The document discusses controversies around the management of menopause and quality of life (QoL) for menopausal women. It discusses two types of medical practice - individual clinical medicine and population-based social medicine. It argues practitioners should not overemphasize epidemiological associations that are not necessarily cause-effect findings. The document also discusses interactions between cardiovascular disease, osteoporosis and obesity, and reviews evidence that hormone therapy may be safe and effective for relieving menopausal symptoms in younger women.
This document discusses treatment options for climacteric (menopausal) women based on the experience and perspectives of Dr. Manuel Neves-e-Castro. It begins by introducing Dr. Castro and his background. It then discusses definitions and objectives related to treating climacteric women, including critical objectives like diagnosis, risk identification, and symptom/disease treatment. It also discusses specific objectives and targets related to conditions like cardiovascular disease, CNS issues, bones, reproductive organs, and more. The document provides examples of treatment options and projects for various objectives. It continues discussing controversies, lessons from studies like WHI, effects on heart disease and breast cancer risk, and considerations around hormone therapy.
1. The document provides an overview of integrative medicine, discussing definitions of primary care, healthcare trends, evidence-based treatments, and the role of complementary and alternative medicine.
2. It describes a typical day in the life of a physician, including patient cases, medical education and certification requirements, and professional positions held.
3. The future of healthcare is discussed, focusing on healthcare reform, accountable care organizations, and rewriting medical education through programs like the MS ACP at National University of Health Sciences.
The natural medicine physician plays an important role within a new healthcare paradigm focused on wellness rather than just disease treatment. Conventional medicine has had successes but also problems like high costs, side effects, and not addressing the root causes of disease. Patients increasingly seek natural medicine due to these issues with conventional care. A wellness-oriented approach to primary care that emphasizes prevention, lifestyle, and addressing underlying causes can help reduce the disease burden and rising healthcare costs crisis. Research supports that addressing modifiable risk factors through lifestyle and behavioral changes can significantly reduce mortality and morbidity from chronic diseases. Overcoming political and reimbursement barriers can help create a system that better facilitates this wellness-focused approach.
1) The document provides an overview of falls prevention and treatment for older adults. It discusses epidemiology facts about falls and examines assessment strategies across four domains: medical, cognitive, functional, and environmental.
2) Key points covered include that 25% of community-dwelling older adults fall each year, with 5-10% of falls causing serious injuries like fractures. Falls are also the most common cause of traumatic brain injury in the elderly.
3) The document emphasizes the importance of assessing multiple risk factors across different domains to identify potentially treatable diagnoses. It provides examples of medical, cognitive, functional, and environmental risk factors and stresses that etiologies of falls are usually multifactorial.
The document discusses the field of geriatrics, including definitions, common medical conditions among elderly patients, complications in their treatment, and various geriatric specialties. Key topics include delirium, medication management, falls, atypical presentation of diseases, and palliative care for seniors. The aging population is driving increased demand for specialists trained in the unique healthcare needs of older adults.
The document discusses exercise for cancer patients across the cancer care trajectory. It covers goals of cancer rehabilitation including prevention, restoration, support, and palliation. It then discusses exercise for prevention, detection, coping with treatment, rehabilitation after treatment, survival, health promotion, and palliation. Specific benefits of exercise discussed include reducing cancer risk and recurrence, managing treatment side effects, and improving physical and psychological well-being.
Transition from allopathic to integrated medical practiceLouis Cady, MD
This is the keynote lecture of the series of three lectures that Dr. Cady presented to the World Link Medical seminar in Salt Lake City, Utah on June 1, 2012.
Pediatric rheumatoid arthritis is a form of arthritis that affects approximately 1 in 1,000 children each year. It involves inflammation of one or more joints and can cause pain, swelling, and stiffness. The most common types are juvenile rheumatoid arthritis and arthritis following a viral or bacterial infection. Treatment focuses on controlling inflammation through medications like DMARDs and biologics to prevent joint damage and disability. Nurses monitor for signs of arthritis, ensure proper treatment, educate patients and families, and help patients manage pain and maintain function.
This document discusses treatment options for climacteric (menopausal) women based on the experience and perspectives of Dr. Manuel Neves-e-Castro. It begins by introducing Dr. Castro and his background. It then discusses definitions and objectives related to treating climacteric women, including critical objectives like diagnosis, risk identification, and symptom/disease treatment. It also discusses specific objectives and targets related to conditions like cardiovascular disease, CNS issues, bones, reproductive organs, and more. The document provides examples of treatment options and projects for various objectives. It continues discussing controversies, lessons from studies like WHI, effects on heart disease and breast cancer risk, and considerations around hormone therapy.
1. The document provides an overview of integrative medicine, discussing definitions of primary care, healthcare trends, evidence-based treatments, and the role of complementary and alternative medicine.
2. It describes a typical day in the life of a physician, including patient cases, medical education and certification requirements, and professional positions held.
3. The future of healthcare is discussed, focusing on healthcare reform, accountable care organizations, and rewriting medical education through programs like the MS ACP at National University of Health Sciences.
The natural medicine physician plays an important role within a new healthcare paradigm focused on wellness rather than just disease treatment. Conventional medicine has had successes but also problems like high costs, side effects, and not addressing the root causes of disease. Patients increasingly seek natural medicine due to these issues with conventional care. A wellness-oriented approach to primary care that emphasizes prevention, lifestyle, and addressing underlying causes can help reduce the disease burden and rising healthcare costs crisis. Research supports that addressing modifiable risk factors through lifestyle and behavioral changes can significantly reduce mortality and morbidity from chronic diseases. Overcoming political and reimbursement barriers can help create a system that better facilitates this wellness-focused approach.
1) The document provides an overview of falls prevention and treatment for older adults. It discusses epidemiology facts about falls and examines assessment strategies across four domains: medical, cognitive, functional, and environmental.
2) Key points covered include that 25% of community-dwelling older adults fall each year, with 5-10% of falls causing serious injuries like fractures. Falls are also the most common cause of traumatic brain injury in the elderly.
3) The document emphasizes the importance of assessing multiple risk factors across different domains to identify potentially treatable diagnoses. It provides examples of medical, cognitive, functional, and environmental risk factors and stresses that etiologies of falls are usually multifactorial.
The document discusses the field of geriatrics, including definitions, common medical conditions among elderly patients, complications in their treatment, and various geriatric specialties. Key topics include delirium, medication management, falls, atypical presentation of diseases, and palliative care for seniors. The aging population is driving increased demand for specialists trained in the unique healthcare needs of older adults.
The document discusses exercise for cancer patients across the cancer care trajectory. It covers goals of cancer rehabilitation including prevention, restoration, support, and palliation. It then discusses exercise for prevention, detection, coping with treatment, rehabilitation after treatment, survival, health promotion, and palliation. Specific benefits of exercise discussed include reducing cancer risk and recurrence, managing treatment side effects, and improving physical and psychological well-being.
Transition from allopathic to integrated medical practiceLouis Cady, MD
This is the keynote lecture of the series of three lectures that Dr. Cady presented to the World Link Medical seminar in Salt Lake City, Utah on June 1, 2012.
Pediatric rheumatoid arthritis is a form of arthritis that affects approximately 1 in 1,000 children each year. It involves inflammation of one or more joints and can cause pain, swelling, and stiffness. The most common types are juvenile rheumatoid arthritis and arthritis following a viral or bacterial infection. Treatment focuses on controlling inflammation through medications like DMARDs and biologics to prevent joint damage and disability. Nurses monitor for signs of arthritis, ensure proper treatment, educate patients and families, and help patients manage pain and maintain function.
Osteopathic medicine began in the United States with DOs believing in manipulation to positively affect physiology. While early DOs had varying scopes of practice, today all DOs have equal practice rights to MDs. To become a DO requires an undergraduate degree, high MCAT scores, medical school acceptance and training which includes rotations in specialties and primary care. Osteopathic medical schools have grown from 5 private schools in the late 19th/early 20th century to 25 schools today, with some publicly funded to address physician shortages.
The document describes a case study of a 58-year-old man referred to physical therapy for low back pain. During the initial evaluation, the physical therapist discovered an abdominal aortic aneurysm (AAA) as the likely cause of the patient's symptoms through abdominal palpation. Computed tomography imaging confirmed a 5.5 cm AAA. The purpose of the case study was to demonstrate the clinical reasoning that led to the identification of an AAA despite the patient's reported mechanical low back pain, and to describe an evidence-based approach for evaluating patients with possible AAAs.
Geriatric rehabilitation aims to care for the elderly population. Methods of treatment include physical therapy and fall prevention exercises to increase leg strength and balance. Additionally, emotional therapy and music therapy can help address depression and anxiety that is common in elderly patients. The goal is to help seniors live as independently as possible through a variety of rehabilitation techniques.
The document discusses arthritis, including its two main types - osteoarthritis and rheumatoid arthritis. Osteoarthritis normally affects the hips, knees and hands and is caused by normal wear and tear as we age, sometimes worsened by injury. Rheumatoid arthritis frequently appears on hands, wrists and feet and is caused by the immune system attacking tissues in joints.
The DOH has several programs to help reduce arthritis deaths, including aquatic and exercise programs run by the Arthritis Foundation, as well as nationwide campaigns promoting healthy lifestyle. The DOH disseminates information through television, radio and other media.
