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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The successful evaluation of tamoxifen as an antiestrogenic therapy for advanced breast cancer in the early 1970's, has resulted in its availability in more than 70 countries around the world. Currently the drug development process is focusing attention upon long-term adjuvant therapy and the future prospect of chemosuppression. Progress at this stage, however, must be cautious. Trials conducted using women with stage I disease have a high proportion of women who may never have a recurrence. At this point, the risk is justified because the toxicity of tamoxifen is low and disease recurrence is invariably very difficult or impossible to control. Future studies in the general population must be carefully weighed to ensure that the hazards do not exceed the benefits. The pharmacology of tamoxifen seems to be a balance of estrogenic and antiestrogenic effects. Longer treatments with the drug must be carefully monitored. Uterine tissue should be examined to ensure that excessive stimulation does not occur. This is particularly true in the light of the recent report that a human uterine carcinoma, transplanted into athymic mice, can grow more rapidly during tamoxifen therapy (Satyaswaroop et al., 1984; Clark and Satyaswaroop, 1985). In fact, we have recently confirmed this observation in a collaborative study with Dr. Satyaswaroop. We have demonstrated that when athymic mice are transplanted in one axilla with an MCF-7 breast tumor and the human endometrial tumor in the other, tamoxifen causes the endometrial tumor to grow, but not the breast tumor. This again illustrates the target site specific effects of tamoxifen. If, in the long run, the estrogenic side effects of tamoxifen are too severe then there is a case for the development of a non-estrogenic antiestrogen. Clearly this may provide benefit for short term (1-2 years) therapy and avoid any estrogen-like stimulation of tumor growth. Similarly, the concern about antithrombin III depression will be avoided. On the negative side, however, the concerns about atherosclerosis and osteoporosis will again have to be addressed with a new generation of agents.
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PMID:Long-term tamoxifen therapy to control or to prevent breast cancer: laboratory concept to clinical trials. 328 87

As a result of decreases in maternal mortality and infectious diseases, women's life expectancy has increased rapidly in this century and is expected to reach 83 years by the year 2000. However, there are a large number of chronic conditions that negatively affect the quality of life of women today: urinary tract infection, menstrual cycle disorders, hypertension, diabetes, osteoporosis, arthritis, eating disorders, substance abuse, and mental depression. Although women's life expectancy is 7.5 years greater than that of men, the morbidity rates are significantly higher for women. As women continue to enter the labor force in large numbers, questions are being raised regarding the physical and psychological hazards of jobs traditionally considered to be women's work, the risks associated with jobs that are physically demanding or involve exposure to toxic substances, and the association between pregnancy outcome and employment. Further research is needed on the effects of multiple role stress on women's health. Another recent trend has been the feminization of poverty: 2/3 of all US adults classified as poor are women. The lack of financial resources has a detrimental effect on nutrition, access to health care, and other preventive behaviors. Yet another social change related to women's health is the increasing number of elderly in the population. Women comprise 72% of the elderly poor, and over 80% of all retiring female workers do not have pension benefits. Access to, availability of, and payment for health care are problems for elderly women. It is important that research address the physiologic, psychosocial, and economic factors that together affect women's health status.
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PMID:Changing factors and changing needs in women's health care. 351 29

Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the "typical" menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45-55 years in Massachusetts. It is demonstrated that menopause itself does not cause poorer health status (either physical or psychologic); menopause itself does not cause an increase in utilization behavior; occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: representative samples of apparently healthy women; and prospective data which elucidate cause-effect relations.
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PMID:Health status and utilization behavior associated with menopause. 378 39

Exercise merits special consideration in caring for postmenopausal women, who face both the normal physical decline accompanying aging and climacteric changes resulting from diminished ovarian function. Regular physical exercise may decrease a woman's risk of developing several medical illnesses, including osteoporosis, cardiovascular disease, obesity, and depression. Moreover, regular exercise has been shown to have a beneficial effect on flexibility, coordination, mood, and alertness. Physicians bear a special responsibility in encouraging and motivating their older patients. At this juncture in their lives, many postmenopausal women seek guidance and assistance from their doctors.
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PMID:Exercise in the postmenopausal woman. 380 30

