Demographic and Psychiatric Associations With Dry Eye in a Medicare Population.

PURPOSE: The purpose of this study was to investigate the impact of demographic characteristics and psychiatric comorbidity on the prevalence of dry eye disease in the American geriatric population. METHODS: Data were collected from a 2011 nationwide sample of Medicare beneficiaries aged 65 years and older (N = 1,321,000). Age, sex, race/ethnicity, residential area, climate region, and income, along with psychiatric comorbidities including depression and anxiety, were collected. Multivariable logistic regression models were used to assess the relationship between demographic and psychiatric factors and the prevalence of dry eye disease. RESULTS: Among 21,059 patients with clinically significant dry eye, women had higher odds of having dry eye compared with men [odds ratio (OR) 2.03, 95% confidence interval (1.97-2.10)]. Asian and Native American patients had increased odds of having dry eye compared with White patients [OR 1.85 (1.69-2.02) and OR 1.51 (1.19-1.93)], while Black patients were less likely to have dry eye [OR 0.83 (0.79-0.87)]. Patients aged 75 to 84 years and 85+ were more likely to have dry eye compared with those aged 65 to 74 years [OR 1.49 (0.45-1.53) and OR 1.54 (1.48-1.60)]. Having both depression and anxiety were associated with higher odds of having dry eye [OR 2.38 (2.22-2.55)] compared with having depression alone [OR 1.95 (1.86-2.04)] or anxiety alone [OR 2.22 (2.10-2.35)]. CONCLUSIONS: Significant racial and regional disparities in dry eye prevalence were found. Psychiatric association with dry eye varied with age, sex, race, and residence region. Further research is needed to comprehend the underlying mechanisms, implications, and to address disparities in the diagnosis and management of dry eye.

The Impact of Neighborhood Factors on Physical Activity in Older Adults With Visual Impairment.

PURPOSE: To investigate the associations of neighborhood-level socioeconomic and environmental characteristics with physical activity in persons with glaucoma. DESIGN: Cross-sectional study (N = 230). METHODS: Home addresses were used to extract neighborhood factors (NFs): Area Deprivation Index, crime rate, and the proportion of racial and ethnic minorities, poverty, college graduates, and park area in their census tract. Participants' average number of daily steps and nonsedentary minutes were collected over 7 days using an accelerometer. Visual field (VF) loss was quantified as integrated VF sensitivity. Multivariable negative binomial regression models and additional models with an interaction term evaluated the effect of NF on physical activity and whether these relationships differed by VF loss severity. RESULTS: Participants were on average 70.6 years of age, 51.7% were male, and 27.8% were black. A higher Area Deprivation Index or poverty share was associated with fewer NSM (incidence rate ratio [IRR] = 0.96 per 1 Area Deprivation Index decile increment, P = .01; IRR = 0.92 per 10% poverty share increment, P = .02), while higher share of college graduates was associated with greater NSM (IRR = 1.03 per 10% increment; P = .03). Stronger associations were noted between both high crime rate and poverty share with NSM in individuals with severe VF damage as opposed to no/mild VF damage (IRR = 0.44, P = .001; IRR = 0.81, P = .02). CONCLUSIONS: Select NFs (poverty share and crime rate) may disproportionately affect physical activity in patients with severe VF loss. Interventions to overcome activity limitations within the context of poverty and high socioeconomic disadvantage are important for addressing glaucoma-related disability, particularly in those with severe VF loss.

The maize low-lignin brown midrib3 mutant shows pleiotropic effects on photosynthetic and cell wall metabolisms in response to chilling.

Maize (Zea mays L.) is one of the major cereal crops in the world and is highly sensitive to low temperature. Here, changes in photosynthetic and cell wall metabolisms were investigated during a long chilling exposure in inbred line F2 and a low-lignin near-isogenic brown midrib3 mutant (F2bm3), which has a mutation in the caffeic acid O-methyltransferase (COMT) gene. Results revealed that the plant biomass was reduced, and this was more pronounced in F2bm3. Photosynthesis was altered in both lines with distinct changes in photosynthetic pigment content between F2bm3 and F2, indicating an alternative photoprotection mechanism between lines under chilling. Starch remobilization was observed in F2bm3 while concentrations of sucrose, fructose and starch increased in F2, suggesting a reduced sugar partitioning in F2. The cell wall was altered upon chilling, resulting in changes in the composition of glucuronorabinoxylan and a reduced cellulose level in F2. Chilling shifted lignin subunit composition in F2bm3 mutant to a higher proportion of p-hydroxyphenyl (H) units, whereas it resulted in lignin with a higher proportion of syringyl (S) residues in F2. On average, the total cell wall ferulic acid (FA) content increased in both genotypes, with an increase in ether-linked FA in F2bm3, suggesting a greater degree of cross-linking to lignin. The reinforcement of the cell wall with lignin enriched in H-units and a higher concentration in cell-wall-bound FA observed in F2bm3 as a response to chilling, could be a strategy to protect the photosystems.