Living with Arthritis - Lauren Kennish - 10.15.19Summit Health
By conservative estimates, nearly 40 million people in the U.S. are affected by some form of arthritis. Slightly more than half of those cases suffer from osteoarthritis, which is degenerative, and a small percentage suffer from rheumatoid arthritis and psoriatic arthritis, autoimmune disorders that inflame the lining of the joints. Our expert will provide an overview of different types of arthritis, with a focus on symptoms, diagnosis, and new treatment and management strategies.
This document discusses physical therapy approaches for cancer patients experiencing common symptoms like fatigue, pain, and breathing difficulties. It covers:
1. Definitions and screening tools for cancer-related fatigue and pain. Fatigue is graded on a scale and can interfere with daily activities. Pain is also assessed for intensity.
2. Non-pharmacological treatments for fatigue and pain including energy conservation, exercise, massage, heat/ice therapy, and electrotherapy. Exercise is recommended for patients during and after cancer treatment.
3. Cancer pain has multiple causes and classifications. The WHO pain ladder provides guidance on pain management strategies from non-opioid to opioid approaches. Physical therapy can help address pain through techniques like
It's a Pain in the Neck (and Back too!)Summit Health
Thank you to the Montclair Public Library for hosting SMG's Joanne Owsiak, MD, Interventional Pain Management specialist, for a community lecture on Neck and Back Pain. Eighty-five percent of people experience low back pain during their lifetime, and back pain has become the fifth most common reason for all physician visits. Dr. Owsiak shared with the audience the many causes of neck and back pain and the pain management options available for treating all types.
Exploiting Marginality In Health: Is Subhealth Another Case of Disease MongeringHK Metropolitan University
Subhealth is a concept in China that refers to a state between full health and disease. It has been promoted by Chinese companies and media to market health products. While subhealth research aims to understand chronic disease risks, critics argue it has been used more for commercial gain through dubious diagnostic methods and aggressive marketing. Recommendations include refining subhealth definitions and criteria, focusing research on true chronic disease prevention rather than profits, and separating subhealth research from political and economic interests.
This study examined the role of diet and fasting on arthritis disease activity through a survey of 100 arthritis patients in Kashmir, India. 80% of rheumatoid arthritis patients and 53% of osteoarthritis patients believed their symptoms were aggravated by certain foods. Red meat was most commonly reported to exacerbate symptoms, by 80% of rheumatoid arthritis patients and 41.1% of osteoarthritis patients. Fasting during Ramadan provided relief from symptoms for 61% of rheumatoid arthritis patients and 49.3% of osteoarthritis patients. The study concluded that diet and fasting can influence disease activity in joint disorders.
Audio and slides for this presentation are available on YouTube: http://youtu.be/Tt8WlPsohCU
Fatigue is a common side effect of cancer treatment. Fatigue from treatment can make everyday tasks and activities difficult to complete or enjoy. Join Jean Boucher, RN, an Oncology Nurse and Clinical Inquiry Specialist from the Nursing Department at Dana-Farber Cancer Institute, and discover how to manage cancer fatigue, improve sleep, mood, and nutrition habits, and boost energy levels.
Psikiyatri ve mental sağlıkta fizyoterapi gündemiUfuk Yurdalan
The document discusses the agenda for physical therapy in psychiatry and mental health. It mentions the International Organization of Physical Therapists in Mental Health (IOPTMH), which was recognized as a subgroup in 2011. It also lists the president of IOPTMH and mentions Mental Health Subgroup 5, which focuses on evidence-based physical therapy in mental health. Finally, it provides a link to the International Centre for the Prevention of Psychiatry and Mental Illnesses website on conferences.
Evidence based management of osteoarthritis in primary care - Dr Jonathan Quickepcsciences
Dr Jonathan Quicke is an NIHR Academic Clinical Lecturer in Physiotherapy (Keele University). Dr Quicke presented at the 2017 Musculoskeletal Education Day, where he discussed how we can ensure that best practice can be implemented within general practice for patients suffering with osteoarthritis
Osteopathic medicine provides all the benefits of modern medicine like drugs, surgery, and technology for diagnosis and treatment, while also offering hands-on osteopathic manipulative medicine. It emphasizes prevention and wellness. DO students complete four years of medical school coursework covering topics like anatomy, biochemistry, and clinical specialties. They must pass board exams to graduate and become licensed physicians, then complete 3-8 years of residency training in a specialty to also become board certified.
This study examined the relationship between falls and muscle strength, flexibility, and balance in 133 postmenopausal women with osteoporosis and 133 without osteoporosis. The researchers found that a significantly higher percentage of women with osteoporosis (51%) reported at least one fall in the previous year compared to women without osteoporosis (29%). Logistic regression analysis showed that lower trunk extension strength and the presence of osteoporosis were associated with an increased risk of falls. Specifically, greater trunk extension strength was associated with a lower risk of falls, while the presence of osteoporosis increased the risk of falls.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This document outlines an MSc nursing course focused on orthopedic nursing. The course consists of 1100 hours of instruction over 2 years, with 150 hours of theory and 950 hours of practical experience. The course aims to develop expertise in orthopedic nursing and enable students to function as orthopedic nurse practitioners. It covers topics like assessment of orthopedic patients, care of devices, trauma/injuries, infections, tumors, deformities, and more. Students gain clinical experience in orthopedic wards, operating theaters, and rehabilitation units. The course evaluates students through theory exams, practical assignments, case studies, and clinical performance evaluations.
This document discusses how art therapy can help individuals with Chronic Fatigue Syndrome (CFS). [1] CFS is a disabling condition characterized by severe fatigue, pain, and cognitive impairment. [2] Art therapy allows CFS patients to engage in a controllable and mentally relaxing activity. [3] Studies have found art therapy can reduce stress, build self-esteem, and help CFS patients find meaning in their lives despite their illness.
This presentation is an overview of the resources of the Computing, Multimedia and Telecommunication Studies of the Open University of Catalonia (Universitat Oberta de Catalunya - UOC): the virtual campus, virtual labs, innovation projects and physical spaces.
This document provides an introduction and background information on a study examining startle response and pre-pulse inhibition in adolescent rats from three groups: 1) rats that received neonatal lesions of the ventral hippocampus, 2) rats that were prenatally stressed, and 3) control rats. The study found that rats with neonatal lesions had significantly higher startle amplitudes compared to controls and prenatally stressed rats. Prenatally stressed rats had significantly lower startle responses compared to both other groups. Both experimental groups showed higher pre-pulse inhibition compared to controls. The document discusses etiological factors in schizophrenia like genetics, prenatal factors, and neurochemical dysfunction. It provides context on animal models using stress, lesions, and pre-pulse inhibition
Stevens Institute of Technology Annual Report 2004-2005pberzins
This annual report from Stevens Institute of Technology summarizes the 2004-2005 school year. It highlights advances in research related to homeland security, cybersecurity, nanotechnology, and environmental systems. It also discusses the growth of academic programs in engineering, the expansion of international partnerships, and the achievements of Stevens students and faculty. The President and Chairman express optimism about Stevens' trajectory and potential to become one of the top research institutions in the U.S. and world.
The document provides an overview and objectives of analyzing LibQUAL+® survey results. It discusses interpreting results internally by identifying areas of best and worst performance. It also covers benchmarking results externally against consortium data and longitudinally to assess the impact of changes. The document outlines quantitative analysis of survey scores and qualitative analysis of comments. It recommends using tools like LibQUAL+® Analytics and SPSS to further analyze results data.
Osteopathic medicine began in the United States with DOs believing in manipulation to positively affect physiology. While early DOs had varying scopes of practice, today all DOs have equal practice rights to MDs. To become a DO requires an undergraduate degree, high MCAT scores, medical school acceptance and training which includes rotations in specialties and primary care. Osteopathic medical schools have grown from 5 private schools in the late 19th/early 20th century to 25 schools today, with some publicly funded to address physician shortages.
The document describes a case study of a 58-year-old man referred to physical therapy for low back pain. During the initial evaluation, the physical therapist discovered an abdominal aortic aneurysm (AAA) as the likely cause of the patient's symptoms through abdominal palpation. Computed tomography imaging confirmed a 5.5 cm AAA. The purpose of the case study was to demonstrate the clinical reasoning that led to the identification of an AAA despite the patient's reported mechanical low back pain, and to describe an evidence-based approach for evaluating patients with possible AAAs.
Geriatric rehabilitation aims to care for the elderly population. Methods of treatment include physical therapy and fall prevention exercises to increase leg strength and balance. Additionally, emotional therapy and music therapy can help address depression and anxiety that is common in elderly patients. The goal is to help seniors live as independently as possible through a variety of rehabilitation techniques.
The document discusses arthritis, including its two main types - osteoarthritis and rheumatoid arthritis. Osteoarthritis normally affects the hips, knees and hands and is caused by normal wear and tear as we age, sometimes worsened by injury. Rheumatoid arthritis frequently appears on hands, wrists and feet and is caused by the immune system attacking tissues in joints.
The DOH has several programs to help reduce arthritis deaths, including aquatic and exercise programs run by the Arthritis Foundation, as well as nationwide campaigns promoting healthy lifestyle. The DOH disseminates information through television, radio and other media.
