Analysis of Damage and Wound Healing in the Retinal Pigmented Epithelium.

Previous studies of retinal pigment epithelium (RPE) morphology found cell-level and spatial patterning differences in many quantitative metrics in comparing normal and disease conditions. However, most of these studies examined eyes from deceased animals. Here we sought to compare noninvasively imaged RPE cells from live mice to histopathology. We describe changes to improve noninvasive imaging of RPE in the live mouse. In retinal diseases, there can be invasion by Iba1-positive cells, which can be detected by noninvasive imaging techniques. Here we can detect potential Iba1-positive cells at the level of the RPE noninvasively.

Premature menopause and psychological well-being.

This study aimed to investigate the psychological well-being of women who had experienced menopause before the age of 40 years. Participants were women known to the reproductive endocrinology service of a London teaching hospital. They were contacted and invited to participate in the questionnaire study by post. Sixty-four women (41.6%) who completed and returned their questionnaires formed a usable sample. Participants reported high levels of depression and perceived stress, and low levels of self-esteem and life satisfaction, compared to the general population. Self-reports on several dimensions of sexuality were significantly more negative. The following factors could affect the degree of reported distress: age, age at diagnosis, time since diagnosis, already having children, being in a long-term relationship, or having psychological treatment in the past or present. The results suggest that premature menopause could pose significant psychological difficulty for a sizeable proportion of those who have the condition. It is argued that the provision of psychological care should be an integral part of clinical management.

Cognitive-behavioural approaches and weight management: an overview.

The prevalence of obesity has been on the increase and, on the whole, improvements in patient education have not led to the desired outcome of weight maintenance--let alone weight loss. For some time therapeutic techniques derived from behavioural psychology, such as self-monitoring, stimulus control and goal setting, have been incorporated as adjuncts to the treatment of weight problems--intended to help obese people make positive changes to their eating and activity habits. In more recent decades, behaviour modification approaches have also incorporated strategies from cognitive therapy, which have involved the identification and modification of 'dysfunctional' thinking patterns and consequent negative mood states; hence the term 'cognitive behaviour therapy' (CBT). There is increasing interest in adopting CBT approaches to achieve more modest and sustainable weight loss and improved psychological well-being. It is possible to train non-psychologists to use CBT strategies, though the level of training required for effective delivery has not yet been established. While CBT is not a panacea for problems of overweight it does offer additional treatment choice for some--and is compatible, as an adjunct, with other forms of obesity management.

Preparation for menopause: prospective evaluation of a health education intervention for mid-aged women.

Many women approach menopause with uncertainty about what will happen and how to deal with changes that occur. The current study aimed to evaluate the short-term outcome of a health education intervention devised to prepare 45-year old women in general practices. One hundred and seventy-eight 45-year old women registered at five general practices in south London were targeted for the research; 106 of the women responded and 86 of these women formed a usable pre-menopausal sample which was randomly allocated to the preparation intervention and control conditions. Preparation involved two health education sessions carried out in small groups and covering information and discussion of the normal menopause transition in the context of mid-life. The women completed pre- and post-intervention (3 and 15 months) questionnaires which assessed knowledge and beliefs about menopause and a number of health-related behaviours. Knowledge improved significantly at the follow-up assessments for the preparation group but not for the control group. On the whole, the prepared women's beliefs about menopause became less negative following the intervention, although there were also some changes reported by the control group. The proportion of smokers decreased from 25 to 20% for the prepared women although this did not reach statistical significance. There was no change in the prevalence of regular exercise. There was also a decrease in the intention to take hormonal treatments following the intervention. Suggestions for further development of health promotion services for mid-aged women and more holistic health care practices are proposed.

A psychological analysis of menopausal hot flushes.

Hot flushes and night sweats are one of the main symptoms accompanying the menopause, and are a main reason for seeking medical help at this time. This study of 61 women (reporting hot flushes once a week or more) investigates dimensions of subjective reporting using open questions and rating scales. Two separate factors were delineated using a principal component factor analysis - frequency (of hot flushes and night sweats) and problem ratings (of distress, interference and perception of flushes as problematic) - which had high test-retest reliability. The frequency ratings correlated highly with prospective daily monitoring. Depressed mood, anxiety and low self-esteem, but not frequency, discriminated between those who regarded flushes as problematic and those who did not. It is suggested that these two subjective measures should be used in assessment and in evaluation of hormonal and psychological interventions.

Determinants of treatment choice for menopausal hot flushes: hormonal versus psychological versus no treatment.

Sixty-one women, reporting hot flushes once a week or more frequently, completed questionnaires eliciting information about demographic details, health, mood and health beliefs. They were interviewed and asked to choose between no treatment, hormone treatment (HRT), psychological treatment (cognitive-relaxation therapy (CRT) and no preference for either CRT or HRT. Seventy-five per cent wanted treatment, with approximately 40% of these women preferring HRT and 60% CRT. Women who wanted treatment for hot flushes were significantly more anxious, coped less well with stress, had lower internal locus of control scores and lower self-esteem, compared with those not seeking treatment. Hot flush frequency was the same for both groups, but those wanting treatment viewed flushes as being more problematic. Few differences emerged between those preferring hormonal or psychological treatment. However, particular reasons were given based upon past experience, views about medication and practical considerations. This study highlights the need for the development of alternative treatment regimens for women seeking help for menopausal problems.

Intentions to use hormone replacement therapy in a community sample of 45-year-old women.

A sample of 45-year-old women from 5 general practices in South London were asked about their intentions to use hormone replacement therapy by postal questionnaire. One hundred and six women (60%) responded. Ninety women who were not taking HRT formed the study sample. Over 80% expressed an opinion when asked about future HRT use. Forty-four percent expressed an intention to use HRT, 42% expressed an intention not to, and 13% expressed a lack of knowledge on which to base a decision. Reasons given by intenders were based on general hopes to 'feel better' among others. Non-intenders gave reasons reflecting disinclination to use drugs and to interfere with a normal process, as well as concerns about side-effects. The characteristics of intenders and non-intenders were compared. There were no significant differences between groups in socio-demographic variables, or in general and gynaecological health factors. However, HRT intenders reported significantly lower self-esteem, higher levels of depressed mood, anxiety, and negative attitudes to the menopause. They also expressed stronger beliefs in their doctors' ability-as opposed to their own- to control their menopause experience. These results suggest that some women might be seeking HRT at menopause to help alleviate pre-existing emotional difficulties and this may have important implications for treatment adherence.