Evaluation of away-from-home excursion patterns after falling among individuals with glaucoma: a longitudinal study.

BACKGROUND: Unintentional falls among older adults are associated with an ensuing decline in physical activity. Our objective is to evaluate the associations between fall status and changes in excursions after a fall. METHODS: Prospective cohort study of older adults with glaucoma or suspected glaucoma who reported falls for 1 year and wore a GPS device for 1-week at the baseline and 1 year later. GPS data were quantified into average: daily excursions, daily time away from home, and time per excursion. Fall status was categorized as fallers, injurious fallers, recurrent fallers, and recurrent injurious fallers. Multivariable negative binomial regression and generalized estimating equations models were employed to evaluate relationship between excursion parameters and fall status. RESULTS: A total of 192 eligible participants were included in the analyses. Approximately half were males (50.5%) with a mean age of 70.1 years and one-fourth were Black (28.1%). There were no significant associations between fall status and end-of-study excursion parameters (p > 0.06 for all), and visual field damage did not modify these relationships (p > 0.07 for all). For instance, patients with multiple falls during a one-year study period did not demonstrate more daily excursions (incident rate ratio [IRR] = 1.16, 95% confidence interval [CI] = 0.85 to 1.57), longer time per excursion (IRR = 0.79, 95% CI =0.59 to 1.06), or more average daily time away (IRR = 1.05, 95% CI = 0.84 to 1.30) conducted at the end-of-the study. Excursion parameters at the final assessment were not significantly different from those at baseline (p > 0.09 for all) and the changes did not vary by fall status (p > 0.23 for all). CONCLUSIONS: Older adults with glaucoma did not modify their travel away from home after experiencing a fall. Additional research is necessary to understand how often maintenance of travel outside the home after a fall reflects proper compensation for greater fall risk or continued activity despite the risk of falling.

Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma.

BACKGROUND: Visually impaired older adults have a greater risk of falling, making them particularly susceptible to fall-related health consequences and restricted physical activity. Unclear however, is the relationship between having falls and longitudinal changes in daily patterns of objectively measured physical activity in older adults with visual impairments. METHODS: We created a three-year prospective cohort study (Falls in Glaucoma Study) of older adults with primary or suspected glaucoma at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Cumulative incidence of falls was determined through self-reported fall calendars over 12 months. Participants were then classified into one of three groups: multiple fallers (≥2 falls), single fallers (1 fall), and non-fallers (0). Daily physical activity was measured over 1 week using a waist-bound accelerometer during baseline and three-year follow-ups. Activity fragmentation was defined as the reciprocal of the mean activity bout length, with higher fragmentation reflecting shorter, more fractured bouts of continuous activity. Multivariate linear mixed-effects models were used to assess three-year longitudinal changes in: 1) activity fragmentation, and 2) accumulation of activity across six three-hour intervals from 5 AM to 11 PM. FINDINGS: In adjusted models accounting for visual field damage and other factors, multiple fallers demonstrated greater annual declines (per year) in daily active bouts (-1.79 bouts/day, 95% confidence interval [CI]: -3.35, -0.22), daily active minutes (-17.15 min/day, 95% CI: -26.35, -7.94), and increased fragmentation (1%, 95% CI: 0, 2%) over the three-year follow-up period as compared to non-fallers; no such changes were seen when comparing single fallers and non-fallers. In time-of-day analyses, multiple fallers experienced greater annual declines in average hourly steps over all periods of the day, though the rate of decline was only significant between 5 PM and 8 PM (-27.07 steps/hour, 95% CI: -51.15, -2.99) compared to non-fallers. INTERPRETATION: In an older population with visual impairment, multiple falls over 12 months were associated with more transient and fragmented activity over a subsequent three-year period, and activity declines during evening hours, compared to non-fallers. These findings suggest that multiple fallers with visual impairment may be at high risk for a decline in physical capacity and endurance, warranting clinical interventions. FUNDING: The research was supported in part by National Institutes of Health Grant EY022976.