Living with Arthritis - Lauren Kennish - 10.15.19Summit Health
By conservative estimates, nearly 40 million people in the U.S. are affected by some form of arthritis. Slightly more than half of those cases suffer from osteoarthritis, which is degenerative, and a small percentage suffer from rheumatoid arthritis and psoriatic arthritis, autoimmune disorders that inflame the lining of the joints. Our expert will provide an overview of different types of arthritis, with a focus on symptoms, diagnosis, and new treatment and management strategies.
This document discusses physical therapy approaches for cancer patients experiencing common symptoms like fatigue, pain, and breathing difficulties. It covers:
1. Definitions and screening tools for cancer-related fatigue and pain. Fatigue is graded on a scale and can interfere with daily activities. Pain is also assessed for intensity.
2. Non-pharmacological treatments for fatigue and pain including energy conservation, exercise, massage, heat/ice therapy, and electrotherapy. Exercise is recommended for patients during and after cancer treatment.
3. Cancer pain has multiple causes and classifications. The WHO pain ladder provides guidance on pain management strategies from non-opioid to opioid approaches. Physical therapy can help address pain through techniques like
It's a Pain in the Neck (and Back too!)Summit Health
Thank you to the Montclair Public Library for hosting SMG's Joanne Owsiak, MD, Interventional Pain Management specialist, for a community lecture on Neck and Back Pain. Eighty-five percent of people experience low back pain during their lifetime, and back pain has become the fifth most common reason for all physician visits. Dr. Owsiak shared with the audience the many causes of neck and back pain and the pain management options available for treating all types.
Exploiting Marginality In Health: Is Subhealth Another Case of Disease MongeringHK Metropolitan University
Subhealth is a concept in China that refers to a state between full health and disease. It has been promoted by Chinese companies and media to market health products. While subhealth research aims to understand chronic disease risks, critics argue it has been used more for commercial gain through dubious diagnostic methods and aggressive marketing. Recommendations include refining subhealth definitions and criteria, focusing research on true chronic disease prevention rather than profits, and separating subhealth research from political and economic interests.
This study examined the role of diet and fasting on arthritis disease activity through a survey of 100 arthritis patients in Kashmir, India. 80% of rheumatoid arthritis patients and 53% of osteoarthritis patients believed their symptoms were aggravated by certain foods. Red meat was most commonly reported to exacerbate symptoms, by 80% of rheumatoid arthritis patients and 41.1% of osteoarthritis patients. Fasting during Ramadan provided relief from symptoms for 61% of rheumatoid arthritis patients and 49.3% of osteoarthritis patients. The study concluded that diet and fasting can influence disease activity in joint disorders.
Audio and slides for this presentation are available on YouTube: http://youtu.be/Tt8WlPsohCU
Fatigue is a common side effect of cancer treatment. Fatigue from treatment can make everyday tasks and activities difficult to complete or enjoy. Join Jean Boucher, RN, an Oncology Nurse and Clinical Inquiry Specialist from the Nursing Department at Dana-Farber Cancer Institute, and discover how to manage cancer fatigue, improve sleep, mood, and nutrition habits, and boost energy levels.
Psikiyatri ve mental sağlıkta fizyoterapi gündemiUfuk Yurdalan
The document discusses the agenda for physical therapy in psychiatry and mental health. It mentions the International Organization of Physical Therapists in Mental Health (IOPTMH), which was recognized as a subgroup in 2011. It also lists the president of IOPTMH and mentions Mental Health Subgroup 5, which focuses on evidence-based physical therapy in mental health. Finally, it provides a link to the International Centre for the Prevention of Psychiatry and Mental Illnesses website on conferences.
Evidence based management of osteoarthritis in primary care - Dr Jonathan Quickepcsciences
Dr Jonathan Quicke is an NIHR Academic Clinical Lecturer in Physiotherapy (Keele University). Dr Quicke presented at the 2017 Musculoskeletal Education Day, where he discussed how we can ensure that best practice can be implemented within general practice for patients suffering with osteoarthritis
Osteopathic medicine provides all the benefits of modern medicine like drugs, surgery, and technology for diagnosis and treatment, while also offering hands-on osteopathic manipulative medicine. It emphasizes prevention and wellness. DO students complete four years of medical school coursework covering topics like anatomy, biochemistry, and clinical specialties. They must pass board exams to graduate and become licensed physicians, then complete 3-8 years of residency training in a specialty to also become board certified.
This study examined the relationship between falls and muscle strength, flexibility, and balance in 133 postmenopausal women with osteoporosis and 133 without osteoporosis. The researchers found that a significantly higher percentage of women with osteoporosis (51%) reported at least one fall in the previous year compared to women without osteoporosis (29%). Logistic regression analysis showed that lower trunk extension strength and the presence of osteoporosis were associated with an increased risk of falls. Specifically, greater trunk extension strength was associated with a lower risk of falls, while the presence of osteoporosis increased the risk of falls.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This document outlines an MSc nursing course focused on orthopedic nursing. The course consists of 1100 hours of instruction over 2 years, with 150 hours of theory and 950 hours of practical experience. The course aims to develop expertise in orthopedic nursing and enable students to function as orthopedic nurse practitioners. It covers topics like assessment of orthopedic patients, care of devices, trauma/injuries, infections, tumors, deformities, and more. Students gain clinical experience in orthopedic wards, operating theaters, and rehabilitation units. The course evaluates students through theory exams, practical assignments, case studies, and clinical performance evaluations.
This document discusses how art therapy can help individuals with Chronic Fatigue Syndrome (CFS). [1] CFS is a disabling condition characterized by severe fatigue, pain, and cognitive impairment. [2] Art therapy allows CFS patients to engage in a controllable and mentally relaxing activity. [3] Studies have found art therapy can reduce stress, build self-esteem, and help CFS patients find meaning in their lives despite their illness.
This presentation is an overview of the resources of the Computing, Multimedia and Telecommunication Studies of the Open University of Catalonia (Universitat Oberta de Catalunya - UOC): the virtual campus, virtual labs, innovation projects and physical spaces.
This document provides an introduction and background information on a study examining startle response and pre-pulse inhibition in adolescent rats from three groups: 1) rats that received neonatal lesions of the ventral hippocampus, 2) rats that were prenatally stressed, and 3) control rats. The study found that rats with neonatal lesions had significantly higher startle amplitudes compared to controls and prenatally stressed rats. Prenatally stressed rats had significantly lower startle responses compared to both other groups. Both experimental groups showed higher pre-pulse inhibition compared to controls. The document discusses etiological factors in schizophrenia like genetics, prenatal factors, and neurochemical dysfunction. It provides context on animal models using stress, lesions, and pre-pulse inhibition
Stevens Institute of Technology Annual Report 2004-2005pberzins
This annual report from Stevens Institute of Technology summarizes the 2004-2005 school year. It highlights advances in research related to homeland security, cybersecurity, nanotechnology, and environmental systems. It also discusses the growth of academic programs in engineering, the expansion of international partnerships, and the achievements of Stevens students and faculty. The President and Chairman express optimism about Stevens' trajectory and potential to become one of the top research institutions in the U.S. and world.
The document provides an overview and objectives of analyzing LibQUAL+® survey results. It discusses interpreting results internally by identifying areas of best and worst performance. It also covers benchmarking results externally against consortium data and longitudinally to assess the impact of changes. The document outlines quantitative analysis of survey scores and qualitative analysis of comments. It recommends using tools like LibQUAL+® Analytics and SPSS to further analyze results data.
Avoiding Problems Asian Enterprises Confront in US Patent Litigation - by Mic...SHIMOKAJI IP
US patent infringement litigation for Asian companies can involve multiple, concurrent proceedings, unfavorable venues, the need for early infringement and invalidity contentions, producing documents in native language, and facing racial bias from a judge or jury.
Network security, change control, outsourcingNicholas Davis
This document discusses network security, change control, and outsourcing. It provides an overview of key network security concepts like authentication, authorization, firewalls and intrusion prevention systems. It also discusses the importance of change control processes for network security and preventing unauthorized access. The document outlines potential security threats when outsourcing like theft of intellectual property and introduces countermeasures like electronic vaults, access controls and compartmentalization of data.
Generating Revenue and Reducing Costs of Patent Litigation for Taiwan Compani...SHIMOKAJI IP
Generate revenue from your patent portfolio. What are expected damages and/or injunction in patent litigation. How to reduce the high cost of patent litigation, including flexible fee arrangements. Contact info@shimokaji.com for more information.
How to electronically file a pfd or affadavitgacfc
The document provides instructions on how executive directors and members of State Boards, Commissions or Authorities in Georgia are now required to electronically file an annual affidavit rather than a personal financial disclosure statement. It explains how to access the electronic filing system, obtain log-in credentials, and file the required affidavit. The affidavit confirms these individuals took no official action in the previous year that materially affected their private financial or business interests.
Advanced redaction technology can help governments comply with privacy laws by automating the removal of sensitive information from records. Automated redaction software uses optical character recognition to locate personal data like social security numbers and then redacts it. This saves significant time and costs compared to manual redaction. The accuracy of the software impacts verification needs and costs, with higher accuracy software requiring less human review. As privacy laws continue to expand the types of protected data, automated redaction helps governments scale redaction efforts over growing volumes of records.
