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A 10-year follow-up of postmenopausal women on long-term continuous combined hormone replacement therapy: Update of safety and quality-of-life findings.

https://arctichealth.org/en/permalink/ahliterature80782
Source
J Br Menopause Soc. 2006 Sep;12(3):115-25
Publication Type
Article
Date
Sep-2006
Author
Heikkinen Jorma
Vaheri Raija
Timonen Ulla
Author Affiliation
The Deaconness Institute of Oulu, Isokatu, Oulu, Finland.
Source
J Br Menopause Soc. 2006 Sep;12(3):115-25
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Breast Neoplasms - chemically induced - epidemiology
Cerebrovascular Accident - chemically induced - epidemiology
Dose-Response Relationship, Drug
Endometrial Neoplasms - chemically induced - epidemiology
Estradiol - administration & dosage - adverse effects - analogs & derivatives
Estrogens, Conjugated (USP) - administration & dosage - adverse effects
Female
Finland
Follow-Up Studies
Hormone Replacement Therapy - adverse effects - psychology
Humans
Medroxyprogesterone 17-Acetate - administration & dosage - adverse effects
Middle Aged
Postmenopause - drug effects - physiology
Quality of Life
Treatment Outcome
Abstract
OBJECTIVE: To assess the safety and health-related quality of life (HRQOL) of continuous combined hormone replacement therapy (ccHRT) with estradiol valerate/medroxyprogesterone acetate (E(2)V/MPA) over nine years and at follow-up one year after discontinuation. Study design: A total of 419 women were randomized to one of four treatments: once-daily 1 mg E2V/2.5 mg MPA (1 + 2.5 group); 1 mg E2V/5 mg MPA daily (1 + 5 group); 2 mg E2V/2.5 mg MPA daily (2 + 2.5 group); 2 mg E2V/5 mg MPA daily (2 + 5 group) (Indivina, Orion Pharma). For the last six months, all received the 1 + 2.5 dosage. The 2 + 2.5 dosage was discontinued at the end of year 7. A total of 198 women continued after year 7. RESULTS: Annualized percentage rates for cardiovascular events [corrected] and endometrial cancers [corrected] were below national rates for Finland and those reported for the Women's Health Initiative. There were no serious events with the 1 + 2.5 dosage or after ccHRT discontinuation. Climacteric symptoms remained significantly below baseline values after dosage reduction; some symptoms recurred after discontinuation of ccHRT. HRQOL ratings improved with ccHRT, irrespective of dosage, including depressed mood, anxiety, health perception and sexual interest. Scores on a scale assessing daily functioning and enjoyment (Q-LES-Q) improved from year 7 to year 9. They deteriorated during follow-up in women not continuing ccHRT. CONCLUSIONS: Lower dosages of HRT were as effective as higher doses in improving climacteric symptoms and HRQOL ratings and had fewer safety concerns. Following discontinuation of ccHRT, patient satisfaction was variable, with 15% electing to continue or restart HRT and 7% resuming at follow-up. This supports the need for an individualized approach to therapy recommendations.
Notes
Erratum In: J Br Menopause Soc. 2006 Dec;12(4):174
PubMed ID
16953985 View in PubMed
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A 24-year follow-up of body mass index and cerebral atrophy.