Characterization and allogeneic transplantation of a novel transgenic cone-rich donor mouse line.

OBJECTIVES: Cone photoreceptor transplantation is a potential treatment for macular diseases. The optimal conditions for cone transplantation are poorly understood, partly because of the scarcity of cones in donor mice. To facilitate allogeneic cone photoreceptor transplantation studies in mice, we aimed to create and characterize a donor mouse model containing a cone-rich retina with a cone-specific enhanced green fluorescent protein (EGFP) reporter. METHODS: We generated OPN1LW-EGFP/NRL-/- mice by crossing NRL-/- and OPN1LW-EGFP mice. We characterized the anatomical phenotype of OPN1LW-EGFP/NRL-/- mice using multimodal confocal scanning laser ophthalmoscopy (cSLO) imaging, immunohistology, and transmission electron microscopy. We evaluated retinal function using electroretinography (ERG), including 465 and 525 nm chromatic stimuli. Retinal sheets and cell suspensions from OPN1LW-EGFP/NRL-/- mice were transplanted subretinally into immunodeficient Rd1 mice. RESULTS: OPN1LW-EGFP/NRL-/- retinas were enriched with OPN1LW-EGFP+ and S-opsin+ cone photoreceptors in a dorsal-ventral distribution gradient. Cone photoreceptors co-expressing OPNL1W-EGFP and S-opsin significantly increased in OPN1LW-EGFP/NRL-/- compared to OPN1LW-EGFP mice. Temporal dynamics of rosette formation in the OPN1LW-EGFP/NRL-/- were similar as the NRL-/- with peak formation at P15. Rosettes formed preferentially in the ventral retina. The outer retina in P35 OPN1LW-EGFP/NRL-/- was thinner than NRL-/- controls. The OPN1LW-EGFP/NRL-/- ERG response amplitudes to 465 nm stimulation were similar to, but to 535 nm stimulation were lower than, NRL-/- controls. Three months after transplantation, the suspension grafts showed greater macroscopic degradation than sheet grafts. Retinal sheet grafts from OPN1LW-EGFP/NRL-/- mice showed greater S-opsin + cone survival than suspension grafts from the same strain. CONCLUSIONS: OPN1LW-EGFP/NRL-/- retinae were enriched with S-opsin+ photoreceptors. Sustained expression of EGFP facilitated the longitudinal tracking of transplanted donor cells. Transplantation of cone-rich retinal grafts harvested prior to peak rosette formation survived and differentiated into cone photoreceptor subtypes. Photoreceptor sheet transplantation may promote greater macroscopic graft integrity and S-opsin+ cone survival than cell suspension transplantation, although the mechanism underlying this observation is unclear at present. This novel cone-rich reporter mouse strain may be useful to study the influence of graft structure on cone survival.

Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma.

IMPORTANCE: Gait dysfunction is common in older people with visual impairment and is a major cause of falls. OBJECTIVE: To compare 3-year longitudinal changes in gait measures across the spectrum of baseline visual field (VF) damage in glaucoma. DESIGN, SETTING, AND PARTICIPANTS: A post hoc analysis was designed on September 1, 2018, following a prospective cohort study, which enrolled older adults with glaucoma or suspected glaucoma from September 2013 to March 2015 and followed up for up to 3 years. Baseline VF damage was defined by integrated VF (IVF) sensitivity and categorized as normal/mild (IVF >28 dB), moderate (IVF, 23-28 dB), and severe (IVF, <23 dB). Each participant walked on an electronic walkway back and forth twice at normal pace each study year. Linear mixed-effects models evaluated longitudinal change in gait outcomes (1) stratified within each VF severity category and (2) across the range of IVF sensitivity. Analysis took place from October 2019 to October 2020. MAIN OUTCOMES AND MEASURES: Three-year changes in 7 gait assessments under usual-pace walking, including base support and its coefficient of variation, stride length and its coefficient of variation, stride velocity and its coefficient of variation, and cadence. RESULTS: Of 241 participants, the mean (SD) age was 70.8 (7.7) years, 116 (48.2%) were women, and 70 (29.0%) were African American. When comparing longitudinal gait changes over 3 years across the spectrum of IVF sensitivity, each 5-unit (dB) decrement was associated with more rapid declines in stride velocity (-0.05 z score unit/y; 95% CI, -0.09 to -0.01; P = .01) and cadence (-0.07 z score unit/y; 95% CI, -0.10 to -0.03; P < .001). When evaluating gait changes within each glaucoma severity group, shorter stride length was associated with persons with normal/mild (-0.06 z score unit/y; 95% CI, -0.10 to -0.03; P = .001), moderate (-0.08 z score unit/y; 95% CI, -0.12 to -0.04; P < .001), and severe VF damage (-0.16 z score unit/y; 95% CI, -0.24 to -0.07; P < .001), while stride velocity (-0.18 z score unit; 95% CI, -0.28 to -0.07; P = .002) and slower cadence (-0.15 z score unit; 95% CI, -0.25 to -0.04; P = .006) were associated with those with severe VF damage. CONCLUSIONS AND RELEVANCE: At worse levels of baseline VF damage, patients with glaucoma in this study demonstrated an exacerbated decline in walking speeds (ie, stride velocity and cadence), indicating that mobility speeds decrease faster over time in older adults with glaucoma.

