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The article presents information on a study which assessed predictors of reported performance of screening clinical breast examination (CBE) by internists, family physicians and gynecologists. Results from randomized controlled trials show the benefit of breast cancer screening among women 50-69 years of age. Meta-analyses have shown a 20%-30% reduction in death from breast cancer among women screened with mammography and CBE. This reduced mortality is evidence that early detection and treatment of asymptomatic breast cancers among women ages 50-69 years has a true advantage over no screening. As a result of these findings, annual or biannual mammography and CBE for women over age 50 is recommended by the U.S. Preventive Services Task, Force, the American College of Obstetrics and Gynecology, the American College of Physicians and the American Cancer Society. This study evaluates use of and attitudes about the use of CBE by primary care doctors. The goal was to uncover factors most highly associated with reported performance of screening CBE in a primary care setting.

The article presents topics discussed during the seminar facilitated by the Office of Research on Women's Health in the U.S., on chronic pain in women. The seminar includes three presentations: the prevalence and incidence of chronic pain conditions in women based on epidemiological data; chronic disabling pain, particularly oral facial pain and the role of genetics in pain, particularly how pain affects women differently from men. Pain can be defined as a subjective perception of distress, particularly in response to actual tissue damage or potential tissue damage. Pain cannot easily be quantified, although it engenders a greater emotional response than any other of the senses. It is necessary to differentiate between chronic pain and acute pain. Chronic pain is persistent pain, not something that is easily goes away. It acts as a signal for a disease process or an injury that may occur and often disappears with appropriate treatment. Chronic or persistent pain may no longer serve any useful function and it is unresponsive, to a wide variety of therapeutic approaches.

The article presents an update on women's health issues. As everyone concerned with women's health must know, a number of factors have been found that affect a woman's risk of developing breast cancer. Physicians look at a woman's age, history of breast cancer in her family, age at menarche and pregnancy history in assessing the likelihood of her becoming one of the 180,000 American women diagnosed each year with the disease. Pressure from United Nations agencies, private groups and women themselves has made inroads against the tradition of genital mutilation of girls, practiced widely in certain parts of tribal and Muslim Africa. This has become a public health concern in the U.S. communities of recent African immigrants. Progesterone synthesized from yams, structurally identical to the hormone produced naturally in the human female, has been approved by the U.S. Food and Drug Administration (FDA), for treatment of secondary amenorrhea and for use with estrogen therapy to prevent an overgrowth of cells in the uterine lining in premenopausal women who are taking conjugated estrogens.

The fear of breast cancer has been suggested as a potential reason why only a relatively small percentage of postmenopausal women who would benefit from hormone replacement therapy (HRT) are current users. The equivocal results from a large number of epidemiologic studies make it difficult to evaluate whether an association does indeed exist between the use of HRT and the incidence of breast cancer. The inability to provide conclusive evidence for or against this relationship may be attributed to methodologic problems in these studies, including small sample sizes, lack of information, on specific hormonal preparations (e.g., dose and type), failure to control for the type of menopause, and surveillance bias. In an attempt to generalize results from different studies in a systematic manner, several meta-analyses have been conducted of the effects of estrogen replacement therapy (ERT) or HRT on the risk of breast cancer. This article summarizes the data from these meta-analyses and incorporates data from studies published after these meta-analyses that have addressed this question Data from ongoing studies that use a randomized, controlled, longitudinal design on large numbers of women are necessary before a possible association between the use of HRT and breast cancer can be ascertained. [ABSTRACT FROM AUTHOR]

We hypothesized that women employees working in a hospital environmental would be particularly attuned to aspects of personal health, well-being, and disease prevention. We performed an observational study at a local hospital, offering free assessments in its outpatient women's wellness screening program ton women employees aged 39-60 years. Data from the first 60 women to enroll in the program are presented as a test of our hypothesis. Undiagnosed hypertension, abnormal lipid profiles, glucose intolerance, alcohol abuse, abnormal cervical cytology, breast masses, depression, or combinations of these were found in 4 of the 60 women. Twenty-one women were obese. Most women with abnormal findings did not follow specific, personalized recommendations for remedial follow-up, including referral to a specialist An important percentage of midlife women employees at this hospital exhibited unhealthful personal behaviors, bad unrecognized disease, and did not use recommended health screening practices. The data emphasize the benefit for employees who participate in medical facility worksite health promotion programs. [ABSTRACT FROM AUTHOR]

