Background: Women are more likely to develop age-related cognitive impairment compared with men of the same age. Pregnancy complications, such as preeclampsia (PE), and menopause may contribute to an elevated risk of cognitive decline with aging in women potentially through an adverse impact on vascular function. PE is associated with a heightened risk of hypertension and large elastic artery stiffness (i.e., aortic and carotid arteries) for several years postpartum. Persistent large artery stiffness may be further amplified in women with a history of PE during the menopause transition, which is marked by an accelerated rate of vascular aging. However, large artery stiffness has not been studied extensively in postmenopausal women with a history of PE. Age-related elevations in large artery stiffness are associated with cognitive decline in middle-aged and older adults however, this relation has not been investigated in young women with a history of PE. Moreover, the degree to which elevated large artery stiffness is amplified and associated with reduced cognitive function among postmenopausal women with a history of PE remains unknown. The purpose of this study was to examine the extent to which large elastic artery stiffness is associated with reductions in cognitive function in premenopausal and postmenopausal women with a history of PE. Methods: Large elastic artery stiffness and domains of cognitive function were assessed in young women one year postpartum (n=18, ages 24-41 yrs.) and postmenopausal women (n=19, ages 52-77 yrs.) thirty-five years postpartum. Aortic stiffness was measured via non-invasive applanation tonometry at the carotid and femoral pulse sites and expressed as carotid-femoral pulse wave velocity (cfPWV). Carotid artery stiffness was quantified as beta-stiffness index (β-stiffness) was measured via ultrasonography and carotid tonometry. Cognitive tests were administered to assess cognitive function in immediate and delayed recall, working memory, processing speed, and executive function. Results: Premenopausal women with a history of PE had higher systolic blood pressure (121 ± 4 vs. 101 ± 3 mmHg, p =0.01) one year postpartum but did not differ significantly from controls in cfPWV (6.2 ± 0.4 vs. 5.1 ± 0.2 m/s, p =0.08), β-stiffness (6.1 ± 0.5 vs. 6.1 ± 0.7 U, p =0.97), or cognitive domains of memory, executive function, or processing speed (all p>0.05). Higher systolic blood pressure was associated with lower executive function (r = -0.53, p = 0.05) in young women one year postpartum. Postmenopausal women with a history of PE did not differ from controls in blood pressure, large artery stiffness, or age-adjusted cognitive domains of memory, executive function, or processing speed (all p>0.05). Large artery stiffness was not associated with cognitive function in premenopausal or postmenopausal women. Conclusions: Young women with a history of PE had elevated systolic pressure one year postpartum, which was associated with reductions in executive function. Large artery stiffness was not elevated or related to cognitive function in postmenopausal women with a history of PE. These preliminary findings suggest that young women with a history of PE are susceptible to reductions in selective cognitive domains related to higher blood pressure, but this effect does not appear to extend into the postmenopausal period.

A grounded theory method was used to investigate the experiences of women who use naturopathic medicine, a system of alternative therapy, for health care during the menopausal transition. Transcripts of 16 in-depth interviews with women who received naturopathic health care during the menopausal transition were analyzed with respect to three research questions: (a) Why do women seek naturopathic health care during the menopausal transition? (b) Do women who use naturopathic treatment for menopausal health care share similar experiences of menopause? and ( c) Are women satisfied with the naturopathic treatment they receive for menopausal health care? Conditions leading to informants' use of naturopathy were represented by two categories: Practicing natural self-care, and Rejecting the conventional medical system Experiences of menopause were represented by three categories: It's not a singular event, Paying attention to changes in and around me, and Information helps. Informants' satisfaction with naturopathy for menopause-related health care was represented by four categories: Naturopathy is consistent with engaging in natural self-care practices, Naturopathy is effective in treating troubling menopausal signs, Naturopathy addresses individual and interrelated aspects of menopause, and Naturopathy provides moral and informational support. Continued analysis of the data revealed a core category, Exchanging infonnation, that provided a foundation for the theoretical model representing the experience of women who use naturopathic health care at menopause. The grounded theory developed in this study may be useful to health professionals by increasing understanding of the naturopathic health care option for menopausal women. Suggestions for further study include quantitative evaluation of components of the theory developed in this study, continued qualitative and quantitative investigation of aspects of information exchange between patients and their conventional and alternative practitioners, application of grounded theory methodology to studies of women's use of hormone replacement therapy, and application of grounded theory methodology to studies of patients' selection of alternative medicine for health matters other than menopause.