https://arctichealth.org/en/permalink/ahliterature9325
Source
Neurology. 2004 Nov 23;63(10):1876-81
Publication Type
Article
Date
Nov-23-2004
Author
D. Gustafson
L. Lissner
C. Bengtsson
C. Björkelund
I. Skoog
Author Affiliation
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. deb.gustafson@neuro.gu.se
Source
Neurology. 2004 Nov 23;63(10):1876-81
Date
Nov-23-2004
Language
English
Publication Type
Article
Keywords
Adult
Alcohol drinking - epidemiology
Atrophy
Body mass index
Cardiovascular Diseases - epidemiology
Cerebral Cortex - pathology - radiography
Comorbidity
Dementia - epidemiology
Diabetes Mellitus - epidemiology
Educational Status
Female
Follow-Up Studies
Health Surveys
Hormone Replacement Therapy
Humans
Hyperlipidemia - epidemiology
Middle Aged
Obesity - epidemiology - pathology
Research Support, Non-U.S. Gov't
Risk factors
Smoking - epidemiology
Sweden - epidemiology
Tomography, X-Ray Computed
Waist-Hip Ratio
Abstract
OBJECTIVE: To investigate the longitudinal relationship between body mass index (BMI), a major vascular risk factor, and cerebral atrophy, a marker of neurodegeneration, in a population-based sample of middle-aged women. METHODS: A representative sample of 290 women born in 1908, 1914, 1918, and 1922 was examined in 1968 to 1969, 1974 to 1975, 1980 to 1981, and 1992 to 1993 as part of the Population Study of Women in Göteborg, Sweden. At each examination, women completed a survey on a variety of health and lifestyle factors and underwent anthropometric, clinical, and neuropsychiatric assessments and blood collection. Atrophy of the temporal, frontal, occipital, and parietal lobes was measured on CT in 1992 when participants were age 70 to 84. Univariate and multivariate regression analyses were used to assess the relationship between BMI and brain measures. RESULTS: Women with atrophy of the temporal lobe were, on average, 1.1 to 1.5 kg/m2 higher in BMI at all examinations than women without temporal atrophy (p
Notes
Comment In: Neurology. 2005 Jun 14;64(11):1990-1; author reply 1990-115955971
SummaryForPatientsIn: Neurology. 2004 Nov 23;63(10):E19-2015557485
PubMed ID
15557505 View in PubMed
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Actual practice vs guidelines in laboratory monitoring of older patients with primary hypothyroidism in primary care.

https://arctichealth.org/en/permalink/ahliterature169851
Source
Aging Clin Exp Res. 2006 Feb;18(1):34-9
Publication Type
Article
Date
Feb-2006
Author
Seija I Eskelinen
Raimo E Isoaho
Sirkka-Liisa Kivelä
Kerttu M Irjala
Author Affiliation
Department of Family Medicine, University of Turku, Lemminkiisenkatu 1, FIN-20014 Turku, Finland. seija.eskelinen@utu.fi
Source
Aging Clin Exp Res. 2006 Feb;18(1):34-9
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Female
Finland
Follow-Up Studies
Guidelines as Topic
Hormone Replacement Therapy
Humans
Hypothyroidism - blood - therapy
Laboratories - standards
Male
Middle Aged
Primary Health Care
Thyroid Function Tests
Thyrotropin-Releasing Hormone - blood
Thyroxine - blood - therapeutic use
Abstract
Clinical guidelines are produced in order to achieve an acceptable standard of care, especially for patients with common diseases in primary care. The treatment of primary hypothyroidism serves as an example of the content of clinical guidelines and actual practice. The aim of this study was to compare the follow-up of primary hypothyroidism by thyroid function tests, serum TSH and serum-free T4, in older patients managed in primary care, with recommendations in treatment guidelines and textbooks.
Participation rate 82% (n=1260), mean age 74 years, (range 64-100 yrs). Patients with primary hypothyroidism were identified by means of cross-sectional survey (Lieto Study 1998-1999) and 4-year retrospective collection of laboratory database medical records (1994-1998), performed in autumn 2003.
In most stable (=treated for more than 14 months) thyroxine users, both serum TSH (mean 1.4 measurements/year) and serum-free T4 (mean 0.8 measurements/year) values were measured over the 4-year period of thyroxine treatment. 66.4% of serum TSH and 85.3% of serum-free T4 values were within normal range. 41.7% of serum-free T4 determinations had been performed without indication (=with TSH in normal range).
Compared with the recommended testing frequency given in various guidelines, a considerable number of extra measurements, especially serum-free T4, were performed. However, some key issues in the recommendations were difficult to interpret, and the age or other main characteristics of the patient were not taken into consideration adequately.
PubMed ID
16608134 View in PubMed
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Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones. A population-based study in northern Sweden.

