Why Is HRT Prescribed For Menopausal Women

Why Is HRT Prescribed For Menopausal Women This dissertation to answer the research question (Why HRT is prescribed for menopausal women despite the risk of breast cancer?) was carried out as mentioned in the methodology section using the literature review methodology. The selected studies were appraised with the critical appraisal tools by the Public health resource Unit. The methodology of literature review had well assisted to review all the studies in the perspective of the other and divulge meaningful evidence and information which in a single study capacity would have been otherwise unnoticed. The Critical appraisal tools have assisted to review all the studies comprehensively to ensure there validity, reliability and applicability so that the result could be generalized to all the menopausal women population. The studies which have been reviewed were conducted in various settings with participants from all types of study population hence the results are a wholesome reunion of the existing predisposing factors with the associated risk of HRT in the incidence of breast cancer. ANSWER TO THE RESEARCH QUESTION Every doctor has the relief of the patient of utmost importance while prescribing a treatment and every treatment is meant to bring relief. And treatment has dose schedules, administration guidelines and perhaps side-effects which are generally explained by the doctor. But unlike other medicines there is a lot of unrest around the use of HRT though the associated risk when evaluated with other factors is not high. Keeping the results and conclusions derived from these studies in the present and elements for further research in front, it is seen that HRT does have benefits. These associated benefits with use of HRT according to this study are: 1) Use of HRT decreases the risk of death overall (Sellers et.al,1997) (Sener et.al, 2009) and is associated with recurrence, metastasis-free survival and better overall and disease-free survival than HRT nonusers in the univariate analysis irrespective of the start of menopause (Sener et.al , 2009) (Bonneir et.al, 1998) 2) HRT does not increase the risk of breast cancer when administered to women for whom other risk factors have been excluded (Tzingounis et.al, 1996). 2) There is an inverse relationship between HRT and mortality due to coronary heart disease, stroke and cancers other than breast (Sellers et.al, 1997) 4) Use of HRT gives fewer locally advanced cancers and smaller and better-differentiated cancers compared to non-users (Bonneir et.al, 1998). 5) HRT is a favourable prognostic factor for breast cancer. (Bonneir et.al, 1998) 6) Use of HRT counteracts the increased incidence of breast cancer with the lower incidence of other tumors. (Olsson et.al, 2001) 7) Long term HRT use has a favorable effect against colorectal and endometrial cancer. (Writing Group for the Womens Health Initiative Investigators, 2002) (Corrao et.al, 2008). 8) Use of trans-dermal HRT compared to the oral use of HRT is associated with lesser risk of breast cancer (Million women study collaborators, 2003) (Corrao et.al, 2008) which is presumed by the WHI, 2002. However these benefits depend on many other inter-connected factors of duration of use, age of the menopausal woman, past personal history of HRT used, family history related to breast cancer, dose of the HRT administered and type of HRT regime prescribed. These same factors affect the element of risk as well in the following way. 1) Risk of breast cancer may be increased with HRT use for duration of 5 years or less in women with family history of breast cancer (Sellers et.al,1997) (Olsson et.al, 2001). 2) Increased risk of breast cancer after prolonged use of HRT (Olsson et.al, 2001) (Sellers et.al, 1997) (Corrao et.al, 2008) (Sellers et.al, 1997) (Olsson et.al, 2001). This risk increased with increasing duration of use and decreased with time and reached at baseline with 5 years time. (Ewertz et.al, 2005) (Million women study collaborators, 2003) 3) Higher risk in current users than in past users which was greater for combined therapy than for other oral types of HRT (Million women study collaborators, 2003). 4) Women who used combined estrogen and progestin HRT regime are at increased risk of breast cancer (Stahlberg et.al, 2004) (Million women study collaborators, 2003) and Oral HRT use for long term had a higher risk of breast cancer than trans-dermal use of HRT (Corrao et.al, 2008). 5) Increased risk of breast cancer with current use of HRT in women of 50 years of age and above which increased with increased use. No increased risk in women between the ages of 40-49 (Ewertz et.al, 2005) (Million women study collaborators, 2003). 6) The risk of breast cancer increased in women who were current HRT users and had used OC in the past. (Lund et.al, 2007) 7) HRT users developed breast cancer at a younger age than non HRT users (Sener et.al, 2009). According to the synopsis of the issues and factors derived it can be concluded that there are benefits associated with use of HRT which mutually depend on the risk factors. And this is the reason why HRT is prescribed for menopausal women despite the risk of breast cancer. And these will again depend on gynecologist judgment and patients level of knowledge and awareness (2006). RECOMMENDATIONS To bring the optimal benefit with minimally associated risk, HRT could be prescribed to menopausal women for lesser duration which the studies present as 5 years. This duration which could be disputable and the age of the women also has to be considered with the link of different effects of HRT in different age groups would again depend on the individual gynecologists judgment and the patients compliance for regular follow up and mammographic screening. An attempt has been made to clear the otherwise existing dilemma of prescribing HRT or not but this again depends on many other factors which are most importantly the patients follow up and the doctors perception of the associated prescribing strategies. However more research is needed as within the limitations of this dissertation though it is possible to conclude that there are benefits associated with the use of HRT despite the risk of breast cancer; it is not possible to chalk out an effective prescribing strategy. And to bring any considerable changes a prescribing strategy and better patient compliance for follow-up would be needed. LESSONS LEARNT These total results, conclusions and opinions from the studies have presented some principle elements which could guide through the dilemma of prescribing HRT to yet another menopausal woman. 1) It is evident that duration has a role to play in the increase of the foresaid risk of breast cancer and that there is no risk with the use of HRT in the past. 2) A lot would also depend on the gynecologist or the physicians prescribing principles. It would be needed by them to follow some guiding factors like evaluating high-risk and low-risk women, family history and previous history of Oral Contraceptives which would vary for each patient. 3) A regular follow-up and timely check up as mentioned would help to catch otherwise unnoticeable breast changes. 4) Another factor which needs to be pursued for future research and studies is the type of HRT regimes. In routine HRT is prescribed orally hence less is known about other methods of administration which could perhaps assist in reducing the risk. 5) It would also be helpful to find if there is a link with the BMI and use of HRT. Generally obesity is linked to many diseases and unhealthy conditions and this would help to categorize women into high or low risk group. This dissertation has tried to bring up some associating factors which could help to extract the optimal benefits with lesser risk. This systematic approach has helped conduct this dissertation so as to answer the research question. However research in healthcare is never ending and is expanding every day (Aveyard, 2010). New studies with various designs are being conducted around this topic as I write my dissertation which will bring in more new opinions and evidences which will form base for yet another dissertation or study tomorrow to help develop a successful prescribing strategy.

