Liposome-templated gold nanoparticles for precisely temperature-controlled photothermal therapy based on heat shock protein expression.

Mild temperature photothermal therapy is gaining more and more attention due to high safety, high specificity and moderate efficacy. However, the therapeutical outcome of mild photothermal therapy is limited due to the overexpression of heat shock proteins (HSPs). Therefore, the precise management of HSP expression is the key to improvement of mild temperature photothermal therapy. However, the correlation between HSP expression and photothermal temperature in vivo is still unclear. To precisely control the photothermal temperature by managing the HSP expression, we quantified the HSP expression at different photothermal temperatures after irradiation on liposome-templated gold nanoparticles, which have high photostability, high photothermal conversion efficiency and low temperature fluctuation (smaller than 1 â„ƒ). We found that the expression of HSP70 was least at 47 â„ƒ, which was the optimal temperature for HSP management. We chose to co-administrate HSP70 inhibitor during 47 â„ƒ photothermal therapy, leading to greatly enhanced tumor inhibition. Our precise temperature-controlled photothermal therapy based on HSP expression offers a new strategy for clinical tumor photothermal therapy.

Liposomal Glucose Oxidase for Enhanced Photothermal Therapy and Photodynamic Therapy against Breast Tumors.

Organic near-infrared fluorescent dye mediated photothermal therapy (PTT) and photodynamic therapy (PDT) suffer from heat shock response, since, heat shock proteins (HSPs) are overexpressed and can repair the proteins damaged by PTT and PDT. Starvation therapy by glucose oxide (GOx) can inhibit the heat shock response by limiting the energy supply. However, the delivery of sufficient and active GOx remains a challenge. To solve this problem, we utilize liposomes as drug carriers and prepare GOx loaded liposome (GOx@Lipo) with a high drug loading content (12.0%) and high enzymatic activity. The successful delivery of GOx shows excellent inhibition of HSPs and enhances PTT and PDT. Additionally, we apply the same liposome formulation to load near-infrared dye 1,1'-dioctadecyl-3,3,3',3'-tetramethylindotricarbo cyanine iodide (DiR) and prepare DiR contained liposomes (DiR@Lipo) for PTT and PDT. The liposomal formulation substantially enhances the PTT and PDT properties of DiR as well as the cellular uptake and tumor accumulation. Finally, the combination therapy shows excellent tumor inhibition on 4T1 tumor-bearing mice. Interestingly, we also find that the starvation therapy can efficiently inhibit tumor metastasis, which is probably due to the immunogenic effect. Our work presents a biocompatible and effective carrier for the combination of starvation therapy and phototherapy, emphasizing the importance of auxiliary starvation therapy against tumor metastasis and offering important guidance for clinical PTT and PDT.

Food sources of fat and sex hormone receptor status of invasive breast tumors in women of the Malmö Diet and Cancer cohort.

We examined associations between food intakes and incident breast cancer, defined by estrogen receptor (ER) and progesterone receptor (PR) status in the Malmö Diet and Cancer cohort (∼17,000 women aged 45-73 yr). The hazard ratios (HRs) of ER+PR+ (n = 270), ER+PR- (n = 87), and ER-PR- (n = 61) tumors and all cancer (n = 544) were estimated after 10 yr of follow-up. In multivariate analysis of ER+PR+ tumors, a protective linear risk trend, indicating change between adjoining food categories, was seen with yogurt (HR = 0.89, 95% CI = 0.80-0.99), but increased risks with eggs (HR = 1.10, 95% CI = 1.01-1.20) and dried soups/sauces (HR = 1.10, 95% CI = 1.00-1.22). In ER-PR- tumors, vegetable-oil-based margarine (HR = 1.31, 95% CI = 1.09-1.59) and dried soups/sauces (HR = 1.31 95% CI = 1.05-1.64) showed increased risks. Heterogeneity was observed between ER+PR+ and ER-PR- tumors for vegetable-oil-based margarine (P < 0.01). Regular milk showed decreased, and dried soups/sauces increased, risk with all breast cancer. The study suggests that fat-containing food may contribute both to hormonal and nonhormonal mechanisms in breast tumor development and supports observations of positive associations between characteristics of Westernized diets and postmenopausal breast cancer.

An activatable liposomal fluorescence probe based on fluorescence resonance energy transfer and aggregation induced emission effect for sensitive tumor imaging.