This document provides information on air barrier design and testing for large buildings. It discusses how air barriers can reduce energy costs and improve occupant comfort by limiting air infiltration and exfiltration. Different air barrier designs are described for exterior envelopes and interior partitions. The document emphasizes that a properly designed, installed, and tested air barrier is essential but complex, requiring coordination between trades and quality assurance measures to ensure continuity and effectiveness of the air barrier. It recommends hiring experienced air barrier consultants to help with design, testing, and troubleshooting of large building air barriers.
RadiciGroup at 6th European Nylon Symposium - 27-28 February 2012 RadiciGroup
RadiciGroup is a major producer of polyamides such as Nylon 6 and Nylon 66. The document discusses trends in the global polyamide market showing strong growth forecast for polyamide plastics compared to fibers. It also outlines several market challenges for polyamides including requirements for lower emissions, lighter weight materials, and improved sustainability. RadiciGroup is developing new high performance and sustainable polyamide grades to meet these market challenges including those with better heat resistance, higher filler levels, and grades made from bio-based feedstocks.
Coping strategies and management measures to strengthen national capacity to ...International Aquafeed
This report provides a brief overview of coping strategies and management measures to strengthen national capacity to address aquafeed supply and to mitigate against rising costs of aquafeed ingredients in terms of policies, research and private sector and farmers’ initiatives.
Oklahoma spray foam insulation r-value is not the only thing to consider in ...Kool Foam
While R-value is an important measurement of an insulation's ability to resist heat transfer, it does not tell the whole story. Other factors like air sealing and resistance to mold/mildew growth are also important. Spray foam insulation has a higher R-value than common alternatives like fiberglass or rigid foam boards. It also acts as an air barrier and moisture barrier to reduce energy costs and create a healthier home. When choosing insulation for homes in Oklahoma, homeowners should consider R-value alongside other benefits like those provided by spray foam.
Bioinsight's Corporate Presentation. Check it out and find out Who we are, our vision and mission, Sector we serve, Our services and Innovative methods we use for consultancy services provided to Clients who undertake economic activities that potentially have significant impacts on Biodiversity and the Ecosystems.
This document analyzes and summarizes several black and white film noir images through the lens of typical film noir techniques and themes. The images depict lone male figures walking at night, a close-up of a woman in a doorway with soft lighting, two silhouetted figures of a man and woman with the woman as the focus due to her darker shading and the smoke covering the man, and finally an image of a couple in the foreground with a male figure in the background holding a weapon. Key techniques discussed include the use of shadows, contrasts, lighting, costuming, props, facial expressions, and character positioning to convey meaning and advance the film noir style and genre conventions.
The document provides background research for a short film about teens with super abilities who don't fit in with society. It discusses researching similar films like X-Men for character inspiration and comparing qualities of short films to full-length films. Key points include keeping characters limited, focusing on 1-2 brief scenes, and basing characters on films like X-Men for representation of differences.
Good contracts will take into account CDM 2007 arrangements. Learn from these practical examples when drafting your contracts - presentation by Julian Scott of Squire Sanders exclusively for ARMSA Consulting wind energy clients.
Stockist software or stock management software, this is what people needed to make their work easy and to maintain everything and all can be provided by kapture that helps in managing every aspect of your business.
Articles of Constitution of India which make reference to courtsYatendra Kumar
The document contains excerpts from the Constitution of India that mention the word "Court". Some key points:
- It establishes the Supreme Court of India and High Courts in states, and outlines their powers and jurisdiction.
- It guarantees the right to move the Supreme Court for enforcement of fundamental rights.
- It discusses the appointment and removal of judges, and their salaries.
- It limits discussion of judges' conduct and makes their decisions final.
- It prevents questioning of constitutional amendments in courts.
The document discusses the experience and lessons learned by the author, a medical doctor specializing in women's health, in treating menopausal women over the course of his career. Some key points made include:
- Looking after menopausal women is a fascinating, gratifying, and complex experience for physicians due to the holistic factors involved.
- Recent large studies like WHI have been misinterpreted by medical professionals and caused unnecessary fear, when properly interpreted they show hormone therapy is generally safe and effective for relieving menopausal symptoms.
- Younger women may receive heart protection from estrogen therapy, and risks of conditions like breast cancer return to normal after stopping therapy.
- Occult breast cancers are actually
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
The document discusses a presentation on lifestyle medicine and exercise prescription, including goals of providing knowledge on foundational muscle physiology concepts, exploring exercise as medicine, and developing skills to write exercise prescriptions and motivate patients to change habits. Barriers to counseling patients on exercise are reviewed, along with efficacy evidence of physician counseling, and the need to better train medical students on exercise as preventive medicine.
role of physician in health care system.pptxDeepak Bansal
1: Learner should know 5 Roles of IMG(Indian Medical Graduate) as suggested by NMC correctly
Clinician
Leader and member of the healthcare team
Good Communicator
Lifelong learner
Professional.
2 : Learners should know some other Roles of physicians in the health care system correctly
Researcher
2. Teaching
3. Manager
4. Policy maker
Daniel Lee, M.D., of UC San Diego Owen Clinic, presents "Update from the 15th International Workshop on Co-Morbidities and Adverse Drug Reactions in HIV"
Megan McLelland is a physician who focuses on primary care and manual medicine. She has a holistic outlook influenced by Dr. Andrew Taylor Still, the founder of osteopathic medicine in 1892. Dr. Still opened the first osteopathic school in Missouri after studying alternative treatments and believing orthodox medicine was ineffective. Osteopathic medicine focuses on how the musculoskeletal system impacts health and uses osteopathic manipulative medicine to improve the body's functioning and ability to heal. Today, the majority of osteopathic physicians specialize in family/general practice, and while differences between DOs and MDs exist, their roles are becoming increasingly similar with both licensed in all 50 states.
Vinay Prassad, hematólogo-oncólogo y profesor de Medicina en la Oregon Health and Sciences University. Ponencia presentada en el marco de la jornada Cómo revertir prácticas clínicas de escaso valor organizada por la Societat Catalana de Gestió Sanitària el 18 de mayo de 2018.
This document discusses the basic principles of palliative care, including definitions, goals, ethical issues and barriers. It provides statistics on palliative care needs in Palestine, including causes of death, cancer rates and lack of services. Recommendations are made to establish national palliative care policies and programs, train healthcare workers, ensure availability of pain medications, and incorporate palliative care into existing healthcare systems to improve end of life care.
Holly Thacker, Update on: Menopause, Hormone Therapy, Sex, Politics, and the ...Cleveland HeartLab, Inc.
This document provides an overview and summary of a presentation on menopause, hormone therapy, cardiovascular health, and women's health issues. It discusses the aftermath of the Women's Health Initiative study 12 years later, compares risks of hormone therapy to other medications, and examines risk/benefit ratios of hormone therapy for cardiovascular disease. It also addresses politics surrounding women's health issues and "war on women" narratives related to hormone therapy. The presentation aims to provide an updated perspective on these issues based on newer research findings.
This lecture discusses how personal choices and lifestyle factors are powerful influences on health. It begins by exploring current health statistics in America, which show high rates of obesity, diabetes, heart disease and other chronic diseases. These poor health outcomes are linked to most Americans eating more calories, sugar, salt and meat compared to the past, while being less physically active. The lecture then reviews several scientific studies that demonstrate how lifestyle modifications like improved nutrition, increased exercise, weight management and avoiding tobacco can significantly reduce risks for chronic diseases and mortality. It emphasizes that lifestyle is a major determinant of health outcomes. The lecture concludes by encouraging participants to prioritize healthy living through personal goal setting and lifestyle changes.
The document discusses the role of doctors in society. It begins by outlining how doctors are often portrayed unrealistically in media as able to solve any problem. This sets unrealistic expectations for patients. The document then discusses the need for doctors to be honest about limitations and for patients and doctors to work together, with patients taking more responsibility for their own care. It argues the role of doctors should change from solving all problems to helping patients overcome illness by changing lifestyles or coming to terms with death. Overall, the document advocates for clearer values of putting patients first, constant improvement, acceptance of limitations, and evidence-based practices.
A DO is a physician who receives a Doctor of Osteopathic Medicine degree and emphasizes a holistic approach to medicine, including osteopathic manipulative medicine. The first DO school was founded in 1892 by Dr. Andrew Taylor Still, who believed orthodox medicine was ineffective. Today, DOs are licensed to practice in all 50 U.S. states and focus on primary care more than other specialties. While the differences between DOs and MDs have lessened over time, DOs still place greater emphasis on preventative health and treating the whole patient. Becoming a DO requires an undergraduate degree with prerequisite courses, the MCAT, and graduation from an accredited osteopathic medical school.
Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian...EsserHealth
Lifestyle Medicine focuses on applying behavioral and environmental principles to managing lifestyle-related health problems. Chronic diseases now account for 75% of healthcare costs in the US, many of which are strongly associated with diet and physical inactivity. While genetics play a role, the rise of these "lifestyle diseases" correlates with changes in American diets and exercise patterns over recent decades. Prospective randomized studies demonstrate that organized lifestyle interventions can significantly reduce disease incidence and healthcare costs compared to prescription medications. Lifestyle Medicine aims to educate and empower individuals to make personal choices that can transform health outcomes on both individual and societal levels.