No description available.

Low physical activity levels and high serum C-reactive protein (CRP) levels are risk factors for coronary artery disease (CAD) in both men and women. However, postmenopausal women who take hormone replacement therapy (HRT) may have increased risk of CAD because of HRT-related increases in serum CRP. There are two manuscripts in this dissertation. The purpose of the first manuscript was to determine whether higher physical activity energy expenditure was associated with lower serum CRP, independent of oral HRT status and body fatness, in 133 postmenopausal women. Higher physical activity energy expenditures were significantly associated with lower serum CRP levels (r=-0.21, p=0.0l9), independent of oral HRT use, age, smoking behavior, alcohol consumption, aspirin use, and statin use. However, in the complete multivariate model, which included body fat, the association between higher physical activity and lower serum CRP levels was abolished. The purpose of the second study was to quantify the biological variability of insulin resistant CAD risk factors in a sample of 8 postmenopausal women. Risk factor outcomes, including serum total cholesterol, serum triglycerides (TG), serum high-density lipoprotein cholesterol (HDL-C), serum glucose, plasma insulin, serum CRP, waist and hip circumferences, abdominal sagittal diameter, body fat, systolic (SBP) and diastolic blood pressure, and self-reported physical activity energy expenditure, were measured on two occasions, 7-12 days apart. High absolute biological variability values (by standard error of measurement) were observed for serum TG (32.0 mg/dl), serum CRP (5.6 mg/l), SBP (4.0 mmHg), and physical activity (9.4 kcal/kg/week). High relative biological variability (by within-subjects coefficient of variation ���27.3%) was also observed for serum TG, serum CRP, and physical activity. Bland-Altman plots identified individual outliers for serum TG, serum CRP, plasma insulin, and SBP. Together, the results suggest that the correlations between lower levels of serum CRP and higher levels of physical activity, though significant, may have been attenuated by the high biological variability of both serum CRP and physical activity. Thus, the importance of higher levels of physical activity, in decreasing serum CRP and the concomitant risk of heart disease, may be underestimated in the absence of serial measurement of serum CRP and physical activity. / Graduation date: 2002

In the United States, falls are the leading cause of unintentional death with one of every three people 65 years and older falling each year. Falls account for approximately 95% of hip fractures among older adults and falls to the side predominate hip fracture related falls in this population. However, risk factors for side and frequent falls are poorly understood. Furthermore, few data exist to explain differences in bone mineral density among older postmenopausal women. In particular, data regarding the timing of hormone replacement therapy (HRT) among older women is scarce. In the first aim of this dissertation, we examined changes in mobility and balance-related risk factors for side falls as well as differences in these risk factors according to fall status in a population of 107 independent, elderly women (>70 yrs), who were followed over 2 years. We found hip abduction strength decreased (p<.001) in all subjects, with side-fallers exhibiting weaker hip abduction strength (p=.008), greater sway velocity (p=.027), and slower performances on the tandem walk (p=.039) and Get Up and Go (p<.001) compared to non-fallers. For the second study, in the same population, we examined 2-year changes in balance self-efficacy (BSE) and the relationship of BSE to side fall risk factors and falls incidence. Results showed BSE at baseline was predictive of Get Up and Go, hip abduction strength and tandem walk at follow-up (p<.008), but that BSE decreased only among the non-fallers (p=.013). In the third study, we examined 3-yr hip bone mineral density (BMD) changes in women with distinct hormone replacement therapy (HRT) profiles: 1) no hormone replacement therapy (N0HRT), 2) HRT continually since menopause (Continual), 3) HRT begun 10 years after menopause (Late), 4) HRT initiated within 5 years (New), and compared the change in BMD of the hip across HRT groups. Only the NoHRT group lost bone over the 3 years (p=.014). We also assessed BMD of the lateral spine across levels of estrogen use in a sub-sample of participants and found long-term HRT users had significantly higher lateral spine BMD (p=.041) compared to women who had never been on HRT. / Graduation date: 2003

