Jim Robinson has one word for anyone living near how to buy cheap lasix online a wildfire. Leave. Jim Robinson (pictured with Karen Fiscus) wants others to know about his experiences with the most recent wine country fire. (Courtesy Jim Robinson.)He wishes he had done that sooner.
Like so many others, he underestimated the intensity and speed of a fire that ended up trapping him and his girlfriend, Karen Fiscus. For them, it was the LNU Lightning Complex fire that devastated wine country beginning in mid-August.The costs of waiting have been much too high. He and Fiscus had to hide in a drainage pipe as fire surrounded them twice before emergency responders were able to reach them.Today, Robinson is still recovering from second- and third-degree burns on 27% of his body following seven weeks in the UC Davis Burn Center. He also is grieving, as his girlfriend died from her injuries.
His Napa hog farm is now an eerie moonscape and his animals are gone.Still, he wants to talk about what happened, and offer advice to those in wildfire zones.âIn the past, weâve been able to wait out the fires,â Robinson said. ÂIt kind of goes with living where I live. But this fire was different. Way different.
It had its own atmosphere.âUC Davis surgeon Tina Palmieri is a nationally recognized expert on treating and improving outcomes for burn patients.Two bright spots for Robinson as he recovers have been his family and the Burn Center, where a specially trained team treated his injuries and helped him accept his survival. The weeks he spent there were, he said, âOne of the best experiences I ever had. The doctors and nurses were phenomenal.âThe Burn Center treats adults in Northern California and Western Nevada who need intensive burn care. Tina Palmieri, a burn surgeon and director of the center, said the number of wildfire-injured patients her team treats has steadily increased over the past few years.âWildfire-related burns can be particularly challenging because they are often severe, and because transportation to a hospital for care can be delayed by the fire itself,â Palmieri said.Palmieri echoes Robinsonâs guidance about leaving quickly once a fire breaks out in your area.
She also suggests covering up from head to toe, despite the heat of a fire, and bringing a flashlight. Both helped Robinson. His clothes offered some protection for his skin and the flashlight guided emergency responders to him.As wildfires in Northern California increase so do the number of patients in UC Davisâ Burn Center with wildfire-related injuries.If you do get burned, Palmieri said, rinse the burn injury with cool water for up to 20 minutes if you can, as this may decrease the extent of the injury. However, keep the rest of your skin covered and dry.
And, as soon as possible, get emergency care.Robinson said that while protecting your property may be your first instinct in a fire, you should ignore that instinct.âGive yourself enough time to get your belongings together and just go,â he said. ÂYou can start over, but you canât bring a life back.â A Center of Excellence, the Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center unites the exceptional surgical, critical care and rehabilitation resources of UC Davis Health to care for the unique needs of adult burn patients. The team also treats pediatric burn patients through a partnership with Shriners Hospitals for Children â Northern California. In addition to a comprehensive clinical program, the burn center conducts research aimed at improving patient outcomes, leads community outreach to support burn survivors, and provides education to reduce burn injuries.
More information is on the Burn Center website.The Burn Center also hosts a support group for all burn survivors in the region. For information about joining, email Lauren Spink at lhspink@ucdavis.edu.Related stories and resourcesThe Burn Center team braces for wildfire seasonDonât forget to include these health items in your emergency âgo bagâStaying safe during a wildfire information from the U.S. Centers for Disease Control and Prevention CAL FIRE incident mapNurse Carla Martin, executive director for Patient Care Services at UC Davis Medical Center, saw first-hand the preparedness, the anxiety and the stress in receiving and treating the first known community-transmitted hypertension medications patient in the U.S.In her harrowing and inspirational account of those tense hours and days, Carla shares her unique perspective on how UC Davis Health leaders and care providers navigated totally uncharted waters.Hear the full story, in Carlaâs own words.In celebration of Florence Nightingale's 200th birthday, 2020 is the Year of the Nurse. Beginning on National Nurses Week (May 6-12) and continuing throughout the year, a special blog will feature the stories, memories and motivations of UC Davis Health nurses.Hear their words, and get to know why and how they invest such heart, passion, expertise and commitment in their life-changing work..
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When we took the editorship fluid medicine lasix of Evidence-Based Mental Health a fantastic read (EBMH) at the end of 2013, we set two main objectives. To promote and embed an evidence-based medicine (EBM) approach into daily mental health clinical practice, and fluid medicine lasix to get an impact factor (IF) for EBMH. Both aims have fluid medicine lasix been big challenges and we have learnt a lot.EBM has been around for about 30 years now, shaping and changing the way we practice medicine. When Guyatt and colleagues published their seminal paper in 1992,1 EBM was described as the combination of three intersecting domains.
