Complementary and alternative medication (CAM) use during menopause is a growing public and women's health issue. The use of CAMs is increasing and evidence of CAM use in the general population suggests that women in the menopausal age range are more likely to use CAMs. In the context of menopause, preliminary research has indicated that women are using a number of CAMs to address symptoms. In a study of American women aged 45 to 65 years, 22% of women used CAMs during menopause, specifically herbal or naturopathic remedies (13%), relaxation techniques (9%) and dietary soy supplements (7%). Fourteen percent (14%) of women strongly agreed with the proposition that approaches such as nutrition and vitamins were better than hormones (Newton et al., 2002). The term 'menopause' is a concept of varying perceptions and perspectives. From the biological perspective, menopause is constant, however from the individual perspective, menopause is a unique experience shaped by cultural, emotional, psychological and physical characteristics. Symptoms commonly cited during menopause include hot flushes, night sweats palpitations, irregular menses and muscle and bone pain. The use of CAMs during menopause has the potential to address current symptoms and promote long term health and wellness. The reviewed literature indicated that while a preliminary understanding of CAM use during menopause is evident, further research is needed to clarify and contextualise current prevalence rates and types used. In addition, an understanding of the reasons and factors that influence women to use CAMs during this transition is crucial to understanding women's menopausal experience. This project aimed to explore the prevalence of CAM use during menopause and to identify the reasons that influence women to use these therapies during the transition. To address this question, a two phase study was designed to incorporate both quantitative and qualitative research methods. For Phase 1, a secondary data analysis was undertaken on a dataset that explored women's menopausal experiences and therapies used to address symptoms and for phase 2, focus groups were used to explore women's personal experiences and perceptions of CAM use during menopause. The secondary data analysis was undertaken on a population based sample of 886 women aged 47-67 years. Women were randomly selected from the electoral roll on the basis of gender, age and postcode, which were selected to ensure representation of urban and rural and varying socioeconomic status. From this analysis, the findings indicated that 80% of women used at least one type of CAM with therapeutic techniques (activities such as walking and swimming) the most commonly used (83.0%), followed by nutrition (66.8%), phytoestrogens (55.8%), herbal therapies (41.3%) and CAM medications (25.1%). Women who used CAMs were more likely to experience anxiety and vasomotor (hot flushes and night sweats) symptoms, have higher education levels, be low to middle income earners, be aged under 55 years, be previous users of hormone therapy (HT) and have participated in self breast examinations. CAM users were 40 to 90% less likely to be currently using HT or to smoke more than 20 cigarettes per day. The results of the secondary data analysis indicated the prevalence and factors associated with CAM use, however the factors that influence women to use CAMs during the menopause were unclear. A series of three focus groups and two telephone interviews were undertaken with a group of 15 women, who were current users of CAMs, aged 47-67 years and fluent in English. Women were recruited through an advertisement placed in a newsletter distributed by a large metropolitan hospital; a flyer displayed on noticeboards of libraries and shopping centres; and a media release through the local community newspaper and on a state wide radio station. Analysis of the transcripts indicated that a number of factors interact to influence a woman's decision to use CAMs. Influences included relationships with family, friends and health practitioners, effects of symptoms, information on CAMs and menopause, current menopause research, personal perceptions of health, wellness and effectiveness of CAM therapies to alleviate symptoms. Taken together, the results of the Phase 1 and 2 combined with the literature indicated that women were using multiple forms of CAMs. A post hoc analysis was undertaken and the CAM questions analysed in Phase 1 were critiqued within this new knowledge of CAM use. As a consequence, CAMs were redefined into four groups to enhance current understandings. After reclassification, the use of at least one CAM was 71.6%, with the most commonly used dietary phytoestrogens (60.0%), followed by dietary supplements (47.0%), herbal therapies (35.9%) and phytoestrogen supplements (33.0%). Sociodemographic, health and symptom characteristics were further profiled against the redefined categories of dietary phytoestrogens, dietary supplements, herbal therapies, phytoestrogen supplements and users of multiple CAMs. The consistency of associations varied according to the CAM category with no significant association present across all four CAM categories. This post hoc analysis clarified CAM categorisation and highlighted the high prevalence of women who were using multiple forms of CAMs. Additionally, multivariable analysis validated and confirmed the results of Phase 1 as similar profiles of a CAM user were found. This research has identified the prevalence of CAM use during menopause in Queensland women and has begun to elucidate the reasons that influence women to use these therapies during this transition. The utilisation of both quantitative and qualitative methods has provided a comprehensive and holistic depiction of women's use of CAMs during menopause. The results and conclusions drawn from this research have highlighted areas that need addressing within the research and health service domain. For future research, development of a comprehensive CAM survey instrument is required and clarification of the definition of CAMs is also needed. Multiple definitions are currently used to describe CAM use, creating confusion in classifying types of CAMs and comparing prevalence rates between studies. With regard to health service recommendations, there is a need for increased access to information on menopause and alternative therapies for women. Open, active and participatory relationships between health practitioners and menopausal women are essential and health practitioners need to be aware women are using a variety of CAMs during the menopause and are likely to continue to do so even if health practitioner support is not apparent.