Urge incontinence has a profound effect on the day-to-day lives of women. The purpose of:. this study was to identify specific aspects of functioning and well-being affected by urge in-continence or mixed. incontinence with a primary urge component We conducted six focus groups of 65 racially and age diverse, community-dwelling women with urge incontinence. Transcripts of the focus groups were quantitatively for word use frequency with QSR NUD*JST® software. Demographics, symptomatology, and the impact of incontinence on daily activities and feelings were assessed by questionnaire. Participants in the focus groups were. on average 62 years of age; 52% were nonwhite, and 26% had a high school or less education. in the three identified broad domains, 52% of domain-related words were associated with feelings, 40% with activities, and 8% with relationships. Frequently identified references were bathroom availability (24%), loss of control (14%), anxiety (11%), and sleep disturbance (10%). Women under the age of 70 compared with older women more commonly identified feeling unattractive and low self-esteem (12% versus 2%, p < 0.007) and adverse effects on dating and sexual activity. (45% versus 0%, p <0.02). The effect of incontinence on quality of life correlated with frequency, nocturia, and pad use (Kendall's tau β 0.02-0.32, p < 0.05). Urge incontinence affects many quality of life issues and contributes to limitation of activities, loss of control,. and negative self-perception. Focus groups of diverse women with urge incontinence symptomatology are useful in understanding these effects. [ABSTRACT FROM AUTHOR]

Women have a higher prevalence of obesity than men in most developed countries. Obesity affects many aspects of women's health by increasing risk for heart disease, diabetes, breast cancer, and infertility One reason for the gender difference in obesity may be that fluctuations in reproductive hormone concentrations throughout women's lives uniquely predispose them to excess weight gain. Studies in experimental animals and women have shown that hormonal changes across the menstrual cycle affect calorie and macronutrient intake and alter 24 hour energy expenditure. Pregnancy is a significant factor in the development of obesity for many women Various factors are associated with excess weight retention following pregnancy, including weight gain during pregnancy, ethnicity, dietary patterns, and interval between pregnancies. There is a need to tailor recommendations for energy intake during pregnancy to Individual women, and recent evidence also suggests that the timing of `weight gain during pregnancy is a critical factor. Menopause is also a high-risk time for `weight gain in women Although the average woman gains 2-S pounds during menopausal transition, some women are at risk for greater weight gains. There is also a hormonally driven shift in body fat distribution, from peripheral to abdominal at menopause, which may increase health risks in older women. Hormone therapies have varying impacts on body weight and fat distribution In summary, hormonal fluctuations across the female life span may explain the increased risk for obesity in women. Awareness of these factors allows development of targets for prevention and early intervention. [ABSTRACT FROM AUTHOR]

The prevalence of vaginal symptoms and response to those symptoms in a nonclinic setting has not been previously described. Two thousand women living throughout the United States identified by random digit dialing completed a computer-assisted telephone interview about history of vaginal symptoms and use of healthcare services in response to these symptoms. The analysis was limited to 1698 white (WA) and 144 African American (AA) women (n = 1842). An episode of vaginal symptoms of any severity during 1995 was reported by 7.5% of WA women and 18.1% of AA women. Fifty-five percent of WA women and 83% of AA women with symptoms consulted a healthcare professional about their most recent episode. The racial difference in prevalence and consultation was not explained by marital status, education, employment, or lifetime number of sex partners. Most women purchased an over-the-counter antifungal preparation to treat their symptoms, whether or not a physician was consulted. The racial differences in prevalence and use of health services in response to vaginal symptoms observed here should be confirmed, and the potential causes should be explored. [ABSTRACT FROM AUTHOR]