The Unexpected Journey Essay -- Literary Analysis, The Hobbit

I. Subject The Hobbit is a novel about the adventures of a hobbit as he embarks on an unexpected adventure. The story begins by describing a humble hobbit-hole located in a world filled with magic and where mysterious creatures flourished. The home belonged to the hobbit, Bilbo Baggins. Bilbo, the protagonist of the story, lived a simple, happy life and wouldn’t want to change a thing. He dreaded anything unexpected; when a wizard named Gandalf came looking for someone to go on an adventure, Bilbo tried all he could to avoid joining. Unfortunately for him he found himself traveling with thirteen dwarfs and a wizard on a quest to take back their stolen treasure from a fierce dragon. Near the beginning of their journey, Bilbo was quite vulnerable to the dangers and was frequently rescued by the others. As he progressed through the quest, he went on his own little adventures which helped him become braver and wiser. He found the One Ring of Power which made him invisible; it served a great use for the dwarfs and especially Bilbo from when they were endangered. Gandalf had to leave the party halfway through the quest and the dwarfs feared that they wouldn’t go far without him, but Bilbo was a great help to the dwarfs as they progressed through their journey. He gained respect from the others because of his courageous feats of heroism. The group finally reached the dragon’s lair on a mountain known as the Misty Mountains. They had successfully regained the treasures, but rumors of the dead dragon’s treasure attracted creatures from all over the lands to head towards the mountain. This led to a war known as the Battle of Five Armies where the dwarfs, elves, and humans fought against the goblins and Wargs. Bilbo did not participate... ...es place in a nonexistent and unreal world or concerns incredible and unreal characters†¦ or may be employed merely for whimsical delight, or it may be the medium for serious comment on reality† (Harmon 192). The Hobbit takes place in an imaginary world with events, items, and characters that are fictional, but there are things that a person can relate in reality. Bilbo is a hobbit which is obviously a fictional creature, but, however, has realistic traits that a person in reality could also have. A sub-genre for this novel is a psychological novel. â€Å"[It] usually [emphasize] on interior characterization and on the motives, circumstances, and internal action that spring from, and develop, external action† (382). Bilbo grows physically and as well as mentally throughout his adventure. Tolkien focuses on Bilbo’s journey of maturation and how he changes at the end.

Human Trafficking Essay

Human trafficking, better known as modern day slavery, has existed within America ever since the government began to look at the world in shades of gray, and not judge people by race, religion, or gender. Thousands of Americans including women, men, and children are victims are human trafficking, and the questions in the minds of people everywhere are what exactly is taking place, why is it taking place, how is it taking place, and also who are the main targets and what can we do to help them. These innocent civilians are victims of something much bigger than just the faces sleeping on the street, selling drugs, and even worse selling their bodies. They are helpless beings of earth not criminals, and their human rights are being mentally, physically, and emotionally abused. â€Å"Combating human trafficking is going to require creativity and collaboration amongst government authorities, law enforcement, social services, academics, and victim advocates† (Thakur). Trafficking of humans seems to be this unrealistic, unheard of problem; however, it is not. â€Å"Cases of human trafficking have been reported in all 50 U.S. States† (National Human Trafficking Resource Center Report). Victims are recruited, transported, transferred, and harbored to America for the purpose of exploitation. They are forced to work in sweatshops, in houses as domestic slaves, farms, and for the commercial sex industry such as prostitution, escorts, and even in pornography. These are in nocent people that are forced to lessen themselves as people, and when law enforcement steps in, looked upon as criminals. Instead of the help and the therapy these beings of life so desperately need, they get throw into juvenile detention, which then forces them to endure more trauma to their lives than they already have been through. In cases like these, victim’s civil rights are completely taken out of the situation and tossed aside for â€Å"appropriate punishment†. Traffickers use particularly