[Truncated abstract.] Alzheimer’s disease (AD) is the most common form of dementia world-wide accounting for more than two thirds of all dementia cases. AD is characterised by the presence of extracellular amyloid plaques, neurofibrillary tangles and congophillic amyloid angiopathy in the brain tissue of affected individuals. Of these neuropathological features the extracellular amyloid plaques are the most characteristic containing a peptide termed amyloid- beta (Aβ); the major protein component of these structures. In addition a number of genetic risk factors for AD have been identified. Of these the ε4 allele of the apolipoprotein E (APOE) gene found on chromosome 19 is considered to be the main genetic risk factor attributing to about 40-60% of all AD cases in most populations. Although there is strong evidence that genetic risk factors play an important role in AD they do not actually trigger the disease process. Deficits in memory and learning are the most common clinical signs of AD in the initial stages of the disease. Neuropsychological tests such as the CAMCOG and California Verbal Learning Test (CVLT) are important diagnostic tools used for the assessment of cognition. The CAMCOG is an accurate and efficient measure of global cognitive ability, while the CVLT is more specific to areas of cognition influenced in the early stages of the disease such as verbal memory. Substantial evidence indicates that changes in sex hormones following menopause in women are important factors in AD. Specifically, the reduced levels of oestrogen in post-menopausal women have been linked to cognitive decline and an increased risk of dementia. In addition the elevated level of the gonadotropins, a characteristic of the post-menopausal period, have been implicated with the disease. Numerous nonhormonal factors such as age and education may also be associated with the development and progression of cognitive decline.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1971.

Thesis (M.S.)--University of Michigan, 1971.

Made available in DSpace on 2014-06-11T19:23:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-19Bitstream added on 2014-06-13T18:50:47Z : No. of bitstreams: 1 carvalho_fg_me_arafcf.pdf: 662906 bytes, checksum: b01eca6154c2a1b53dcdc4ffa1a8d2c8 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / Mulheres pós-menopausadas estão mais susceptíveis a problemas de saúde relacionados hipoestrogenismo, o que favorece ao processo de estresse oxidativo, inflamatório e ao desenvolvimento de doenças crônicas. Visto que a inclusão de cereais integrais na alimentação veicula componentes bioativos de efeito antioxidante e hipolipemiante, como as lignanas, o objetivo do presente estudo foi avaliar os efeitos hipolipemiantes, inflamatórios e antioxidantes de lignanas provenientes da ingestão de quinoa (Chenopodium quinoa) em um grupo de mulheres pós-menopausadas. Foi realizado um estudo prospectivo, randomizado, duplo cego e controlado por placebo, no qual participaram 35 mulheres que foram submetidas ao consumo diário de 25 gramas de quinoa em flocos ou placebo, no período de 4 semanas consecutivas. No início e ao final do tratamento, após as quatro semanas, foram realizadas avaliações antropométricas: peso corporal, estatura e circunferência da cintura; e coleta de sangue para a quantificação de glicose, colesterol total, LDL-C, HDL-C, triglicerídeos, marcadores de estresse (GSH e TBARS), Vitamina E, marcadores inflamatórios (IL-6 e TNF-α) e enterolignanas (END e ENL); e urina de 24 horas para quantificação de enterolignanas. Os resultados obtidos foram analisados em dois diferentes estudos os quais foram escritos na forma de artigo científico, sendo que o primeiro artigo abordou o efeito do consumo de quinoa sobre as concentrações de glicose, colesterol total e frações e de marcadores de estresse oxidativo, e o segundo artigo abordou o efeito das enterolignas sobre os marcadores inflamatórios em um grupo de mulheres pós-menopausadas. Ao comparar as dosagens no início e ao final do experimento, o presente estudo mostrou um possível efeito benéfico proveniente da ingestão do cereal quinoa, pois foram constatadas reduções significativas nas concentrações... / Postmenopausal women are more susceptible to health problems related to declining estrogen concentrations, which favor the oxidative stress and inflammatory process and the development