Health professionals are experts who keep people healthy by using evidence-based medicine and compassion. They identify and treat illnesses, injuries, and both physical and mental challenges in line with the needs of the communities.
Chapter 1 Introduction to Health Psychology.pdfAyesha Yaqoob
This document provides an introduction and overview of key concepts in health psychology. It discusses the goals of studying health from multiple perspectives and integrating different approaches. Key terms are defined, including health psychology, health, disease, and illness. The document outlines the historical development of health psychology as a field and how it began to integrate biological, behavioral, and social factors influencing health. Major causes of death are discussed, noting the increasing role of lifestyle behaviors. Theories of attribution, health locus of control, and unrealistic optimism related to health beliefs and behaviors are also introduced. Culture is discussed as an important macro-level influence on concepts of health and disease.
Dr. Barry White, former HSE National Director, Clinical Strategy and ProgrammesInvestnet
The document discusses issues with the modern healthcare system including a reductionist approach, unrealistic expectations of health, and the failure to address behavioral factors. It argues that defining health as complete well-being has medicalized society and generated unnecessary demand. Bloodletting was the dominant medical practice for over 2000 years based on the ancient humoral theory but provided no improvement in life expectancy. While reductionism led to advances in the 20th century, a holistic approach is also needed. The key is developing self-awareness among both patients and clinicians to reconcile physical, psychological and social well-being.
The document discusses holistic healthcare and presents the WHO ICF (International Classification of Functioning) model of illness as a framework for achieving holistic care. The WHO ICF model views health as determined by four domains - body functions, activities, participation in life situations, and contextual factors of the individual. It recognizes that illness arises from an inability to adapt due to internal or external stresses on the whole person within their physical and social environments. For healthcare to be truly holistic, this biopsychosocial model must be adopted and services must be organized around supporting people based on their various social roles and needs over the course of their condition.
The document discusses the evolution of mental health services from the 20th to 21st century. It describes how quality of care, community-based services, and clinical governance were prioritized in restructuring an Irish mental health service based on a mission of independent, human rights-based and recovery-focused care. Key metrics like length of stay, readmission rates, and user satisfaction improved under this new model.
1) The WHI study found small increases in cardiovascular risks and breast cancer for women taking combined estrogen and progestin HRT. However, the absolute risks for individual women were very small.
2) The results do not necessarily apply to lower drug doses, different formulations, or non-oral routes of administration. Absolute risks were far smaller than relative risks suggested.
3) The main goal for women's health practitioners should be maintaining overall health and disease prevention for postmenopausal women, not long-term hormonal treatment alone. Alternative non-hormonal strategies also exist.
The document discusses controversies around the management of perimenopause and postmenopause. There are debates due to a lack of proper evaluation of published results, ignoring the whole woman in medical practice, political lobbying, and a lack of scientific honesty. The document also summarizes discussions and conclusions from several international symposiums on menopause, including debates between European and US perspectives on the implications of clinical trials like WHI for cardiovascular disease and cancer risk in younger women. Overall, the document examines ongoing controversies and perspectives regarding hormone therapy management in the menopausal period.
Este documento resume uma reunião científica sobre a saúde da mulher madura. Aborda temas como o envelhecimento com ou sem terapia hormonal, a abordagem holística à saúde da mulher, e como melhorar a qualidade de vida das mulheres mais velhas através de estratégias preventivas e terapêuticas.
This document summarizes key learnings from major observational studies and clinical trials on menopause. It discusses that systemically administered progestogens may negate some benefits of estrogens and slightly increase breast cancer risk with treatment durations over 5 years. It notes that isolated estrogens did not impact breast cancer risk in hysterectomized women compared to controls in WHI. It also states that metabolic effects of estrogens and progestogens may differ based on administration route and regimen of sequential vs. continuous combined therapy.
1) The document discusses the history of hormone treatments for menopausal women from ancient times to modern developments.
2) It notes that while hormone treatments helped relieve symptoms, long term use revealed risks like increased chances of endometrial and breast cancer as well as vascular diseases.
3) The document argues that today's focus should be on women's overall health, disease prevention, and treatment options that consider quality of life - not just debating long term hormone use but finding the best approach.
1) Hormone replacement therapy (HRT) is a misnomer and should be called postmenopause hormone treatment (PMHT) as it is not replacing anything physiological.
2) PMHT refers to the use of estrogens and other hormones when indicated along with non-hormonal treatments and lifestyle changes to maintain health and prevent diseases associated with menopause.
3) It is important not to view HRT/PMHT as obligatory or the only option for postmenopausal women. Treatments must be individualized based on risk factors and health needs.
El documento critica a los "terroristas hormonales" que imponen reglas sobre la práctica clínica sin experiencia. Argumenta que los estudios epidemiológicos como el WHI tienen validez interna pero no externa, y que los riesgos asociados con la THR son mínimos. Aboga por que los médicos informen a las mujeres para que tomen sus propias decisiones sobre el tratamiento de
Este documento resume a IX Reunião Científica da SPM. Apresenta informações sobre envelhecimento com ou sem terapia hormonal substitutiva, abordando o assunto de uma perspectiva holística que considera fatores biopsicossociais. Discute também a importância de ações preventivas e terapêuticas para promover a saúde e qualidade de vida das mulheres em idade madura.
Este documento presenta un resumen de las nuevas perspectivas en el manejo de la mujer posmenopáusica. El autor discute los riesgos de depender exclusivamente de la evidencia de estudios epidemiológicos y los medios de comunicación para determinar la práctica clínica, y enfatiza la importancia de considerar la experiencia clínica. También advierte sobre los riesgos de desinformación y alarmismo cuando solo se consideran riesgos relativos sin tener en cuenta riesgos absolutos.
This document discusses the interpretation of results from the Women's Health Initiative (WHI) study on hormone therapy (HT).
[1] The WHI study was not designed to study the effects of HT in symptomatic women during the early postmenopausal period. It studied older women, on average over 10 years past menopause, using a single continuous regimen of HT.
[2] Initial reports of increased health risks from the WHI study were overstated and not justified based on further analysis, particularly for peri- and early postmenopausal women. More recent analyses show HT may have benefits for cardiovascular health when started soon after menopause.
This document discusses lifestyle factors and their impact on health and aging. It suggests that lifestyle modifications through practices like exercise, nutrition, stress management and social support can help maintain health and prevent disease by affecting aging at the cellular level. Specifically, it discusses how telomeres and telomerase are markers of biological aging and how lifestyle interventions may help preserve telomere length and telomerase activity to slow cellular aging. Overall, the document advocates that lifestyle medicine which focuses on prevention through lifestyle changes may be more effective than medical treatments alone.
What has been learned from the major observationalfalcaoebarros
The document discusses 4 main lessons learned from major observational studies and clinical trials on hormonal treatments: 1) Progestagens may suppress some benefits of estrogens and slightly increase breast cancer risk with long-term use; 2) Estrogens alone did not increase breast cancer risk; 3) Metabolic effects of hormones differ by route and regimen; 4) Hormones are effective for vasomotor symptoms but not secondary cardiovascular prevention. It also discusses the need for evidence-informed practice over strictly evidence-based medicine and emphasizes balancing risks and benefits of treatments tailored to individual needs and preferences.
This document discusses the crisis facing women and physicians regarding hormone replacement therapy (HRT) and menopause. It notes that volcanic studies like the Women's Health Initiative have spread wrong information about HRT, scaring women and doctors about side effects like breast cancer. As a result, many women give up HRT and suffer from vasomotor symptoms, while doctors fail to persuade them to continue HRT due to its benefits outweighing risks. The document will focus on HRT and breast cancer, reasons for doctors' failed persuasion, and lessons learned from menopausal women over 40 years.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
3. There are controversies about the
present management of the
climacterium which are due to:
• a lack of culture that prevents a correct
criticism of the published results
• a bad practice of medicine that ignores the
woman in her totality (holism)
• political lobbies from the NIH
• a lack of scientific honesty manifested by
many of the WHI writers
• lobbies from several pharmaceutical
industries through the activities of many well
known doctors that “offer” themselves to transmit
their “messages”
4. HOW TO DO IT ?
•The Objective QoL
•The Target the Woman
•The Agent (or Actor) the Doctor
7. QoL = Health !
“A condition of physical, mental and
social well-being and not only the
absence of disease”
WHO
Therefore one must:
- prevent diseases
- promote health
8. The midaged Woman
• How does she feel? Confused? Insecure?
• What is she afraid of ? Hormones?
• What does she want from the Doctor? QoL !
9. Definition
A Climacteric woman
is a woman (gender based medicine)
is an ageing person (geriartrics)
is perimenopausal (hormone deficient)
10. Looking after a menopausal woman is a
most
fascinating,
gratifying and
complex
vivid experience in the life of a physician.
MNC/2005
12. The Doctor : a Gynecologist?
If so
• What is in his/her mind? WHI? Million WS?
• What does he/she know about it?
• What is he/she afraid of? Cancer? TED?
• How does he/she practice Medicine?
• How should midaged women be taken care
of?
