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There has been plentiful research from a medical perspective medicine universities buy discount careprost 3 ml on-line, for example into the impact of hormone replacement therapy or the effects of a decline in estrogen on osteoporosis and cardiovascular disease symptoms of breast cancer buy careprost 3ml otc. This emphasis has positioned menopause as a pathological condition and neglected the psychological and social experiences of the women going through it treatment for hemorrhoids buy careprost without a prescription. Most research had been with patient populations and thus, findings did not reflect the experiences of women who had not been seen in a clinic. It is critical to understand why some women report severe and problematic symptoms at menopause whereas others notice relatively few changes. Research indicates that maternal age and experience of complaints at menopause is predictive of the age of onset of menopause in their daughters, which suggests that there is a genetic component (Murabito, Yang, Fox, Wilson, & Cupples, 2005; Van Asselt et al. This is supported by the identification of specific polymorphisms that are associated with more severe and more frequent hot flushes (Schilling et al. However, the biological perspective has focused mainly on hormone replacement and even after more than 60 years of using estrogen to replace declining hormones in women (Geist & Spielman, 1932), the medical profession knows little about the exact mechanisms of hot flushes and night sweats. Furthermore, researchers acknowledged the relevance of socio-psychological factors in influencing symptom appraisal but there had been few studies that explicitly attempted to quantify their relative importance at menopause (Ayers, Forshaw, & Hunter, 2010). When conducting research with women going through menopause, the author had noticed that some women reported severe symptoms and immediately sought medical treatment but other women perceived equally severe symptoms but had eschewed this solution (Rubinstein & Foster, 2012). This raised questions as to what factors might be influential in triggering treatment uptake. Moreover, the author wanted to locate the experience of menopause within the social context of womens daily lives. Specifically, the study aimed to identify how menopause was socially constructed and to understand what role these constructions had, if any, in influencing symptom perceptions and treatment uptake. This seemed especially important in the light of concerns about long-term risks of hormone therapy, which had resulted in a dramatic decline in prescribing, leaving many women with no solution to their problems. Since the start of this study, there has been a wholesale review of the data on which these concerns were based (Million Women Study Collaborators, 2003; Writing Group for the Womens Health Initiative Investigators, 2002) and there is currently a renewed effort to promote hormone therapy (Panay, Hamoda, Arya, & Savvas, 2013). The fundamental conclusion is that social constructions of menopause play a key role in determining perceptions of symptoms. Other factors such as general Health wellbeing, levels of emotional stability, the number of attributions made to menopause and the existence of prior illness were important predictors of symptom appraisals but the social constructions that women placed on menopause remained predictive even after controlling for these factors. Additionally, these social constructions were critical to determining whether and what category of treatment women decided to use, over and above perceived symptom severity. Socially constructing menopause as an illness and a condition of aging but a condition that hormone therapy can alleviate (and possibly prevent) mediated between symptom severity and increased the likelihood of pursuing biomedical solutions. Socially constructing menopause as an illness condition but one that is a temporary phase that women recover from mediated between symptom severity and increased the likelihood of pursuing alternative, non- biomedical solutions that can be perceived as natural and safer than hormone therapy. Changing these constructions of menopause will be difficult because they are deeply embedded within Western society. Beliefs about menopause are intrinsically connected to fears of aging and loss of function and are passed on between women from generation to generation and within generations in conversations among women who are menopausal. The media reflects these beliefs, thus reinforcing ideas about menopause as a symbol of aging and decline (Gannon & Stevens, 1998; Gannon, 1999; Lyons & Griffin, 2003). Despite the fact that women play a more active role in society and despite new medical knowledge about the role of activational hormones, there is still a conspiracy of silence about menopause. First, it contributes to misinformation and myths and second, women still feel embarrassed to admit to being menopausal. The result is that women can feel isolated and become depressed during this stage of life and may not seek treatments from which they could derive benefit. Even considering that only a minority seek treatment for menopause, this research indicated that most women (91%) had sought some form of treatment for a symptom related to menopause at this stage of their lives. The boundary between treatment-utilisers and non-treatment-utilisers was not clearly delineated and there was a significant minority (15%) from the general population who had the same characteristics as those in the clinical population � the only difference being that the clinical population had managed to get a referral to a specialist clinic and were on hormone therapy. One group of implications relates to the need for fundamental research and this is discussed below in the section on future directions. The women in this study reported that they had received contradictory advice from different clinicians within the same practice or from the same clinician at different times. In a recent report from the Royal College of Obstetricians and Gynaecologists (2011, p. To date, this recommendation has not been acted on and in the current political climate it is doubtful that womens health at menopause will be a priority.