of chronic diseases. Since daily consumption of grains involves bioactive components with an antioxidant and hypolipidemic effects, like lignans, the aim of the present study was to investigate the effect of quinoa consumption on the concentrations of glucose, total cholesterol and fractions, oxidative stress and inflammatory markers in a group of postmenopausal women. A prospective, randomized, double-blind and placebo-controlled study has been conducted on 35 women who had to consume 25 grams/day of quinoa flakes or placebo, over a period of 4 consecutive weeks. At the beginning and at the end of the intervention, after four weeks, anthropometric assessment was performed by body weight, height and abdominal circumference; and blood was collected for the determination of glucose, total cholesterol and fractions, oxidative stress and inflammatory markers, vitamin E and enterolignans, and 24-h urine was obtained for the determination of enterolignans. The results were analyzed in two different studies which were written in the form of a scientific paper, the first one emphasizes the effect of quinoa intake on consumption on the concentrations of glucose, total cholesterol and fractions, oxidative stress markers and in the second paper investigated the effect of enterolignans on inflammatory markers in a group of postmenopausal women. Comparing the beginning and the end of the intervention, the present study showed a possible beneficial effect by quinoa intake, because significant reductions were observed in serum triglycerides, TBARS and vitamin E concentrations, and an increase in enterolignan urinary excretion in the groups that consumed quinoa and placebo. A significant reduction of total cholesterol... (Complete abstract click electronic access below)

Introdução: Climatério é definido como o período de tempo onde ocorre a mudança de vida reprodutiva para não reprodutiva, com extensão de duração variável. Durante esse período e após o estabelecimento da menopausa, é comum o surgimento de diversos sintomas que expressam o esgotamento dos folículos ovarianos. Dentre os sintomas, o mais comumente relatado pelas mulheres são os sintomas vasomotores ou fogachos. Além da Terapia de Reposição Hormonal (TRH), outras medicações como os Inibidores Seletivos da Recaptação da Serotonina (ISRS) têm sido empregadas na tentativa de melhorá-los. Justificativa: TRH não pode ser aplicado a todas as mulheres com sintomas. As medicações não hormonais, apesar de apresentarem melhores respostas que placebo, ainda demonstram pouco impacto clínico na redução dos sintomas vasomotores. Esta lacuna permite avaliar outras alternativas terapêuticas, como a Estimulação Transcraniana por Corrente Direta (ou tDCS, do inglês transcranial direct current stimulation). O racional para estudar o efeito desta técnica neste contexto, é o seu possível efeito modulatório autonômico. O que reforça a escolha desta técnica é o fato de ter eficácia demonstrada em outras patologias como depressão, dor, doença Parkinson dentre outras. A tDCS é um método de neuromodulação transcraniana não invasivo, que se baseia na aplicação de correntes contínuas de baixa intensidade, através de eletrodos colocados sobre o escalpo, de forma simples e indolor. Objetivo: Avaliar o efeito da tDCS (tratamento ativo) comparada ao tDCS-sham (placebo) nos sintomas vasomotores de mulheres na pós- menopausa como objetivo primário; e como objetivo secundário, seus efeitos na qualidade de vida. Método: Ensaio Clínico Randomizado realizado em 30 pacientes pós-menopáusicas com queixa de pelo menos 05 episódios de fogachos/dia. Participantes foram selecionadas no ambulatório de Climatério do Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre e via chamamento de jornal. Estas foram randomizadas para um dos grupos: tDCS ou placebo-sham. A intervenção consistiu na aplicação de sessões diárias de estimulação com corrente elétrica de 02 mili Ampere, pelo período de 10 dias consecutivos, à exceção dos finais de semana. Por uma semana anterior à intervenção e por 30 dias após, as participantes registravam o número e intensidade dos fogachos ao dia. Responderam ao Women´s Health Questionaire (WHQ) antes e ao termino da intervenção. Resultados: A média de fogachos/dia se comportou de forma semelhante nos dois grupos havendo uma redução do número de fogachos nas três primeiras semanas após intervenção com retorno ao