We sought to examine the prevalence of self-reported multiple cardiovascular disease (CVD) risk factors (hypertension, high blood cholesterol, diabetes, overweight, and current smoking) among women in 1992 and 1995 in the United States using data f mm the Behavioral Risk Factor Surveillance System. In 1992, 37.5%, 344%, and 28.1% of women had zero, one, and two or more of the five risk factors, respectively. In 1995, the respective estimates were 35.5%, 34.3%, and 30%. In both years, the prevalence of two or more risk factors increased with age, decreased with educational level, was higher among black women (lowest among Hispanic women and women of other ethnic groups), and higher among women reporting cost as a barrier to healthcare. The percentage of women with two or more risk factors was higher in 1995 than in 1992 for 35 of 48 states, being statistically significant for 7 states. The percentage of women with at least two risk factors was not significantly lower in 1995 than in 1992 for any state. A higher percentage of women reported having multiple CVD risk factors in 1995 compared with 1992. A multifactorial approach to primary prevention and risk factor reduction should be encouraged to help reduce the prevalence and burden of CVD among women. [ABSTRACT FROM AUTHOR]

The process of incorporating new material into an existing medical curriculum frequently produces lengthy debate, political maneuvering, and competition for curricular time. The faculty of the Women's Health Education Program at MCP-Hahnemann School of Medicine, developed a stepwise process, or framework, for including women's health teaching for Students in the problem-based curriculum. This process can be applied to the integration of any body of information. The key elements of the process are to define the full scope of what needs to be taught, develop teaching objectives, identify opportunities to introduce the information into the curriculum, develop strategies that capitalize on existing curricula, enlist the collaboration of a broad range of key faculty, develop evaluation tools, and assess whether students have achieved the expected competencies. [ABSTRACT FROM AUTHOR]

This article addresses social and ethical priorities on the agenda for women's health research in the next century. Specifically, the relevance of genetic discoveries for healthcare reform and why both topics ought to be among these priorities are discussed. If the present gap between diagnosis and treatment of genetic diseases could be bridged, especially in such common diseases as cancer and heart disease, arguments for universal access to healthcare would be vastly strengthened. Important scientific and ethical problems are involved in bridging the gap, including volatile issues of research with human embryos and fetuses. Other issues deserve high priority on the women's health research agenda: adequate funding for biomedical research, maintaining an equitable number of women in clinical trials, and creating a knowledge base in gender-based biology. Progress in genetic research is clearly relevant to women's health for understanding and treating common diseases, as well as for reproductive decisions. Until recently, genetic services have been aimed exclusively at reproductive choices, including counseling, prenatal diagnosis, and carrier screening. However, the meaning of the term needs to be vastly broadened to include the uses of genetic information in mainstream medicine. Through genetic testing and DNA technology, it will be increasingly possible for physicians to have access to family history and a reliable profile of each patient's genetic health risks. Drugs will be designed that will be responsive to individual genetic variability and risks for disease. If scientific and ethical obstacles are overcome, there may also be effective human gene therapy to correct mutations and prevent lifelong harm. In my view, linking the agenda for women's health research with the unfinished social task of ensuring access to adequate primary and preventive care, which foreseeably will include genetic services and human gene therapy, strengthens the agenda and promotes solidarity with the needs of the majority of Americans. This link will help to prevent political and moral isolation of women's health research. [ABSTRACT FROM AUTHOR]

The article focuses on lifestyle change in women with coronary heart disease (CHD). CHD is the leading cause of death in Western culture. The impact of the disease spreads beyond the suffering of an individual patient. Society also pays an enormous price. Traditional invasive approaches to treatment are expensive. Coronary artery bypass graft surgery, for instance, consumes more health dollars than any other medical procedure. Strategies to promote healthier lifestyles, rather than invasive surgical or medical procedures, hold promise for helping ease individual suffering while reducing the use of medical services and containing costs. Few studies, however, have related behavioral and psychosocial factors to lifestyle change or linked lifestyle change to coronary risk reduction. Rarer, still are studies relating lifestyle change specifically to CHD in women. Researchers increasingly are recognizing the need to take into account gender differences in the course of CHD. The article reviews what is known about psychosocial factors related to lifestyle change in women with heart disease. Because of the paucity of studies focused specifically on women, the review includes not only recent studies of CHD exclusively in women but also relevant studies of CHD that include men as well as women.