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The result confirmed the chronic Objective: the purpose of the study was to course of the disease symptoms lupus cheap careprost online. The nummular eczema assess clinical findings and aggravating factors affected quality of life of patients and itching of nummular eczema and to evaluate caused the most impairment treatment abbreviation order careprost 3ml without a prescription. They skin disease that is characterised by multiple coin- also underwent a physical examination medicine qhs purchase careprost 3ml on-line. It is important to had history of atopic dermatitis and half had rule out diseases that have a similar pattern, such as history of atopy or contact dermatitis. From guttate psoriasis, dermatophytosis, allergic contact patch tests, the most common allergen was dermatitis, atopic dermatitis and stasis dermatitis. The internal factors are dry skin, emotional stress and drinking alcohol aggravated the stress, stasis and the manifestation of atopic 1,3-5 disease. The external factors may or skin dryness tended to have persisting also play a role such as auto-eczematisation from disease. The allergens commonly implicated were rubber chemicals, formaldehyde, neomycin, chrome and nickel, as well as mercury in From 1. Positive patch tests to the Siriraj Hospital, Mahidol University, Bangkok, Thailand allergen Dermatophagoides farinae and the house 2. Institute of Dermatology, Department of Medical dust allergen were reported in elderly patients with Services, Ministry of Public Health, Bangkok, Thailand 8 nummular eczema. Staphylococci and micrococcus Corresponding author: Sukhum Jiamton may be the direct cause or induce hypersensitivity E-mail: sukhum. Seasonal variation may also affect Submitted date: 20/5/2012 patients, as they have a peak frequency of lesions in Accepted date: 30/7/2012 the winter when the hydration state is low, which makes the stratum corneum become drier than 36 Clinical features in nummular eczema 8,10 usual. Summer may also worsen the lesions study had been approved by the Ethical Committee 10 predominantly in men. Oral systemic drugs diagnosed by dermatologists as having nummular were shown to relate to nummular eczema, such as eczema were included in the study. Routine laboratory tests to give written informed consent before the usually showed no abnormalities. Exclusion criteria included the patients should be considered for patients with severe or who declined to sign the informed consent or could 14 persistent disease. Methotrexate showed efficacy in age, sex, occupation and evaluated parameters, 16 children with nummular eczema. The pruritus can including the onset of disease, duration of current 15 be relieved by antihistamine. In one exacerbation due to summer or winter weather, series, patients were followed up to two years; 22 frequent bathing, long periods of standing or percent were dermatitis-free, 25 percent had had walking, emotional stress, alcoholic drinking, drug lesion-free periods ranging from weeks to years, and use, duration of treatment, medication used and the 53 percent had never been free of dermatitis, except lesion-free period. The questionnaires developed by Finlay and Khan to questions examined whether the disease had an measure the effects of different skin disorders on the impact on work, leisure, daily activities, personal quality of the patients life. Methods Statistical analyses the study was a single centre, cross-sectional Statistical analyses were performed using a study. The general data, history and clinical dermatology clinic at Siriraj Hospital, Mahidol characteristics were calculated to descriptive University, Bangkok, Thailand between May 2005 statistics. Comparisons of patients who had lesion- and June 2006 were enrolled into this study. This free periods and the possible aggravating factors and associated findings were performed using cross 37 Asian Pac J Allergy Immunol 2012;31:36-42 tabulation for two-way table data and t-tests for Table 2. About half of the patients were office Median 365 workers and one quarter were labourers. Co-existing findings were dryness of the skin (67%), varicose vein (8%) and other skin diseases, such as chronic hand dermatitis (5%), prurigo the possible causes and associated findings in nodularis (2%), cellulitis (2%), cutaneous fungal our patients with nummular eczema are shown in infection (2%) and miscellaneous (10%). Fourteen patients (14%) fulfilled Hanifin and Rajkas Criteria of 21 atopic dermatitis. Demographic data of patients with nummular family history of atopy, mostly allergic rhinitis. Most of them were Office workers 47 (47%) also not relevant to the disease except contact Labourers 24 (24%) Traders 13 (13%) dermatitis, emotional stress and alcoholic drinking.