Importance and Severity Dependence of Physical Activity by GPS-Tracked Location in Glaucoma Patients.

PURPOSE: To quantify the association of visual field (VF) damage on physical activity away-from-home, per away-from-home excursion, and at-home. DESIGN: Prospective cohort study. METHODS: Among 229 participants with glaucoma or suspected glaucoma, the severity of VF damage was defined as average sensitivity within the integrated VF (IVF). Participants wore accelerometers and global positioning system trackers for 7 days to measure physical activity and characterize activity location. Multivariable negative binomial regressions were used to test whether away-from-home activity per day, physical activity per away-from-home excursion, and at-home activity per day varied by the severity of VF damage. RESULTS: Each 5-dB decrement in IVF sensitivity was associated with a lower number of away-from-home activities per day (18% less moderate and vigorous physical activity [MVPA] minutes/d, 95% confidence interval, 0.69-0.97) and physical activities per away-from-home excursion (20% less MVPA minutes/excursion, 95% confidence interval, 0.65-0.98). Similar findings were noted for other away-from-home activity measures (including active minutes/steps per day, or active minutes/steps per excursion). However, worse IVF sensitivity was not associated with measures of at-home activities (MVPA minutes/d, active minutes/d, and steps/d), time spent at or away from home, or excursions/wk (P > .1 for all). CONCLUSIONS: Restriction of physical activity in more patients with severe glaucoma results mostly from activity restriction outside the home environment. These findings highlight the importance of maintaining a safe home environment (where activity is less restricted) and increasing confidence to perform activity, particular high-intensity activity, when leaving the home amongst patients with glaucoma.

Characterization of a novel strain of Aspergillus aculeatinus: From rhamnogalacturonan type I pectin degradation to improvement of fruit juice filtration.

Aspergillus spp. are well-known producers of pectinases commonly used in the industry. Aspergillus aculeatinus is a recently identified species but poorly characterized. This study aimed at giving a comprehensive characterization of the enzymatic potential of the O822 strain to produce Rhamnogalacturonan type I (RGI)-degrading enzymes. Proteomic analysis identified cell wall degrading enzymes (cellulases, hemicellulases, and pectinases) that accounted for 92 % of total secreted proteins. Twelve out of fifty proteins were identified as RGI-degrading enzymes. NMR and enzymatic assays revealed high levels of arabinofuranosidase, arabinanase, galactanase, rhamnogalacturonan hydrolases and rhamnogalacturonan acetylesterase activities in aqueous extracts. Viscosity assays carried out with RGI-rich camelina mucilage confirmed the efficiency of enzymes secreted by O822 to hydrolyze RGI, by decreasing viscosity by 70 %. Apple juice trials carried out at laboratory and pilot scale showed an increase in filtration flow rate and yield, paving the way for an industrial use of enzymes derived from A. aculeatinus.

Three novel rhamnogalacturonan I- pectins degrading enzymes from Aspergillus aculeatinus: Biochemical characterization and application potential.

Rhamnogalaturonans I (RGI) pectins, which are a major component of the plant primary cell wall, can be recalcitrant to digestion by commercial enzymatic cocktails, in particular during fruit juice clarification process. To overcome these problems and get better insights into RGI degradation, three RGI degrading enzymes (RHG: Endo-rhamnogalacturonase; ABF: α-Arabinofuranosidases; GAN: Endo-ß-1,4-galactanase) from Aspergillus aculeatinus were expressed in Pichia pastoris, purified and fully biochemically characterized. All three enzymes showed acidic pH optimum, and temperature optima between 40-50 °C. The Km values were 0.5 mg.ml-1, 1.64 mg.ml-1 and 3.72 mg.ml-1 for RHG, ABF, GAN, respectively. NMR analysis confirmed an endo-acting mode of action for RHG and GAN, and exo-acting mode for ABF. The application potential of these enzymes was assessed by measuring changes in viscosity of RGI-rich camelina mucilage, showing that RHG-GAN enzymes induced a decrease in viscosity by altering the structures of the RGI backbone and sidechains.