The article presents a discussion on the treatment of menopausal symptoms. Vasomotor instability, leading to hot flashes, is the most commonly reported menopausal discomfort, afflicting 60% to 80% menopausal women. In up to 57% of women, hot flashes persist for over 5 years and in up to 10% of women, hot flashes persist for over 15 years. Women who undergo surgical menopause may experience more frequent and intense hot flashes, which are usually more prominent during the first 6 months after surgery. The flashes are described as a feeling of intense heat that begins in the upper chest or neck and rises up to the face and heads. The sensation lasts from several seconds to minutes and is often followed by profuse perspiration. Hot flashes are more prone to occur during times of stress and are more frequent and in tense at night, often leading to insomnia. Certain emotional changes associated with menopause, including anxiety, irritability, memory loss, general malaise and mood swings, are attributed to insomnia secondary to night sweats. The exact etiology of hot flashes is not completely understood. It is thought that the flashes are associated with changes in hypothalamic neurotransmitters caused by loss of negative feedback from estrogen.

The article provides abstracts on women's health. The purpose of one the studies was to evaluate the tumor biology with respect to bilaterality and recurrence rates for bilateral infiltrating lobular breast carcinoma in comparison with other histological types. A prospectively accrued data base containing 1,548 breast cancer cases as well as H. Lee Moffitt Cancer Center's cancer registry compiled during the same period were queried for specific features relating to bilaterality and recurrence. In another study the objective was to determine the neonatal outcome in women with well-characterized antiphospholipid syndrome treated during pregnancy with low-dose aspirin. Thirty-eight babies born after 36 pregnancies of 33 women diagnosed with antiphospholipid syndrome were compared with a group of 38 control infants matched for the same gestational age. The maternal events associated with the antiphospholipid syndrome, mothers' treatment, and neonatal data were studied. Antiphospholipid antibody syndrome is thought to be associated with 16% of pregnancy losses and is found in 15% of women with recurrent pregnancy loss.

Studies of young, premenopausal women suggest that changes in coronary risk factors do not persist after discontinuation of oral contraceptive use. However, little is known about long-term effects of past oral contraceptive use in older, postmenopausal women, who typically have a more atherogenic profile. This study examines the relation of past oral contraceptive use (including duration) to heart disease risk factors in postmenopausal women. Subjects were 517 women aged 50-69 from the Rancho Bernardo Study who attended follow-up clinic visits. Past oral contraceptive use was reported by 24.2% and two thirds had used oral contraceptives ≤ years. After adjustment for covariates, the only significant difference was that past users had higher diastolic blood pressures than never users (p < 0.01). Among older women, the diastolic blood pressure of past users was 3.9 mm Hg higher than that of never users (p <0.01). Women who used oral contraceptives for ≤5 years had diastolic blood pressures 3.6 mm Hg higher than those of never users (p ≤ 0.01). No differences were found among younger women or those who used oral contraceptives ≥6 years. Past oral contraceptive users may be at increased risk for heart disease because of a small but significant elevation in diastolic blood pressure that persists many years after discontinuing oral contraceptive use. [ABSTRACT FROM AUTHOR]

The epidemiology, clinical course, response to treatment, and ultimate outcome of essential hypertension vary as a function of gender. Three early trials on hypertension reported an increase in all-cause mortality in treated white women compared with black women or with men of both races. Later studies, however, suggest that drug therapy has similar and beneficial effects in hypertensive men and women. Women may tolerate hypertension better than do men. Diastolic hypertension correlates with higher mortality from coronary artery disease in men than in women. Special considerations apply to treating the hypertensive woman. Use of oral contraceptives may precipitate or accentuate the problem in contrast, in the posts menopausal female, estrogen replacement may actually improve hypertension, via several mechanisms. These include the impact of the hormone on vasomotricity, its enhancement of baroreceptor sensitivity, and its impact on the hyperinsulinemia characteristic of menopause. Treatment of hypertension must be individualized with respect to gender. More data on the consequences of treatment of women with hypertension are needed, particularly longterm studies to assess the impact of treatment on mortality. [ABSTRACT FROM AUTHOR]

