To investigate the use of alternative drugs for the climacteric in Finland, which products are used, and who are the women using them.
The study was based on a population-based survey conducted in 1989 among 2000 Finnish women aged 45-64 (response rate 86%).
11% of the women reported the use of alternative drugs for the climacteric. Food supplements and bee products were the most common types of alternative drugs used. Some of them may have allergic or other side effects. Users differ little from other women judging by health habits and the utilization of health care services. The best predictors for alternative drug use were urban residence, more than 9 years of general education, and among 50 54-year olds, the use of prescription or OTC drugs for menopause. Over half of the users of alternative drugs had also used hormone therapy.
Women using alternative drugs during and after the climacteric represent a large group. More information is needed about the clinical effects of alternative drugs, and the characteristics of alternative drug users.
A questionnaire was sent to all 475 members of the Norwegian Gynaecological Society. It was based on a similar study previously performed in Denmark and Sweden. 85% of the members returned the questionnaire. 382 (80%) had answered the questions; 153 (40%) women, 228 (60%) men, and one case where the sex was not stated. The mean age was 48 years (SD 10). The male gynaecologists had a more liberal attitude towards hormone replacement therapy than their female counterparts, 43% of them recommending oestrogen for all women, compared to 31% of the female gynaecologists. The younger doctors were more restrictive in their recommendations but attitudes became more liberal the older the doctors were. Among gynaecologists over 55 years, 49% of males and 50% of females recommended oestrogen for all women. The final decision as to whether or not to take hormone replacement therapy was most often made by the patient herself (61%). The majority of both female (86%) and male (75%) gynaecologists considered risk factors for heart disease to be an indication for oestrogen. In perimenopausal women, 356 (93%) preferred oral cyclical oestrogen combined with progestagen, whereas in postmenopausal women 333 (87%) preferred to take oral oestrogen combined with progestagen continuously.
The objective of this cross-sectional study was to analyse the influence of biological, socio-demographic, and psychosocial factors and current perimenopausal status on hypertension in a geographically defined population of 10,766 women aged 50-59 years, of whom 6901 attended the study. Altogether 1887 (27.3%) women had hypertension: 996 with drug treatment and 891 diagnosed at the study. In a logistic multiple regression analysis (controlled for age), drug treatment of hyperlipidaemia, family history of hypertension, waist-to-hip ratio, body mass index (BMI) increase > or = 25% during the past 25 years, S-triglycerides, S-cholesterol, education up to comprehensive school, and to upper secondary school, consumption of 84-167 g of alcohol/week, and of > or = 168 g of alcohol/week, were positively associated with hypertension, while high-density lipoprotein cholesterol and current smoking were negatively associated. A significant interaction was found between current smoking and BMI increase, with a lower risk for hypertension among smokers who had increased their BMI > or = 25%. No interaction was found between smoking and alcohol. In conclusion, hypertension was predominantly associated with biological factors, and with heredity for hypertension. Of the socio-demographic factors, only low level of education was associated with hypertension in a comprehensive analysis. Perimenopausal status showed no relation to occurrence of hypertension in the multiple regression analysis. The risk for hypertension increased with moderate and high consumption of alcohol, whereas smoking showed a decreased risk. Among women with weight gain, present smoking remained protective. Although both smoking and hypertension are established risk factors for cardiovascular disease, they seem not to be directly linked, indicating a complexity of mechanisms.
A questionnaire study was carried out in 6000 randomly selected women in the County of Jämtland in Sweden. The response rate was 61.2%. Questions were asked about general health, height and body weight, sleep, menstruation and menopausal complaints. There were also questions about visits to doctors and the use of sleeping pills and hormone preparations. A deterioration of the night's sleep after the age of 60 years was associated especially with a low body mass index (BMI). In the subgroup with a BMI below 20 (kg m-2), frequent awakenings were reported 4 times more often in women 60-64 years old than in those aged 40-44 years. No such difference was found with a BMI > or = 30. In the age group 60-64 years twice as many women with BMI > or = 30 as women with BMI or = 30kg m-2.
Few studies have focused on the care setting transitions that occur in the last year of life. People living in rural areas may have more difficult care setting transitions and also more moves in the last year of life as health changes occur. A mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred in the last year of life. These moves were most often identified (65%) on a likert-type scale as "very difficult," with the free text information revealing these trips were often emotionally painful for themselves and physically painful for the decedent. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) traveling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families.
We assessed the determinants of onset of hypertension in a large, prospective population-based study of perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. The data collection started in 1989, when a baseline postal inquiry was sent to all women aged 47-56 years (n=14 220) residing in the Kuopio Province in Eastern Finland. Names, social security numbers and addresses were obtained from the Population Register Centre of Finland. A total of 11 798 women responded at baseline and at 5-year follow-up in 1994. After the exclusion of 1777 women with prevalent hypertension at baseline and women with missing height or weight information, the study population consisted of 9485 without established hypertension at baseline. New cases of established hypertension during the follow-up (n=908) were ascertained with the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). According to the National Health Insurance, the SII granted 90% reimbursement for drug costs in defined chronic illnesses necessitating continuous medication, like arterial hypertension. Weight and weight gain both raised the risk by 5% per kg (P
A cohort of 23 233 women who had received estrogen prescriptions was recruited for a prospective study of estrogen therapy and the associated risk of endometrial cancer. For a detailed study, a comprehensive questionnaire was mailed to 735 randomly sampled cohort members, and 89 per cent of them responded. Estrogen exposure and its implications were described in a preceding paper (part I). The present paper reports the distribution in the cohort sample of personal features known to be risk factors for endometrial cancer. A comparison with results from various materials derived from population-based surveys and case-control studies implied that the cohort members might have a lower proportion of nulliparity (infertility) and a somewhat higher prevalence of hypertension. Differences in the distributions of age at menarche or menopause, weight, height and prevalence of diabetes were according to these comparisons slight and probably without clinical significance. It was concluded that the prevalence of risk factors for endometrial cancer other than estrogen exposure was not higher in the cohort than in the background population. Moreover, approximately one-fifth of the estrogen takers had been freed of their risk through hysterectomies.
The "social shaping of technologies" approach holds that a technology is both socially embedded and that it shapes the social environment. The aim of this study was to investigate how hormone therapy use during the climacterium and subsequently was socially shaped in texts published in the main Finnish medical journals and lay magazines during 1955-1992. In these two arenas physicians, especially gynecologists, played the major role in the debate and their professional knowledge on hormone therapy was mixed with their views on women's status and roles, the quality of life and fears about aging when they were promoting hormone use, especially in the lay magazines. This type of argument for the promotion of hormone use persisted in the most recent texts, despite the availability of substantial evidence both for the against of hormone therapy. Overall, the texts clearly favored the benefits of the therapy. Three periods of differing orientation can be discerned. Attitudes towards hormone therapy tended to be cautious from 1955 through the 1970s, more enthusiastic in the 1980s, and mixed at the start of the 1990s. In the most recent texts critical comments came from individual women who had used the therapy or decided not to, including female physicians and other professionals. The results suggest that hormone therapy is socially embedded, but may also shape perceptions and the understanding of women's aging. The social shaping of the technology approach may improve our understanding of the development of health policy towards women at and after the age of the climacterium.