13. What has experience thought
me over the years about how
to give QoL after the
menopause:
14. Is there a Menopausal
Medicine?
There is only ONE Medicine (L. Speroff)
There are only TWO Medicines (M.N.C.):
a BAD Medicine and
a GOOD Medicine
18. There are two types of medical
practice:
– the Medicine for one individual, at a
time (Clinical Medicine)
– the Medicine for many individuals,
the population, at the same time,
(Social Medicine,Public Health
Medicine)
MNC/05
19. Who are the actors ?
• Is a clinician
The practitioner • Sees patients in the office
• Treats individuals
• Works in Hospitals
• Is not a clinician
The public health doctor
• Does not see patients in an
office
• Does not treat individuals
• Works in a Public Health
department
20. Concerns of the
Doctor of an individual •Absolute risk reduction
(practitioner)
•Absolute risk increase
•Benefit/risk analisys
The Public Health Doctor •Relative risk reduction
•Relative risk increase
•Cost/benefit analysis
21. But ... today ...
many • Act in their offices as if they
were public health doctors...
practitioners
and many
public health doctors • Act in their departments as if
they were clinicians ...
This is wrong!
22. WHI results calculated as:
NNT/1 year NNH/1 year
CHD 1428
Stroke 1250
VTE 588
Breast Cancer 1250
Colon Cancer 1667
Osteoporotic fractures 227
Neves-e-Castro M. Menopause in crisis post-Women´s health Initiative? A view
based on personal clinical experience. Human Reproduction 2003;18:2512-8
23. Public Health doctors are guided by
what epidemiologists suggest ...
but ...
most epidemiologists only establish
associations of events and seldom
determine cause/effect relationships
MNC/05
24. Practioners are guided:
• by the best available information that
can be extrapolated with validity to
their patients, and
• by their acumulated experience
MNC/05
25. thus ...
both,the practitioners who act as if they
were public health doctors,
and the public health doctors who act as if they
were clinicians,
should not overemphasize the
epidemiological associations of events that are
not necessarily cause/effect findings
MNC/05
26. We must manage our
Clinical Practice by objectives:
objectives
- Critical
Objectives (C.O.)
- Specific Objectives (S.O.)
- S.O. Targets (S.O.T.)
- S.O. Projects (S.O.P.)
27. Critical Objectives
a) The diagnosis of health
b) The identification of risk factors
c) The presence of symptoms
• gender related
• age related
• hormone related
28. Critical Objectives
d) The treatment of symptoms
e) The elimination of risk factors
f) The diagnosis of diseases
g) The treatment of diseases
29. Specific Objectives
(S.O.)
1. CVD and metabolic diseases
a) obesity
b) dislipidemias
c) hypertension
d) insulin resistance (metabolic syndr.)
etc
30. S.O.
2. CNS
a) vasomotor symptoms
b) mood, sleep
c) sexual disfunctions, libido,
etc
36. S.O. Targets
1. exercise
2. nutrition
3. mental health
4. sexual conseling
5. pharmacotherapy
a) hormonal
b) non-hormonal
37. S.O. Projects
(treatments)
P, E+P, E
Androgens
Ca + vit D
Bisfosfonates, Strontium
Statins
IACE
Diuretics
α and β Blockers
Aspirin
Serm’s
Tibolone
Gabapantin
Psychotherapy
etc
routes, schemes of administration
38. and now
think about the interelation of
CVD, Osteoporosis and Obesity...
since they seem to share common risk
factors...
39. The unified hypothesis of interactions among
the bone, adipose and vascular systems:
'osteo-lipo-vascular interactions'.
Epidemiological evidence has established
a link among hyperlipidemia, visceral
obesity, osteoporosis, and cardiovascular
diseases (CVD).
Koshiyama H et al. Med Hypotheses 2006;66:960-3
40. The unified hypothesis of interactions among
the bone, adipose and vascular systems:
'osteo-lipo-vascular interactions'.
The unified hypothesis of three organs,
which we call 'osteo-lipo-vascular
interactions', may be explained by the
common origin of the cells in each organ.
Koshiyama H et al. Med Hypotheses 2006;66:960-3
41. The unified hypothesis of interactions among
the bone, adipose and vascular systems:
'osteo-lipo-vascular interactions'.
The mesenchymal stem cells are capable
of differentiating into osteoblasts, vascular
smooth muscle cells, and adipocytes.
Koshiyama H et al. Med Hypotheses 2006;66:960-3
42. The unified hypothesis of interactions among
the bone, adipose and vascular systems:
'osteo-lipo-vascular interactions'.
Alternatively, macrophages may evolve
into osteoclasts or infiltrate both the
vascular and adipose tissues, thereby
leading to chronic inflammation.
Koshiyama H et al. Med Hypotheses 2006;66:960-3
43. Osteoporosis and cardiovascular disease:
brittle bones and boned arteries, is there a link?
Elevated LDL and low HDL cholesterol are
associated with LBMD; altered lipid
metabolism is associated with both bone
remodeling and the atherosclerotic
process, which might explain, in part, the
co-existence of osteoporosis and
atherosclerosis in patients with
dyslipidemia. Similarly, inflammation plays
a pivotal role in both atherosclerosis and
osteoporosis.
McFarlane SI et al. Encdocrine 2004;23:1-10
44. Osteoporosis and cardiovascular disease:
brittle bones and boned arteries, is there a link?
Elevated plasma homocysteine levels are
associated with both CVD and osteoporosis.
McFarlane SI et al. Encdocrine 2004;23:1-10
45. Osteoporosis and cardiovascular disease:
brittle bones and boned arteries, is there a link?
Nitric oxide (NO), in addition to its known
atheroprotective effects, appears to also play a
role in osteoblast function and bone turnover.
McFarlane SI et al. Encdocrine 2004;23:1-10
46. Osteoporosis and cardiovascular disease:
brittle bones and boned arteries, is there a link?
Statins, agents that reduce atherogenesis,
also stimulate bone formation
McFarlane SI et al. Encdocrine 2004;23:1-10
47. Osteoporosis and cardiovascular disease:
brittle bones and boned arteries, is there a link?
Bis- phosphonates, used in the treatment of
osteoporosis, have been shown to inhibit
atherogenesis. Intravenous bisphosphonate
therapy significantly decreases serum LDL and
increases HDL in postmenopausal women
McFarlane SI et al. Encdocrine 2004;23:1-10
48. anyway,and
in the light of the present evidence,
doctors and women should be
reassured that the suggested HT’s for
the relief of symptoms in the
menopause
are safe and very effective !
49. Many women taking hormones were
urged by their physicians to stop taking
these medications immediately or
decided to stop taking them on their own.
Petitti DB. JAMA. 2005;294:245-246.
51. Based on the WHI study group,
implementation of the results
into clinical practice has little, if
any, scientific basis.
Adam Ostrzenski and Katarzyna M Ostrzenska. Am J Obst Gynecol
2005;193:1599-604
52. The applicability of the WHI
findings to women between age of
51.1 and 56.1 years and younger is
unknown...
Ostrzenski A and Ostrzenska KM.
Am J Obst Gynecol 2005;193:1599-604
54. Effects of conjugated Equine Estrogen in Postmenopausal Women
with Hysterectomy.JAMA, 2004;291:1701-1712
55.
56.
57. Stroke
“In women 50-59 years not taking HT,
ischemic stroke is expected to occur in
3 out of 1000 women during 5 years.
Five years use of HT would yield 1
additional case of stroke/ 1000 women”
women
EMAS Statement; 2004.
58.
59.
60. Biased opinions
be they pro or con,
dishonor the profession
and
harm our patients.
Sacket DL. The arrogance of preventive medicine. Can Med Assoc J
2002;167:363-364
61. Then, why all this noise?...
noise
Mainly because the conclusions of
recent trials were severely misinterpreted
by the medical professionals, the media
professionals
and by the women, themselves
MNC/05
62. Causes of Death Among
Women*
Other Cancers
Heart Disease
15%
Breast Cancer 34%
Diabetes 4%
3%
Chronic Lower 6%
Respiratory
Disease
10%
28%
Other Cerebrovascular
Disease
*Percentage of total deaths in 1999
among women aged 65 years and older.
Anderson RN. Natl Vital Stat Rep. 2001;49:1-13.
63. Hormones and the Heart
1 in 3 women will die from coronary
heart disease (CHD) in the USA.
1 in 25 women will die from breast
cancer
Fitzpatrick LA. JCEM 2003;88(12):5609-10
64. “HRT is associated with a
35% reduction in mortality
for women who suffered
myocardial infarction”.
Shlipack MG, Angeja B, Go AS, et al Circulation 2001;104:2300-2304
65. Effect on the risk of CHD
WHI Significant increased risk
RR 1.29 (CI 1.02-1.63); 29 % increased risk
AR 0.37% vs 0.30% (ie, 37 vs 30 events
annually per 10.000 women)
HERS Nonsignificant decreased risk
RR 0,99 (CI 0.84-1.17); 1% decreased risk
AR 3.66% vs 3.68% (ie, 366 vs 368 events
annually per 10.000 women)
66. NNH / Year
(Number Needed to Harm)
(the reciprocal of the AR,or of the atributable AR)
Coronary Heart Disease
WHI (RR 1.29) 1428
HERS (RR 0.99) 5000
Breast Cancer
WHI (RR 1.26) 1250
HERS (RR 1.27) 833
MNC
67. “Not everything that can be
counted counts;
and not everything that
counts can be counted”
Albert Einstein
68. Hormone replacement therapy:
where to now?