Stephens (2001) remarks that hot flushes can be interpreted by some women as a weakness and women who feel well exhibit a moral superiority; crediting themselves with looking after their health and having a positive attitude treatment junctional tachycardia order careprost 3 ml on-line. The implication is that women who succumb to hot flushes lack moral virtue because they suffer from negativity and have failed to look after their health treatment zinc overdose careprost 3ml online. The ambivalent/confusion discourse: doctors dont have all the answers so women must be responsible for their own health It seems that it is hard for women to ignore the ubiquitous biomedical construction of menopause whilst at the same time finding means to resist and negotiate positions within it (Ussher medicine journal purchase careprost with a mastercard, 2011, p. One of the problems for women is that their knowledge about menopause is poor in comparison with other female bodily functions such as childbirth or menstruation, which are more openly discussed. Women sometimes complain that they are unprepared for menopause (Utian & Boggs, 1999) and indeed exhibit minimal knowledge until the change is actually upon them (Liao & Hunter, 1995; Rubinstein, 2010). This means that women do not know what is normative, in part because the menopause is not an open topic of conversation. In this environment, a new discourse has emerged, which acknowledges that the medical profession may not know everything about menopause and hence the management of symptoms must be by women themselves (Buchanan, Villagran, & Ragan, 2002; Hvas & Gannik, 2008a; Lyons & Griffin, 2003). This discourse can sometimes be related to a health promotion message, that is, women should keep in shape and focus on changes to lifestyle (diet, exercise, giving up smoking) to modify any risks associated with menopause and to avoid disease. Whilst this gives women a more active role in their own health, experts still have the right answers and set the agenda. Lyons & Griffin (2003) comment that this discourse may be used as a means to smooth over the tensions between the disease and the natural discourses. It also reinforces a view that womens bodies at menopause are confusing and mysterious. Here, women are consumers, not patients, who are able to make decisions as to what is the best course. Unfortunately, women report that the information they get about menopause is unclear, contradictory, and confusing (Bond & Bywaters, 1998) and they frequently feel on the receiving end of inadequate or incorrect information (Buchanan et al. Thus, it is difficult to make an informed choice and this may explain why women hold such diverse attitudes and beliefs about menopause. The literature on constructions of menopause is limited and most of it has been confined to small- scale qualitative research. It is likely that the social construction of the menopause has changed because of changes in womens social roles, the introduction of new technologies. Jones (1994) argued that there is a discrepancy between the social construction of menopause in society as aging, deficient and about decline, and womens embodied experience. There is some support for this idea, as women who have high levels of body awareness and feel ashamed of their bodies also have more negative attitudes to menopause (McKinley & Lyon, 2008; Rubinstein & Foster, 2012) and, as has already been discussed, holding negative attitudes is in turn related to the higher reporting of symptoms. Health Keep in shape, avoid osteoporosis, modify menopausal status and Promotion risks by lifestyle changes Management Menopause is like a chronic disease that cannot be cured; women must be made responsible for their own health (may link to the health promotion discourse) Consumer Women should have a choice and by keeping informed they can decide whether or not to use Hormone Replacement Therapy 47 the various discourses affect how women define, treat, accept or fight bodily changes at menopause. Thus, quantifying the scale and importance of meanings and social constructions used by women in understanding the menopause will contribute to our understanding of when and whether women decide to seek treatment. In addition, it will be important to understand how women use, negotiate and resolve conflicting sources of information in their efforts to embrace or resist the discourses being used. The degree to which women find this phase of life difficult or easy to manage, disconcerting or positive depends not only on the number and severity of symptoms reported but also cultural, dispositional, situational and social factors. The review of the literature in the previous chapters has revealed several important gaps in our knowledge. The typology of beliefs and meanings about menopause and their prevalence in our society has not been formally assessed. Literature within the field of health psychology attests to the fact that beliefs are important factors in determining an individuals response to illness and her ability to cope but the impact of beliefs on symptom reporting or treatment utilisation has rarely been tested empirically with menopausal women (Janz & Becker, 1984; Leventhal, Brissette, & Leventhal, 2003; Weinstein & Rutgers, 1993). As much of the research on menopause has been either medical or epidemiological, our knowledge of the daily lived experience of women who have symptoms at menopause is limited, as is our knowledge of the coping strategies used. Much of the research has been with clinical populations and so we cannot be sure how many women in the general population actively need or want advice and treatment, nor do we know whether they expect to get such advice from physicians or from elsewhere. There are large individual differences in womens experiences of menopause and it is evident that the factors influencing these experiences are biological, cognitive, psychological and social. It is rare that these factors are studied simultaneously and hence we know little about how these factors interrelate or interact to affect symptom reporting and levels of treatment utilisation. Specifically to compare predictors of biomedical treatments with non-biomedical treatments. To explore how womens beliefs about the menopause are located within the social context of their daily lives 49 Specific treatment utilisation hypotheses are that: 1.