Of the almost 200,000 people who die each year from diabetes or its complications, almost 110,000 are women. Compared with breast cancer--the disease women fear most--diabetes exacts more than twice the toll in lives. This article, the first of two on women's nutritional health and diabetes, deals primarily with the impact of diet and exercise on type 2 diabetes and with the major complication of diabetes, heart disease. "For every person in the United States who has diabetes and is diagnosed, there is one who is not," says Lesley Fels Tinker, a nutrition scientist at Seattle's Fred Hutchinson Cancer Research Center and a member of the American Dietetic Association's Nutrition & Health Campaign for Women advisory board. Obesity, a chronic disease in itself, is also a major risk factor for diabetes, especially for women. "Although type 2 diabetes is largely genetic," explains Roger Mazze, senior vice president at the Minneapolis International Diabetes Center, "obesity will set it off." INSETS: IMPACT STATEMENT: DIABETES;GLUCOSE FOR COMFORT;TALKING THE TALK;RECAP OF THE DIABETES CONTROL AND COMPLICATIONS TRIAL (DCCT)

This article presents information on several new drugs, which are initiated to treat diseases affecting women. The pharmaceutical industry has made a concerted effort to focus on drug research targeted to improving women's health. The new medications cover a range of diseases, many of which are listed as the prominent killers of women, including cardiovascular disease and cancer, as well as significant debilitating conditions such as arthritis and osteoporosis, respiratory ailments, reproductive and endocrine problems, and psychiatric diseases. Cancer is the second leading cause of death among women. Lung cancer claims the most lives, while breast cancer has the highest incidence of new cases. Cancers of the ovary, endometrium, and cervix also challenge women's health. There are 140 new drugs under development to treat cancers affecting women: 61 for breast cancer, 41 for lung cancer, 27 for ovarian cancer, 10 for cervical cancer, and 1 for endometrial cancer. Eleven new drugs are in development to treat autoimmune diseases: 7 for multiple sclerosis, 3 for psoriasis, and 1 for lupus.

This article presents several case studies on thyroid disease in women. Thyroid disease is complex and frequently comes charged with emotional overtones. Patients with thyroid disease frequently experience severe stresses in their lives. Imbalances of thyroid function have profound effects on the body and the mind and, therefore, holistically in the experience of these patients' lives. Detection of thyroid problems, particularly in women, can be challenging because the symptoms are often nonspecific and frequently are dismissed as stress, fatigue, or depression. Four recent cases are discussed, including the thought processes that went into management of the women. These cases highlight the importance of screening and identifying thyroid problems in women and review the issues that need to be considered in patients with seemingly simple thyroid problems. A 17-year old girl had been complaining of fatigue, difficulty sleeping, and difficulty waking in the morning. There was a family history of thyroid disease. This case was fascinating and instructive. First, it highlights how useful the current thyroid-stimulating hormone assay is to diagnose sub clinical thyroid disease, particularly in screening patients without suspected thyroid disease. Second, it illustrates the usual evaluation of a patient who has thyrotoxicosis.

Cardiovascular disease is the leading cause of death among older American women. Estrogen replacement therapy (ERT) appears to reduce the risk of heart disease. For nearly five decades, the Type A behavior p alien (TABP) has been implicated in the cardiac morbidity and moretality of both men and women, but no studies have examined the use of replacement estrogen or whether its association with heart disease risk factors is different in Type A venus Type B women. We examined the effects of ERT and TABP on heart disease risk factors in a large population-based sample. Subjects were 1070 postmenopausal women, aged 50-89 years, who had been participants in the Rancho Bernardo Study. At a clinic visit made during 1984-4987, TABP was assessed with the Bortner Rating Scale, and heart disease risk factors (total cholesterol, high-density and low-density lipoprotein (HDL and LDL), triglycerides, fasting and postchallenge insulin and glucose, and blood pressure) were measured. Based on a median split (median = 154.0) of scores on the Bortner Rating Scale, 52% of these women were classified as Type A. Type A women were significantly younger than Rating women (mean = 684 versus 710 years, respectively). After adjustment for age, significantly more Type A than Type B women were on ERT (35% venus 24.7%, p = 0.001). Analyses stratified by TABP indicated that within the Type A group, current users of ERT had higher levels of HDL cholesterol (p) = 0.00 1) and lower levels of LDL cholesterol (p < 0.01), fasting plasma glucose (p <0.001), and fasting insulin (p < 0.01). Among Type B women, current users of ERT had higher levels of HDL cholesterol (p = 0.07) and triglycerides (p < 0.01), lower levels of LDL cholesterol (p <0.01), and lower systolic blood pressure (p < 0.05) but no significant differs ences in either fasting or postchailenge levels of either plasma glucose or serum insulin (each p < 0.01). Results of this study suggest that ERT may be associated with significant differences in the heart disease risk factor profile in Type A versus Type B women, and these differences may favor Type A women. [ABSTRACT FROM AUTHOR]

