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1.
BMJ Qual Saf ; 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38902020

RESUMO

BACKGROUND: Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial. OBJECTIVE: This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays. DESIGN: A retrospective observational study. SETTINGS: Acute care hospitals in Japan. PARTICIPANTS: Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures. METHODS: Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays. RESULTS: Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'. CONCLUSIONS: Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.

2.
J Nurs Res ; 32(3): e333, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38814998

RESUMO

BACKGROUND: Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. PURPOSE: This study was designed to identify the unit characteristics significantly related to fall risk. METHODS: A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. RESULTS: Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). CONCLUSIONS: The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.


Assuntos
Acidentes por Quedas , Humanos , Acidentes por Quedas/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Estudos Transversais , Japão , Feminino , Masculino , Incidência , Idoso , Pessoa de Meia-Idade , Fatores de Risco , Adulto , Inquéritos e Questionários , Idoso de 80 Anos ou mais
3.
Eur J Pharmacol ; 944: 175525, 2023 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-36740036

RESUMO

17α-ethinylestradiol (EE2), a derivative of 17ß-estradiol (E2), is a potent estrogenic substance that is used as the estrogenic component of oral contraceptives (OCPs). However, women who take OCPs have an increased risk of cardiovascular events. Since few studies have examined EE2 endothelial effects, we explored the effects of EE2 on endothelial function in ovariectomized and isoflavone-free rats. After ovariectomy, 12-week-old female Sprague-Dawley rats were assigned to EE2, E2 or control groups. After 16 weeks, the EE2 and E2 groups were orally administered EE2 (8.3 µg/day) and E2 (12.6 µg/day) for 4 weeks, respectively. At 18 weeks, endothelial denudation of the left common carotid arteries was performed, and they were harvested at 20 weeks. The rats in the EE2 and E2 groups exhibited significantly decreased body weights and significantly increased uterine weights, respectively, but no differences were observed between the EE2 and E2 groups. The EE2 and E2 groups showed significantly enhanced acetylcholine-induced endothelium-dependent relaxation, with apamin plus charybdotoxin inhibiting only the EE2 group. Endothelial nitric oxide (NO) synthase expression was significantly higher in the EE2 group than in the control, but lower than in the E2 group. The intima-to-media ratio of denuded arteries was significantly lower in the E2 group than in the other groups, suggesting that NO decreased in the EE2 group compared to the E2 group. We conclude that EE2 has a weaker ability than E2 to produce NO and, for the first time, we demonstrate the ability of EE2 to enhance the activity of endothelial-derived hyperpolarizing factor.


Assuntos
Estradiol , Etinilestradiol , Ratos , Feminino , Animais , Etinilestradiol/metabolismo , Ratos Sprague-Dawley , Endotélio/metabolismo , Artérias Carótidas/metabolismo
4.
J Bone Miner Metab ; 40(5): 748-754, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35690967

RESUMO

INTRODUCTION: Pregnancy- and lactation-associated osteoporosis (PLO) is a condition in which young women develop fractures during pregnancy or breastfeeding. Though PLO is a severely debilitating disease, its pathophysiology and epidemiology have not been clarified and its treatment has not been established. We aimed to identify the incidence and factors associated with fractures occurring within 2 years following an obstetric hospitalization. MATERIALS AND METHODS: We extracted data on fractures occurring within 2 years of an obstetric hospitalization from the Japanese Diagnosis Procedure Combination database. We analyzed the implementation of bone mineral density and bone metabolism marker tests, prescription status, and factors associated with fractures occurring within 2 years of an obstetric hospitalization. RESULTS: Among 837,347 patients with a history of obstetric hospitalization from 2010 to 2014, 379 patients had a history of hospitalization due to a fracture occurring within 2 years (4.5/10,000 pregnancies). Among the patients with fractures occurring within 2 years of an obstetric hospitalization, 6.7% underwent bone mineral quantification or a bone metabolism marker test, and 7.5% were prescribed a lactation inhibitor or osteoporosis treatment. Factors associated with fractures occurring within 2 years following an obstetric hospitalization identified included Cushing syndrome, Charlson Comorbidity Index score ≥ 1, age ≥ 40 years old at pregnancy, smoking history, and steroid administration. CONCLUSION: We investigated fracture cases occurring within 2 years of an obstetrics hospitalization. This finding may be useful in selecting preventative measures for patients at risk of fractures within 2 years after obstetric hospitalization, including PLO.


