifically, I examine how key SES measures such as educational attainment, employment status, and income singly and collectively predict the odds of diabetes for Ghanaian men and women. I also examine the explanatory value of the reversal hypothesis, which posits that those of high SES experience higher rates of non‐communicable diseases. Overall, I find that while Ghanaian men experience increased odds of diabetes with increased education, Ghanaian women have higher odds of diabetes compared to men regardless of educational attainment. Understanding health patterns in LMICs like Ghana is important for sociological inquiry on health disparities seeking to incorporate more global perspectives.     

Safe and shealthy integration into semiskilled jobs: does gender matter?

Women report fewer injuries than men when they are young, but report a higher proportion of professional diseases later in life (35 years +). Understanding early work conditions that lead to postponed health outcomes is necessary if we are to prevent women's injury as well as men's. Introduction to work and safe integration programs are often put forward to prevent injuries among youth. This paper aims to illustrate some differences in the job introduction / integration process for men and women and to discuss some gender-based Occupational Health and Safety (OHS) implications. Data come from two waves of interviews with 31 students enrolled in vocational training for a semiskilled trade. Results demonstrated differences between men and women: trades chosen, OHS complaints, supervising patterns, integration to work, etc. Women often choose customer service jobs, have less formal supervision and are often left to themselves when learning to do their job. Men declared more accidents while women reported more musculoskeletal symptoms. Findings from this research suggest young women's OHS issues should not be trivialized and that specific youth prevention programs for sectors where women are more present, such as customer service, should be developed.     

Untangling Inequalities: Gender,Race, and Socioeconomic Differences in Depression1

In their important paper, Link and Phelan (1995) argue that socioeconomic status is a fundamental cause of variation in well‐being and that the social resources associated with socioeconomic status constitute the fundamental cause of variation in well‐being. In this article, I elaborate on the fundamental cause perspective in three respects: by suggesting an expansion of the definition of resources, by examining how race and gender influence variation in the relationship between resources and mental health, and by developing a model of the relationship between social class, race, and gender that takes account of the potential asymmetry in the influence of resources across race and gender. Using the 2003 National Health Interview Survey and ordinary least squares regression, I find that black and white men are significantly less depressed than black and white women. However, women accrue greater mental health advantage from marriage, home ownership, and education. African‐American men experience less depression as a result of being unmarried and non‐Hispanic white women experience less benefit from full‐time employment, relative to African‐American women and men. Results are discussed in terms of implications for future research on race, class, and gender differences in health.