Liposomes are of great interest and importance in tumor imaging, since they can greatly improve the imaging sensitivity and specificity by increasing the accumulation of contrast agents. Still, most liposome-based probes have high background signals during blood circulation, which limits enhancement of S/B ratio and tumor imaging sensitivity. To enhance the S/B ratio of tumor imaging, we construct a fluorescence resonance energy transfer (FRET) and aggregation induced emission (AIE) based liposomal fluorescence probe TPE/BHQ-lipo with excellent FRET effect (99 %) and great fluorescence enhancement upon liposome rupture (120-fold) as well as efficient fluorescence recovery in tumor cell imaging. Finally, we used the TPE/BHQ-lipo to image 4T1 tumor upon intravenous injection of liposomes and the group showed enhanced signal to background ratio of 4.1, compared to 1.8 from control AIE-based liposomal group (TPE-lipo). Our work offers an excellent FRET and AIE-based liposomal probe for high-sensitive tumor imaging.

Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position: a population-based study of middle-aged Swedish men and women.

BACKGROUND AND PURPOSE: Low socioeconomic status is associated with increased incidence of stroke. This study investigated stroke incidence, recurrence, and case-fatality after stroke among middle-aged Swedish men and women and whether this association differs by gender or stroke subtype. METHODS: A total of 69 625 (49% men) citizens, aged 40 to 65 years, living in the city of Malmö in 1990 were studied in relation to total annual income and occupation class, ie, 2 indicators of socioeconomic status. Incidence of first-ever stroke, stroke recurrence, and case-fatality (death within 28 days or 1 year after stroke) were studied over 10 years of follow-up. RESULTS: During the follow-up, a total of 1648 subjects developed a first-ever stroke of whom 275 also experienced a recurrent stroke. By using Cox regression model with covariate adjustments, the incidence of stroke was significantly increased (relative risk: 1.75, 95% CI:1.36 to 2.25) in women who were in the lowest quartile of income compared with the women being in the highest quartile. Corresponding relative risk in men was 1.29 (1.06 to 1.58). Both in men and women, income was significantly associated with ischemic, but not hemorrhagic, subtypes of stroke. Similar relationships were observed between occupation level and incidence of stroke. In addition, low income was associated with higher 28-day and 1-year fatality rates in men (relative risk: 3.13, 1.35 to 7.24 and 2.17, 1.18 to 4.00, respectively), but not in women. In contrast, recurrence of stroke was inversely associated with income only in women. CONCLUSIONS: Incidence of stroke, stroke recurrence, and case-fatality increased with decreasing socioeconomic status; however, this relationship differed by gender and subtype of events.

Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study.

BACKGROUND: Approximately 10-20% of stroke cases have normal blood pressure (BP). The objective of this study was to explore whether the risk of ischemic stroke is related to the carotid intima-media thickness (CIMT) and atherosclerotic lesions in a cohort of subjects with normal BP. METHODS: Common CIMT and the presence of carotid plaque were determined by B-mode ultrasound in 6,103 subjects, randomly recruited between 1991 and 1994 from the 'Malmo Diet and Cancer' study. Normal BP was defined as BP <140/90 mm Hg, without pharmacological treatment for hypertension. Carotid artery atherosclerosis (CAA) was defined as CIMT > or =0.81 mm or/and the presence of plaque (i.e. focal CIMT >1.2 mm). The incidence of ischemic stroke was followed over a mean period of 10.7 years. RESULTS: A total of 2,228 subjects (791 men and 1,437 women) had normal BP. During the follow-up, 34 patients suffered a first-ever ischemic stroke (crude incidence: 1.51/1,000 person-years). The Prevalences of CAA in subjects with and without stroke were 68.6 and 39.0%, respectively. It was estimated that the subjects with CAA had a 3-fold higher risk of ischemic stroke (RR: 3.33, 1.37-8.14), independent of other cardiovascular risk factors. Each increase of 1 standard deviation (0.13 mm) in CIMT increased the stroke risk by 43% (RR: 1.43, 1.002-2.02). Several factors were found to have a notable relation with CAA, including age, male sex, smoking, diabetes, systolic BP, HbA1c (glycosylated hemoglobin) and cholesterol. CONCLUSIONS: CIMT and atherosclerotic lesions are independent clinical markers for ischemic stroke among normotensive individuals.

Long-term stroke prognosis in relation to medical prevention and lifestyle factors. A prospective population-based study.