Assuntos
Fraturas Ósseas , Osteoporose , Fraturas por Osteoporose , Adulto , Densidade Óssea/fisiologia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Hospitalização , Humanos , Japão/epidemiologia , Osteoporose/epidemiologia , Osteoporose/etiologia , Fraturas por Osteoporose/complicações , Gravidez
5.
J Reprod Dev ; 67(4): 241-250, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-33980767

RESUMO

In the present study, we investigated the regulatory mechanisms underlying sperm hyperactivation enhanced by 5-hydroxytryptamine (5-HT) in hamsters. First, we examined the types of 5-HT receptors that regulate hyperactivation. Hyperactivation was significantly enhanced by 5-HT2A and 5-HT4 receptor agonists. Moreover, the results of the motility assay revealed that 5-HT2A, 5-HT3, and 5-HT4 receptor agonists significantly decreased the velocity and/or amplitude of sperm. Under 5-HT2 receptor stimulation, hyperactivation was associated with phospholipase C (PLC), inositol 1,4,5-trisphosphate (IP3) receptor, soluble adenylate cyclase (sAC), and protein kinase A (PKA). In contrast, under 5-HT4 receptor stimulation, hyperactivation was associated with transmembrane adenylate cyclase (tmAC), sAC, PKA, and CatSper channels. Accordingly, under the condition that sperm are hyperactivated, 5-HT likely stimulates PLC/IP3 receptor signals via the 5-HT2A receptor and tmAC/PKA/CatSper channel signals via the 5-HT4 receptor. After sAC and PKA are activated by these stimulations, sperm hyperactivation is enhanced.


Assuntos
Receptores de Serotonina/fisiologia , Serotonina/farmacologia , Espermatozoides/fisiologia , Animais , Receptores de Inositol 1,4,5-Trifosfato/metabolismo , Masculino , Mesocricetus , Receptor 5-HT2A de Serotonina/efeitos dos fármacos , Receptor 5-HT2A de Serotonina/fisiologia , Receptores de Serotonina/efeitos dos fármacos , Receptores 5-HT4 de Serotonina/efeitos dos fármacos , Receptores 5-HT4 de Serotonina/fisiologia , Transdução de Sinais/fisiologia , Motilidade dos Espermatozoides/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Fosfolipases Tipo C/metabolismo
6.
Artigo em Inglês | MEDLINE | ID: mdl-33727945

RESUMO

OBJECTIVE: The KOSMOS study, a multicenter, randomized, double-blind, placebo-controlled trial, investigated the effects and safety of kamishoyosan (TJ-24), a traditional Japanese medicine, in the treatment of climacteric disorder. METHODS: Japanese women with climacteric disorder were administered a placebo during a 4-week run-in period, after which they were classified as placebo responders (R group) if their score on the modified Questionnaire for the Assessment of Climacteric Symptoms in Japanese Women (m-QACS) with excitability and irritability as the primary outcome improved by ≥ 3 points and as placebo nonresponders (NR group) otherwise. Members of the NR group were randomly allocated to receive either TJ-24 or placebo. After 12 weeks, their m-QACS scores, anxiety and depression, sleep, and overall quality of life (QOL) were compared. RESULTS: The TJ-24 and placebo arms in the NR group included 20 patients each. The change in the m-QACS scores of members of the NR group for excitability and irritability at 12 weeks versus baseline was -3.1 ± 1.7 in the TJ-24 arm, a significant decrease, but compared with -2.7 ± 2.2 in the placebo arm, no significant difference was between two arms. However, the proportion of participants whose score improved by ≥3 points was significantly higher in the TJ-24 arm. In the subgroup analysis of premenopausal women, the changes in the score for excitability and irritability were significantly larger in the TJ-24 arm. The incidence of adverse drug reactions or adverse events did not differ between the two arms, and no serious events were reported. CONCLUSION: Although no significant difference was identified for the primary outcome, a significantly higher proportion of patients who received TJ-24 displayed improvement. Its high level of safety and effects on excitability and irritability in premenopausal women suggest that TJ-24 may be a useful treatment.