Colorectal cancer is the third most common non-skin malignancy in women, after breast and lung cancer. Although approximately 40% of the 65,000 women diagnosed each year eventually die of the disease, colon cancer is highly curable when diagnosed at an early stage. More- over, because the majority of colon cancers arise in previously benign colonic potyps, there is a substantial period, up to several years, in which removal of polyps can reduce the risk of colon cancer. Recently, the United States Preventive Task Force recommended universal screening for colon cancer after age 50. Strong evidence from randomized controlled trials and case-control studies supports use of annual testing for occult blood in stool and flexible sigmoidoscopy every 5-7 years. Although the risk of colon cancer is similar in men and women, women frequently have the perception that colorectal cancer is a man's disease. Partially in consequence, women are less likely than men to undergo screening sigmoidoscopy. Further barriers include primary care providers' lack of awareness of updated guidelines and patients' lack of compliance with multiple screening tests and their fear of discomfort. Be- cause the risk of colorectal cancer can be reduced by up to 75% in those who undergo screening and subsequent surveillance to remove further polyps, it is crucial that women be targeted to undergo screening tests for colorectal cancer. [ABSTRACT FROM AUTHOR]

One third of women between the ages of 50 and 75 have cardiovascular disease, which accounts for more than 50% of all deaths among women annually. Cardiovascular disease not only is the leading cause of death among women; it is more lethal and less aggressively treated in women than in men. Twice as many women-505,440-die from heart disease as from all forms of cancer combined. Despite the compelling statistics, only 8% of women consider cardiovascular disease a personal health threat. The scenario is troubling because women appear to understand so little or to deny their cardiac risks and so not recognize their ability to Control them. Clearly, there is an urgent and compelling need for physicians to take an active role in identifying health behaviors that may affect the risk of cardiovascular disease in theft female patients./bialogue between the physician and patient should begin early to foster preventive steps, and the communication and education must continue throughout the patient's life span. Cardiovascular risk factors, including cigarette smoking, physical inactivity, hypertension, elevated cholesterol, overweight, diabetes, and menopause, should be identified and addressed for all women. [ABSTRACT FROM AUTHOR]

This article presents developments in the Society for the Advancement of Women's Health Research, as of February 1, 1998. The Society held its Annual Scientific Advisory Meeting on October 21, 1997 focusing on a type of research that is having a major impact on women's health and women's health research. The increased interest in outcomes research has paralleled the growth in women's health research. For example, several cardiovascular disease studies have provided evidence that women with heart disease are treated less aggressively than men who had the same symptoms, in spite of the fact that heart disease is the leading killer of both men and women. A report on the Society's meeting will be published by the Society in early 1998. The National Institute of Environmental Health Sciences was encouraged to expand its efforts to better understand why some people are more susceptible to environmental exposure than others. Cardiovascular diseases, the number one killer of both men and women and a main cause of disability, were also highlighted for attention.