https://arctichealth.org/en/permalink/ahliterature63498
Source
J Intern Med. 2003 Aug;254(2):176-83
Publication Type
Article
Date
Aug-2003
Author
C. Andersson
E. Innala
T. Bäckström
Author Affiliation
Department of Family Medicine, University Hospital, Umeå, Sweden. christer.andersson@fammed.umu.se
Source
J Intern Med. 2003 Aug;254(2):176-83
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Abortion, Spontaneous - etiology
Adolescent
Adult
Aged
Aged, 80 and over
Contraceptive Agents - therapeutic use
Contraceptives, Oral - therapeutic use
Drug Combinations
Estradiol - therapeutic use
Female
Hormone Replacement Therapy - methods
Humans
Menopause - physiology
Middle Aged
Porphyria, Acute Intermittent - complications - drug therapy - epidemiology
Pregnancy
Progesterone - therapeutic use
Retrospective Studies
Sweden - epidemiology
Vagina - drug effects
Abstract
OBJECTIVE: To describe the clinical expression of acute intermittent porphyria (AIP) in women, their use of exogenous sex hormones, and the effects on AIP. DESIGN: A retrospective population-based study. SUBJECTS: All women aged > or =18 years (n = 190) with DNA-diagnosed AIP in northern Sweden. RESULTS: A total of 166 women (87%) participated; 91 (55%) had manifest AIP. Severe attacks were reported by 82%; 39% reported recurrent premenstrual AIP attacks and 22% reported chronic AIP symptoms. Oral hormonal contraceptives had been used by 58% of all these women and by 50 with manifest AIP (57%). Twelve women (24%) associated oral contraceptives as precipitating AIP attacks; in nine cases their first attack. One woman experienced relief from AIP symptoms. On commencing their treatment, 72% of the women with manifest AIP had not yet suffered their first attack. Twenty-two women (25%) aged > or =45 years had used hormonal replacement therapy (HRT) at menopause to remedy climacteric symptoms (the percutaneous route was most frequently used); no AIP attack was precipitated. HRT to remedy vaginal dryness was used by 26 women (28%) aged > or =45 years without triggering an AIP attack. Miscarriages were more frequent in women with manifest AIP (50%) than in the latent group (30%, P = 0.014). CONCLUSIONS: About half of the women with AIP had used oral hormonal contraceptives. As 25% of women with manifest AIP reported attacks associated with such drugs, caution must still be recommended. Menopausal HRT only rarely affected the disorder. Miscarriage was more common amongst women with manifest AIP.
PubMed ID
12859699 View in PubMed
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Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database.

https://arctichealth.org/en/permalink/ahliterature183465
Source
Osteoporos Int. 2003 Oct;14(10):808-13
Publication Type
Article
Date
Oct-2003
Author
Alexandra Papaioannou
George Ioannidis
Jonathan D Adachi
Rolf J Sebaldt
Nicole Ferko
Mark Puglia
Jacques Brown
Alan Tenenhouse
Wojciech P Olszynski
Pauline Boulos
David A Hanley
Robert Josse
Timothy M Murray
Annie Petrie
Charlie H Goldsmith
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Osteoporos Int. 2003 Oct;14(10):808-13
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Aged
Alendronate - therapeutic use
Analysis of Variance
Canada
Diphosphonates - therapeutic use
Drug Therapy, Combination
Etidronic Acid - therapeutic use
Female
Follow-Up Studies
Hormone Replacement Therapy - psychology
Humans
Male
Middle Aged
Osteoporosis - drug therapy - psychology
Osteoporosis, Postmenopausal - drug therapy - psychology
Patient compliance
Proportional Hazards Models
Prospective Studies
Registries
Abstract