7.
J Obstet Gynaecol Res ; 47(1): 420-424, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33078868

RESUMO

A 27-year-old woman, gravida 1, para 0, was transferred to our hospital with acute abdominal pain. Her serum human chorionic gonadotropin level was 60 231 mIU/mL. Transabdominal ultrasound revealed an echo-free space, and emergency laparoscopy-assisted surgery was performed with a preoperative diagnosis of ruptured ectopic pregnancy. The pelvic cavity was filled with clots, and the peritoneal surface of the uterine fundus was swollen and showed continuous bleeding. The lesion was located on peritoneum and not connected with the uterine cavity. Histological examination of the conceptus showed features of a complete hydatidiform mole. After a mild decrease, hCG levels adversely increased 3 weeks later with multiple lung nodules. With a diagnosis of invasive moles, the patient was administered chemotherapy. This case demonstrates that it is important to recognize the potential of ectopic hydatidiform moles through abdominal pregnancy. This is the first report of an invasive abdominal hydatidiform mole, and hCG monitoring seemed to be essential for gestational trophoblastic neoplasia detection.


Assuntos
Doença Trofoblástica Gestacional , Mola Hidatiforme Invasiva , Mola Hidatiforme , Neoplasias Pulmonares , Neoplasias Uterinas , Adulto , Gonadotropina Coriônica , Feminino , Doença Trofoblástica Gestacional/diagnóstico , Doença Trofoblástica Gestacional/cirurgia , Humanos , Mola Hidatiforme/diagnóstico , Gravidez , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
8.
Congenit Anom (Kyoto) ; 59(4): 118-124, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30883906

RESUMO

The vital role of folic acid is to reduce the risk of having a neonate afflicted with neural tube defects. The prevalence of neural tube defects (myelomeningocele and anencephaly) has been reported in an incomplete form over the last 40 years in Japan. We aimed to evaluate the total number of neural tube defects including those delivered or terminated, to clarify the proportion of those terminated, and to internationally compare their prevalence. Through information on >311 000 deliveries obtained from 262 hospitals/clinics for 2 years of 2014 and 2015, we identified that the rate of total neural tube defects (termination of pregnancy, live births and stillbirths) was 8.29 per 10 000 deliveries for the year 2014 and was 8.72 for 2015, which were 1.5 and 1.6 times higher than the respective values (live births and stillbirths) reported. It is also observed that the ratio of the total number of myelomeningocele (termination of pregnancy, live births, and stillbirths) to that of anencephaly was approximately 1:1.2, that a half of pregnancies afflicted with neural tube defects were terminated, and that the proportion of termination of pregnancy due to myelomeningocele and due to anencephaly was 20% and 80%, respectively. Internationally, the real prevalence of neural tube defects in Japan was comparatively high, ranking fifth among the seven developed countries. In conclusion, the real prevalence of total neural tube defects was approximately 1.5 times higher than that currently reported by the Japan Association of Obstetricians and Gynecologists.


Assuntos
Defeitos do Tubo Neural/epidemiologia , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Defeitos do Tubo Neural/diagnóstico , Gravidez , Diagnóstico Pré-Natal , Prevalência , Vigilância em Saúde Pública
9.
J Obstet Gynaecol Res ; 44(9): 1800-1807, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30051538

