Artículos de revistas
The Attitude Of Gynecologists In São Paulo, Brazil 3 Years After The Women's Health Initiative Study
Registro en:
Maturitas. , v. 56, n. 2, p. 129 - 141, 2007.
3785122
10.1016/j.maturitas.2006.06.022
2-s2.0-33846052684
Autor
Lazar Jr. F.
Costa-Paiva L.
Morais S.S.
Pedro A.O.
Pinto-Neto A.M.
Institución
Resumen
Objective: The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication. Design: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the São Paulo Society of Obstetrics and Gynecology. Results: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p < 0.0001). The principal reason for physicians to discontinue HT in a patient was increased risk of breast cancer (62.3%), whereas, according to the physicians, the most important factor for the patients was fear of HT (80.3%). Conclusion: A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose. © 2006 Elsevier Ireland Ltd. All rights reserved. 56 2 129 141 Mosca, L., Collins, P., Herrington, D.M., Hormone replacement therapy and cardiovascular disease-a statement for healthcare professionals from the American heart association (2001) Circulation, 104, pp. 499-503 Bush, T.S., Barret-Connor, E., Cowan, L.D., Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the lipid research clinics program follow-up study (1987) Circulation, 75 (SUPPL. 6), pp. 1102-1109 Barret-Connor, E., Wingard, D.L., Criqui, M.H., Postmenopausal estrogen use and heart disease risk factors in the (1989) JAMA, 262, pp. 2095-2100 Matthews, K.A., Meilahn, E., Kuller, L.H., Kelsey, S.F., Caggiula, A.W., Wing, R.R., Menopause and risk factors for coronary heart disease (1989) N Engl J Med, 321, pp. 641-646 Hulley, S., Grady, D., Bush, T., Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women (1998) JAMA, 280, pp. 605-613 Grady, D., Herrington, D., Bittner, V., Cardiovascular disease outcomes during 6.8 years of hormone therapy. Heart and estrogen/progestin replacement study follow-up (HERS II) (2002) JAMA, 288, pp. 49-57 Writing Group for the Women's Health Initiative Investigators, Risks and benefits of estrogen plus progestin in healthy postmenopausal, women. Principal results from the Women's Health Initiative randomized controlled, trial (2002) JAMA, 288, pp. 321-333 Alving, B., NIH asks participants in Women's Health Initiative estrogen-alone study to stop study pills, begin follow-up phase (2004) South Med J, 97, pp. 425-426 Heitmann, C., Greiser, E., Doren, M., The impact of the Women's Health Initiative randomized controlled trial 2002 on perceived risk communication and use of postmenopausal hormone therapy in Germany (2005) Menopause, 12, pp. 363-365 Hoffmann, M., Hammar, M., Kjellgren, K.I., Lindh-Astrand, L., Brynhildsen, J., Changes in women's attitudes towards and use of hormone therapy after HERS and WHI (2005) Maturitas, 52, pp. 11-17 Blumel, J.E., Castelo-Branco, C., Chedraui, P.A., Patients' and clinicians' attitudes after the Women's Health Initiative (2004) Menopause, 11, pp. 57-61 Neyro, M., Cancelo, M.J., Quereda, F., Palacios, F., Relevance of the results of the Women's Health Initiative on the prescription of hormone therapy in Spain (2005) Climateric, 8, pp. 36-48 Nassar, A.H., Essamad, H.M., Awwad, J.T., Khoury, N.G., Usta, I.M., Gynecologists' attitudes towards hormone therapy in the post "Women's Health Initiative" study era (2005) Maturitas, 52, pp. 18-25 North American Menopause Society, Recommendations for estrogen and progestogen use in peri- and postmenopausal women: October 2004 position statement of the North American Menopause Society (2004) Menopause, 11 (6), pp. 589-600 International Menopause Society, Guidelines for hormone treatment of women in the menopausal transition and beyond position statement by the Executive Committee of the International Menopause Society (2004) Climacteric, 7, pp. 333-337 Machado, R.B., Fernandes, C.E., Maia, E., Melo, N.R., Baracat, E.C., Hormone therapy following the Women's Health Initiative (WHI) study: perception of gynecologists in Brazil (2005) Minerva Ginecol, 57, pp. 563-568 Barros, A.J., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol, 3, p. 21 Beral, V., Breast cancer and hormone-replacement therapy in the Million Women Study (2003) Lancet, 362 (9382), pp. 419-427. , Million Women Study Collaborators Filho, A.S., Soares Junior, J.M., Arkader, J., Maciel, G.A., Baracat, E.C., Attitudes and practices about postmenopausal hormone therapy among female gynecologists in Brazil (2005) Maturitas, 51, pp. 146-153 Klaiber, E.L., Vogel, W., Rako, S., A critique of the Women's Health Initiative hormone therapy study (2005) Fertil Steril, 84, pp. 1589-1601 Speroff, L., Alternative therapies for postmenopausal women (2005) Int J Fertil Women Med, 50, pp. 101-114 Haimov-Kochman, R., Hochner-Celnikier, D., Haimov-Kochman, R., Hochner-Celnikier, D., Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us? (2005) Acta Obstet Gynecol Scand, 84, pp. 972-979 Sondergaard, K.M., Hindsberger, C., Toft, U., Adser, L., Damsgaard, J.J., Hvas, A.C., Menopause, hormone therapy and alternative medicine: a cross-sectional study in Roskilde County in 1998 (2005) Ugeskr Laeger, 167, pp. 3185-3189 Dobson, R., Popular herbal remedy for hot flushes is no better than placebo (2005) Br Med J, 331 (7522), p. 924 Speroff, L., WHI trial: it's time to be critical! (2003) Am J Obstet Gynecol, 189, pp. 621-626 Grodstein, F., Manson, J.E., Stampfer, M.J., Hormone therapy and coronary heart disease: the role of time since menopause and age at hormone initiation (2006) J Womens Health (Larchmt), 15, pp. 35-44 Doren, M., Nilsson, J.A., Johnell, O., Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women: a meta-analysis (2003) Hum Reprod, 18, pp. 1737-1746 Wells, G., Tugwell, P., Shea, B., Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women (2002) Endocr Rev, 23, pp. 529-539 Doren, M., An assessment of hormone replacement therapy to prevent postmenopausal osteoporosis (1999) Osteoporos, 9 (SUPPL. 2), pp. S53-S61 McIntosh, J., Blalock, S.J., Effects of media coverage of Women's Health Initiative study on attitudes and behavior of women receiving hormone replacement therapy (2005) Am J Health Syst Pharm, 62, pp. 69-74 Barber, C.A., Margolis, K., Luepker, R.V., Arnett, D.K., The impact of the Women's Health Initiative on discontinuation of postmenopausal hormone therapy: the Minnesota Heart Survey (2004) J Womens Health (Larchmt), 13, pp. 975-985