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Early safety and efcacy of percutaneous left atrial appendage studies on human atrial myocardium symptoms vitamin b deficiency order genuine careprost on line. Evaluation of epicardial microwave ablation lesions: his- and type of leaks and their clinical implications treatment 0 rapid linear progression cheap 3ml careprost with visa. Histopathology of intraoperatively induced linear radiofre- early results of a multicenter trial symptoms joint pain fatigue buy generic careprost on line. J Thorac Cardiovasc Surg 2011; quency ablation lesions in patients with chronic atrial brillation. Heart Rhythm clip occlusion in patients with atrial brillation undergoing cardiac surgery: 2009;6(12 Suppl):S41�S45. Epicardial microwave ablation on the beating heart for atrial Surg 2014;45(1):126�131. Late neurologic events after surgery for atrial brillation: rare but ovasc Surg 2006;132(2):355�360. The Society of Thoracic Surgeons Mitral Repair/Replace- of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg 2008; ment Composite Score: a report of the Society of Thoracic Surgeons Quality 85(3):909�914. Effectiveness of the maze procedure using cooled-tip ra- J Thorac Cardiovasc Surg 2011;141(1):113�121. Impact of follow-up on the success rate of the cryosurgical maze matic mitral valve disease. Left atrial radiofrequency ablation during mitral valve surgery Cardiovasc Surg 2006;131(5):1073�1079. A prospective, single-center clinical trial of a modied Cox left atrial cryoablation for permanent atrial brillation in patients undergoing maze procedure with bipolar radiofrequency ablation. Left atrial radiofrequency ablation during mitral valve sur- center experience in 100 consecutive patients. Comparison of cardiac surgery with left atrial surgical ablation Cox-maze procedure: a propensity analysis. Isolating the entire posterior left atrium improves surgical randomized multicentre study. Surgical ablation for treatment of atrial brillation in cardiac sur- 135(4):870�877. Recurrent atrial arrhythmia after minimally invasive pu- brillation: different approaches. Surgical treatment for isolated atrial brillation: minimally inva- brillation: a meta-analysis. A new epicardial lesion set for minimal of atrial brillation: a systematic review and preliminary meta-analysis. J Cardi- tion of persistent atrial brillation: techniques for assessing conduction block ovasc Electrophysiol 2008;19(6):583�592. Atrial brillation ablation in patients undergoing aortic ure for chronic atrial brillation in mitral valve surgery. Pulmonary vein isolation in 2012: is it necessary to perform a atrial brillation during coronary artery bypass grafting using implantable loop time consuming electrophysical mapping or should we focus on rapid and safe recorders. Impact of concomitant surgical atrial brillation ablation in pa- 2013;10(1):24�33. Persistent atrial brillation ablation concomitant to coronary quency energy on the beating heart. Theconvergent procedure:amultidisciplinary atrial brillation and progress of minimally-invasive surgery in the treatment of atrial brilla- treatment. Dilated left atrium as a predictor of late outcome after pulmo- hensive atrial brillation procedure. Eur J Cardiothorac Surg 2015;48(5):765�777; discus- ablation in patients undergoing ablation of long-standing persistent atrial bril- sion 777. Video-assisted bilateral pulmonary vein isolation and left atrial consecutive patients. Journal of Innovations in Cardiac Rhythm Management appendage exclusion for atrial brillation.

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