RESUMO

AIM: We modified the antimicrobial prophylaxis of surgical site infection (SSI) according to the guidelines of the Japanese Society of Chemotherapy and Japan Society of Infectious Diseases (hereinafter referred to as optimization) and measured outcomes. METHODS: From April 2016 to March 2017, we performed cesarean section and open hysterectomy with optimization, and compared the outcome to that of surgery performed without optimization between April 2014 and March 2016. We measured the rates of antibiotic discontinuation, appropriate antibiotic selection, SSI incidence, resumption of antibiotic therapy and fever incidence, as well as the length of postoperative hospital stay and medical expenses for antibiotics to evaluate the appropriateness and outcomes of antibiotic prophylaxis. RESULTS: Optimization resulted in a change in the method of selecting antibiotics for cesarean section, but there was no change in SSI incidence rate (0.74% vs 0.0%, P = 0.36). Optimization reduced the use of antibiotics and medical expenses of hysterectomy (median reduction of 50% and 78% for hysterectomy without or with lymphadenectomy, respectively). However, there was no change in outcome regarding SSI incidence (5.7% vs 0.0%, P = 0.11 and 7.8% vs 9.5%, P = 0.77, respectively). CONCLUSION: Appropriate use of antibiotics according to guidelines reduced antibiotic dose and medical expenses, but there was no change in outcome regarding SSI incidence rate. These findings suggested that implementation of dosing regimens according to the guidelines would be useful to reduce antibiotic medicine costs and prevent resistant bacteria and complications associated with antibiotics.


Assuntos
Antibioticoprofilaxia/normas , Cesárea/normas , Histerectomia/normas , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Cesárea/métodos , Feminino , Humanos , Histerectomia/métodos , Japão , Pessoa de Meia-Idade
10.
J Obstet Gynaecol Res ; 44(8): 1355-1368, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29957860

RESUMO

Hormone replacement therapy (HRT) plays a large part in maintaining and improving the quality of life (QOL) of postmenopausal women. Despite this obvious role, the use of HRT has stagnated in Japan as well as the United States, since the interim report of the HRT trial of Women's Health Initiative study was published in 2002. The Japan Society of Obstetrics and Gynecology and Japan Society for Menopause and Women's Health formulated the Guidelines for Hormone Replacement Therapy in 2009, which was subsequently revised in 2012, with the aim of organizing perceptions about HRT and allowing people to provide or receive HRT with a sense of security. Later on, in light of changes in indications for HRT and attitudes toward its impact on cancer risks, amendments were made again in 2017. With the establishment of the 2017 guidelines, practitioners in Japan are able to address various issues related to HRT with more appropriate judgment. Moreover, the practice of reliable, safe and effective HRT is expected to promote further efforts toward improvement or maintenance of QOL in patients.


Assuntos
Terapia de Reposição de Estrogênios/normas , Ginecologia/normas , Menopausa , Obstetrícia/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Humanos , Menopausa/efeitos dos fármacos , Menopausa/metabolismo
11.
J Cardiovasc Pharmacol ; 65(5): 500-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25636070

RESUMO

BACKGROUND: S-equol is known as an estrogenic substance, but its ability to restore vascular endothelial function is unknown. The aim of this study was to investigate the impact of S-equol on endothelial function and intimal thickening under isoflavone- and estrogen-deficient circumstances. METHODS: Twelve-week-old female Sprague-Dawley rats were bilaterally ovariectomized and assigned to one of the 3 groups: control, isoflavone-deficient (ID), or ID plus equol (n = 12, respectively). The control group received a normal diet containing isoflavones, while ID and ID plus equol groups received isoflavones-free diet. At 16th week, subcutaneous administration of S-equol (200 µg/d) started in the ID plus equol group. At 18th week, endothelial denudation of the left common carotid artery was performed in all groups, and thoracic and carotid arteries were collected at 20th week. RESULTS: In thoracic artery, endothelium-dependent relaxation, cyclic guanosine monophosphate levels in the tissue, and endothelial nitric oxide (NO) synthase expression and phosphorylation were significantly higher in the groups of ID plus equol and control than in the ID. The ratio of intima to media of the injured carotid artery in the control group was the lowest. CONCLUSIONS: Removal of dietary soy isoflavones decreased endothelium-derived NO level in ovariectomized rats. S-equol supplementation partially improved NO-related endothelial function.


