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Topics will include diet therapy, medication administration, foot care, hypoglycemia treatment, home monitoring of blood sugar, sick-day management and prevention of complications.
After two reminders 1 376 69% ; of the questionnaires were returned. Results: Eighteen per cent of those responding were willing to join the trial. Younger women tended to be more interested than older ones. When the age was standardized, birthgiving, visits to a physician the previous year, and current use of a calcium preparation were indicators increasing women's willingness to join. Education, place of residence, employment status, alcohol and tobacco use or physical exercise in the leisure time did not correlate with the willingness to join. Conclusion: Use of health services, possibly reflecting the women's interest in their health, correlated with their willingness to join this trial. In other terms they did not differ from the population group they belonged to. FC2.16.03 EFFICACY OF A NEW ESTRIOL PESSARY PAUSANOL ; IN THE TREATMENT OF VAGINAL ATROPHY T. Miettunen 1 ; , J. Mkinen 2a ; , S. Meltomaa 2a ; , O. Neirama 2a ; , P. Klemi 2b ; , J. Kenraali 1 ; , T. Jouhikainen 1 ; , J. Menp 1 ; 1 ; Leiras Oy, Clinical Research, Helsinki, Finland. 2a ; Dept. OB GYN, University Hospital, Turku, Finland. 2b ; Dept. Pathology, University Hospital, Turku, Finland. Objectives: This study was performed in order to show the efficacy of a new pessary containing 0.5 mg of estriol PAUSANOL ; P ; in the treatment of vaginal atrophy in comparison with an already established pessary OVESTIN ; O ; . Study Methods: Fifty postmenopausal women 55 years ; with vaginal pH over 4.5 and atrophy verified by maturation index i.e. no superficial cells in the Pap smear ; were included in this randomized, parallel, comparative, double-blind study with daily treatment with intravaginal estriol. The efficacy was judged by the change after a 14-day treatment period in maturation value MV ; , vaginal pH and vaginal dryness and dyspareunia assessed by the patients using visual analogue scale VAS ; . In both VASs 0 indicated maximal symptoms and 100 no symptoms. Results: The median MV increased P: from 56 to 74, O: from 32 to 69 ; and the median vaginal pH decreased P: from 6.5 to 4.5, O: from 6.5 to 5.0 ; statistically significantly in both groups during the 14-day treatment P was not inferior to O ; . The median VAS scores of vaginal dryness P: from 30 to 84, O: from 22 to 82 ; and dyspareunia P: from 39 to 90, O: from 45 to 96 ; increased statistically significantly in both groups. Conclusions: Both treatments resulted in marked maturation of the cells of the vaginal epithelium and recovery of the vaginal atrophy in 14 days. Furthermore, both treatments improved the quality of life, since subjective symptoms of vaginal atrophy were dramatically decreased. FC2.16.04 IMPACT ON COMPLIANCE OF HORMONE REPLACEMENT THERAPY IN PERI-MENOPAUSAL WOMEN BY PROVIDING CONTINUOUS LOW DOSE PROGESTROGEN THROUGH LEVONORGESTREL INTRA-UTERINE SYSTEM LNG-IUS ; Shashi P. Singh, Lordswood Health Centre, Chatham, Kent, U.K. Objective: To study the impact on compliance of Hormone Replacement Therpay HRT ; in peri-menopausal women requiring contraception and suffering from menorrhagia or dysmennorrhoea in the absence of serious organic pathologies, byproviding continuous, inta-uterine progestrogen through LNG-IUS. Method: I have fitted 398 women with LNG-IUS since it's launch in the U.K., after counselling & consent, under adequate analgesia, after a thorough pelvic examination & excluding genital infection & serious pathologies through pelvic ultrasound with the same techniques as other IUCD's. Relevant blood tests were also carried out e.g. Haemoglobin Hb ; , Thyroid Function Test. 95 of these patients were peri-menopausal, symptomatic or high risk women, mean age 49 ; , requiring oestrogen along with LNG-IUS releasing 20mcg of Levonorgestrel daily ; , providing the progetstrogenic component of HRT. Patients were followed up at 2, 6, 12 months and then yearly. A yearly pelvic ultrasound was carried out. Data was collected on bleeding patterns, self-assessed subjective menstrual blood loss MBL ; , symptomatic improvement, pre-menstrual symptoms PMS ; , weight change, side-effects, patient satisfaction. Transdermal oestrogen delivery system was preferred by 90% of patients 70% patches, 20% gel ; . 10% opted for oral HRT, for example, drug interactions.
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Geriatric Clinical Pharmacology GER ; .Room 304 Therapeutic Drug and Toxicology Monitoring THE ; .Orange County 4 Pediatric and Maternal Pharmacology PED ; .Gold Key 1 Hematologic and Neoplastic Diseases HEM ; .Room 315 Pharmacoepidemiology, Drug Safety and Outcomes Research PHE ; .Room 312. Alone supported by formal health and social care services. They may move to live with family or friends, who provide informal care. In this case, informal care may be a substitute for previous formal care services. If informal care is not adequately costed, then the financial cost decreases, but not the opportunity cost of providing care 35 ; . In contrast, in a secondary analysis of a large-scale disability survey in the United Kingdom, disabled elderly people with more severe cognitive disability received more intensive care and were referred more often to health care services 23 ; . In analysis of Canadian data 27 ; in which a bivariate regression model was used to assess the relationship between severity of disease and costs, each 1-point decrease in MiniMental State Examination MMSE ; scores was associated with an average increase in costs of $1, 343 Canadian dollars, 1996 prices ; . Even when informal care time was valued by using industrial aggregate wage levels rather than minimum wage levels, the relationship between severity and costs remained statistically significant. The relationship between costs of care and severity of disease is complex. Increases in the costs of care as disease becomes more severe represent in part a greater use of institution-based care as people become more cognitively and functionally disabled by their disease. They may also reflect aging and the effect of comorbidities 23 ; . In addition, informal carers age and may be affected by declining health and less ability to provide care. Setting of Care An important determinant of the costs of health and social care is the distribution of people with AD by setting of care. For most of the studies reported in Table 89.2, the costs of long-stay care are 1.5 to 2.5 times higher than those of home-based care. The exceptions to this are the study by Gray and Fenn 7 ; , in which the costs of long-stay care were 10 times higher than those of community care. The study by Rice et al. 28 ; indicated roughly equal costs for long-stay and home-based care. Determinants of the setting of care include the severity of cognitive and functional disability, the presence of other health problems, the ability of informal carers to support the person at home, and the structure of health and social care service provisions. The data in Table 89.2 indicate that the proportion of people cared for in long-stay care settings is between 6% and 53% for people with mild to moderate disease and 33% to 86% for people with severe disease. Kavanagh and Knapp 23 ; found cost variations between long-stay care locations in their sample, and they also found the prevalence of severe cognitive disability to be higher in the more expensive settings. In the regression analysis by Holmes et al. 25 ; , the use of institutional care increased with the number of years since diagnosis and the age of the carer. For each additional year of age of the carer, the costs of institutional care were predicted to increase by roughly $264 per year.
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