The Workshop on Epidemiologic and Public Health Aspects of Physical Activity and Exercise was conducted by the Centers for Disease Control on September 24-25, 1984. Fundamental topics were identified prior to the workshop, and experts were invited to participate. Ten papers were written, discussed at the workshop, revised, and are herewith published. The beneficial effects of physical activity on health are becoming progressively more apparent. A reduced risk of coronary heart disease, desirable weight control, and the reduction of symptoms of anxiety and mild to moderate depression are established. Beneficial effects on hypertension, type II diabetes, osteoporosis, and certain psychiatric and psychologic conditions appear likely but require additional study. Although the importance of physical activity to health is becoming better established, several important gaps in our knowledge remain. Physical activity is a complex behavior that is difficult to measure, and the accuracy of most measurement instruments is not known. Knowledge of the patterns of physical activity within our society and the determinants of those patterns is limited. Information on the rates of mechanical, metabolic, and psychologic risks of physical activity is largely absent. In addition, there is a need to know more about the dose-response effects of physical activity, the differential effects on various subgroups of the population, the specific dimensions of activity which effect different aspects of health, and the efficacy of various intervention and promotional strategies. Each paper stands as an independent contribution to the literature. As a group, the authors of these papers have provided the public health and scientific communities with a succinct yet comprehensive summary of the status of knowledge plus specific recommendations for future research in the areas of physical activity, public health, and epidemiology.
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PMID:Workshop on Epidemiologic and Public Health Aspects of Physical Activity and Exercise: a summary. 392 Jul 10

Monophotonic absorption densitometry of the forearm is an exact method for the evaluation of the bone mineralisation, provided the positioning of the forearm is strictly controlled. It is also able to demonstrate progressive enlargement of the bones with age, up until the ages of about 60 to 70 years. The measurements should be performed in two sites: diaphyseal (cortical bone) and epiphyseal (cortical and trabecular bone). The curves obtained from 1,011 controls are in agreement with the current state of knowledge concerning the variations in bone mass during life in both sexes. In women, the number of pregnancies has no influence on the mineralisation index (MI). The values obtained in 156 osteoporotic patients and in 53 subjects with idiopathic hypercalciuria were appreciably lower than those obtained in age-matched controls. In individual subjects, this method appears to be much more discrimination than the measurement of the trabecular bone volume (TBV) for the diagnosis of osteoporosis and no statistically significant correlation was observed between the MI and the TBV. In male controls, there was a depression of the mean curves around the age of 45 years in all four sites of measurement. This depression was also observed in male subjects with hypercalciuria. They correspond to the generations born between 1930 and 1940. The responsibility of a relative nutritional deficiency affecting growing boys during the 1939-45 war is proposed.
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PMID:[Bone densitometry by monochromatic photon absorption. Study of a normal population and values obtained in various pathological conditions]. 409 71

Selected studies on the physiology of the perimenopausal years and the subtle transitional changes that occur up to the postmenopause are reviewed. Extraovarian sources of estrogen, which must be considered when recommending dosage of replacement therapy, are described. The effects of hormonal therapy on endogenous hormones and the important roles of progesterone and prolactin are highlighted. The collected evidence suggests that (a) the vasomotor disturbance and depression experienced by estrogen-deficient women are not psychosomatic disorders, (b) osteoporosis is preventable if estrogen therapy is initiated soon after cessation of ovarian function, and (c) administraton of a weak estrogen combined with a progestogen can effectively prevent or treat the difficulties experienced during the female climacteric.
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PMID:The physiology of the perimenopausal years: a minireview. 610 68

