Stephen M. Pribut, D.P.M., F.A.C.F.A.S.
APMA News, April 1998
As we mentioned last month, Podiatric Medicine has always recognized the needs of women, with the typical Podiatric practice being comprised of over 70% female patients. We will continue our search for knowledge of women's health issues on the Internet. This month, we will take an overall look at general womens health issues and resources. Womens health as a vital issue has come a long way. From benign neglect and negligence to the Nurses Health Study and the Office of Research On Women's Health (ORWH) at the National Institutes of Health (NIH), women are now finally starting to receive their due in health care research. Several web sites have exceptional collections of resources for womens health and material of specific interest to women on non-health matters.
Office of Research On Women's Health
ORWH was established to ensure that research supported by NIH properly addresses the issue of women's health and that there be adequate participation of women in clinical research. The Office coordinates NIH activities regarding research and women, and has the added mission of interacting with the scientific, medical, and lay communities, the Congress, and other components of Government about NIH's programs related to women's health. An overview of their work may be seen at (http://ohrm.od.nih.gov/orwh/women.html). Their far reaching agenda is evident at their site.
Womens Unique Physiology
Hormonal fluctuations, both over the course of a lifetime and on a daily basis, influence health, disease and drug metabolism. The presence of ample Estrogen in the younger years, protects most women from cardiovascular disease until they are post menopausal. The sudden dip in estrogen in mid-life and later, results in the loss of protection from cardiovascular disease and unless precautions are taken, the incipient development of osteoporosis.
Women have unique problems and unique responses to certain health problems that are shared between men and women. These problems relate to many different medical specialties including reproductive, dermatological, rheumatological and cardiovascular.
Health and Fitness Alert
Most of us have long been under misconceptions about what constitutes a womens gravest health dangers. In fact, surveys reported by the Mayo Clinic indicate that only 8% of women know what constitutes the gravest dangers to a womans health. Although breast cancer is a devastating disorder and affects many more women than other cancers, it is lung cancer that over the last 30 years has become the largest cause of cancer deaths of women. But it isnt cancer that kills most women. Heart disease and strokes kill about five times as many women as breast cancer and are responsible for one of every two deaths of women. While smoking doubles the risk of heart disease for both men and women, the combination of smoking and taking oral contraceptives increases the risk 39 times. Smoking, also appears to be responsible, for the 500% increase in the incidence of lung cancer in women since 1960.
A recent report from the "Nurses Health Study" in the New England Journal of Medicine, (Postmenopausal hormone therapy and mortality F. Grodstein, et. al. N Engl J Med 1997; 336: 1769-75), showed that postmenopausal hormone replacement therapy lessened the severity of osteoporosis, while significantly lowering deaths from cardiovascular disease. Another recent study in the same journal reported that physical fitness not only lessened the incidence of cardiovascular disease, but also seemed to reduce the incidence of breast cancer by up to 37%.
The chronic diseases men and women suffer are somewhat different. Between the ages of 45 65, hypertension is suffered equally by men and women, but many more women suffer from arthritis and more men suffer from hearing loss. An important means of lessening the chances of suffering from hypertension, heart disease and perhaps even breast cancer is by instituting a regular physical fitness program. A goal should be for four sessions of 30 minutes of aerobic exercise each week. While keeping our patients feet healthy and pain free we can contribute and encourage them in this pursuit.
Over the course of a womens life different disorders occur. While the teen years are the potentially best years to store calcium in bone for future years, young, competitive, athletic women may develop the female athletes triad. This disorder includes eating disorder with weight loss, amennorrhea and osteoporosis. More information on this disorder and others affecting female athletes can be found at https://www.drpribut.com/sports/spwomen.html.
Two sites stand out as valuable resources for womens health issues. The first is the Mayo Clinic site "Oasis". This site at http://www.mayohealth.org/ has current articles and archives on nearly every imaginable topic regarding womens health. A trip here will also reveal articles on many other health topics and will quickly result in this site being added to your list of browser bookmarks. Outstanding articles on Calcium, Osteoporosis, Breast Cancer, Reproductive issues, Gynecological problems and the latest on hormone replacement therapy are found here. The articles are directed to both physicians and the intelligent lay public.
Another outstanding site on both womens health issues and other health care topics is Medscape. This site should also be in your bookmark file. A visit to http://www.medscape.com/ will be a rewarding one. This site is directed towards the practicing physician and has peer reviewed articles on many issues affecting women and also on many other medical specialties. It should also be visited at your next web surfing expedition.
One more site with excellent resources on womens health is the New York Times web site which has a special section on Womens health at: http://www.nytimes.com/specials/women/whome/. This site has articles on a variety of issues concerning womens health and a listing of 100 web reference sites. You can also view statistics from the Centers for Disease Control on diseases and causes of death for men and women since 1960. A look at the numbers shows that heart disease is the number one killer of both men and women followed by strokes, lung cancer and breast cancer.
In late 1998 the Journal of the American Medical Association began a site on women's health that includes an excellent search engine and a variety of articles.
Also visit the "Womens Wire", a site designed specifically for women located at http://www.women.com. Here women will find information on health, the Internet, diet, careers, entertainment and links galore.
Search the JAMA Women's Health Web site
Using the Excite search engine, you can use Natural Language to find what you are looking for.
Other Internet Resources:
Women and Sports Medicine Female Athlete Triad, Stress Continence, by Dr. Pribut and Amelia Perri-Pribut, M.B.A., R.N.
Women's Health Center of Journal of the American Medical Association at http://www.ama-assn.org/special/womh/index.htm
The Osteoporosis and Related Bone Diseases~National Resource Center (ORBD-NRC) at http://www.osteo.org/
The National Osteoporsis Foundation at http://www.nof.org/
The Priocal Home Page at http://www.priocal.se/
Osteovision Home Page at http://www.osteovision.ch/