Science and advocacy as partners: the Office of Research on Women's Health in the 1990s.

The federal government's investment in research related to sex/gender differences in health and disease has resulted in better understanding of the health of women and men and holds promise for improved health. By working together, advocates for women's health and the scientific community have expanded the focus of women's health research and created new opportunities in science. The Office of Research on Women's Health has assessed and identified progress and needs in women's health in its Agenda for Research on Women's Health for the 21st Century and will continue to collaborate with the advocacy and scientific communities to keep women's health research a high national priority that is responsive to changing public health needs.

Agenda for women's health research. Improving women's musculoskeletal health.

Increased attention and resources focused on women's health during the past decade have resulted in new offices, policies, and programs of the Federal government. The Office of Research on Women's Health, established by the National Institutes of Health in 1990, is a focal point for all National Institutes of Health-supported efforts to improve women's health through biomedical and behavioral research. The Office of Research on Women's Health ensures women's appropriate inclusion in research studies supported by the National Institutes of Health. Through the development of a comprehensive agenda for research on women's health, the Office of Research on Women's Health encourages the consideration of gender issues and gender differences in health and disease in research sponsored by the National Institutes of Health. The importance of research to study and improve women's musculoskeletal health has become increasingly recognized. Clinicians, researchers, and representatives of professional and advocacy organizations concerned with women's musculoskeletal health participated in the development of the initial research agenda on women's health in 1991 and participated in the meetings to update and revise the agenda in 1996 and 1997. As a result of meetings convened to review and revise the agenda on women's health for the twenty-first century, many recommendations for additional research on women's musculoskeletal health have been developed and now are being implemented across the National Institutes of Health.

The diverse faces of violence: minority women and domestic abuse.

In research and clinical practice, the failure to detect and/or elicit information about domestic abuse is exacerbated by social, economic, and cultural factors. Because domestic violence cannot be separated from the cultural and social context in which it occurs, such factors must be integrated into research studies and the development of interventions. The National Institutes of Health's expanded guidelines on the inclusion in its clinical trials of women from all ethnic and racial backgrounds, along with an increased recognition of the importance of socioeconomic and psychosocial factors in health and disease, has strengthened efforts to improve understanding of domestic violence in diverse communities. The involvement of researchers from minority communities is crucial to the success of such efforts. Study of the relationships among race, ethnicity, culture, and domestic violence must be fully incorporated into medical school curricula to sensitize students and enable them to develop the skills needed to detect more effectively deal with, and ultimately prevent, family and intimate violence.

Older women's health: clinical care in the postmenopausal years. A roundtable discussion part 2.

Prevention of late-life disability is an important goal in managing the health care of older women. Hormone replacement therapy and regular exercise can protect against osteoporosis and heart disease. Dietary measures can control weight and prevent diabetes. Adequate calcium and vitamin D intake help protect bones from fractures. Mammography and Pap smears are proven screens for early cancer detection. Depression is not unusual in older women, but it is often masked by physical symptoms. Physicians can help women at risk for caregiver burnout by providing referrals and information on community resources. Use of other health professionals, as well as patient education videos and printed materials, can help physicians provide comprehensive care within the time limits of office practice.

Older women's health: 'taking the pulse' reveals gender gap in medical care.

In the United States, for every 100 men age 65 and older, there are 147 women, a ratio that has social and medical consequences. Five panelists "take the pulse" of older women's health in general and in the offices of primary care physicians in particular. They assess the status of medical education and the need to include older women in research and drug trials, issues of gender bias in health insurance and quality of treatment, ways to improve the use of preventive health services--such as mammography and Pap smears--by older women, and the role of office physicians in identifying and helping victims of domestic violence.

The evolution of the Women's Health Initiative: perspectives from the NIH.

The Women's Health Initiative (WHI) addresses some of the major health concerns of postmenopausal women. It is designed to test whether long-term preventive measures will decrease the incidence of cardiovascular disease, certain cancers, and fractures, and it seeks to find better predictors of future health and disease in older women. This report traces the evolution of the clinical trial and observational study (CT/OS) components of WHI from early planning in the 1980s to the current status of the WHI CT/OS as an integrated, ongoing clinical study. Particular attention is directed to the antecedent planning meetings and feasibility studies that formed the underpinnings of the WHI. The issues of hormone replacement therapy and of the optimal diet for postmenopausal women were investigated for almost a decade prior to WHI. However, no studies of sufficient size and duration to confidently test the value and risks of these approaches were initiated because of the cost and insufficient political commitment. The initiation of WHI in 1991 represents the confluence of scientific need and capability with the social priorities to improve the health and welfare of women.

The role of the NIH's Office of Research on Women's Health.

The Office of Research on Women's Health (ORWH) at the National Institutes of Health (NIH) was created in 1990 to carry out three major mandates: (1) to strengthen, develop, and increase research into diseases, disorders, and conditions that are unique to, more prevalent among, or more serious in women, or for which there are different risk factors for women than for men; (2) to ensure that women are appropriately represented in biomedical and biobehavioral research studies, especially clinical trials, that are supported by the NIH; and (3) to direct initiatives to increase the number of women in biomedical careers. One of the ORWH's first accomplishments was a 1992 report that serves as a basis for the ORWH's research agenda; its recommendations focus on scientific issues affecting women's health from birth to old age. To implement these recommendations, the ORWH does not fund studies directly but instead provides funds through NIH institutes and centers to augment new research initiatives, to expand ongoing studies to address high-priority areas concerning women's health (14 of which were identified for special consideration in FY 93), and to increase the participation of women in clinical studies. In addition, the ORWH is playing a key advisory role in the NIH's Women's Health Initiative, a long-term study of over 100,000 women to examine the major causes of death, disability, and frailty--heart disease and stroke, breast and colorectal cancers, and osteoporosis--in older women of all races and from all socioeconomic strata.(ABSTRACT TRUNCATED AT 250 WORDS)