The article presents an update on programs and conferences on women's health issues, to be held in April 1999, in the U.S. The Summer Institute on Aging Research, sponsored by the Brookdale Foundation and the National Institute on Aging, National Institutes of Health, offers new researchers intensive exposure to issues and challenges in research on aging. This year's conference will be held from July 10 to 16, 1999. The American Heart Association (AIM) has renamed its Stroke Division, created in 1997, as the American Stroke Association, a Division of the American Heart Association. Bleeding disorders, most notably von Willebrand disease will affect as many as 3% of all girls and women, yet misdiagnosis and clinical mismanagement are common. The National Hemophilia Foundation will hold a conference for healthcare professionals on June 11, 1999 in San Francisco, California. The American Social Health Agency has announced the National ASHA STD Action Plan to enhance public awareness, patient education, provider training and public policy related to sexually transmitted diseases.

The article presents news from the Society for the Advancement of Women's Health Research, as of December 1998. Over the next three years, nearly $600,000 in grants will go to medical school faculty to advance the science of women's health. These grants are being made possible via a program sponsored by the organization Pfizer Women's Health. The Pfizer Scholars Program in Women's Health is modeled after the Pfizer Scholar's Grants for Faculty Development started in 1984. The careers of more than 100 scientists/researchers have been launched through the Pfizer grant program. The 105th U.S. Congress put a major downpayment on promises to double the National Institutes of Health (NIH) budget within 5 years when it passed and sent on to U.S. President Bill Clinton the Omnibus Appropriations bill for fiscal year 1999. According to sources at the NIH, funding for women's health research is expected to grow by 8% next year, whereas NIH as a whole received a 15% increase. Increasing public and private funding for women's health has long been one of the society's priorities. During this Congress, the society has focused its attention on increasing awareness among legislators of the importance of a federal investment in research and adequate funding for the federal agencies conducting research on women's health.

Last month, the results of Heart and Estrogen/Progestin Replacement Study (HERS), the first large, randomized, secondary prevention trial of hormone replacement therapy (HRT) to prevent heart disease were announced and published. The results were surprising: there was no overall cardiovascular benefit to women with heart disease assigned to active hormone therapy. Headlines emphasized the null results as individuals in both the medical and lay communities struggled to understand how these findings could be so different from the large body of observational evidence showing a cardio-vascular benefit of estrogen therapy. With the formal analysis, Hers was a null study showing no effect of HRT on the risk of subsequent coronary disease in women with heart disease. HERS is a randomized clinical trial, which is the study design least likely to yield biased results. It has been suggested that the results of HERS (null) differ from the results of the observational studies because the observational studies are more likely to be biased, particularly by a healthy-user effect.

The article presents a discussion on women and heart disease. It is well known and documented that heart disease is the number-one killer of women. This is a hard message to get through to the general public, because it does not engender the same level of emotive concern as cancer deaths. Yet, every year, an estimated 485,000 American women die from a cardiovascular disease, more than twice the number who die from all forms of cancer. The American Heart Association generates these statistics; they were well publicized during National Women's Heart Health Day in February 1998. Several websites are presented in the article from women can gather information related to heart diseases. A website of the Women's Health Interactive, which is a consumer-education interactive site, uses technologies to disseminate a range of information on women's health topics, including a national listing of women's health clinics. It has a medical advisory board of women's health professionals and organizations. The Mining Co. is a useful site and is extensive in scope. However, there is a problem with resources that are constructed with hidden frames. Frames are split screens that scroll independently, as happens in the Women's Health Interactive site.

There is no reason for women to suffer in silence over their loss of bladder control. Many Women do not view the condition as serious enough to warrant medical attention and are unaware that a physician can treat urinary incontinence Numerous options are available to manage this medical condition ranging from pelvic-floor exercises and medications to surgery. The burden of urinary incontinence causes both an emotional and economic hardship on women trying to cope without treatment. Encouraging women to seek treatment and to raise physicians' responsiveness to the complaint of urine leakage is the goal of an educational campaign. This comprehensive book "Pamphlets for Your Patients," is geared to those who care for people with incontinence, as well as to the general public, with the aim of increasing aware as regarding the available solutions to control and to resolve urinary incontinence. It provides an overview' to assist physicians in approaching the problem with patients, and it outlines management interventions including behavior, surgery, and medical drugs.

