Does hormone replacement therapy affect the use of prescription medicines in postmenopausal women: experience from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757].

OBJECTIVE: To determine how postmenopausal hormone therapy (HRT) is related to the use of other prescription medication. DESIGN: Follow up of a randomised controlled trial with a blind subtrial of hormone therapy versus placebo and a nonblind subtrial of open label hormone therapy versus nontreatment. POPULATION: A total of 1823 postmenopausal women aged 50-64 at the time of sampling participated in the trial from 1999 to 2004. METHODS: Use of prescription medication was identified by records in the central computerised database of the Estonian Health Insurance Fund. MAIN OUTCOME MEASURES: The use of 21 classes of prescription medication was compared in the hormone therapy arms and placebo or nontreatment trial arms. The influence of women's socio-economic characteristics on the intensity of concomitant medication use was also examined. RESULTS: The proportion of women using any prescription medication besides hormone therapy did not differ between the arms. However, the type of prescribed drugs varied between the arms. After combining data from both hormone therapy arms, for women using HRT the combined hazard ratio was 1.26 (95% CI: 1.05-1.53) for the use of calcium channel blockers, 1.48 (95% CI: 1.10-1.99) for local vaginal treatment, 0.70 (95% CI: 0.50-0.99) for hypnotics and sedatives and 0.77 (95% CI: 0.60-0.99) for selective serotonin reuptake inhibitors (SSRIs). Women who were older, who had a higher body mass index, who were unemployed and who lived outside the capital used more prescription drugs in comparison with others. CONCLUSIONS: Hormone therapy did not increase the overall use of prescription medication other than hormone therapy, but the types of drugs used in hormone therapy and nontherapy arms varied, with increased use of calcium channel blockers for hypertension and local vaginal treatments for vaginal candidiasis and decreased use of hypnotics, sedatives and SSRIs in the HRT arms.

Patients' and nurses' assessment of cancer pain.

The purpose of this study was to examine hospitalised cancer patients' and nurses' assessment of patients' cancer pain and to compare them. The data were collected from 51 patient-nurse pairs in two hospitals from oncological and medical clinics. Each nurse and patient took part in the study no more than once. The data were collected with a structured interview and the questionnaire. The intensity of pain was measured with a visual analogue scale (VAS) and the Finnish version of the McGill Pain Questionnaire (FPQ). The results showed that the differences between patients' and nurses' assessments were statistically significant for most intensive pain and for acceptable pain. In both cases nurses' assessments of the intensity of pain were lower than patients' assessments. The nurses identified 40 words in the verbal FPQ that the patients used in describing their experiences of pain. The words used most often by patients were agonizing, tender, wave-like and radiant. The word that the nurses used most often was that of intense. Nurses' knowledge about pain medication in general and morphine in particular was clearly associated with the differences observed in estimates of the intensity of pain. Nurses with poor knowledge underestimated the patients' most intensive experiences of pain. The difference was statistically significant.

Cosmetic and postmastectomy breast implants: Finnish women's experiences.

The purpose of this study was to compare women's satisfaction with and short-term problems of silicone breast implants after cosmetic breast augmentation and after mastectomy. Women (n = 224) were recruited through advertising in mass media, and 91% responded to a questionnaire asking for their experiences, both positive and negative, with silicone breast implants. Approximately equal numbers of women received their implants for cosmetic reasons (augmentation group) and postmastectomy (113 and 111, respectively). Mean time from first implantation was 9 years (SD 7.3) in the cosmetic group and 8 years (SD 4.9) in the postmastectomy group. Women in the postmastectomy group received their implants at an older age than women in the cosmetic group (percent of women 45 and older, 59% and 3%, respectively). Women's overall preoperative knowledge of and postoperative satisfaction with their implants were similar in the two groups; 58% of women said that they had insufficient knowledge of breast implants preoperatively, 26% of women said they would not choose the implants again, and 44% of women expressed no dissatisfaction with their breasts. However, women in the cosmetic group were better informed about possible physical problems. One third of the women in the postmastectomy group had one or more reoperations, most frequently because of implant slippage (30%), encapsulation (26%), or implant size and shape (23%). Because insertion of breast implants is a lifelong decision, in-depth counseling about complication rates and possible risks should be given to women before implantation, and nonsurgical alternatives should be discussed, particularly for cosmetic implantation.