Therapies for osteoporosis must be taken for at least 1 year to be effective. The purpose of this study was to determine the difference in adherence to etidronate, alendronate and hormone replacement therapy in a group of patients seen at our tertiary care centres. The Canadian Database of Osteoporosis and Osteopenia (CANDOO), a prospective observational database designed to capture clinical data, was searched for patients who started therapy following entry into CANDOO. There were 1196 initiating etidronate, 477 alendronate and 294 hormone replacement therapy women and men aged (mean, SD) 65.8 (8.7) years in the study. A Cox proportional hazards regression model was used to assess differences between treatment groups in the time to discontinuation of therapy. Several potential covariates such as anthropometry, medications, illnesses, fractures and lifestyle factors were entered into the model. A forward selection technique was used to generate the final model. Hazard ratios and 95% confidence intervals (CI) were calculated. Adjusted results indicated that alendronate-treated patients were more likely to discontinue therapy as compared with etidronate-treated patients (1.404; 95% CI: 1.150, 1.714). After 1 year, 90.3% of patients were still taking etidronate compared with 77.6% for alendronate. No statistically significant differences were found between hormone replacement therapy and etidronate users (0.971; 95% CI: 0.862, 1.093) and hormone replacement therapy and alendronate users (0.824; 95% CI: 0.624, 1.088) after controlling for potential covariates. After 1 year, 80.1% of patients were still taking hormone replacement therapy, which decreased to 44.5% after 6 years. Increasing age and presence of incident non-vertebral fractures were found to be independent predictors of adherence. In conclusion, alendronate users were more likely to discontinue therapy than etidronate users over the follow-up period. Potential barriers to long-term patient adherence to osteoporosis therapies need to be evaluated.
PubMed ID
14523610 View in PubMed
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Adipose tissue PCB levels and CYP1B1 and COMT genotypes in relation to breast cancer risk in postmenopausal Danish women.

https://arctichealth.org/en/permalink/ahliterature258362
Source
Int J Environ Health Res. 2014;24(3):256-68
Publication Type
Article
Date
2014
Author
Elvira V Bräuner
Steffen Loft
Anja Wellejus
Herman Autrup
Anne Tjønneland
Ole Raaschou-Nielsen
Author Affiliation
a Danish Building Research Institute, Construction and Health, Aalborg University , Copenhagen , Denmark .
Source
Int J Environ Health Res. 2014;24(3):256-68
Date
2014
Language
English
Publication Type
Article
Keywords
Adipose Tissue - metabolism
Aryl Hydrocarbon Hydroxylases - genetics
Breast Neoplasms - chemically induced - enzymology - genetics
Case-Control Studies
Catechol O-Methyltransferase - genetics
Data Interpretation, Statistical
Denmark
Female
Genotype
Hormone Replacement Therapy
Humans
Middle Aged
Polychlorinated Biphenyls - analysis - pharmacokinetics - toxicity
Polymorphism, Single Nucleotide
Postmenopause - metabolism
Prospective Studies
Risk
Abstract
Exposure to PCBs may be an etiologic factor for breast cancer. The cytochrome P450 1B1 (CYP1B1) and catechol-O-methyltransferase (COMT) enzymes are involved in estrogen metabolism and PCB metabolism, both of which may relate to breast cancer susceptibility. Polymorphisms in genes regulating these enzymes control efficiency. Our objective was to assess whether CYP1B1 and COMT gene polymorphisms modulate the effect of PCBs in breast cancer risk, among postmenopausal Danish women. Neither CYP1B1 Leu432Val polymorphisms nor adipose tissue PCBs were independently associated with breast cancer risk. When assessing the independent effect of the COMT Val158Met polymorphism, we observed reduced risk for breast cancer amongst hormone replacement therapy using women who were homozygous carriers of the variant allele compared with those carrying the wild-type variant (RR?=?0.41; 95% CI: 0.29-0.89). We found no statistically significant interactions between any of the PCB groups and CYP1B1 or COMT polymorphisms on the risk of breast cancer.
PubMed ID
23869875 View in PubMed
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Agreement of self-reported estrogen use with prescription data: an analysis of women from the Kuopio Osteoporosis Risk Factor and Prevention Study .