Menopause is a critical life-cycle transition for women, and is associated with osteoporosis and cardiovascular disease, leading causes of morbidity and mortality in US women. Efforts to curb symptoms of menopause include HRT and ERT, although conflicting evidence exists linking ERT and HRT with the risk of breast cancer. Physicians attitudes and preferred mode of treatment have been extensively studied, but with the increased utilization of nurse practitioners in the field, a new paradigm is being established. The overall goal of this study was to assess the nurse practitioners knowledge and attitudes about menopause, hormone replacement therapy and estrogen replacement therapy. More specifically, the objectives include to: 1) determine methods of patient education for menopausal women; 2) examine whether attitudes of menopause are predictors of preferred modes of treatment; and 3) determine whether demographic factors of nurse practitioners are predictors of preferred modes of treatment. A random selection of nurse practitioners from the state of Oregon were mailed a self-administered survey along with a stamped, addressed envelope. The questionnaire focused on knowledge of menopausal treatments, attitudes of menopause, continuing education in the menopause research, and methods of patient education. Follow-up surveys were mailed to non-responders at two and four-week intervals following the first mailing. Response rate was 60% with a sample size of 192. Results describe the management practices of nurse practitioners and what influenced their prescribing and management practices. The influences included the following factors: perceptions about adequacy of formal education, continuing education and attitudes about menopause and managing menopause. Only 47.4% of the respondents felt that their formal education in menopause treatment and protocols was adequate. When asked how they treated women, a majority (64.6%) of the nurse practitioners depended on the women and her beliefs about menopause, HRT, and ERT when they considered how they cared for a menopausal women. Sixty-one percent were very likely to take time during a visit to discuss the changes a woman was going through, while 23.7% were most likely to answer questions if the client had any, otherwise leave the introduction of menopause to the client. When contraindications were present, all nurse practitioners were less likely to prescribe both ERT and HRT. A surprising trend was the high number of participants who were uncertain about how they would prescribe when contraindications were present. In summary, this study describes Oregon nurse practitioners attitudes about menopause, the perceived adequacy of their formal education, and likelihood of prescribing ERT and HRT. Since almost 50% of the nurse practitioners felt their education was inadequate in menopause, a systematic analysis of masters level nurse practitioner programs in the area of menopause and menopausal treatments is needed. Ideally, a nationwide survey comparing physicians and nurse practitioners prescribing practices would help quantify differences between the two types of health care providers. / Graduation date: 1997

One of the most critical elements in empowering the patient, and ensuring concordance, is communication of the possible benefits and harms of different actions in health care. Risk assessment is a complex task due both to the different interpretations of the concept of risk, and the common lack of hard facts. Hormone, or hormone replacement, therapy (HT) is used by many women in, and after, the menopause. The benefits and possible harms associated with short and long term treatment with HT have been extensively discussed the last decade and the use of HT has decreased dramatically internationally the last few years. The aims of this thesis were to study the interaction between patient and physician when discussing risks and benefits of different treatment alternatives, and to suggest strategies to improve risk communication in clinical practice. The studies have focused on how risks and benefits with HT were communicated between women and physicians during firsttime consultations in 1999- 2000 on this subject (20 women, 5 gynaecologists), and through questionnaires how attitudes towards HT have changed between 1999 (n=1,760) and 2003 (n=1,733) among women entering the menopause (53-54 years). Through a qualitative analysis of the risk communication in the consultations a system was constructed to classify how risk is communicated in relation to benefits. This was used to assess and present differences in risk communication in the consultations. Different rhetorical strategies by the physicians were identified and the dominating tendency was a move from the woman’s current problems to the long-term effects of HT. The questionnaires showed a marked difference in attitudes towards HT between the years. In 2003 women perceived HT to be associated with higher risk and less benefits than in 1999. This correlated to a drastic reduction in the use of HT over the same period. Media was the most frequent source of information about HT during the last twelve months before the questionnaire in 2003. Possible explanations for the different attitudes towards HT between women entering the menopause and gynaecologist; how this difference might have influenced the results; and how they may have implications for future communication strategies are discussed. This thesis illustrates the importance of a deeper understanding in health care of the concept of risk in order to achieve an adequate communication of risk. This is important both in consultations and in campaigns to educate and inform the public. / Reprinted figure 1 on page 32 with permission from Science Ref # 05-17260-Revised. Copyright 2006 AAAS.