The best available fluid medicine lasix evidence, the clinical state and circumstances, and patientâs preferences and values. EBM and EBMH have since continuously evolved to deepen our understanding of these three fluid medicine lasix domains.The best available evidenceWe keep complaining about the poor quality of studies in mental health. To properly assess the effects of interventions and devices before and after regulatory approval, we all know that randomised controlled trials are the best study design.2 3 However, real-world data are crucial to shed light on key clinical questions,4 especially when adverse events5 or prognostic factors6 are investigated. It necessarily â¦IntroductionQuality-adjusted life years (QALYs) have been increasingly used in general medicine and in psychiatry to evaluate the impact of a disease on both the quantity and quality of life.1 fluid medicine lasix One QALY is equal to 1 year in perfect health, can range down to zero (death) or may take negative values (worse than death).
QALYs can be used to compare the burdens of various diseases, to fluid medicine lasix appreciate the impact of their interventions, to help set priorities in resource allocations across different diseases and interventions and to inform personal decisions.The representative method to evaluate QALYs is the generic, preference-based measure of health including the Euro-Qol five dimensions (EQ-5D)2 3 and the SF-6D based on Short Form Survey-36 (SF-36).4 5 Of these, the EQ-5D is the most frequently used and is the preferred instrument by the National Institute of Health and Care Excellence in the UK. While the responsiveness of such generic measures to various mental fluid medicine lasix conditions, especially severe mental illnesses, has been questioned,6 its validity and responsiveness to common mental disorders including depression and anxiety have been generally established.7 8However, the traditional focus of measurements in mental health has centred mainly on symptoms. Many trials have, therefore, not administered the generic health-related quality of life measures. This has hindered comparison of impacts of mental disorders vis-Ã -vis other medical conditions on the one hand and also evaluation of values of their interventions on the other.9 10We have been collecting individual participant-level data from randomised controlled trials of internet cognitive-behavioural fluid medicine lasix therapies (iCBT) for depression,11 several of which administered both symptomatologic scales and generic health status scales simultaneously.
This study, therefore, attempts to link the depression-specific fluid medicine lasix measure onto the generic measure of health in order to enable estimation of QALYs for depressive states and their changes. Such cross-walking should facilitate assessment of burden of depression at its various severity and of the impacts of its various treatments.MethodsDatabaseWe have been accumulating a data set of individual participant data of randomised controlled trials of iCBT among adults with depressive symptoms, as established by specified cut-offs on self-report scales or by diagnostic interviews.11 For this study, we have selected studies that have administered the EQ-5D and depression severity scales at baseline and at end of treatment. We excluded patients if they had missing data in either of the two scales at baseline or at fluid medicine lasix endpoint. We excluded studies that focused on patients with fluid medicine lasix general medical disorders (eg, diabetes, glioma) and depressive symptoms.MeasuresEQ-5D-3LThe EQ-5D-3L comprises five dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each rated on three levels corresponding with 1=no problems, 2=some/moderate problems or 3=extreme problems/unable to do.
This produces 3Ë5=243 different health states, ranging from fluid medicine lasix no problem at all in any dimension (11111) to severe problems on all dimensions (33333). Each of these 243 states is provided with a preference-based score, as determined through the time trade-off (TTO) technique in a sample of the general population. In TTO, respondents are asked to give the relative length of time in full health that they would be willing to fluid medicine lasix sacrifice for the poor health states as represented by each of the 243 combinations above. The EQ-5D fluid medicine lasix scores range between 1=full health and 0=death to minus values=worse than death bounded by â1.
The scoring algorithm for the UK is based on TTO responses of a random sample (n=2997) of noninstitutionalised adults. Over the years, value sets for EQ-5D-3L have been produced for many countries/regions.2 3 7Depression severity scalesWe included any validated depression fluid medicine lasix severity measures. The scale scores were converted into the most frequently used scale, namely, the Patient Health Questionnaire-9 (PHQ-9),12 using the established conversion algorithms13 14 for the Beck Depression fluid medicine lasix Inventory, second edition (BDI-II)15 or the Centre for Epidemiologic Studies Depression Scale (CES-D).16The PHQ-9 consists of the nine diagnostic criteria items of major depression from the DSM-IV, each rated on a scale between 0 and 3, making the total score range 0â27. The instrument has demonstrated excellent reliability, validity and responsiveness.
The cut-offs have been proposed as 0â4, 5â9, 10â14, 15â19 and 20- for no, mild, moderate, moderately severe and severe depression, respectively.12Statistical analysesWe first calculated Spearman correlation coefficients between PHQ-9 fluid medicine lasix and EQ-5D total scores at baseline, at end of treatment and their changes, to establish if the linking is justified. Correlations were considered weak if scores were <0.3, moderate if scores were â¥0.3 and<0.7 and strong if scores were â¥0.7.17 Correlations â¥0.3 have been recommended to establish linking.18 We then fluid medicine lasix applied the equipercentile linking procedure,19 which identified scores on PHQ-9 and EQ-5D or their changes with the same percentile ranks and allows for a nominal translation from PHQ-9 to EQ-5D by using their percentile values. This approach has been used successfully for scales in depression, schizophrenia or Alzheimerâs disease.14 20â22 We analysed all trials collectively rather than by trial to maximise the sample size, ensure variability in the included populations and attain robust estimates.We conducted a sensitivity analysis by excluding studies that require the conversion of various depression severity scores into PHQ-9.All the analyses were conducted in R V.4.0.2, with the package equate V.2.0.7.23Ethics statementThe authors assert that all fluid medicine lasix procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Ethical approval was not required for this study as it used only deidentified patient data.FindingsIncluded studiesWe identified seven RCTs of iCBT (total n=2457), which administered validated depression scales and EQ-5D both at baseline and at endpoint (online supplemental eTable 1).