https://arctichealth.org/en/permalink/ahliterature160362
Source
Menopause. 2008 Mar-Apr;15(2):282-9
Publication Type
Article
Author
Lorenzo Sandini
Kati Pentti
Marjo Tuppurainen
Heikki Kröger
Risto Honkanen
Author Affiliation
Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland. Lorenzo.Sandini@uku.fi
Source
Menopause. 2008 Mar-Apr;15(2):282-9
Language
English
Publication Type
Article
Keywords
Aged
Data Collection - methods
Estrogens - therapeutic use
Female
Finland
Health Surveys
Hormone Replacement Therapy - statistics & numerical data
Humans
Middle Aged
National Health Programs - statistics & numerical data
Osteoporosis - drug therapy
Postal Service
Reproducibility of Results
Self Administration - statistics & numerical data
Abstract
Self-reported data are usually used for the evaluation of the effects of hormone therapy in population studies. We examined the agreement between self-reported hormone therapy use and nationwide prescription data from the Social Insurance Institution of Finland to evaluate the accuracy of self-reports.
The 10-year questionnaire of the population-based Kuopio Osteoporosis Study was sent in 1999 to 12,562 women aged 57 to 67 years; 11,377 women who completed questionnaires were eligible for analysis. We asked women whether they had been taking estrogen hormone therapy as a gel, plaster, or tablet for the treatment of climacteric symptoms or osteoporosis and if the answer was yes, to specify the brand and duration of treatment for each year from 1994 to 1999.
Among the 11,377 women, 3,105 (27.3%) reported the use of an estrogen-based preparation in 1996 to 1999, and 97.6% were confirmed by Social Insurance Institution of Finland to have been prescribed hormone therapy during that time. In these women the median duration of use was 32 months (range, 1-41), according to Social Insurance Institution of Finland data. An additional 1,738 women had been prescribed hormone therapy for short periods, but those women did not report it. The duration of self-reported hormone therapy use was compared to the duration of prescriptions. A difference of 3 months or less per year was observed in 63.4% to 77.0% of women during the years 1996-1998.
A postal inquiry is a reliable method of recording long-term hormone therapy use.
PubMed ID
17998884 View in PubMed
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An analysis of the effect of selection bias on the association of hormone replacement therapy and breast cancer risk.

https://arctichealth.org/en/permalink/ahliterature172268
Source
Chronic Dis Can. 2005 Spring-Summer;26(2-3):73-9
Publication Type
Article
Author
Ilona Csizmadi
Christine M Friedenreich
Heather E Bryant
Kerry S Courneya
Author Affiliation
Division of Population Health and Information, Alberta Cancer Board, 1331-29 Street NW, Calgary, Alberta T2N 4N2, Canada. ilona.csizmadi@cancerboard.ab.ca
Source
Chronic Dis Can. 2005 Spring-Summer;26(2-3):73-9
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Breast Neoplasms - epidemiology
Case-Control Studies
Female
Hormone Replacement Therapy - statistics & numerical data
Humans
Middle Aged
Odds Ratio
Risk factors
Selection Bias
Abstract
A sensitivity analysis was conducted to determine the impact on measures of effect of a suspected differential participation response rate between hormone replacement therapy (HRT) users and nonusers, among controls recruited to a population-based case-control study of breast cancer. The age-specific prevalence of current HRT use among controls was compared to data from the 1996 Canadian National Population Health Survey (NPHS). Control women identified as current HRT users were randomly re-sampled to replicate the prevalence of HRT use reported by the NPHS. Unconditional logistic regression was conducted to estimate odds ratios (OR) and 95 percent confidence intervals (CI) for the use of HRT and breast cancer risk before and after re-sampling. Multivariate adjusted ORs for breast cancer and estrogen-only and estrogen-progestin formulations were 0.76 (0.53-1.10) and 0.94 (95% CI: 0.64 - 1.38), respectively, using the original case-control controls and 0.99 (0.77-1.27) and 1.57 (95% CI: 1.02 - 2.40), respectively, following re-sampling of the controls. This sensitivity analysis illustrates the extent to which differential participation rates between HRT users and nonusers may affect estimates of measures of effect.