contradictive, deceptive ways to manipulate their victims to believe the false promises they propose. Some offer opportunities for a good job, education, or marriage. Since most of the victims happen to be children, the traffickers pose as a boyfriend, caretaker, or protector; however, if the victim refuses or denies, they will not hesitate to use force, threat, fraud, abduction, abuse of power, or even payments and benefits. â€Å"The vast majorities are sold through class ified ads on websites. The Attorney General’s office documented that underage girls were sold through these ads in at least 22 states† (Axtell). Vulnerability plays a huge role in trafficking. Traffickers tend to target younger children mostly because of their immaturity, gullibility, and vulnerability. McMahon 2 The risk in being caught as a trafficker deals with prison time or even death sentence, so is the risk and guilt of trafficking human beings worth all the trouble? â€Å"The National Human Trafficking Resource Center estimates it’s a $32 billion industry, with about 50% of this revenue coming from industrialized countries. This surpasses the sale of illegal arms† (Axtell). Basically, the traffickers are receiving free labor while making billions of dollars. Not to mention when demand is there, supply will follow, and there is an outrageous command for modern day slaves. Unfortunately, when an illegal industry grows so great, it takes an immense amount of time and patience to even get close to putting an end to it. Although it does seem like mission impossible to put an end to the misery, it can happen. Since authorities are beginning to see these people as victims and not criminals government programs are being created all the time. First off, they changed the law so ch ildren could not be incarcerated for their exploitation and abuse. Second, programs such as GEMS (girls education and mentoring service), and SHE (survivor healing and empowerment) are constantly providing support for victims of human trafficking. Stop Child Trafficking Now donated 21,060 dollars to help fund for the prevention of trafficking, and the 2012 Nation Walk raised 210,000 dollars. SCTNow has funded programs such as cyber teams, rescue centers, rehabilitation centers, and special investigation teams. â€Å"The cyber teams are talented, professional men McMahon 3 and women who make Internet pathways safe for children† (SCTNow). They identify and track down cyber predators who pose online as teenagers. Also, they keep all communities aware with the community investigative teams they fund as well. On top of funding programs to stop trafficking SCTNow focus a vast amount of energy of the effort on stopping the demand for human trafficking. With this entire desperate endeavor to stop the abuse on civil rights, one day it might just happen. Even though anyone can be trafficked, traffickers target vulnerable people. Factors that cause vulnerability include lack of opportunities, poverty, unemployment, abusive homes and young age. Although men, women and children are all defenseless, but young women are especially of interest because the traffickers force them into prostitution that financially benefits them. â€Å"At least 12.3 million people in the world are trafficked† (CRS). Out of the 12.3 million people trafficked, 1 million of th em were children alone; however, on average, only one person is convicted for every 800 trafficking cases worldwide. Not even one percent of the children victims are identified. Ages twelve to fourteen are the primary target for traffickers. Most of the young girls who end up in the sex trade come from dysfunctional, abusive homes and they just end up running away; however, some of the children do not have parents at all and have experienced an extremely rough life. They fall into the lies that the traffickers tell them. The traffickers paint them McMahon 4 a picture of a new, happy future, but more often than not they end up dead, an addict, or more miserable then before. In the United States, California has 3 of the FBI’s 13 highest child sex trafficking areas in the nation: Los Angeles, San Francisco, and San Diego. Modern day slavery, also known as human trafficking has torn apart families, taken away civil rights, caused mental, physical, and emotional damage, and killed innocent people. Ideas are held on why and how people do it, knowledge of who the victims are and what happens to them when in the possession of a trafficker, and the government and other programs are continuously doing the best they can to help prevent, stop, and save victims of human trafficking. â€Å"Those who deny freedom to others deserve it not for themselves† (Lincoln).

