Hormones and the health of women: past, present, and future. Keynote address

The application of evidence-based practice to nonspeech oral motor treatments

PURPOSE

The purpose of this article is to help speech-language pathologists (SLPs) apply the principles of evidence-based practice (EBP) to nonspeech oral motor treatments (NSOMTs) in order to make valid, evidence-based decisions about NSOMTs and thus determine if they are viable treatment approaches for the management of communication disorders.

METHOD

A detailed description of EBP is provided, including levels of evidence for rating the quality of evidence. NSOMTs are described and a survey of the literature on NSOMTs is provided along with a determination of the level of evidence of each study reported. A systematic literature search was conducted using the electronic databases of MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) within an unrestricted time period. In addition, reference lists from identified articles were also reviewed. Ethical and fiscal issues related to EBP and NSOMTs, as well as clinical implications of EBP for the use of NSOMTs, are discussed.

RESULTS

A total of 45 articles/reports were published between 1981 and 2006 in peer-reviewed and non-peer-reviewed journals. Most of the sources (25) relied on weak anecdotal evidence and opinions. Moreover, studies that employed stronger designs reported negative results for NSOMTs (i.e., evidence against the use of NSOMTs for modifying speech).

CONCLUSION

Despite their use for many years and their popularity among some SLPs for the treatment of a wide variety of speech problems in children and adults, NSOMTs are controversial because sufficient evidence does not exist to support their effectiveness in improving speech. Moreover, limited evidence exists for the use of NSOMTs to facilitate nonspeech activities. Therefore, the available evidence does not support the continued use of NSOMTs as a standard treatment and they should be excluded from use as a mainstream treatment until there are further data. SLPs should consider the principles of EBP in making decisions about NSOMTs.

Effects of botanical dietary supplements on cardiovascular, cognitive, and metabolic function in males and females

BACKGROUND

The onset of menopause marks a pivotal time in which the incidence of hypertension and of cardiovascular disease (CVD) begins to increase dramatically in women. Before menopause, the incidences of these diseases are significantly lower in women than in age-matched men. After menopause, the rates of these diseases in women eventually approximate those in men. The loss of endogenous estrogen at menopause has been traditionally believed to be the primary factor involved in these changes.

OBJECTIVE

This review summarizes recent findings regarding the effectiveness of botanicals in the treatment of some menopausal symptoms and other symptoms of aging (eg, rise in arterial pressure, cognitive decline, insulin resistance, and hyperlipidemia).

METHODS

Articles were selected for inclusion in this review based on the significance of the research and contribution to the current understanding of how each botanical elicits cardioprotective effects. To this end, PubMed and MEDLINE databases were searched, using terms that included the name of the specific botanical along with the relevant aspects of its action(s), such as blood pressure, glycemic control, and lipids. Most of the articles used were published within the past 5 years, although some older articles that were seminal in advancing the current understanding of botanicals were also included.

RESULTS

Soy has been found to lower plasma lipid concentrations and arterial pressure in postmenopausal women and age-matched men, and to have protective effects in heart disease and atherosclerosis of the carotid and coronary circulation. Soy was also found to lower fasting insulin concentrations and glycosylated hemoglobin concentrations. Grape seed extract, another frequently used botanical, contains polyphenols that have been found to reduce arterial pressure and salt-sensitive hypertension in estrogendepleted animal models.

CONCLUSION

Several botanical compounds have been found to have beneficial effects in the treatment of the symptoms of menopause and other symptoms of aging, including CVD, cognitive decline, and metabolic diseases.

Women's use of hormone therapy before and after the Women's Health Initiative: a psychosocial model of stability and change

OBJECTIVE

This longitudinal study examined factors underlying hormone therapy (HT) use before and after termination of the landmark Women's Health Initiative (WHI) estrogen plus progestin HT trial in July 2002, after which dramatic reductions in HT use occurred.

METHODS

A community sample of 324 women (aged 40-86) from Arizona was interviewed four times between 1995 and 2003. A model of medical and psychological factors underlying intentions for long-term HT use expressed in 1995/1996 was developed and employed to predict subsequent use and discontinued use pre- and post-WHI.

RESULTS

Philosophy of menopause and perceived susceptibility to breast cancer predicted perceived benefits of and barriers to long-term HT use, beyond age, oophorectomy, and physician recommendation. Age, benefits, and barriers predicted intentions for long-term HT use over and above current use. Intentions predicted use 3 years later, controlling for previous use. HT use in 1995/1996 predicted use until the WHI announcement, but not thereafter. Oophorectomy predicted continued HT use before WHI trial termination; perceived barriers, expressed 8 years earlier, predicted discontinued use after WHI trial termination.

CONCLUSIONS

Medical and psychological factors predicted sustained and discontinued HT use before and after the WHI announcement. The WHI findings apparently activated potential barriers to use expressed almost a decade earlier.

Evidence-based practice in communication disorders: what do we know, and when do we know it?

Evidence-based practice (EBP), a framework that originated in clinical medicine, offers a principled means of addressing longstanding questions about clinical practice in communication disorders. However, in several respects EBP represents a radical departure from traditional thinking in speech-language pathology and audiology. In this paper, I first describe some of the ways in which the EBP orientation challenges conventional wisdom. I then describe criteria from the EBP literature to be used in evaluating evidence on diagnostic procedures. Using EBP criteria to design, conduct, and interpret studies will increase the quality of evidence available to support clinical decision-making in communication disorders, and to the credibility of the field as a whole.

LEARNING OUTCOMES

(1) Readers will be able to explain why rigorous scientific studies provide a stronger basis for clinical decision-making than do the opinions of authorities. (2) Readers will be able to list five EBP criteria for evaluating a study of diagnosis. (3) Readers will be able to describe and interpret two measures of diagnostic accuracy. (4) Readers will be able to explain the limitations of small-sample studies of diagnostic procedures.

Hormone replacement therapy: short-term versus long-term use

Midwives manage health care of women throughout the life cycle including prescribing hormone replacement therapy (HRT). This article presents a history of research on the use of HRT, as well as risks and benefits. Older research on the effects of HRT on heart disease, osteoporosis, and breast cancer is included. The results and recommendations of the Women's Health Initiative are examined.