BACKGROUND: Few studies have focused on the quality of secondary prevention among long-term stroke survivors. This study explores the intensity of medical intervention and the impact of lifestyle and other risk factors on the long-term stroke prognosis in a population-based setting of Swedish individuals with a history of stroke. METHODS: A population-based cohort (n = 28,449) in Malmo, Sweden, was recruited during 1991-1996. Of them, 394 had a history of stroke, according to self-reported physician diagnosis and record linkage with the Stroke Register in Malmo. Information on medical intervention and lifestyle factors was collected from the questionnaire. The incidence of a cardiac event (CE) or recurrent stroke was followed for 7.5 years after the baseline examination. RESULTS: The prevalence of hypertension was 79.4% in patients with a history of stroke. Only half of them received blood-pressure (BP)-lowering medication, and 11.5% of them achieved a BP <140/90 mm Hg. Most patients with hypercholesterolemia did not receive lipid-lowering medication. Antithrombotic agents were used by 38%. Nearly one third were still smoking, and two thirds were overweight or obese. Compared to subjects without a history of stroke, the risk of cardiovascular disease (CVD, i.e. CE or recurrent stroke) was significantly higher in stroke survivors. The increased CVD risk was significantly associated with elevated BP levels. No significant relationship was found between CVD risk and lifestyle risk factors reported at the time of baseline examination. CONCLUSIONS: There was a large gap between recommended secondary preventive measures and their implementation in subjects with a history of stroke. Achieving recommended hypertension control may prevent a substantial proportion of the CE and recurrent strokes in this group.

Sex-specific cardiovascular morbidity and mortality in a cohort treated for hypertension.

OBJECTIVE: Incidence of cardiovascular disease (CVD) is higher in men than in women. The aim of this study was to investigate whether the gender differential can be modified by pharmacological intervention in a population-based setting. DESIGN AND METHOD: In a prospective population-based cohort--the Malmö Diet and Cancer study--a total of 3608 hypertensives (1559 men, 2049 women), 45-73 years old, with a mean of 10 years' treatment at baseline examination, participated in the study. Information on blood pressure-lowering medication was collected in a questionnaire. Incidences of first-ever cardiac event, stroke or CVD death were followed. The mean period of follow-up was 7.4 years. RESULTS: During follow-up, 341 first-ever CVD events and 128 CVD deaths occurred. The risk of CVD morbidity or mortality was significantly higher in hypertensive men than in hypertensive women: cardiac event [relative risk (RR) = 3.11; 95% confidence interval (CI): 2.13-4.54], stroke (RR = 1.50; 95% CI: 1.01-2.22) and CVD death (RR = 2.96; 95% CI: 1.86-4.20). However, the gender gap in CVD risks was reduced with advancing age. Two background factors--single household and concomitant diabetes--are apt to have an independent sex-specific impact on CVD risk. CONCLUSIONS: Gender remains a strong independent predictor for CVD morbidity and mortality, irrespective of antihypertensive intervention or other risk factors. Increased clinical attention should be given to hypertensive men living alone and hypertensive women with diabetes.

Risk of stroke and hormone replacement therapy. A prospective cohort study.

OBJECTIVE: The purpose of this study was to examine the risk of first-ever stroke in relation to use of hormone replacement therapy (HRT) among middle-aged and older Swedish women. MATERIALS: A total of 16,906 women, 45-73 years old, from the 'Diet and Cancer' study in Malmö, Sweden were examined. Women were considered as HRT users if they took systemic hormone therapy regularly. Incidence of stroke was followed for a mean period of 10.5 years. RESULTS: In all, 2148 (12.7%) women used HRT. A total of 461 stroke cases occurred during follow-up, 48 of them in HRT users. Incidence of total stroke and ischemic subtype had no significant relation to HRT use. However, an increased risk of hemorrhagic stroke was found in women taking unopposed estrogen (RR=2.55, 95%CI: 1.03-6.35) or un-native estrogen regimens (RR=4.27, 95%CI: 1.71-10.66). Although not significantly, the risk of stroke was 33% lower in women who started their treatment before menopause. Among HRT users, the risk of stroke was associated with advancing age, smoking, excess body weight and hypertension. CONCLUSIONS: There is no significant association between hormone therapy and risk of total stroke in women during 10.5 years follow-up. Preparations of estrogen and time for initiation of treatment may affect the risk of stroke.

Risk factors for stroke in subjects with normal blood pressure: a prospective cohort study.