Objective: To explore the informational and behavioural factors, that affect women’s participation in physical activity (PA) and body weight changes during perimenopause. Methods: An environmental scan of online health websites to determine availability and quality of information for women about body weight changes during transition to menopause. An interpretive descriptive qualitative study of women age 40 – 60 to explore factors influencing their PA. Descriptive and inductive qualitative analysis were used. Results: Six of 52 websites (11.5%) contained information specific to perimenopausal women, with one site citing evidence. For 26 women interviewed, the most common enabling factors were daily structure, positive feelings, and accountability; while common barriers were disruptions in daily structure, competing demands, and self - sacrifice. Conclusions: There is a lack of information regarding body weight changes for perimenopausal women. Perimenopausal women attribute their PA participation to psychosocial factors, and not the physiology of menopause.

Objective: To explore the informational and behavioural factors, that affect women’s participation in physical activity (PA) and body weight changes during perimenopause. Methods: An environmental scan of online health websites to determine availability and quality of information for women about body weight changes during transition to menopause. An interpretive descriptive qualitative study of women age 40 – 60 to explore factors influencing their PA. Descriptive and inductive qualitative analysis were used. Results: Six of 52 websites (11.5%) contained information specific to perimenopausal women, with one site citing evidence. For 26 women interviewed, the most common enabling factors were daily structure, positive feelings, and accountability; while common barriers were disruptions in daily structure, competing demands, and self - sacrifice. Conclusions: There is a lack of information regarding body weight changes for perimenopausal women. Perimenopausal women attribute their PA participation to psychosocial factors, and not the physiology of menopause.

Realizamos estudios hemodinámicos in vivo, in vitro con anillos aórticos y estudios bioquímicos sobre 3 grupos: Ratas SD castradas, con operación simulada y castradas con tratamiento sustitutivo con 17bEstradiol. La ovariectomía indujo un incremento de la Presión Arterial y disminución del Índice Cardíaco, acompañados de una alteración de la vasodilatación arterial por disfunción endotelial. Esta alteración parece deberse a una disminución en la liberación de Óxido Nítrico (NO) y a un alteración del estado redox. La terapia de sustitución con 17bEstradiol previno los cambios hemodinámicos observados tras la ovariectomía, y restauró la función de NO y el estado redox. Tras bloqueo de la síntesis de NO, la administración directa de Estradiol incrementó las resistencias vasculares sistémicas, mediado por una potenciación endógena de la acción de la Angiotensina II. La administración precoz de 17bEstradiol tras la ovariectomía es beneficiosa para el sistema cardiovascular, pero en situaciones de disfunción endotelial es perjudicial. / We did haemodynamic studies in vivo, in vitro with aortic rings and biochemical studies on three groups: SD ovariectomized rats, sham-operated rats and ovariectomized rats with 17bEstradiol replacement therapy. Ovariectomy induced Hypertension and decreased Cardiac Index, accompanied by an alteration of arterial vasodilation secondary to an endothelial dysfunction. This disorder appears to be due to a decrease in the release of Nitric Oxide (NO) and an alteration of redox state. 17bEstradiol Replacement therapy prevented hemodynamic changes observed after ovariectomy, and restored the function of NO and redox state. After blocking the synthesis of NO, the direct administration of Estradiol increased systemic vascular resistance mediated by potentiation of the action of endogenous Angiotensin II. Early administration of 17bEstradiol after ovariectomy is beneficial to the cardiovascular system, but in situation of endothelial dysfunction is detrimental.