women biological and psychosocial issues.?
Women's health is the concept that examines gender differences in health and disease states. The average life expectancy has almost doubled for women (79 years for women and 73 years for men), when compared with averages during the turn of the century. Because of the gender gap in lifespan, women comprise approximately two thirds of the population older than 65 and three fourths of the population aged 85 years and older. Currently the fastest growing group in the United States is persons aged 85 years and older. Because of gender life expectancy differences, it is estimated that at the beginning of the twenty-first century, women will outnumber men in the 85 years and older category by 3:1. The reasons for this variance are primarily due to physiological differences among men and women.
During different phases of a women's life cycle there are complex interactions that exist between sex hormones, physiological changes, and emotional issues. Physiological changes occur as early as embryonic development when hormones program structural differences between male and female brains. During reproductive years, sex hormones profoundly influence reproduction and development, which creates a spectrum of gender specific health issues. With advancing age and onset of menopause, women's risk factors for disease is comparably similar to men's. Although the same disease may affect women as men, it is thought that biological mechanisms and psychosocial differences influence the clinical course of the disease (natural history) differently in women. The number of women working has doubled within the past 50 years. The effect of work stress, new environmental exposures and multiple roles is expected to have health and social impact.
The leading causes of death among women are cardiovascular disease, malignant cancer, cerebrovascular disease, chronic lung disease, pneumonia/influenza, and diabetes. Additionally, women can be prone to osteoporosis, alcohol abuse, psychological disorders, human immunodeficiency virus infection, and violence.
Heart Disease accounts for approximately a third of all deaths in women. About 250,000 women die annually of coronary heart disease or a one in three chance after age 40 years. The incidence of heart disease occurs about 10 years later in women than in men, since estrogens in premenopausal women has a protective effect. African American women are more prone to die from heart disease up to age 75. Beyond 75 years of age the propensity is reversed. Native American and Hispanic women have lower death rates from heart disease.
Malignant cancers are the most common cause of premature death among women. Breast cancer is the second leading cause of death in women and the most commonly diagnosed cancer. Lung cancer, secondary to cigarette smoking is the leading cause of cancer death among women.
Cerebrovascular disease, or stroked related deaths account for approximately 6% of all deaths in women and it is the third leading cause of mortality. The least common form of stroke, subarachnoid hemorrhage, is the more common cause in women.
The prevalence of cigarette smoking has increased greatly in women and this is correlated with pulmonary disease. Death rates for pulmonary disease including cancer and infectious causes of death are expected to rise for women.
Diabetes, a leading cause of death in women is more prevalent among Hispanic, African American, and Native American women. Past age 45, diabetes affects about one in six women.
Women can also develop:
osteoporosis, or loss of the quantity of bone, common in postmenopausal women who have estrogen changes.
alcohol abuse, characterized by repeated usage of alcohol despite negative consequences. These women frequently do not seek treatment because of fear of consequences (i.e., loss of child custody). This disease can also have adverse affects on fertility and in the developing fetus if the mother continues to consume alcohol (fetal alcohol syndrome).
psychological disorders, such as depression and eating disorders.
acquired immunodeficiency syndrome (AIDS), which represents the highest percent increase in death rates.
violence, a leading cause of death, primarily caused by a perpetrator who is or was a partner.
Causes and symptoms
Cardiovascular disease can be caused by blockage of a blood vessel, high blood pressure, or a secondary complication to another disease. There may be an abnormal heart rhythm or cell death. Patients may complain of a broad spectrum of symptoms that may include pain chest discomfort, high blood pressure, or strain during physical exertion.
When attempting to define the cause and symptoms of cancer, it is important to assess the type of cancer and location. Additionally, if the tumor is localized (benign) or has spread to other areas (malignant), is vital for treatment planning and overall prognosis. In cases of breast cancer there mat be a lump discovered during self-examination or mammography (special breast x rays).
Cerebrovascular disease may cause tremors (shaking), loss of balance and coordination, or functional and sensation loss of some parts of the body. Patients may have sudden transient strokes that could result in temporary loss of consciousness and amnesia of the incident. Patients may also develop chronic neurological states that causing memory loss and behavioral changes (Alzheimer's disease).
Patients with pulmonary (lung) cancer may develop shortness of breath, fatigue, weight loss, worsening cough, and coughing up bright red blood with sputum. Lung infections such as pneumonia may present with high fever, weakness, difficulty breathing, and abnormal breathe sounds heard with a stethoscope during physical examination.
Diabetes is a syndrome with disordered metabolism and high blood sugar due to an abnormality in the chemical that regulates sugar levels. It is characterized by an increased thirst, urination, and chronic skin infections.