BACKGROUND AND PURPOSE: Although stroke is strongly associated with hypertension, some individuals with normal blood pressure (BP) experience a stroke. This prospective study explored risk factors for stroke in subjects with normal BP. METHODS: A total of 11,228 men and 17,174 women, 45 to 73 years old, were examined in a population-based cohort study. Normal BP was defined as BP <140/90 mm Hg and no treatment for hypertension. The incidence of stroke was followed over a mean period of 6 years. RESULTS: In the cohort, 10,938 (38%) had normal BP. Of them, 56 patients experienced a first-ever stroke (12% of all stroke). Compared with subjects without stroke during follow-up, these stroke subjects were older, had lower education, were often smokers and alcohol nondrinkers, and had a history of coronary heart disease (CHD), gastric ulcer, or renal calculus. Subjects with stroke had a higher body mass index (BMI) and a high-normal BP (130 to 139/85 to 89 mm Hg) more often. In a backward stepwise Cox-regression analysis, age (per 1 year; relative risk [RR], 1.12), current smoking (RR, 3.21), BMI (per SD; RR, 1.39), high-normal diastolic BP (RR, 2.35), history of CHD (RR, 4.92), and gastric ulcer (RR, 2.21) remained significantly associated with incidence of stroke. CONCLUSIONS: In subjects with normal BP, there are a number of potentially modifiable risk factors associated with an increased incidence of stroke.

Blood pressure control and risk of stroke: a population-based prospective cohort study.

BACKGROUND AND PURPOSE: Adequate control of blood pressure (BP) is a cornerstone in stroke prevention. This study explored the risk of stroke in relation to the quality of BP control in a population-based cohort and whether control of hypertension was related to background characteristics of patients. METHODS: A total of 27,936 subjects (10,953 men and 16,983 women), 45 to 73 years old, living in Malmö, Sweden participated in the study. Incidence of stroke was followed-up for a mean period of 6 years. Controlled BP was defined as BP <140/90 mm Hg in subjects with pharmacological treatment for hypertension. RESULTS: In the whole cohort, 16 648 subjects (60%) had hypertension (BP > or =140/90 mm Hg) and 23% of them received treatment. Among treated hypertensives, 88.2% had BP levels > or =140/90 mm Hg and 49.5% had BP levels >or =160/100 mm Hg. During the follow-up, 137 strokes occurred among treated hypertensive subjects. The crude incidence of stroke was 289/100 000 person-year in controlled hypertensive subjects and 705/100,000 person-year in treated hypertensive subjects with BP >or =140/90 mm Hg. It was estimated that approximately 45% of all strokes among subjects with treatment for hypertension might be attributed to uncontrolled BP. In treated hypertensives, the risk of stroke increased significantly with advancing age, current smoking, high level of diastolic BP, and diabetes. In hypertensive subjects without treatment (n=12 819), incidence of stroke was 363/100,000 person-year. CONCLUSIONS: Uncontrolled BP is highly prevalent in patients with pharmacological treatment for hypertension. More than 90% of stroke in this group occurred in those with uncontrolled BP. Adequate hypertension control may prevent a substantial proportion of first-ever stroke among treated hypertensives.

Background factors influencing somatic and psychological symptoms in middle-age women with different hormonal status. A population-based study of Swedish women.

OBJECTIVE: To analyse the influence of socio-demographic characteristics and environmental factors on self-reported somatic and psychological symptoms among middle-aged Swedish women. METHODS: A total of 6917 women living in the Lund area of southern Sweden were participates of this study. They completed a generic questionnaire pertaining to socio-demographic characteristics, lifestyle factors and current health related problems. According to hormonal status, the participants were subdivided into three groups, i.e. premenopause, postmenopause and peri- or postmenopausal women with hormone replacement therapy (HRT). RESULTS: By using multiple logistic regression models, a high risk for somatic symptoms was independently associated with unemployment, no exercise, unmarried, high body weight and diseases affecting the cardiovascular system as well as a history of cancer. Psychological symptoms were independently associated with higher educational level, unemployment, no exercise, unmarried, heavy smoking habits (> or =15 cig/day), weight gain and a history of cancer. In addition, the background factors seemed to have less impact on symptoms among women who used HRT. CONCLUSION: Socio-demographic characteristics, lifestyle factors and concurrent health problems appear to have influences on the frequency and the number of somatic and psychological symptoms in middle-age women. Hormone replacement therapy seems to be able to counteract negative impacts caused by un-healthy lifestyle and other health problems.

Changes in lipid and lipoprotein profile in postmenopausal women receiving low-dose combinations of 17beta-estradiol and norethisterone acetate.

