Findings released from recent pivotal clinical trials on hormone therapy (HT) benefits and risks have stimulated a growing trend towards lower doses and earlier discontinuation of HT for menopausal women. Yet, there is little knowledge regarding women's personal experiences with the resultant earlier and possibly abrupt withdrawal of HT. The purpose of this study was to explore postmenopausal women's vasomotor symptom experiences after discontinuing HT. The data for this study was collected from menopausal women who discontinued HT. The study questionnaire was created through an extensive review of the literature as well as an expert panel review. The questionnaire was also piloted with a small group of women prior to its use in this study. Data analysis consisted of descriptive analysis with means and standard deviations and/or frequency distributions with percentages for demographic data, health behaviors, factors influencing HT decisions, use of CAM and perceived efficacy. Chi-square analysis, Spearman Rho correlation, and logistic regression analysis were conducted for contextual factors and vasomotor symptom experiences. A McNemar test was performed to assess within group differences for vasomotor symptoms experiences pre and post HT. Questionnaires were received from 563 menopausal women throughout the United States. This study revealed that 80% of participants experienced vasomotor symptoms after discontinuing HT. The most common predictors which accounted for only 13% of variance in the occurrence of vasomotor symptoms were younger age, type of menopause and the occurrence of vasomotor symptoms prior to initiation of HT. Of the 563 women participating in the study, less than half reported the use of CAM to treat reemerging vasomotor symptoms. For the most part, less than half of the women felt their treatment choices were helpful in relieving their reemerging vasomotor symptoms Because a woman's experience of menopause can be highly individualized, an adaptation of Bronfenbrenner's ecological theory was used guide this exploratory study. The study findings supported the usefulness of the adaptation of Bronfenbrenner's ecological theory as a model through which to view the vasomotor experiences of menopausal women who have discontinued HT. / text

The effects of exogenous estrogen administration on aspects of memory and cognition in women were examined in two studies. In Study 1, women receiving estrogen replacement therapy were compared to untreated women on four measures of verbal memory. Those receiving estrogen had significantly better scores on a measure of delayed memory for propositional material. In Study 2, women in the early stages of Alzheimer's Disease (AD) were administered either estrogen or placebo on a double-blind basis for six months. Women given estrogen showed improvement on a measure of verbal memory and spatial attention compared to the placebo controls. The combined results of these studies provide evidence that estrogen enhances aspects of verbal memory in both healthy postmenopausal women and in postmenopausal women in the early stages of AD as measured by neuropsychological tests. These effects might be mediated by actions of estrogen on neuronal morphology and physiology in brain areas important for memory and cognition.

Prostate cancer is frequently diagnosed in elderly men and, despite the largely unproven survival benefits of treatment, the majority receive treatment. Treatment options include surgery, radiation, and/or androgen deprivation therapy (ADT). Risks associated with treatment include hip fracture. Current understanding suggests that hip fracture is a frequent cause of morbidity and mortality in the elderly, and both radiation treatment and ADT can increase the risk of hip fracture. It is important to understand these risks so they can be minimized and the morbidity of treatment reduced. The objectives of this study were to estimate the risk of hip fracture as a major adverse outcome of treatment for prostate cancer among elderly men. The specific objectives include estimating: 1) the risk of hip fracture and the dose-risk relationship among patients receiving curative radiation treatment, and 2) the risk of hip fracture associated with palliative ADT and relapsed ADT compared to curative ADT. The cancer diagnosis and treatment records of 32,673 men were linked to their hospital discharge abstracts. The risk of hip fracture was estimated using Cox regression and the estimates were adjusted for age, comorbidity, income, and year of diagnosis. The risk of hip fracture was 59% higher among men who received curative radiation when compared to men who received curative surgery. The risk of hip fracture fell by 6% with each one Gy increase in radiation dose between 55 and 81 Gy Biological Equivalent Dose to the hip-bone. The risk of hip fracture for subjects in the palliative ADT and relapsed ADT categories was 5.98 and 5.77 times the risk in comparison to men who received curative ADT treatment. Curative radiation treatment is associated with an increased risk of hip fracture when compared to curative surgery. The risk of hip fracture is greater with ADT for palliation and relapsed cancer than with curative treatment. Current treatments for prostate cancer contain significant risk of hip fracture for elderly men and these risks should be considered as part of the treatment decision.