The Impact of Routinely Measuring IOP in Younger Adults to Screen for Glaucoma in a Large Eye Hospital.

PRECIS: Intraocular pressure (IOP) screening in adults 18 to 40 years of age identified 1 in 535 young adults with or at risk for developing glaucoma in India with a cost of about Indian rupee 596 (USD 8) per patient diagnosed. PURPOSE: The purpose of this study was to evaluate the outcomes of routine noncontact tonometry as a screening modality for glaucoma in young adults receiving an eye examination at Aravind Eye Hospital, Pondicherry, India. METHODS: Retrospective chart review of adults 18 to 40 years of age screened for IOP from November 2017 to June 2018. The diagnoses were determined by a glaucoma specialist using gonioscopy, dilated fundus examination, and occasionally, Humphrey Field Analyzer, and/or optical coherence tomography. Analyses include detection of glaucoma, ocular hypertension (OHT), angle closure, and calculation of the yield of this screening paradigm. RESULTS: A total of 28,369 younger adults were screened and 296 (1.05%) were referred to the glaucoma unit, 84 for an IOP >21 mm Hg and 208 for other reasons. The hypertensive group had a mean screening IOP of 29.3±8.4 mm Hg and the following diagnoses: OHT (19%), secondary raised IOP (14%), glaucoma (26%), angle closure (4%), healthy (11%) and need for further examination (26%). Fifty-five percent of those with glaucoma were previously undiagnosed. In comparison, the normotensive group had a mean IOP of 16±2.5 mm Hg and the following diagnoses: OHT (1%), glaucoma (5%), occludable angles (8%), healthy (47%) and need of further examination (33%). Nearly 40% of these patients with glaucoma were previously undiagnosed. CONCLUSIONS: One of every 535 young adults screened had both IOP >21 mm Hg and angle closure, OHT, secondary raised IOP or glaucoma. Given their young age and the potential to treat and delay progression, the benefits seem to outweigh the low cost of this screening.

Regulation of carbon metabolism in two maize sister lines contrasted for chilling tolerance.

Maize can grow in cool temperate climates but is often exposed to spring chilling temperatures that can affect early seedling growth. Here, we used two sister double-haploid lines displaying a contrasted tolerance to chilling to identify major determinants of long-term chilling tolerance. The chilling-sensitive (CS) and the chilling-tolerant (CT) lines were grown at 14 °C day/10 °C night for 60 d. CS plants displayed a strong reduction in growth and aerial biomass compared with CT plants. Photosynthetic efficiency was affected with an increase in energy dissipation in both lines. Chilling tolerance in CT plants was associated with higher chlorophyll content, glucose-6-phosphate dehydrogenase activity, and higher sucrose to starch ratio. Few changes in cell wall composition were observed in both genotypes. There was no obvious correlation between nucleotide sugar content and cell wall polysaccharide composition. Our findings suggest that the central starch-sucrose metabolism is one major determinant of the response to low temperature, and its modulation accounts for the ability of CT plants to cope with low temperature. This modulation seemed to be linked to a strong alteration in the biosynthesis of nucleotide sugars that, at a high level, could reflect the remobilization of carbon in response to chilling.

Aqueous humor phospholipids of DBA/2J and DBA/2J-Gpnmb(+)/SjJ mice.