A proven strategy to reduce the risk for coronary morbidity and mortality is the reduction of elevated total and low-density lipoprotein cholesterol concentrations in at-risk individuals. However, data from the National Heart, Lung, and Blood Institute's 1995 Cholesterol Awareness Surveys indicate that only 29% of patients with coronary disease--the population in whom the greatest benefit has been shown--are currently receiving lipid-lowering therapy. One possible explanation for the undertreatment of women with lipid disorders is the paucity of data from large-scale clinical trials to support its use in women at risk for coronary heart disease (CHD). Traditionally, women were not included in trials because of their relatively low risk for developing symptomatic atherosclerotic disease before the onset of menopause, even though theft risk rises after menopause to a level comparable to that of age-matched men. This rationale explains in part why earlier prevention trials focused on middle-aged men, who were at greater shorts term risk for CHD.

The article focuses on breast implants. It is said that breast implants are in resurgence. In the year 1998, in the United Stales, breast implant procedures are approaching 120,000, close to the record high of some 150,000 in 1990 and nearly four times the level of 1992. The reason for the upsurge is quite simple. Women want breast implants and are willing to pay for them. Women are willing to pay even for a lesser cosmetic result than in years past, because the only breast implants available today in the country are those filled with, saline. The upsurge reflects women's renewed interest in these prostheses, after women were temporarily driven away by one of the most incredible fiascoes in the history of women's health, the silicone scare. Women read, heard, and saw story after story stating that breast implants filled with silicone gel caused systemic autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus and scleroderma. What made the scare so powerful was that it seemed. to be based on science, coming from a distinguished federal health agency, the U.S. Food and Drug Administration known for its science-based decision making and its experience in risk assessment.

Another weight loss drug has been voluntarily withdrawn from the market, with a substantial amount of fear generated among its users. The first new medication approved in 20 years to treat obesity, dexfenfluramine, was found to be related to cardiac valve abnormalities after even short periods of use. With the possibility of prosthetic valve placement and lifelong anticoagulation, using dexfenfluramine is not a risk worth taking. Weight loss medications do not bring women to their ideal or idealized weights. Obesity medications generally can aid in the loss of only 10% of body weight during the first 6 months of use. Then there is a large degree of recidivism in weight loss, with the typical patient regaining within 5 years all the weight lost. Primary care physicians are responsible for the initial diagnosis and prevention of many chronic diseases, their psychosocial impact on the patient, and their long-term treatment. Primary care physicians must be adept at diagnosis and treatment of obesity, as for any epidemic disease with significant morbidity and mortality.

Last month, a metaanalysis of six prospective studies demonstrated that alcohol consumption is associated with a dose-related increase in invasive breast cancer. The risks of alcohol consumption in women and the linking of alcohol to perhaps women's most dreaded disease was a widely reported story, with the advice that stopping or reducing alcohol might just be one of the only things women can do to lower their breast cancer risk. The theory is that alcohol ingestion causes an increase in levels of estrogen, a tumor promoter. The report, however, came rapidly on the heels of another widely noted report from the epidemiologic research arm of the American Cancer Society describing the benefits of alcohol on overall mortality in women and even on their risk of contracting certain cancers. The challenge for women and for their doctors is to read beyond the headlines, counter the information whiplash, and tailor advice according to a woman's own medical history, needs and personal tastes.

This article presents several fact sheets and pamphlets, useful for physicians to improve the outcome of the patient's treatment. By relying on professionally prepared written materials, a clinician can save time, improve patient compliance, and enhance the dialogue between patient and physician by providing the patient with written material. This material can provide background into the condition being treated, offer an overview of treatment options, and outline general guidelines for compliance. In this issue, patient education materials on women's health made available by the National Institutes of Health/National Heart, Lung, and Blood Institute and the National Institute on Aging are identified for physician's consideration. The fact sheet "Facts About Heart Disease and Women: Preventing and Controlling High Blood Pressure," provides instruction on implementing lifestyle changes to control or prevent high blood pressure, including alcohol use, salt, physical activity, and weight reduction. The fact sheet "Pacts About Heart Disease and Women: Be Physically Active," highlights the benefits of regular physical activity, tips on getting started, types of activities that promote heart health, keys to success, and a sample walking chart.