Assuntos
Aorta Torácica/efeitos dos fármacos , Lesões das Artérias Carótidas/tratamento farmacológico , Artéria Carótida Primitiva/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Equol/farmacologia , Isoflavonas/deficiência , Óxido Nítrico/metabolismo , Ovariectomia , Animais , Aorta Torácica/metabolismo , Aorta Torácica/fisiopatologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/patologia , Lesões das Artérias Carótidas/fisiopatologia , Artéria Carótida Primitiva/metabolismo , Artéria Carótida Primitiva/patologia , Artéria Carótida Primitiva/fisiopatologia , GMP Cíclico/metabolismo , Modelos Animais de Doenças , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Endotélio Vascular/fisiopatologia , Equol/administração & dosagem , Feminino , Injeções Subcutâneas , Neointima , Óxido Nítrico Sintase Tipo III/metabolismo , Fosforilação , Ratos Sprague-Dawley , Fatores de Tempo , Vasodilatação/efeitos dos fármacos
12.
Artigo em Inglês | MEDLINE | ID: mdl-24648849

RESUMO

Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined cross-sectionally the baseline records of 345 women aged 40-59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment. Results. The women were classified into 4 groups on the basis of their headache frequency, and no significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women's headaches were their age (adjusted OR 0.92 (95% CI 0.88-0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39-2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment. Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms.

13.
J Obstet Gynaecol Res ; 39(5): 1007-13, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23379427

RESUMO

AIM: The aim of this study was to investigate the associations among depression, anxiety and physical symptoms in peri- and postmenopausal women in a clinical setting. MATERIAL AND METHODS: Two hundred and thirty-seven peri- and postmenopausal women enrolled in the Systematic Health and Nutrition Education Program at the Menopause Clinic of the Tokyo Medical and Dental University Hospital. Their responses to the Menopausal Health-Related Quality of Life (MHR-QOL) and Hospital Anxiety and Depression Scale (HADS) questionnaires were subjected to a cross-sectional analysis. The study focused on the relationship between the scores for HADS depression (HADS-D) and anxiety (HADS-A) subscales and those for somatic (nausea, dizziness, numbness, muscle and joint pains, tiredness, headaches), urinary (frequent urination), and vasomotor symptoms (hot flashes, night sweats) in the MHR-QOL questionnaire. RESULTS: The correlations among the scores for the six somatic symptoms and HADS-D and HADS-A were stronger than those for urinary or vasomotor symptoms. Multiple logistic regression analysis revealed that the score for headaches and that for HADS-A were significantly associated with severe depression after adjustment (odds ratio (OR) [95% confidence interval (CI)]: 1.49 [1.06-2.10] and 1.58 [1.37-1.83], respectively), whereas the scores for nausea and numbness, as well as HADS-D, were significantly associated with severe anxiety (OR [95% CI]: 1.65 [1.15-2.39], 1.39 [1.05-1.84], and 1.36 [1.23-1.50], respectively). CONCLUSION: Headaches were associated with depression, whereas nausea and numbness were associated with anxiety in peri- and postmenopausal women. The assessment of underlying mood disorders is required for the management of middle-aged women presenting with these somatic symptoms.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Perimenopausa/psicologia , Pós-Menopausa/psicologia , Distúrbios Somatossensoriais/fisiopatologia , Adulto , Estudos Transversais , Feminino , Cefaleia/etiologia , Humanos , Hipestesia , Japão/epidemiologia , Pessoa de Meia-Idade , Náusea/etiologia , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Distúrbios Somatossensoriais/epidemiologia , Distúrbios Somatossensoriais/etiologia
14.
Maturitas ; 72(1): 61-5, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22326659