PURPOSE: To compare phospholipid profiles [phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylethanolamine (PE), and phosphatidylinositol (PI)] of normotensive and hypertensive aqueous humor (AH) from DBA/2J and compare them with phospholipid profiles of DBA/2J-Gpnmb(+)/SjJ mice. METHODS: AH was obtained from young-normotensive DBA/2J, old -hypertensive DBA/2J mice, young and old DBA/2J-Gpnmb(+)/SjJ mice (aging control). Lipids were extracted using modified Bligh and Dyer method and subjected to mass spectrometric identification using appropriate class-specific lipid standards and ratiometric quantification. Corresponding aqueous phase (of extraction) protein concentrations were measured using Bradford method. RESULTS: The total amount of phospholipids showed a decrease in the hypertensive state compared to normotensive state. The total PE and total PS contributed over 50% of the total amount. Total PS showed a remarkable decrease in hypertensive compared to normotensive state. In contrast, total PE in the hypertensive stage presented an increase in amount. Unique lipid species were found encompassing all four phospholipid classes in normotensive as well as in the hypertensive state. Several phospholipid species were found common to both states but with remarkable differences in amount in individual states. The ratio of lysophospholipids to total phospholipids is significantly reduced in the hypertensive state. Commensurate with reduced level of lysophospholipids, we found an increased level of lysophospholipase D (Autotaxin) in the hypertensive state. The difference of total phospholipids between young and old was 35.4% in DBA/2J group but 10% in DBA/2J-Gpnmb(+)/SjJ mice. CONCLUSION: The significant change of phospholipids including lysophospholipids was found commensurate with the elevated intraocular pressure (IOP).

Community-based participatory research and policy advocacy to reduce diesel exposure in West Oakland, California.

We conducted a multimethod case study analysis of a community-based participatory research partnership in West Oakland, California, and its efforts to study and address the neighborhood's disproportionate exposure to diesel air pollution. We employed 10 interviews with partners and policymakers, participant observation, and a review of documents. Results of the partnership's truck count and truck idling studies suggested substantial exposure to diesel pollution and were used by the partners and their allies to make the case for a truck route ordinance. Despite weak enforcement, the partnership's increased political visibility helped change the policy environment, with the community partner now heavily engaged in environmental decision-making on the local and regional levels. Finally, we discussed implications for research, policy, and practice.

[Effect of soybeans and soy sauce on vasomotor symptoms during menopause]. / Efectos de la soja en los síntomas vasomotores de la menopausia.

During menopause, some women experience symptoms which can interfere with their living quality. Some of these symptoms are the so-called vasomotor symptoms which include suffocations, hot flashes, and nocturnal sweats. Up to now, the most effective remedy was hormone treatment, but a study of isoflavines, such as soybean, suggests it is possible to alleviate the disturbances caused by menopause. Due to this study we consider that the addition of isoflavines can provide benefits to women. Therefore, it is correct to include them in the field of medicines which give an alternative to estrogen therapy. However, one must bear in mind that data about the efficiency and security of alternative medicines in the treatment of menopause symptoms are not conclusive since each woman is unique and it is necessary to have consensus on an individualized health plan which permits one to carry out adequate therapeutic adjustments in accordance to the needs which occur over the entire menopause process.

Efectos de la soja en los síntomas vasomotores de la menopausia / Effect of soybeans and soy gauce on vasomotor symptoms during menopause

Durante la etapa de la menopausia, algunas mujeres experimentan sfntomasque pueden interferir con su calidad de vida. Algunos, los llamados vasomotores, incluyen sofocos y sudores nocturnos. Hasta ahora, el tratamiento con hormonas era el remedio más efectivo, pero el estudio de las Isoflavonas, como la soja, sugiere la posibilidad de aliviar los trastornos propios del climario. Tras el estudio realizado consideramos que el aporte en la dieta de ispflavonas puede ofrecer beneficios a las mujeres, por lo que es acertado incluirlos en el campo de los medicamentos alternativos a la terapia estrogénica. Si bien hay que tener presente que los datos sobre eficacia y seguridad de la mediana alternativa en el tratamiento de los síntomas menopaúsicos no son concluyentes, dado que cada mujeres única y resulta necesario consensuar un plan de salud individual que permita realizar los ajustes rapéuticos adecuados a las necesidades que surján, a lo largo del tiempo, durante su climaterio

During menopause, some women experience symptoms which can interfere with their living quality. Some of these symptoms are the so-called vasomotor symptoms which includes suffocations, hot flashes, and nocturnal sweats. Up to now, the most effective remedy was hormone treatment, but a study of isoflavines, such as soybean, suggests it is possible to alleviate the disturbances caused bymenopause. Due to this study, we consider that the addition of isoflavines can provide benefits to women. Therefore, it is correct to include them in the field of medicines which give an alternative to estrogen therapy. However, one must bear in mind that data about the efficiency and security of alternative medicines in the treatment of menopause symptoms are not conclusive since each woman is unique and it is necessary to have consensus on an individualized health plan which permits one to carry out adequate therapeutic adjustments in accordance to the needs which occur over the entire menopause process