Cancer-treatment-induced bone loss (CTBL) is a well-recognized co-morbidity that affects many cancer patients. Commonly used to treat breast and prostate cancer patients, hormone suppression therapy (HST) may accelerate bone loss, resulting in osteopenia or osteoporosis. Because of their broad clinical utility, lifestyle and dietary modifications, such as regular participation in bone-stressing exercise and calcium supplementation, are starting to play a much larger role in the prevention and treatment of CTBL. However, only limited information is available on the effects that these factors may have on bone mineral density (BMD). Purpose. The purpose of this investigation was to assess the degree of BMD change from the onset of HST to 6 months and to examine the impact that physical activity and calcium intake may have on BMD. Methods. Twelve subjects (8 females and 4 males) undergoing HST for breast or prostate cancer were enrolled in the study. BMD at the spine, dual femur, and total body was assessed by dual-energy x-ray absorptiometry at 0 and 6 months. In addition, subjects wore an accelerometer to assess physical activity level and completed a lifestyle questionnaire at baseline, 3, and 6 months after starting therapy. Aside from the 7 non-exercise subjects, 5 subjects chose to participate in The Cancer Exercise Program at Ball Memorial Hospital or complete bone-stressing exercises at home. Results. No significant changes in BMD were observed after 6 months of HST between the groups at any of the sites. When all subjects were examined together, a significant BMD decrease of 3.2% was observed at the lumbar spine. The accelerometer and lifestyle questionnaires revealed that the males were more active than the females and the exercisers were more active than the non-exercisers at both baseline and after 6 months of HST. Supplementation with calcium did not affect BMD changes at any site;although it is possible this is an effect of gender as all males were included in the same group. Lifestyle factors such as history of smoking and alcoholism were also examined, but were not correlated to changes in BMD. Conclusion. Treatment with HST results in decreases in BMD, particularly at the spine. Bone-stressing exercise helped maintain or improve total body BMD in 3 of the 5 subjects the exercise group. There appears to be no difference in BMD between those who supplemented with calcium and those who did not. / School of Physical Education, Sport, and Exercise Science

Using illustrations of popular media about female hormones that depict and stereotype women, I theorize towards a more positive approach to women's bodies in flux and change that moves away from the conceptualization of women as Hormonal Bodies towards Bodies without Hormones. I challenge biomedical agency, reductionist biology, a predatory pharmaceutical industry and normative social imperatives to question the assumption of women's bodies as a naturalized pathology. To disrupt the disciplining of women socially constructed as deficient and uncontrollable, I point to the conflict between women's naturally fluxing bodies and emotions, and western society's dominant values shaping women, hormones and contemporary health practices. I reframe women's bodies from problem and limitation to resource and possibility. Neo-materialist views of Deleuze and Guattari, nomadic figurations and rhizomatic thinking are contextualized to women and bodies to produce notions of practicing and experiencing a body of choice unbound to female hormones.

Memory function was examined in association with sex hormone levels in women. The results of the first study suggest that self-reports of memory problems were especially prevalent among women attending a menopause clinic compared to a nonpatient sample. In the following investigation, women given placebo after undergoing a bilateral oophorectomy showed decreases in memory performance, specifically on a paired-associate learning task, coincident with declines in estrogen levels. Significant improvements were found in estrogen-treated women pre- to postoperatively in the immediate recall of paragraphs, in association with supraphysiological estrogen levels. A final study on naturally-cycling women found a decline in visual memory performance during the menstrual compared to the luteal phase of the cycle. Visual memory scores were positively correlated with progesterone levels whereas paired-associate recall scores were positively associated with estradiol levels during the luteal phase. These results suggest that certain aspects of memory covary with changes in sex steroid levels in some women.