OBJECTIVE: To evaluate the modification of lipid and lipoprotein by use of low doses of continuous-combined formulations of 17beta-estradiol (E ) and norethisterone acetate (NETA) in healthy postmenopausal women. DESIGN: The study was designed as a double-blind, randomized, placebo-controlled trial. A total of 120 healthy postmenopausal women were randomized to one of three treatment arms: (1) placebo group ( = 40); (2) E /NETA 0.25-mg group-subjects receiving oral continuous-combined E 1 mg and NETA 0.25 mg ( = 40); (3) E /NETA 0.5-mg group-women who were treated with E 1 mg and NETA 0.5 mg ( = 40). The duration of study was 12 months. Plasma levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL) cholesterol, triglycerides, lipoprotein(a), apolipoprotein A and apolipoprotein B were determined on four occasions (i.e., baseline, 3-, 6-, and 12-month visits). RESULTS: There were no differences in the baseline characteristics among the three groups. A total of 102 women completed the study, resulting in a compliance rate of 85%. There was a significant reduction of total cholesterol, LDL cholesterol, and lipoprotein(a) in both combined groups when compared with placebo. The level of apolipoprotein B declined significantly only in the E /NETA 0.25-mg group. Decrements were observed within 3 months of treatment and maintained thereafter. No significant changes were found in triglycerides, VLDL cholesterol, HDL cholesterol, apolipoprotein A, and LDL/HDL ratio. Between the two active combined groups, no statistically significant differences were noted. CONCLUSION: Favorable changes in lipids and lipoproteins were associated with the low dose of E /NETA combinations. These effects may contribute to the reduction or prevention of atherogenesis in postmenopausal women.

Low-dose hormone therapy and carbohydrate metabolism.

OBJECTIVE: To evaluate the influence by two low doses of oral continuous-combined formulations of 17 beta-estradiol (E(2)) and norethisterone acetate (NETA) on carbohydrate metabolism in healthy postmenopausal women. DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: Volunteers at a university hospital. SUBJECT: One hundred twenty healthy postmenopausal women. INTERVENTION(S): One hundred twenty women were randomized to three treatment arms: (1) E(2) 1 mg/NETA 0.25 mg group (n = 40); (2) E(2) 1 mg/NETA 0.5 mg group (n = 40); (3) placebo group (n = 40). A total of 102 women completed 12 months of treatment. An oral glucose tolerance test (OGTT) was performed at baseline and at 3, 6, and 12 months. MAIN OUTCOME MEASURE(S): Fasting glucose, fasting insulin, total area under the curve (AUC) and insulin/glucose index during OGTT. RESULT(S): Fasting levels of glucose and insulin declined significantly in the E(2)/NETA 0.5 mg group. At OGTT, the total AUC for insulin declined in both active arms. The curve for glucose increased significantly in the E(2)/NETA 0.25 mg group. A lower insulin/glucose index was observed during OGTT in both active regimens when compared with placebo. In the active treatment groups, a significant reduction of fasting glucose and/or fasting insulin was encountered in women with higher basal fasting levels (fasting glucose >4.2 mmol/L or log-fasting insulin >0.87). CONCLUSION(S): Oral low-dose E(2) 1 mg/NETA 0.5 mg regimen did not impair carbohydrate metabolism, but seemed to improve insulin sensitivity in healthy postmenopausal women.

Does hormone therapy increase allergic reactions and upper gastrointestinal problems? Results from a population-based study of Swedish woman. The women's health in the Lund area (WHILA) study.

OBJECTIVES: To delineate the use of various drugs particularly pertaining to allergy and upper gastrointestinal problems in relation to hormone status in middle aged women. METHODS: An analysis from a population-based study on women born between 1935 and 1945 and lived in the Lund area southern Sweden. Of 10,766 women, 6,917 provided complete data sets; in turn 5,673 were assessed for the use of medication in this study. Among the cohort, 9% of women were premenopausal (PM), 54% were postmenopausal without hormone replacement therapy (PM0) and 37% were current hormone replacement therapy users (PMT). RESULTS: There were 7 (1.3%) women in PM, 11 (0.4%) in PM0 and 21 (1.0%) in PMT group who used loratadine regularly. There was a significant difference between the PM and PM0 groups and also between the PM0 and PMT groups in the use of loratadine (P < 0.05 ). Among 21 loratadine users in PMT group 4 (19%) used transdermal patches and 17 (81%) used oral HRT. The result for omeprazole use was as follows: 4 (0.8%) of PM group, 39 (1.3%) of PM0 group and 42 (2.0%) of PMT group. The use of omeprazole was significantly higher in the PMT group than in the PM (P = 0.05 ) and PM0 group (P < 0.05 ). There was no relation between the use of omeprazole and smoking or alcohol consumption. CONCLUSIONS: Use of hormone replacement therapy seems to be related to a higher frequency of omeprazole and loratadine use, which implies that hormone replacement therapy, may be associated with more upper gastrointestinal symptoms as well as allergy.

