Posted by: jass
January 7, 2015
It is part of a gynaecologist’s remit to care for the older woman’s bone health. Integrity of the endochondral skeleton is essential to wellbeing and past the menopause transition more attention needs to be focused on preventative measures to guard against osteoporosis.
Osteoporosis is not a deficiency disease but an imbalance of the endocrine systems (parathyroid and estrogen) that provide homeostatic control of extra-cellular calcium by balancing osteoclast and osteoblast activity (Clements NEJM 2014;371:963-4). These systems and their enzymes require vitamins such as D, C, B12 and K for their...
Why don’t governments ban smoking?
Why do they not pass legislation banning cigarette smoking in every place that has a roof?
Politicians know that smoking is bad for the health of the population and that health budgets are growing exponentially. So why not reduce expenditure by preventing the many diseases caused by smoking by enacting anti-tobacco legislation?
Several answers suggest themselves.
Firstly, it would require effort to introduce anti-smoking laws and the positive effects are not well documented (until now). Secondly they will make enemies of the powerful tobacco companies....
The journals are full of articles about national health care systems, economics, austerity
and forecasts of tough times ahead. The Americans continue to spend twice as much
per capita per year than other developed countries ($8000 v$4000) and are wrestling with
how to reduce costs – a quest that is made that much more difficult by their free-market
system. Pharma and specialists make big bucks from affluent people who are prepared
to spend money on their health which fuels “high-end service and over-servicing”. It is
their choice and it is not immoral, it just...
In trawling the journals for O & G articles, one comes across certain healthcare issues that keep appearing but do not strictly fall within the “women’s health” ambit. Topics like obesity, smoking, cardiovascular or cancer statistics, diets and exercise that perhaps all doctors should know about – not only so they can hold down a dinner conversation – but because the subjects do apply their patients, their families and themselves.
JASS sees a part of its task to inform on general health matters. Genomics is one such matter – hence the evaluation of a decade...
The active management of the third stage of labour has saved countless women’s lives. An oxytocic injected at delivery, early clamping of the cord and controlled cord traction are the time-honoured steps in preventing postpartum haemorrhage. But as science has looked more closely at each step in the process, so have the benefits of each become questioned. There is no doubt that an uterotonic agent is essential – but which one and what route of administration? At present it seems there are advantages of parenteral oxytocin over oral misoprostol but there are cogent arguments for the latter...
This month’s emphasis is on lifestyle conditions that seem to be dominating every journal these days. Maybe it is to do with cost and future budgeting with researchers fearing that people who become ill with “personally preventable diseases” will take a large slice out of the healthcare cake – to which they – the healthy ones have been contributing, leaving less for the “good guys”.
Will there be actuarially loaded Medical Aid contributions for smoking, being overweight or not being active? Will doctors have to complete check-lists for every patient...
There are a number of ways of removing a woman’s uterus for benign conditions and the choice of operations continues to expand. The latest contender is robotic surgery where the patient has instruments introduced into her abdomen laparascopically and these tools are then mechanically operated (robotically) by the surgeon who sits at a console in theatre viewing the action on a screen and manipulating the procedure using devices on the console remote from the patient.
Basically it is a sophisticated form of laparascopic surgery. The term robotic is a bit of a misnomer as the surgery...
The Women’s Health Initiative study published in 2003 showed an increase harms over benefits in women taking conjugated equine estrogens plus norethisterone compared with those taking placebo. However, recent work has not supported these decade-old results so revised statements are appearing from influential organisations such as the International Menopause Society and endorsed by The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause, Society, The International Menopause Society, The International...
Posted by: jass
December 4, 2012
Women in developed countries are delaying having their first child with an age of 30 years being
the mean in some European countries. Despite older mothers having a statistically greater risk
of chromosomal abnormalities, hypertension and gestational diabetes, the vast majority of their
pregnancies have happy endings and there is now evidence that their offspring fare better than
those born to younger women (Sutcliffe et al BMJ 2012;345:e5116).
Those born to women between 33 and 40 years old are more likely to be vaccinated, suffer less
trauma and are less likely to be admitted to hospital...
Posted by: jass
December 4, 2012
As doctors we deal with the side effects of obesity but is the solution to being overweight in
One might as well ask – is the solution to crime in the police hands?
The logical response is “Well, if not – then in whose hands?”
This is where I admire New York’s mayor, Michael Bloomberg, who is showing true leadership
in domains that everybody knows about but in which few show statesmanship. He is confronting
those putting profits ahead of moral issues in making a fast buck out of unhealthy fast food and
Let us hope that President...