basal a partir da quarta semana pós-aplicação. No grupo tDCS, se observou uma tendência a uma transferência dos fogachos intensos para leves sugerindo uma melhora clínica. Os resultados, apesar de não apresentarem significância estatística, reforçam a ideia de ampliar a investigação, com maior número de pacientes e com maior tempo de duração além do caráter inovador da pesquisa. / Introduction: Menopause is defined as a period where there is a change from the reproductive stage to a nonreproductive phase, with variable duration. During this period and following the establishment of menopause, there is usually an onset of several symptoms indicating the depletion of ovarian follicles. Among the symptoms, the ones that are more frequently reported by women are vasomotor symptoms or hot flashes. In addition to Hormone Replacement Therapy (HRT), other medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) have been employed to treat them. Justification: HRT may not be applied to all women with symptoms. Non-hormonal medications, despite having better responses than placebo, have still shown little clinical impact on the reduction of vasomotor symptoms. This gap allows other therapeutic alternatives to be considered, such as Transcranial Direct Current Stimulation (tDCS). The rationale for studying the effect of this technique in this context is its possible autonomic modulatory effect. What reinforces the choice of this technique is the efficacy which it has demonstrated in other disorders such as depression, pain, Parkinson's disease, among others. tDCS is a non-invasive transcranial neuromodulation method based on the application of continuous low-intensity currents through electrodes placed to the scalp, in a simple and painless way. Goal: To evaluate the effect of tDCS (active treatment) compared to tDCS-sham (placebo) on vasomotor symptoms in postmenopausal women as a primary endpoint and its effects on quality of life as a secondary endpoint. Method: Randomized Clinical Trial conducted in 30 postmenopausal patients complaining of at least five episodes of hot flashes per day. Participants were selected at the Gynecology and Obstetrics Service Menopause Outpatient Clinic, Hospital de Clínicas de Porto Alegre and via a newspaper call. These were randomized to one of the groups: tDCS or placebo-sham. The intervention consisted of daily sessions in which stimulation was applied with an electric current of 02 milliamperes for 10 consecutive days, except on weekends. Participants recorded the number and intensity of hot flashes per day for one week before and for 30 days after the intervention. They answered the Women’s Health Questionnaire (WHQ) before and after the intervention completion. Results: The mean of hot flashes/day behaved in a similar way in both groups, and there was a reduction in hot flashes in the first three weeks following the intervention with a return to baseline starting in the fourth week after the administration. In the tDCS group, a trend towards a conversion of intensive hot flashes into mild ones was noted, which suggested a clinical improvement. The results, despite not showing statistical significance, supported the idea of extending the investigation with a larger number of patients and longer duration, in addition to the innovating nature of the research.

Nesta dissertação procura-se analisar o contexto histórico da aprovação das políticas públicas destinadas à atenção integral da saúde da mulher (PAISM-PNAISM) e o papel dos diferentes atores sociais e políticos que tiveram um papel decisivo em sua história. A mobilização desses atores possibilitou a elaboração do PAISM, considerada a primeira política de atenção à saúde da mulher. A nova política evoluiu para o Plano Nacional, criando novos direitos, incluindo a questão do climatério/menopausa que será analisado nessa dissertação. / In this thesis seeks to analyze the historical context of the adoption of public policies for the comprehensive care of women's health (PAISM - PNAISM) and the role of different social and political actors who played a decisive role in its history. The mobilization of these actors led to the drafting of PAISM, considered the first policy attention to women's health. The new policy evolved into the National Plan, by creating new rights, including the issue of menopause / menopause, which will be analyzed in this dissertation.