Prostate cancer is frequently diagnosed in elderly men and, despite the largely unproven survival benefits of treatment, the majority receive treatment. Treatment options include surgery, radiation, and/or androgen deprivation therapy (ADT). Risks associated with treatment include hip fracture. Current understanding suggests that hip fracture is a frequent cause of morbidity and mortality in the elderly, and both radiation treatment and ADT can increase the risk of hip fracture. It is important to understand these risks so they can be minimized and the morbidity of treatment reduced. The objectives of this study were to estimate the risk of hip fracture as a major adverse outcome of treatment for prostate cancer among elderly men. The specific objectives include estimating: 1) the risk of hip fracture and the dose-risk relationship among patients receiving curative radiation treatment, and 2) the risk of hip fracture associated with palliative ADT and relapsed ADT compared to curative ADT. The cancer diagnosis and treatment records of 32,673 men were linked to their hospital discharge abstracts. The risk of hip fracture was estimated using Cox regression and the estimates were adjusted for age, comorbidity, income, and year of diagnosis. The risk of hip fracture was 59% higher among men who received curative radiation when compared to men who received curative surgery. The risk of hip fracture fell by 6% with each one Gy increase in radiation dose between 55 and 81 Gy Biological Equivalent Dose to the hip-bone. The risk of hip fracture for subjects in the palliative ADT and relapsed ADT categories was 5.98 and 5.77 times the risk in comparison to men who received curative ADT treatment. Curative radiation treatment is associated with an increased risk of hip fracture when compared to curative surgery. The risk of hip fracture is greater with ADT for palliation and relapsed cancer than with curative treatment. Current treatments for prostate cancer contain significant risk of hip fracture for elderly men and these risks should be considered as part of the treatment decision.

Asthma is a chronic inflammatory disease of the airways. Using a murine model which replicates many characteristic features of human asthma, this study evaluated the effects of treatment with anti-inflammatory drugs on the lesions of chronic asthma, and investigated potential underlying molecular mechanisms. Treatment with dexamethasone, a glucocorticoid, was compared with roflumilast, a novel phosphodiesterase-4 (PDE4) inhibitor. BALB/c mice sensitised to ovalbumin were challenged with a low mass concentration of aerosolised antigen for 30 min/day, 3 days/week for 6 weeks. In weeks 5 and 6, groups of animals were treated with either dexamethasone or roflumilast. Assessment included changes in acute-on-chronic inflammation, structural remodelling of the airways and airway hyper-responsiveness to a bronchoconstrictor stimulus. These were correlated with the expression of pro-inflammatory cytokines and growth factors. Compared to vehicle-treated control animals, dexamethasone- and roflumilast-treated mice exhibited reduced accumulation of intra-epithelial eosinophils and chronic inflammatory cells, including CD3+ T-lymphocytes in the airways. Similarly, both drugs inhibited subepithelial fibrosis and airway epithelial thickening, although only dexamethasone inhibited goblet cell hyperplasia/metaplasia. Airway hyper-reactivity was not diminished by either drug. Both treatments suppressed production of Th2 cytokines by ovalbumin-restimulated peribronchial lymph node cells. In selectively dissected airway tissue from vehicletreated animals, increased expression of mRNA for several pro-inflammatory cytokines (TNF-α, GM-CSF, IL-6) and cytokines characteristic of Th1 (IFN-γ), Th2 (IL-5, IL-13)and Th17 (IL-17A) cells was demonstrated using real-time PCR. Enhanced expression of growth factors (TGF-β1 and FGF-2) was also demonstrated in airway epithelium isolated by laser capture microdissection. Interestingly, whereas treatment with dexamethasone significantly inhibited expression of mRNA for all of the inflammationrelated cytokines examined, roflumilast inhibited only IL-17A, TNF-α, GM-CSF and IL-6. Both drugs inhibited mRNA expression of growth factors by epithelial cells. Because roflumilast was as effective as dexamethasone in suppressing inflammation and most changes of remodelling, the selective suppression of IL-17A, TNF-α, GM-CSF and IL-6 suggests that these mediators, or the cells that produce them, may have critical roles in pathogenesis. Furthermore, they may be particularly appropriate therapeutic targets in chronic asthma.