Osteoporosis may cause the bones to be brittle and weak. It is usually not detected until bones start to break.
The alcohol abuser will continue to drink despite negative repercussions. The person may not seek treatment to evade legal and/or child custody problems. The patient may hide alcohol, or confine drinking to specific times. The disease progresses to where there may be permanent liver damage, memory blackouts and malnutrition.
Depression may manifest a loss of interest and desire. Patients may have difficulty getting out of bed. They may lack motivation to work or tend to daily activities.
Patients with AIDS may not have symptoms for years. When active disease occurs, patients will typically develop recurrent infections that are the usual cause of death.
Domestic violence is usually associated with a perpetrator who is in a relationship with the affected person. Abuse can be manifested by physical violence and/or homicide.
Diagnosis
Diagnosis can be accomplished with a history, physical examination, and specialized tests or procedures. For cardiovascular disease an electrocardiogram can determine the activity of the heart. Additional tests may include echocardiography (ultrasonic waves that generate an image), stress testing, and studies that require placing a catheter with a probe to examine the damage to heart tissue. Special tests with dyes may also be injected to enhance visualization. Cancer may be detected using specialized test called tumor makers and imaging studies such as MRI and CAT scans. Cerebrovascular disease can be detected with a complete neurological examination and specialized imaging technology. Diabetes is usually detected by a careful history presence of risk factors (obesity) and blood analysis of glucose levels. Osteoporosis can be evaluated with specialized bone densitometry. Alcohol abuse can be established by a bio-psycho-social assessment and standardized tests which screen for this disorder. Psychological evaluation (such as the Minnesota Multiphasic Personality Inventory, MMPI) can usually detect depression or eating disorders. AIDS can be established by a careful history, belonging to high-risk groups and Western blot analysis (examination of blood to detect the protein of human immunodeficiency virus). Violence can be established by physical signs of beating, such as cuts and bruises.
Treatment
Treatment depends on the extent of disease and the present health status of the patient. Additionally, in some cases treatment may stopped at sometime, or it may altogether be refused. Treatment for cardiovascular disease may include surgical intervention and/or conservative medical treatment with medications. Diet, exercise, and weight reduction are important parameters for treatment planning. Appropriate referrals, counseling, and follow up are usually indicated. Treatment for cancer may include a combination of surgery, chemotherapy or radiation therapy. These treatment modalities may be given singly or in combination or at different times during disease progression. Cerebrovascular disease can be treated surgically and/or with medications that thin the blood. Symptomatic care may be indicated in addition to close monitoring if the patient develops disability and/or cognitive impairment. Diabetes can be treated by dietary modifications and medications, which treat abnormal levels of blood glucose (sugar). Osteoporosis can be treatment with estrogen replacement and regular vitamin/mineral intake. Alcohol abuse may require long-term therapy, inpatient treatment and medications. Community centered support group meeting are also recommended as a form of treatment maintenance. To date there is no treatment for AIDS, other than medications, that offer symptomatic relief. Alcohol abuse, psychological disorders and violence require therapy, possible medication, and community centered support group meetings.
Alternative treatment
There are numerous studies which support intake of coenzyme Q10 for cardiovascular health. Studies have shown that beta-carotene and vitamin E and C have no effect for cancer. Some studies indicate positive results for reproductive health using acupuncture. Some advocates proposed certain herbs may be beneficial during menopause. According to most medical literature, further research using scientific method is vital for general acceptance.
Prognosis
The prognosis depends on the extent of disease and the physical and emotional status of the patient. Prognosis is also related to tolerance of treatment, adverse drug effects, and complication during or after surgery, disease resurgence and patient compliance with treatment recommendations.
Prevention
One of the most reliable measures of prevention is education and training. The Council on Graduate Medical Education has provided funding for numerous centers to research women health issues. On more individual level preventive and personal habits are vital for good health. Most physicians believe that a baseline physical examination is a reliable comparative tool. Women should receive counseling for special issues concerning cigarette smoking, exercise, diet, primary disease prevention, safe sexual practices, alcohol abuse, psychological disorders, and violence. Additionally, knowledge of family history is important since many diseases have a strong propensity among first-degree relatives. Blood pressure should normally be measured every other year. Screening tests for breast, cervical, and colorectal cancer is recommended. Pap smears taken during routine pelvic examinations can screen for disease processes in the reproductive tract. Serum cholesterol monitoring and reduction are advised. Patients may require postmenopausal estrogen replacement therapy and vitamin/mineral supplements.
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