Brain Development Understanding The Brain During The...

Michael Shen Mrs. Fill Lit/Writing p.7 8 May 2015 Brain Development Brain development research provides essential information leading to the success of our posterity. Understanding the brain during the apex of development, also known as adolescence, allows not only scientists but also parents to work towards an understanding of future generations. In this website, the effects of adolescence, the differences between an adolescent and adult, and the influences of environment will all be thoroughly discussed. When adolescence begins, there are many psychological effects on the teenager. To begin with, there are many hormonal chang es involving large releases of hormones, which affect levels of hormones within an individual. The most noticeable change involves the social behavior of a teenager. During this time, a teenager may find him or herself in a fluster of emotions, unsure of what to think and feel about a certain situation. It is common for teenagers to experience negative moods such as loneliness, depression, and hopelessness during this time of change. In addition, adolescents will begin to struggle for independence and power. This overload of emotions often causes vulnerability, which can lead to peer pressure, and a chance of risky behavior. Furthermore, adolescents also respond to situations differently. The hormonal changes also affect responses to stress. Also, the part of the brain responsible for emotional response also changes during adolescence. Therefore,Show MoreRelated The Servant By James Hunter1605 Words   |  7 PagesThe Servant. That is, that we should lead people the way that we would want be lead ourselves, and that the essence of transcendent leadership can only be expressed through love. 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