Adherence with hormone replacement therapy in menopause.

OBJECTIVE: Lack of adherence to therapy is a common problem in the treatment of various diseases and conditions and there are many well-documented reasons for it. This study was conducted to assess the effect of time spent on medical consultation in relation to the duration of adherence, as well as the reasons to adhere to or drop out from hormone replacement therapy (HRT). DESIGN AND METHODS: Two methods were used, self-filled questionnaires on a sample of patients and telephone interviews on a sample of doctors. The questions dealt with a number of personal and gynecological history variables. The participants were chosen using random sampling from population lists. A total of 74 participating offices recruited all postmenopausal patients, regardless of their HRT use and whether they visited the office for a specific complaint or just for a routine check-up. The doctors were interviewed regarding the average time spent with a patient, prescribing dilemmas and counselling on sexuality. RESULTS: The main finding was that the time spent on consultation and the physicians' interest in postmenopause critically influence the patients' adherence. The effective time spent with patients was in accordance with the National Health Insurance guidelines for public sector doctors, but it was twice as long for private sector doctors. CONCLUSION: This study shows that extended medical consultation promotes better compliance by lowering patient fears, while trusted authorities seem to be more convincing to patients on the benefits of HRT and therefore more effective, even if they do not take more time to talk to patients.

ICRP Publication 142: Radiological Protection from Naturally Occurring Radioactive Material (NORM) in Industrial Processes.

The purpose of this publication is to provide guidance on radiological protection in industries involving naturally occurring radioactive material (NORM). These industries may give rise to multiple hazards and the radiological hazard is not necessarily dominant. The industries are diverse and may involve exposure of people and the environment where protective actions need to be considered. In some cases, there is a potential for significant routine exposure of workers and members of the public if suitable control measures are not considered. Releases of large volumes of NORM may also result in detrimental effects on the environment from radiological and non-radiological constituents. However, NORM industries present no real prospect of a radiological emergency leading to tissue reactions or immediate danger for life. Radiological protection in industries involving NORM can be appropriately addressed on the basis of the principles of justification of the actions taken and optimisation of protection using reference levels. An integrated and graded approach is recommended for the protection of workers, the public, and the environment, where consideration of non-radiological hazards is integrated with radiological hazards, and the approach to protection is optimised (graded) so that the use of various radiological protection programme elements is consistent with the hazards while not imposing unnecessary burdens. For workers, the approach starts with characterisation of the exposure situation, and integration, as necessary, of specific radiological protective actions to complement the protection strategy already in place or planned to manage other workplace hazards. According to the characteristics of the exposure situation and the magnitude of the hazards, a relevant reference level should be selected and appropriate collective or individual protective actions taken. Exposure to radon is also treated using a graded approach, based first on application of typical radon prevention and mitigation techniques, as described in Publication 126. A similar approach should be implemented for public exposure through the control of discharges, wastes, and residues after characterisation of the situation. If the protection of non-human species is warranted, it should be dealt with after an assessment of radiological exposure appropriate for the circumstances, taking into account all hazards and impacts. This should include identification of exposed organisms in the environment, and use relevant derived consideration reference levels to inform decisions on options for control of exposure.