Osteoblast function was investigated in 27 patients with idiopathic osteoporosis. Transiliac bone biopsy specimens were taken after double labelling with tetracycline, and metabolic calcium balance was studied almost simultaneously. Many of the patients showed poor double labelling of their otherwise unremarkable trabecular osteoid, suggesting impaired formation of bone at many of these surfaces. This phenomenon was not accompanied by increased width of osteoid seams (as seen in osteomalacia), indicating that formation of the matrix and its mineralisation were in equilibrium. For the first time, highly significant positive correlations (p less than 0.01) were found between indices of bone formation, determined by labelling with tetracycline, and calcium balance. Thus some patients with osteoporosis who are rapidly losing bone have low rates of formation of trabecular bone both by individual osteoblasts and in relation to available bone surfaces. As histological indices of bone resorption also independently correlated strongly and inversely (p less than 0.01) with calcium balance the rate of initiation of new basic multicellular units by osteoclastic resorption of trabecular surfaces (or the depth of resorption at these surfaces) also appears to be an important determinant of mineral balance. The mechanisms that regulate the effective life span of mature osteoblasts require further investigation, particularly as some promising treatments that can increase trabecular bone volume in osteoporosis, such as parathyroid peptide hPTH (1-34) and sodium fluoride, must work through a reversal of osteoblastic depression.
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PMID:Impaired osteoblast function in osteoporosis: comparison between calcium balance and dynamic histomorphometry. 643 70

A histomorphometric and dynamic study of non-decalcified transiliac biopsies was carried out in 51 cases of osteoporosis who had received double marking with tetracycline before and after two years treatment with association of sodium fluoride (50 mg/day) vitamin, D2 (8,000 IU/day) and calcium (1 g/day). The main effect of fluoride is an increase in the osteoblastic population, which is shown by an increase in the osteoid parameters. The osteoid volume is multiplied by 3,6, the osteoid surfaces by 2,4, and the index of osteoid thickness by 1,2. There exists a lesser increase in the reabsorption surfaces (X 1,2). There results a very significant increase in bony trabecular volume, the average value of which increase from 9,8 +/- 3,1% to 16,6 +/- 9.3% (X 1,8; p < 0.001). These results were found again both in apparently primary osteoporosis and in secondary osteoporosis. No significant depression was noted in the rate of calcification, but six patients developed a state of histological osteomalacia associated in 5 cases with an increased calcified volume. All these results are in good agreement with those of the world literature and indicate that fluoride is able in most cases (60%) to restore normal bones in osteoporosis with reduced risk of fracture.
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PMID:[Histological effects of the treatment of osteoporosis with the combination of sodium fluoride, vitamin D and calcium]. 700 45

In order to determine the effects of parathyroid hormone on bone formation, mean wall thickness (MWT) of trabecular bone packets was measured on transilial undecalcified bone biopsies from 26 patients (14 females and 12 males) with primary hyperparathyroidism (HPT). Mean value of MWT in HPT patients (45.2 +/- 5.8 microns) was found to be significantly lower than in 35 controls (50.1 +/- 8.5 microns) (p less than 0.001). This difference is due to a significant reduction of MWT in HPT females before 50 years of age (46.0 +/- 2.3 microns) when compared with controls (56.2 +/- 7.1 microns; p less than 0.05), whereas there is no significant difference of average MWT in males of any age or in females after 50. These reductions of MWT could explain the rarefaction of spongy bone previously noticed in HPT females younger than 50 years. Furthermore, because of the mild depression of the osteoblastic activity measured by tetracycline double-labeling in HPT, the osteoblastic formation period was determined to be shortened in females before 50 years, and lengthened in females after 50 years of age and in males of any age. This could explain the anabolic effects of 1-34 hPTH fragment on trabecular bone volume in postmenopausal osteoporosis.
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PMID:Effects of parathyroid hormone on remodeling of iliac trabecular bone packets in patients with primary hyperparathyroidism. 706 20


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