Made available in DSpace on 2014-08-13T14:50:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-25Bitstream added on 2014-08-13T18:00:46Z : No. of bitstreams: 1 000754043.pdf: 2158138 bytes, checksum: 7ef7c9ef1a4a3b011dd34994e462754b (MD5) / A atenção integral à saúde da mulher pressupõe assistência em todas as fases de sua vida. O climatério, por compreender um período relativamente longo da vida da mulher, deve merecer atenção crescente da sociedade, pois a expectativa de vida após a menopausa é atualmente equivalente ao período de vida reprodutiva. A presente pesquisa objetivou avaliar a qualidade de vida das mulheres do município de Promissão/SP que estão passando por essa fase, com ou sem uso da terapia de reposição hormonal. Tratou-se de um estudo epidemiológico longitudinal, com amostra de 99 mulheres para cada grupo. Avaliaram-se as características sociodemográficas, clínicas e comportamentais. Aplicou-se Menopause Rating Scale (MRS) para avaliar a intensidade dos sintomas climatéricos, e o questionário Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) para avaliação da qualidade de vida. Na análise dos dados utilizaram-se os testes t de Student, Qui-quadrado e Tukey. As usuárias de TRH apresentaram média etária de 50,76 ± 3,63 anos e as não usuárias de 48,95 ± 6,27anos (p=0,01). Houve diferença estatisticamente significativa em relação ao estado marital (p=<0,001). As usuárias relataram maior frequência de sintomas climatéricos de intensidade leve a moderada. Dos oito domínios de qualidade de vida avaliados, apenas aspectos sociais apresentou escore abaixo de 50 para os dois grupos. Destaca-se o domínio dor com escores por volta de 60. Fenômenos vasomotores com escores também acima de 50 para o MRS foram evidenciados. Houve diferenças entre os grupos em relação aos componentes do SF-36 e MRS para estado geral de saúde, capacidade funcional, menor capacidade, depressão, insônia e fenômenos vasomotores. As mulheres usuárias e não usuárias de TRH apresentaram boa qualidade de vida / The comprehensive care to women's health requires assistance in all phases of his life. The climacteric, it comprises a relatively long period of woman's life, deserves increased attention from society because life expectancy after menopause is currently equivalent to the period of reproductive life. This study aimed to evaluate the quality of life of women in the municipality of Promissão/SP who are going through this phase with or without use of hormone replacement therapy (HRT). This was a longitudinal epidemiological study with a sample of 99 women in each group. We evaluated the sociodemographic, clinical and behavioral. Applied Menopause Rating Scale (MRS) to assess the intensity of climacteric symptoms and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) to assess quality of life. In the data analysis used the Student t test, chi-square and Tukey. HRT users had a mean age of 50.76 ± 3.63 years and nonusers of 48.95 ± 6.27 years (p = 0.01). There was no statistically significant difference in marital status (p = <0.001). Users reported a higher frequency of climacteric symptoms of mild to moderate intensity. Of the eight domains of quality of life assessed only social scored below 50 for the two groups. It stands out with the pain domain scores around 60. Vasomotor phenomena also with scores above 50 were shown to MRS. There were differences between the groups in relation to the components of the SF-36 and MRS to general health, functional capacity, lower capacity, depression, insomnia and vasomotor phenomena. Women users and nonusers of HRT had good quality of life

abstract: Cognitive function is multidimensional and complex, and research indicates that it is impacted by age, lifetime experience, and ovarian hormone milieu. One particular domain of cognitive function that is susceptible to age-related decrements is spatial memory. Cognitive practice can affect spatial memory when aged in both males and females, and in females alone ovarian hormones have been found to alter spatial memory via modulating brain microstructure and function in many of the same brain areas affected by aging. The research in this dissertation has implications that promote an understanding of the effects of cognitive practice on aging memory, why males and females respond differently to cognitive practice, and the parameters and mechanisms underlying estrogen's effects on memory. This body of work suggests that cognitive practice can enhance memory when aged and that estrogen is a probable candidate facilitating the observed differences in the effects of cognitive practice depending on sex. This enhancement in cognitive practice effects via estrogen is supported by data demonstrating that estrogen enhances spatial memory and hippocampal synaptic plasticity. The estrogen-facilitated memory enhancements and alterations in hippocampal synaptic plasticity are at least partially facilitated via enhancements in cholinergic signaling from the basal forebrain. Finally, age, dose, and type of estrogen utilized are important factors to consider when evaluating estrogen's effects on memory and its underlying mechanisms, since age alters the responsiveness to estrogen treatment and the dose of estrogen needed, and small alterations in the molecular structure of estrogen can have a profound impact on estrogen's efficacy on memory. Collectively, this dissertation elucidates many parameters that dictate the outcome, and even the direction, of the effects that cognitive practice and estrogens have on cognition during aging. Indeed, many parameters including the ones described here are important considerations when designing future putative behavioral interventions, behavioral therapies, and hormone therapies. Ideally, the parameters described here will be used to help design the next generation of interventions, therapies, and nootropic agents that will allow individuals to maintain their cognitive capacity when aged, above and beyond what is currently possible, thus enacting lasting improvement in women's health and public health in general. / Dissertation/Thesis / Ph.D. Psychology 2011