Recent studies suggest HRT may inhibit
the process of atherosclerosis in
healthy arteries soon after menopause,
and observational studies (NHS, updated
2006) in younger women starting HRT
strongly suggest a potential
cardiovascular benefit
Mikkola TS, Clarkson TB. Cardiovasc Res 2002;53:605-19.
69. Lessons from the WHI
“…most articles and broadcast segments
tended to focus exclusively on either the
small absolute risks or the larger relative
risks, neglecting the more even-handed
risks
picture that presented both.
Since the sharply increased relative risks
got the most play, news coverage about the
play
trial’s findings had an alarming cast.”
Denzer S. Editorial. Ann Intern Med.2003;138:352-353
70. “WHI: Now that the dust has
settled…”
• To publish data that may or may
not be entirely true or certainly
premature is a disservice to the
medical profession and, most
important, to our patients.
• The majority of the data that were
published is not statistically
significant even at the nominal
level.
Creasman WT. et al. Am J Obst Gynecol 2003;189:621-626
71. Recent reports did not find, for
continuous combined treatments, any
increased risk of either CHD or breast
cancer.
The difference from WHI being that
women were younger, symptomatic
and with lower body weights
Heikkinen J. NAMS 2004, Abstract LB38
Lobo R. Arch Int Med 2004;164:482-484
72. “At the moment, I believe we can say with
relative certainty that hormone therapy in
younger postmenopausal women
results
in lower coronary heart disease events
and total mortality.”
Salpeter S. Climacteric 2005;8:307-310
73. An update of the WHI Study !
WHI investigators reported (Feb 2006) a
statistically significant (34%) lower risk for the
combined endpoint of myocardial infarction
(heart attack), coronary death, coronary
revascularization and confirmed angina among
women who were between the ages of 50 and
59 at the start of the study (RR 0.66; 95% CI
0.45-0.96).
Hsia J et al.Arch Intern Med 2006;166:357-363
74. Younger Women May Receive Heart Protection From
Estrogen Therapy
In women ages 50-59 who had undergone a
hysterectomy, a significant protective effect of
estrogen treatment, when both primary (heart
treatment
attacks and heart attack death) and secondary
(coronary artery bypass surgery, angioplasty,
confirmed angina pectoris) cardiac endpoints
were considered.
Dr. S. Mitchell Harman, director and president of Phoenix-based
Kronos Longevity Research Institute (KLRI) in Archives of Internal
Medicine 2006;106:357-363
75. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
76. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
77. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
78. Press Statement IMS
In a subgroup of women demographically
similar to those in the WHI, there was no
significant relation between HT and CHD among
women who initiated therapy at least 10 years
after the menopause
(RR = 0.87, 95% CI 0.69–1.10 for estrogen alone;
RR = 0.90, 95% CI 0.62–1.29 for estrogen with progestogen).
Feb 2006
79. Press Statement IMS
The estrogen plus progestogen arm of the WHI
and the estrogen-alone arm actually showed that
HT does not
increase the risk of coronary heart disease in
the peri- and early menopause,
and may even carry beneficial effects.
effects
Feb 2006
80. Press Statement IMS
The WHI study was not designed, and
designed
therefore was not powered, to investigate the
consequences of hormone therapy (HT) in
women below 60 years of age. Therefore,
age
any attempt to present the results of the study
as indicating that HT may inflict damage to the
heart in general – a message that was accepted
by many medical societies and regulatory Authorities
is simply wrong and must be amended.
amended
82. Menopausal women and their
doctors are scared about the side
effects of HRT
mainly about breast cancer
MNC/05
83. It must be emphasized that we are
talking about an increased incidence of
the disease, which does not
automatically translate into an increase
in deaths from the disease.
Baum M. The Breast 2005;14:178-80
84. Extended use of estrogen for
10 years increases risks by 0,5%, and by
15 years increases risks by 0,9%
but..
upon cessation of HRT, the
relative risk quickly returns to 1.0 !
Coombs N J, Taylor R, Wilcken N. and Boyages J. BMJ 2005;331:347-349
85. Breast Cancer
• The diagnosis of a breast cancer after the
initiation of a HRT (with a duration of less than 5
years) is only a proof of its growth stimulatory
effect (not of its carcinogenic effect)
• Therefore, the reversal of the risk to 1 after the
cessation of HRT confirms again only its growth
promoting effect and denies a carcinogenic
effect.
Dietel M., Lewis MA. and Shapiro S. Human Reproduction 2005;20:2052-60
86. Breast Cancer
• The doubling time of an initial cancer
cell, up to the diagnosis of a resultant
cell
1cm tumor, is most likely greater than
10 years.
• This is why many dormant cancer cells
may exist in a “normal” breast !
MNC/05
87. Occult Breast Cancer
Clinically occult in situ
BC’s are frequent in
young and middle-aged
women.
Nielsen M et al-Br J Cancer 1987;56:814-9
88. Occult Breast Cancer
Breast malignancy was
found in 22 women
(20%)
Nielsen M et al-Br J Cancer 1987;56:814-9
89. Thus…
• Mammographies give more false
negative than false positive results !
• A “normal” mammography does not
exclude the presence of cancer cells
that may “explode” a few months later…
MNC/05
90. Estrogen replacement therapy in
patients with early breast cancer
The mortality rates from breast cancer for
the ERT users was 4.28% compared with
22.3% in the nonusers.
nonusers
Natrajan PK and Gambrell RD. Am J Obstet Gynecol 2002;187:289-95
91. “Recurrent breast cancer was
found in 9% of HRT users and
15% of nonuser”.
O’Meara ES et al.JNCI 2001;93:754-761
92. Mortality following development of
breast cancer while using
oestrogen or oestrogen plus progestin:
W Chen, DB Petitti and AM Geiger.
British Journal of Cancer 2005;93:392–398
93. This study explored survival after
exposure to oestrogen or oestrogen
plus progestin at or in the year prior to
breast cancer diagnosis
oestrogen plus progestin users
had lower all-cause mortality and
breast cancer mortality
Chen W, Petitti DB and Geiger AM. British Journal of Cancer 2005;
93:392-398
96. A menopausal woman expects
from her attending physician
to be receptive to all of her complains,
to understand her psychic and physical
concerns,
to support her insecurity and
to help overcome her crisis.
crisis
MNC/05
97. Many Doctors fail to persuade
them to go on with HRT, in
despite of telling that the
benefits are far greater than
any potential risk
MNC/05
98. One may easily conclude that
without an adequate technique of
communication, using the proper
language,
there is no possible help
Thus,
physicians must acquire expertise in
the technique of communication
MNC/05
100. Are there risks?
It is crucial that information be given
about the difference between relative
risks and absolute risks, since the latter
risks
are the major cause of misinformation and
alarmism, being the favorites of the
media…
MNC/05
101. Example of Risks
• If you buy one lottery ticket you will
have a one in 1 million chance of
winning (“absolute risk”) 1x 10 6
• If you buy five lottery tickets your
chances are five fold higher or 5 in one
million (“absolute risk”) 5x 10 6
• Your chances of winning are increased
by five fold (“relative risk”) 5.0
102. Relative Risk
The risk of an event occuring
under certain circumstances
compared to the risk under
other circumstances
103. Attributable or Excess Risk
The difference between
underlying risk and risk when
receiving HT is called the
attributable or excess risk
105. Conclusion
• Relative risk is a confusing
word and is only important if
the absolute chances of an
event are high
• Attributable or excess risk is
the thing that one should be
most concerned about
106. Validity
Internal: the study measured what is set out to
measure
External: the results can be extrapolated to
one’s patients
Observational research (NHS) may have
poorer internal validity
better external validity
Randomized controlled trial (WHI)
better internal validity
poorer external validity
MNC/04
107. Confidence interval (C.I.)
A 95% C.I. signifies that there is a 95%
chance that the population “true value”
lies between the two limits.
If C.I. crosses the “line of no
difference” the point at which a benefit
becomes a harm (i.e.1) then one can
conclude that the results are not
statiscally significant
MNC/04
111. “It appears that half of the
benefits in the prevention of
cardiovascular diseases are
not hormone related”!
Mosca L, Grundy SM, Judelson D, et al. Circulation 99;99:2480-4
112. Nurses’s Health Study
from 1980 to 1994 CHD ↓ 31%
↓ Smoking ↓ 13%
↑ Obesity ↑ 8%
↑ THS ↓ 9%
↑ Better nutrition ↓ 16%
Hu FB, Grodstein F et al. Trends in the Incidence of Coronary Heart
Disease and Changes in Diet and Lifestyle in Women. NEJM
2000;343:530-537.
114. What about the best treatments
during the climacterium and
beyond?
Little attention is paid to other
pharmacological interventions (non
hormonal) and strategies that have been
shown to be important for the
prevention of diseases and to maintain or
improve health.
MNC/05
115. Hippocrates promoted specific
diets to prevent and cure
diseases, such as illnesses of
the heart.