RESUMO

OBJECTIVES: To determine the correlation between somatic and psychological symptoms and insomnia and the contribution of depression and anxiety to insomnia in a sample of peri- and post-menopausal women in a clinical setting. STUDY DESIGN: The responses of 237 peri- and post-menopausal women enrolled in the Systematic Health and Nutrition Education Program (SHNEP) at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between November 2007 and December 2010 to the Menopausal Health-Related Quality of Life (MHR-QOL) and Hospital Anxiety and Depression Scale (HADS) questionnaires were subjected to Spearman's rank correlation and logistic regression analyses. RESULTS: The analysis revealed that (1) insomnia is highly prevalent, (2) the symptoms of difficulty in initiating sleep (DIS) and experiencing non-restorative sleep (NRS) are more strongly correlated with psychological than somatic symptoms, and (3) DIS is strongly associated with anxiety while NRS is strongly associated with depression in the population studied. CONCLUSIONS: Insomnia is highly prevalent among peri- and post-menopausal female patients in a clinical setting and more closely associated with psychological than somatic symptoms. DIS is strongly correlated with anxiety while NRS is strongly correlated with depression.


Assuntos
Ansiedade/complicações , Depressão/complicações , Perimenopausa/psicologia , Pós-Menopausa/psicologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Sono , Adulto , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia
15.
Int J Gynaecol Obstet ; 114(2): 149-52, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21669429

RESUMO

OBJECTIVE: To examine the effects of keishibukuryogan (TJ-25)-a medicine of the Kampo tradition (the Japanese adaptation of Chinese herbal medicine)-on middle-aged women with high blood pressure. METHODS: The records of 77 peri- and postmenopausal women with high-normal blood pressure or hypertension were analyzed retrospectively. The women had participated in the Systematic Health and Nutrition Education Program at the Tokyo Medical and Dental University in Tokyo, Japan, and had received education only (controls; n = 47) or education and treatment with TJ-25 (n = 30). RESULTS: The baseline characteristics of the 2 groups were comparable. After approximately 6 months, women in the TJ-25 group showed significant reductions in their systolic blood pressure (from 148.4mm Hg to 134.8mm Hg), diastolic blood pressure (from 89.7 mm Hg to 83.7 mm Hg), pulse rate (from 79.5 beats/min to 73.5 beats/min), and resting energy expenditure (from 1552 kcal/day to 1373 kcal/day). Several menopausal symptoms including perspiration, difficulty in initiating sleep, nonrestorative sleep, and headaches/dizziness were also improved. In addition, women in the TJ-25 group had increased health-related quality of life scores in the domains of physical health and life satisfaction. CONCLUSION: TJ-25 alleviates menopausal symptoms and concurrently lowers the blood pressure of middle-aged women with high blood pressure.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Medicamentos de Ervas Chinesas/administração & dosagem , Hipertensão/tratamento farmacológico , Medicina Kampo , Perimenopausa/efeitos dos fármacos , Pós-Menopausa/efeitos dos fármacos , Tontura/tratamento farmacológico , Metabolismo Energético/efeitos dos fármacos , Feminino , Cefaleia/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Fogachos/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Transtornos do Sono-Vigília/tratamento farmacológico
16.
J Obstet Gynaecol Res ; 37(7): 741-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21395896

RESUMO

AIM: To assess the effects of estrogen and hypnotics on Japanese peri- and postmenopausal women with sleep disturbance. METHODS: Among the records of 1451 participants enrolled in the Systematic Health and Nutrition Education Program conducted at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between 1995 and 2009, those of 202 peri- and postmenopausal women were retrospectively analyzed. These women, who had moderate to severe sleep disturbances, had either received only health and nutrition education (control; n = 119), or had received education with either conjugated estrogen (estrogen [0.625 mg/day]; n = 55) or nightly hypnotics (hypnotics; n = 28), and were followed up for a median interval of six months. RESULTS: Both oral estrogen and hypnotics improved the subjective sleep disturbance scores, while administration of hypnotics decreased the percentage of women reporting difficulty in initiating sleep or non-restorative sleep. Oral estrogen was also effective in alleviating various menopausal symptoms, while hypnotics were not. The health-related quality of life of these patients was significantly promoted by health and nutrition education alone, and neither estrogen nor hypnotics had an additive effect on it. Administration of hypnotics substantially lowered the blood pressure of the subjects (systolic pressure, -10.2%; diastolic pressure, -8.3%) and significantly reduced body weight (-2.1%), body mass index (-2.2%) and body fat (-7.8%), without affecting lean body mass. CONCLUSIONS: Oral estrogen and hypnotics are effective for sleep disturbance in Japanese peri- and postmenopausal women. They can be admininstered either singly or in combination, according to the patient's characteristics.