PubMed ID
16251013 View in PubMed
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Androgen therapy: testing before prescribing and monitoring during therapy.

https://arctichealth.org/en/permalink/ahliterature160341
Source
Can Fam Physician. 2007 Nov;53(11):1936-42
Publication Type
Article
Date
Nov-2007
Author
Alan Katz
Anne Katz
Charles Burchill
Author Affiliation
408-727 McDermot Ave, Winnipeg, MB. Alan_Katz@cpe.umanitoba.ca
Source
Can Fam Physician. 2007 Nov;53(11):1936-42
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Blood Chemical Analysis
Cohort Studies
Drug Utilization
Family Practice
Follow-Up Studies
Hormone Replacement Therapy - adverse effects - methods
Humans
Male
Manitoba
Middle Aged
Monitoring, Physiologic
Prostate - drug effects - metabolism
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - physiopathology
Retrospective Studies
Risk factors
Testosterone - administration & dosage - metabolism
Abstract
To explore the extent to which biochemical testing is used to diagnose androgen deficiency before initiating treatment and to learn whether recommendations for clinical monitoring of men taking androgen therapy are being followed.
Population-based retrospective cohort study.
Winnipeg, Man.
A total of 902 men who filled at least 2 prescriptions for androgen therapy.
Whether men had had baseline prostate-specific antigen (PSA) and testosterone testing before initiation of therapy and whether men had been monitored during the first year of treatment.
Of the 902 men who filled first-time prescriptions during the study period, only 475 (52.7%) had ever had PSA or testosterone tests. Before starting therapy, 315 men (34.9%) had had PSA tests, and 152 men (16.9%) had had testosterone tests. Less than 1% of the entire sample had had 3 or more tests during the year following initiation of therapy.
Indications for androgen therapy in this population appear to be based on clinical symptoms rather than on demonstrated biochemical androgen deficiency. Recommendations for clinical monitoring of men taking androgen therapy are not followed consistently.
Notes
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PubMed ID
18000271 View in PubMed
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Andropause: knowledge and awareness among primary care physicians in Victoria, BC, Canada.

https://arctichealth.org/en/permalink/ahliterature166008
Source
Aging Male. 2006 Dec;9(4):215-20
Publication Type
Article
Date
Dec-2006
Author
Peter J Pommerville
Paul Zakus
Author Affiliation
Can-Med Clinical Research Inc., Victoria, BC, Canada. ppomm@pommerville-urology.com
Source
Aging Male. 2006 Dec;9(4):215-20
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Adult
Andropause - drug effects - physiology
Awareness
British Columbia
Female
Health Knowledge, Attitudes, Practice
Hormone Replacement Therapy
Humans
Male
Middle Aged
Physicians, Family - education
Questionnaires
Testosterone - administration & dosage - therapeutic use
Abstract
The causes, symptoms and treatment options for andropause have been well documented; however, not enough is known about the primary care physicians' (PCPs) knowledge in this therapeutic area. This study assesses the PCPs' awareness and knowledge of andropause in Victoria, British Columbia, Canada.
Self-administered questionnaires were developed for family physicians and general practitioners. Each questionnaire included questions in three domains: 1) General knowledge, beliefs and exposure; 2) Knowledge of diagnostic and treatment options and; 3) General demographics.
A very high percentage of PCPs had heard of andropause (96.3%). Of the physicians who completed the survey, 92.6% agreed that men experience something similar to women's menopause when they age and 98.0% agreed that andropause is associated with an increased risk of osteoporosis. Almost all PCPs (91.5%) agreed that prostate cancer is a contraindication to treatment while around one-third (33.9%) agreed that breast cancer was a contraindication. Slightly more than half of physicians (57.4%) felt that they encountered obstacles to their investigation of andropause with the most prevalent complaint being a lack of access to education resources. There is a need for improved continuing medical education (CME) programmes in the Greater Victoria region to give PCPs the skills to diagnose and manage andropause with confidence.
PubMed ID
17178557 View in PubMed
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248 records – page 1 of 25.