Lyons AS et al. In Medicine: an illustrated History. New York:Abradale
Press,1990:20719
117. Doctors could retrain as
Polymeal chefs or wine advisers
The Polymeal—an evidence based menu that
includes, wine, fish, dark chocolate fruits,
vegetables, garlic, and almonds—promises to be an
almonds
effective, safe, cheap, and tasty solution to reducing
cardiovascular morbidity and increasing life
expectancy.
Polymeal could reduce cardiovascular disease by
more than 75%.
Franco O et al. BMJ 2004;329:1447-50
120. One third of people taking this pill from
age 55 would benefit, gaining on
average about 11 years of life free from
an IHD event or stroke.
Wald N and Law M. BMJ 2003;326:1419-25
121. Moderate exercise cuts breast
cancer biomarkers in
postmenopausal women
Increased physical activity significantly
reduces serum estrogens in
postmenopausal women and thus may
reduce the risk of breast cancer.
McTiernan A. Cancer Res 2004;364:2923-8
122. Aspirin could be used to prevent
cancer
Three recently published studies indicate
that aspirin, already enjoying a second
lease of life in the prevention of heart
disease, may soon become a first line of
defense against cancer.
London O. BMJ 2003;326:565
124. There are no really “safe”
biological active drugs...
There are only “safe” physicians !
Kaminetzy HA 1993
125. “Each time we learn something new, the
astonishment comes from the recognition
that we were wrong before…
I truth, whe ne ve r we d is c o ve r a ne w fa c t, it
n
invo lve s the e lim ina tio n o f o ld o ne s . . .
thus, as it turns out,
WE ARE ALWAYS IN ERROR ! ”
Le wis Tho m a s Eng lis h Bio lo g is t (1 9 1 3 -1 9 9 3 )
126. My Message is:
.To prescribe postmenopausal hormonal
treatments when clinically indicated, if
not contraindicated
. No answers from ongoing clinical
trials are indispensable to practice
today a good Medicine
MNC/05
127. To know
the disease that a woman has
is as important as
to know
the woman who has the disease
William Osler
128. What are the best recommendations of
the climacteric woman’s doctor?
1. Understand what is happening to the body during
the climacteric and the postmenopause
2. Mental occupation
3. Physical exercise
4. Proper nutrition (moderate consumption of red
wine, and abundant fish, vegetables, fruits, soy,
milk, garlic, chocolate, etc)
5. Keep the body mass index (BMI) within normal
limits
6. Keep a normal girdle/hip ratio, waist circumference
7. Refrain from smoking
8. Keep a normal blood pressure
9. Keep the blood lipids within normal values
(statins?)
10. Examine the breasts (palpation, inspection,
mammography)
129. What about the best treatments
during the climacterium and
beyond?
There is a general tendency to consider
that sex steroid hormones are the only
instruments with which to treat women
when they enter in the climacteric phase
of their lives…
MNC/05
130.
131. Which is the best treatment?
In general terms, is the one that is wisely
indicated, if not contraindicated, after
balancing benefits and risks, of all strategies
and interventions, hormonal or not.
It must be aimed at specific objectives and
targets that will be monitored at regular intervals
in order to determine its efficacy and to estimate
the occurrence of any side effects, a condition
that will determine its duration.
MNC/05
132. Which is the best treatment?
Patient needs and preferences are decisive, based on
decisive
the doctors’ advice. Let it not be forgotten that although
many treatments are available, they are nevertheless
not indispensable. Doctors have the duty to give their
indispensable
best unbiased information to their patients so that they
may make the right choices and then be compliant.
compliant
The woman is the decision maker, if the doctor
sees no contraindication.
thus,
the best treatment is what a well
informed woman has chosen.
MNC/05
133. I personally believe that for the healthy
early post menopausal woman the long term
HT’s, other than relieving vasomotor
symptoms, may play an important role in
improving QoL and in the prevention of
CVD, osteoporosis and Alzheimer, under
surveillance.
Systemic (parenteral) estrogens, added
estrogens
when needed to vaginal progesterone or
progestagen loaded IUD’s, may be very
IUD’s
beneficial, largely overpassing minimal
risks.
MNC/05
134. The conclusions of the WHI trial suggest that the
“safe “ woman (NNH between 600-1000 women)
to initiate HT is
- between 50-59 years of age
- with vasomotor symptoms
- less than 10 years after the menopause
- being treated with statins
- with a good lipid profile and
- with a Body Mass Index >25
Neves-e-Castro M. Human Reproduction 2003;18:2512-2518
135. This is precisely the profile of the great
majority of women who come for
consultation after their menopause.
Therefore it seems that what most
gynecologists are doing to their
predominant population of patients is not
unsafe and contributes not only to a
good quality of life but to prevention, as
well.
Neves-e-Castro M. Human Reproduction 2003;18:2512-2518
138. “He who learns,
but does not think
is lost.
He who thinks, but
does not learn is
dangerous”.
dangerous
Confucius
139. If we both learn and think
we will
neither be lost
nor dangerous
to our postmenopausal women
patients”
Wenger NK. Am J Geriatr Cardiol 2000;9:204-9
140. NAMS position statement on
estrogen and progestagen use in
peri-and postmenopausal women
Revised breast cancer statements indicate
that the risk of breast cancer probably
increases with EPT use but not with ET
use.
141. NAMS position statement on
estrogen and progestagen use in
peri-and postmenopausal women
Place no limit on ET/EPT treatment
duration, provided it is consistent with
duration
treatment goals; if monitored regularly, no
stipulation is made regarding when to
reduce or stop therapy
142. If there are no incoming contraindications
we see no reason to establish a time limit
to the duration of therapy, mainly if there is
a recovery of symptoms after its
discontinuation
Cochrane B, NAMS 2004, P53
IMS www.imsociety.org
NAMS www.menopause.org
143. Evidence informed practice
• It is clearly time to change “evidence based
medicine” to “evidence informed practice”.
practice
• I suggest the era of evidence informed rather
than evidence based medicine has arrived
Glasziou P. Centre for Evidence-Based Medicine. University of
Medicine
Oxford OX3 7LF. BMJ 2005;330:92
144.
145. What has been learned from the
major observational studies and
clinical trials?
the first lesson
systematically administered
progestagens may in part suppress
some of the beneficial effects of
estrogens and may also slightly increase
the risk of breast cancer after treatments
with duration greater than five years.
146. What has been learned from the
major observational studies and
clinical trials?
the second lesson
estrogens, when given alone to
histerectomized women, did not appear
to minimally affect the risk for breast
cancer when compared with controls
MNC/05
147. What has been learned from the
major observational studies and
clinical trials?
the third lesson
Metabolic effects of estrogens and
progestagens, as a whole, can differ
depending on the route of administration,
i.e. oral vs. parentheral, and on the
combination of both, in a sequential regimen or
in continuous combined administration.
MNC/05
148. What has been learned from the
major observational studies and
clinical trials?
the fourth lesson
Hormonal treatments are the first choice for
vasomotor symptom relief as long as they
are needed (on and off assessment). They
should not be used for the secondary
prevention of CVD, when atheroma plaques
CVD
are already present.
MNC/05
149. What has been learned from the
major observational studies and
clinical trials?
the fourth lesson (cont)
Conversely, they may protect from CVD
if started early during the transition
into the post menopause.
menopause
Hormonal treatments are preventive of
osteopenia and osteoporosis at any
stage in life
MNC/05
150. What has been learned from the
major observational studies and
clinical trials?
the fifth lesson
Estrogens may prevent degenerative
lesions of the CNS since, so far, they
seem to be the only available drugs with
nerve growth effects
MNC/05
151. Preventing a woman from the
benefits of a
sound postmenopausal
hormone therapy
because of the fear of rare
side effects
does not seem to be
satisfactory Medicine...
M.Neves-e-Castro, 2000
152. Primum non nocere :
neither by excess,
nor by deffect …
M.Neves-e-Castro
156. Secret for longevity
A passerby noticed an old lady sitting on her front step:”I couldn’t help noticing
how happy you look! What is your secret for such a long, happy life?”
157. Secret for longevity
A passerby noticed an old lady sitting on her front step:”I couldn’t help noticing
how happy you look! What is your secret for such a long, happy life?!”
“I smoke 4 packs of cigarettes a day,”she said. “Before I go to bed, I smoke a nice
big joint. Apart from that, I drink a whole bottle of Jack Daniels every week, and
eat only junk food. On weekends I pop a huge number of pills and do no exercise
at all.”
158. Secret for longevity
A passerby noticed an old lady sitting on her front step:”I couldn’t help noticing
how happy you look! What is your secret for such a long, happy life?!”
“This is absolutely amazing at your age!!!!”, says the passerby. “How old are you?”
In contrast with the previous slide of perceived health concerns, this slide shows actual rates for cause of death. What is apparent is that a generalized fear of cancer, and breast cancer specifically, skews postmenopausal women’s understanding of their health risks. Such misinformation often represents a barrier when women make decisions about ET/HT. Although the results of the WHI trial have provided and will continue to provide valuable information on the effects of various preventive strategies on chronic disease in menopausal women, they are unlikely to change this misperception. Anderson RN. Deaths: leading causes for 1999. Natl Vital Stat Rep . 2001;49:1-13.