Assuntos
Terapia de Reposição de Estrogênios , Estrogênios Conjugados (USP)/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Perimenopausa , Pós-Menopausa , Transtornos do Sono-Vigília/tratamento farmacológico , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios Conjugados (USP)/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Japão , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
J Med Dent Sci ; 58(2): 49-59, 2011 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-23896786

RESUMO

The present study investigated resting cardiac autonomic function in Japanese climacteric women using heart rate variability (HRV) power spectral analysis to evaluate the relationship between HRV indices and estrogen, as well as the ability of each HRV index to predict vasomotor symptoms. Forty-five peri- and postmenopausal women completed a questionnaire about the presence of vasomotor symptoms (hot flashes, sweating). To analyze the relationship between HRV and hot flashes or sweating, we classified subjects into groups based on symptoms and combinations of symptoms: no hot flashes (H1), hot flashes (H2), non-sweating (S1), sweating (S2), neither hot flashes nor sweating (V1), either hot flashes or sweating (V2), and both hot flashes and sweating (V3). Values for total power and the low-frequency component of HRV were significantly lower in the H2 group than in H1 (p < 0.05); values for total power and the high-frequency and low-frequency components of HRV were significantly lower in group S2 than S1 (p < 0.05); and values for total power and the high-frequency and low-frequency component of HRV were significantly lower in groups V2 and V3 compared to V1 (p < 0.05). Clinical diagnosis of climacterium relies upon subjective complaints of patients. Our findings suggest that HRV indices may help to evaluate vasomotor symptoms.


Assuntos
Climatério/fisiologia , Estrogênios/sangue , Frequência Cardíaca/fisiologia , Sistema Vasomotor/fisiologia , Fatores Etários , Índice de Massa Corporal , Eletrocardiografia , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Análise de Fourier , Sistema de Condução Cardíaco/fisiologia , Fogachos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Sistema Nervoso Parassimpático/fisiologia , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Respiração , Processamento de Sinais Assistido por Computador , Sudorese/fisiologia , Sistema Nervoso Simpático/fisiologia
18.
Arch Gynecol Obstet ; 284(4): 913-21, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21120510

RESUMO

PURPOSE: To assess the effects of Kampo, a traditional Japanese adaptation of Chinese herbal medicine, on peri- and postmenopausal women with sleep disturbances. METHODS: Among the records of 1,523 peri- and postmenopausal women who are enrolled in the Health and Nutrition Education Program at the Tokyo Medical and Dental University, Menopause Clinic, during 1995-2009, about 151 women suffering from moderate to severe sleep disturbances were retrospectively analyzed. These women had received only health/nutrition education (control; n = 77) or received treatment with one of the three major Kampo formulae: Tokishakuyakusan (TJ-23; n = 42), Kamishoyosan (TJ-24; n = 16), or Keishibukuryogan (TJ-25; n = 16) according to their "Sho" or symptom patterns. Subjective sleep parameters, menopausal symptoms, health-related quality of life, body composition, blood pressure, and pulse rate were compared before and after the intervention. RESULTS: The TJ-25 group had significantly higher body weight, body mass index, body fat, lean body mass, resting energy expenditure, and relatively high blood pressure and heart rate at baseline than the other groups. After ~5-month follow up, TJ-23 reduced the sleep disruption frequency, increased lean body mass, and decreased diastolic pressure. TJ-24 alleviated subjective sleep disturbances; improved difficulties in initiating sleep, disrupted sleep, and non-restorative sleep; and relieved headache/dizziness. TJ-25 improved subjective sleep disturbances, alleviated perspiration, and reduced systolic/diastolic pressure and heart rate. CONCLUSIONS: Each of the Kampo formulae effectively alleviated sleep disturbances in Japanese peri- and postmenopausal women. Middle-aged female patients having sleeping disorder could successfully be treated using Kampo medicines.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Medicina Kampo , Fitoterapia , Transtornos do Sono-Vigília/tratamento farmacológico , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/patologia , Resultado do Tratamento
19.
J Obstet Gynaecol Res ; 36(6): 1229-35, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21040206