Leukocyte count is associated with incidence of coronary events, but not with stroke: a prospective cohort study.

OBJECTIVE: Elevated leukocyte count is a classic marker of systemic inflammation. This study examined whether the leukocyte count is associated with incidence of coronary events (CE) and stroke during a long follow-up period. METHODS: A total of 17,131 men and 2932 women, aged 27-61 years, without history of cardiovascular disease (CVD), were enrolled. Incidence of CE and stroke was studied in relation to leukocyte concentrations over a mean follow-up of 24 years. RESULTS: During the follow-up period, 2600 CE and 1333 stroke events occurred. After risk factor adjustments, leukocyte concentrations in the highest quartile (vs. lowest, >7.0 vs. <4.7 x 10(9)cells/L) were associated with CE in men (HR: 1.31, 95%CI: 1.16-1.48, trend p<0.001), but not significantly in women (HR: 1.46, CI: 0.87-2.46, trend p=0.13). The increased incidence remained significant after adjustments for plasma fibrinogen in a sub-group of 6018 men (HR: 1.31, CI: 1.08-1.60). The association between leukocytes and CE was most pronounced in younger men (aged 27-46) and men without hypertension. In younger men, high leukocytes were associated with early CE (within 10 years of follow-up) and late CE (>10 years of follow-up). In older men (46-61 years), leukocytes were not associated with CE after more than 10 years of follow-up. The leukocyte count was not associated with incidence of stroke. CONCLUSION: Elevated leukocyte count in men is associated with increased incidence of CE, but not with stroke. The increased risk persisted after more than 10 years of follow-up in younger, but not in older men.

Menopause-related symptoms: what are the background factors? A prospective population-based cohort study of Swedish women (The Women's Health in Lund Area study).

OBJECTIVE: The purpose of this study was to analyze the influence of sociodemographic characteristics and environmental factors on self-reported menopause-related symptoms among middle-aged Swedish women. STUDY DESIGN: Women who were born in the years 1935 to 1945 and who were living in the Lund area of southern Sweden were investigated. Each woman completed a generic questionnaire and underwent a personal interview that pertained to sociodemographic characteristics, lifestyle, and current health-related problems. With these background factors, the frequency and intensity of hot flushes and vaginal dryness were determined; risk factor analysis was evaluated with the use of the multiple regression models. RESULTS: There were 6917 participants, with a response rate of 64%. A lower risk for hot flushes was related to older age, high education, and vigorous physical exercise. The major risk factors for vasomotor complaints were current weight gain, part-time employment, oophorectomy, unhealthy lifestyle, and concomitant health problems. Light smoking, late age of menopause, higher education, and excessive weight reduced the risk of vaginal dryness. However, older age, marriage, and chronic diseases negatively affected vaginal complaints. The background factors had less impact on symptoms in women who used hormone replacement therapy. CONCLUSION: Sociodemographic characteristics, lifestyle, and concomitant health problems appear to be important modifiable determinants for menopause-related symptoms.

Health profile of middle-aged women: The Women's Health in the Lund Area (WHILA) study.

BACKGROUND: Middle-aged women experience various health-related problems. The aim of this study was to evaluate the impacts of menopause status and hormone intervention on women's health. METHODS: In an ongoing, population-based study, 4943 women, born 1935 to 1945 and living in the Lund area of Southern Sweden, were included in this analysis. They completed a generic questionnaire pertaining to socio-demographic background and current health-related symptoms. Among the cohort, 9% of women were pre-menopausal (PM), 52% were post-menopausal without hormone replacement therapy (PMO) and 39% were current hormone replacement therapy users (PMT). RESULTS: Hot flushes and vaginal dryness were strongly related to menopausal status. The prevalence of somatic symptoms worsened progressively from the groups of PM to PMO to PMT. The most abundant complaints were headache and muscle-skeletal-joint problems. A total of 85% of women experienced psychological problems. Contrary to our expectation, a poorer profile of psychological health was found in the PMT group when compared with the PMO group. CONCLUSIONS: The high prevalence of symptoms in middle-aged women could be attributed to age, hormonal influence as well as personality.