東京女子医科大学雑誌
Online ISSN : 2432-6178
Print ISSN : 0040-9022
ISSN-L : 0040-9022
最新号
選択された号の論文の5件中1~5を表示しています
目次
総説 性差医療
  • 佐藤 加代子
    2019 年 89 巻 4 号 p. 73-82
    発行日: 2019/08/25
    公開日: 2019/09/06
    ジャーナル オープンアクセス

    Differences in cardiovascular disease are found between the genders. In women, it is known that estrogen has both indirect and direct protective effects on the cardiovascular system. This includes a decrease in low-density lipoprotein cholesterol (LDL-C), an increase in high-density lipoprotein cholesterol (HDL-C), the vasodilatation response by endothelial Nitric Oxide Synthase (eNOS) synthase, and prostacyclin synthesis.

    Many cases of coronary spastic angina and acute coronary syndrome (ACS) have been observed during the menstrual and the late luteal phases of the menstrual cycle, corresponding with low levels of estrogen. After menopause, the risk of atherosclerosis and associated conditions such as; dyslipidemia, hypertension, obesity, diabetes, T cell activation, and adhesion molecules, increase. Consequently, the risk of a cardiovascular event also increases. In addition, regarding the pathological mechanism underlying ACS, erosion is observed most prominently during pre-menopause, whereas plaque rupture is observed in post-menopause.

    Furthermore, microvascular angina is often found in menopausal women displaying various symptoms, thus a diagnosis may be difficult. We recognize a decrease in vascular endothelial function and the coronary flow reserve and a high level of lactic acid in the coronary sinus as diagnostic criteria. Regarding problems associated with the "super-aging" society, there are many elderly female patients with HFpEF (heart failure with preserved ejection fraction) who have diastolic dysfunction. Also well-known are cases of atherosclerosis and osteoporosis progressed by common risk factors, and recently, vascular bone disease.

    There are characteristics in women for microvascular angina and heart failure, as well as ischemic heart disease, due to atherosclerosis caused by the sex hormone environment in later life stages. Considering gender-specific medicine in the prevention and treatment of cardiovascular disease is important for healthy aging of women.

  • 石黒 直子
    2019 年 89 巻 4 号 p. 83-88
    発行日: 2019/08/25
    公開日: 2019/09/06
    ジャーナル オープンアクセス

    Here we present dermatological diseases and symptoms with a focus on women. The diseases and symptoms are divided into the following 3 groups, and we focus mainly on the first: 1) skin diseases/symptoms found more commonly in women, 2) diseases with increased prevalence due to traditional lifestyles of mothers, and 3) non-life-threatening diseases associated with the natural aging process.

    The paper explains the skin symptoms and characteristics of collagen diseases which are extremely common in women. Specifically, it looks at 3 systemic diseases whose early diagnosis requires examination by a dermatologist: systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis (DM). In order to accurately diagnose a patient, healthcare professionals must recognize specific skin symptoms and understand which diseases they signify. For example, butterfly rashes and intractable pernio-like eruptions are indicative of SLE, Raynaud's phenomenon and nail fold bleeding are initial symptoms of SSc, and facial erythema is an early symptom of DM.

    Next, this paper outlines the symptoms and treatment of hand eczema, and the importance of addressing the relationship between traditional gender roles and their prevalence.

    Finally, this paper recognizes that women are increasingly seeking treatment for aging-related skin diseases such as senile pigment freckles, verruca senilis, and diffuse alopecia. We then suggest strategies for meeting the needs of these patients.

原著
  • 野原 理子, 小池 美菜子, 竹内 正樹, 新井田 達雄
    2019 年 89 巻 4 号 p. 89-96
    発行日: 2019/08/25
    公開日: 2019/09/06
    ジャーナル オープンアクセス

    Working hours and workloads have not improved among hospital physicians. In addition to patient care, hospital physicians are expected to perform education, research, and administrative tasks. To improve these conditions, it is important to understand the reasonable allocation of tasks for each physician. We distributed a checklist designed to self-assess the workload of each duty to 201 hospital physicians. One hundred and eighty-six physicians responded (83.6%). More than half of all the physicians who responded indicated that their direct patient care workload was moderate. However, many younger physicians thought that their indirect patient care workload was heavy. More than half of the physicians in their twenties, along with 70% in their thirties and 80% in their forties, responded that their research workload was light. More than 60% of all the physicians responded that their indirect patient care workload needed to be adjusted. Many of the physicians thought that they should manage their self-development and research workloads, and the hospital should be responsible for easing their patient care and administrative workloads. Hospital physicians' perceptions of the workload of each duty differed by age. Each physician's request should be reflected in the discussion of the improvement of working conditions.

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