RESUMO

AIM: Aortic stiffness is widely recognized as an important, independent determinant of cardiovascular risk. The cardio-ankle vascular index (CAVI) has been developed to estimate vascular wall stiffness which is theoretically less affected by varied blood pressure. The purpose of this paper was to evaluate the change of CAVI during one-year use of raloxifene (RLX). MATERIAL & METHODS: Forty-eight women who visited the menopausal clinic in Tokyo Medical and Dental University were enrolled in this study. Twenty-two patients with osteopenia/osteoporosis (mean age 61.3 ± 1.1) out of 48 had RLX 60 mg/day (RLX group). The remaining 26 women (mean age 56.3 ± 1.0) had no medication and were recognized as younger, healthy control (control group). CAVI and ankle-brachial index were measured every 6 months, compared among 0, 6 and 12 months, in respective group. RESULTS: CAVI showed a significant positive correlation to age by the single linear regression analysis. Control group indicated no change of age-adjusted CAVI through 12 months, but RLX group showed significant reduction of CAVI at 6 months and increased to the original level after 12 months. On the other hand, ankle-brachial index change showed significant increase in control group, but slight increase in RLX group, suggesting no increased risk of arterial stenosis. Furthermore, CAVI in the relatively younger group (50 to 59 years; n = 11) indicated stronger reduction at 6 months than older group, suggesting high sensitivity to RLX treatment in the younger group. CONCLUSION: RLX treatment reduced CAVI value at 6 months which was superior in relatively younger group.


Assuntos
Artérias/efeitos dos fármacos , Aterosclerose/prevenção & controle , Cloridrato de Raloxifeno/uso terapêutico , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Idoso , Índice Tornozelo-Braço , Doenças Ósseas Metabólicas/tratamento farmacológico , Estudos de Casos e Controles , Elasticidade/efeitos dos fármacos , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/tratamento farmacológico , Cloridrato de Raloxifeno/farmacologia , Moduladores Seletivos de Receptor Estrogênico/farmacologia
20.
Mol Hum Reprod ; 15(8): 507-12, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19528264

RESUMO

There has been little information demonstrating the roles of dimethylarginine dimethylaminohydrolase (DDAH), which is the hydrolyzing enzyme of endogenous nitric oxide synthase (NOS) inhibitors and, in turn, modulates the intracellular concentrations of NOS inhibitors, in the myometrium during the course of pregnancy. Therefore, the present experiments were designed to investigate whether or not DDAH activity, protein and mRNA expression levels are altered during gestation of the rat and, if altered, those changes reflect on the levels of endogenous inhibitors and endothelin-1 (ET-1), and NO-dependent cyclic GMP generation in the myometrium. The up-regulated changes in DDAH activity, DDAH-2 protein and DDAH-2 mRNA expression at mid-gestation were accompanied by the reduced monomethylarginine and asymmetric dimethylarginine as NOS inhibitors, and ET-1 levels, and by the enhanced NO-dependent cyclic GMP production. At term gestation, on the other hand, down-regulated changes in DDAH activity, DDAH-2 protein and DDAH-2 mRNA expression were accompanied by the increased NOS inhibitors and ET-1 levels, and decreased NO-dependent cyclic GMP generation. These results suggest that alterations in DDAH/NOS inhibitors/NO-dependent cyclic GMP/ET-1 pathway are possibly involved in maintaining myometrial quiescence during gestation and controlling delivery at term.


Assuntos
Amidoidrolases/metabolismo , Miométrio/metabolismo , Contração Uterina/metabolismo , Amidoidrolases/genética , Animais , Arginina/análogos & derivados , Arginina/metabolismo , Western Blotting , GMP Cíclico/metabolismo , Endotelina-1/metabolismo , Feminino , Técnicas In Vitro , Gravidez , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa
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