Caring for vulnerable populations: curricula in U.S. internal medicine residencies.

The Accreditation Council for Graduate Medical Education (ACGME) encourages internal medicine training programs to include specific curricula devoted to health care issues of vulnerable populations. Our aim was to determine the prevalence of curricula involving selected vulnerable populations among U.S.

Alcohol and folate intake and breast cancer risk in the WHI Observational Study.

Background: Alcohol increases breast cancer risk. Epidemiological studies suggest folate may modify this relationship.

Objective: To examine the relationship among breast cancer, alcohol and folate in the Women's Health Initiative-Observational Study (WHI-OS).

Venous thrombosis and conjugated equine estrogen in women without a uterus.

Background: Postmenopausal hormone therapy has been associated with a 2- to 3-fold increased risk of venous thromboembolism (VT) (including deep vein thrombosis and pulmonary embolism) in observational studies and secondary prevention clinical trials. Clinical trial data on the effects of estrogen alone on VT are limited.

Methods: The Women's Health Initiative estrogen trial enrolled 10 739 women aged 50 to 79 years without a uterus.

Women and alcohol.

Primary care providers are uniquely positioned to educate women about alcohol use and misuse. Early identification and intervention can significantly limit the adverse consequences of alcohol abuse. Physicians must recognize the risk factors, presentation, and treatment issues relevant to women.

Principles of diagnosing and managing postmenopausal osteoporosis for the podiatric physician.

Osteoporosis is an asymptomatic disease until a fracture occurs. The prevalence of osteoporosis will rise with the aging of the population. Recent advances have led to more efficacious treatment options.

Perioperative care of the patient with hip fracture.

Primary care physicians can intervene to reduce perioperative complications due to comorbid medical illness in patients hospitalized with hip fracture. We review the role of the primary care physician in the treatment and prevention of perioperative morbidity and mortality.

Diagnosing and managing post menopausal osteoporosis: opportunities for fracture prevention.

Osteoporosis is an asymptomatic disease until a fracture occurs. Management includes primary prevention, early detection through targeted screening, and implementation of appropriate treatment and monitoring strategies. This article explores these issues in depth.

Phytoestrogens: potential benefits and implications for breast cancer survivors.

Phytoestrogens are a group of plant-derived substances that are structurally or functionally similar to estradiol. There has been much interest in the potential role of phytoestrogens in cancer prevention and treatment of estrogen-deficient states. This review summarizes the evidence for phytoestrogen risks and benefits relevant to the breast cancer survivor, including prevention of a second primary breast cancer or metastatic disease, reduction in menopausal symptoms, and interactions with tamoxifen.

Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial.

Context: The Women's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Outstanding issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography.

Objective: To determine the relationship among estrogen plus progestin use, breast cancer characteristics, and mammography recommendations.

Postmenopausal hormone therapy in the aftermath of the WHI. What patients need to know.

HT is now relegated primarily to the treatment of menopausal symptoms. It should be used for this indication at the lowest effective dose and for the shortest duration possible. Consideration should be given to other strategies to control symptoms when patients are willing to try less effective but potentially safer alternatives to HT.

Alcohol use disorders in women. Screening methods and approaches to treatment.

Primary care physicians have a unique opportunity to educate women about alcohol use and to identify those with alcohol problems. Early identification and intervention can significantly limit the adverse consequences of alcohol abuse. To identify alcohol abuse and intervene most effectively, physicians need to recognize the differences in risk factors, presentation, and treatment relevant to women.

Evaluating a lesbian and gay health care curriculum.

Background: Many physicians are not prepared to deal with the health care concerns of their lesbian and gay patients.

Purpose: To examine the impact of a seminar on the self-reported level of preparedness and comfort in dealing with lesbian and gay patients among general internal medicine residents.

Methods: General internal medicine residents at Rhode Island Hospital, Brown University participated in the 3-hr seminar.