Three studies included fluid medicine lasix only patients with major depressive disorder (MDD), one only patients with subthreshold depression and the remaining three included both. All the studies administered fluid medicine lasix EQ-5D-3L. PHQ-9 scores were converted from the BDI-II in three studies24â26 and from the CES-D in one study.27 The mean age of the participants was 41.8 (SD=12.3) years, 66.0% (1622/2457) were women and they scored 14.0 (5.4) on PHQ-9 and 0.74 (0.20) on EQ-5D at baseline and 9.1 (6.0) and 0.79 (0.21), respectively, at endpoint. When using the standard cut-offs of the PHQ-9,12 2.4% (60/2449) suffered from no depression (PHQ-9 scores <5), 20.2% (492/2449) from subthreshold depression (5â¤PHQ-9 scores <10), 33.5% (820/2449) from mild depression (10â¤PHQ-9 scores <15), 26.5% (649/2449) from moderate depression (15â¤PHQ-9 scores <20) and 17.3% (424/2449) from severe depression (20â¤PHQ-9 scores) at fluid medicine lasix baseline.Supplemental materialEquipercentile linkingSpearmanâs correlation coefficient between the PHQ-9 and the EQ-5D scores was r=â0.29 at baseline, increased to r=â0.50 after intervention and was r=â0.38 for change scores.Figure 1 shows the equipercentile linking between PHQ-9 and EQ-5D total scores at baseline and at endpoint.
Figure 2 shows the same fluid medicine lasix between their change scores. Table 1 summarises the correspondences between the two scales.PHQ-9 and EQ-5D total scores at baseline and fluid medicine lasix endpoint. EQ-5D,Euro-Qol Five Dimensions. PHQ-9, PatientHealth fluid medicine lasix Questionnaire-9." data-icon-position data-hide-link-title="0">Figure 1 PHQ-9 and EQ-5D total scores at baseline and endpoint.
EQ-5D,Euro-Qol Five fluid medicine lasix Dimensions. PHQ-9, PatientHealth Questionnaire-9.PHQ-9 change scores and EQ-5D change scores. EQ-5D, Euro-Qol Five fluid medicine lasix Dimensions. PHQ-9, Patient Health Questionnaire-9." data-icon-position data-hide-link-title="0">Figure 2 PHQ-9 fluid medicine lasix change scores and EQ-5D change scores.
EQ-5D,Euro-Qol Five Dimensions fluid medicine lasix. PHQ-9, PatientHealth Questionnaire-9.View this table:Table 1 Conversion table from PHQ-9 to EQ-5D total and change scoresSensitivity analysisWhen we limited the samples to the three studies28â30 that administered PHQ-9 (total n=1375), the linking results were replicated (online supplemental eFigure 1).DiscussionThis is the first study to link a depression severity measure with the EQ-5D-3L both for total and change scores. To summarise, subthreshold depression corresponded with EQ-5D-3L index values of 0.9â0.8, mild major depression with 0.8â0.7, moderate depression with 0.7â0.5 and severe depression fluid medicine lasix with 0.6â0.0. A five-point improvement in PHQ-9 corresponded approximately with an increase in EQ-5D-3L index values by 0.03, and a ten-point improvement can lead to an increase by approximately 0.25.A systematic review of utility fluid medicine lasix values for depression31 found that the pooled mean (SD) utilities based on studies using the standard gamble as a direct valuation method were 0.69 (0.14) for mild, 0.52 (0.28) for moderate and 0.27 (0.26) for severe major depression.
The estimates based on studies using EQ-5D as an indirect valuation method were 0.56 (0.16) for mild, 0.52 (0.28) for moderate and 0.25 (0.15) for severe depression. One recent study regressed PHQ-9 on SF-6D scores among 394 fluid medicine lasix patients in theimproving Access to Psychological Therapies (IAPT) cohort7 32 and estimated none/mild depression on PHQ-9 to be worth 0.73 SF-6D scores, moderate depression 0.65 and severe depression 0.56. Our results are largely in line with these aforementioned studies.There was a consistent difference of about 0.07 EQ-5D scores for the same PHQ-9 score if fluid medicine lasix it represented the baseline or endpoint measurements (figure 1). This is understandable because a patient would rate their health status less satisfactory if they stayed equally symptomatic as before after the treatment and also because it means that they continued to suffer from depression for longer.
It is, therefore, reasonable to use the conversion table at baseline for relatively new cases of depression and that at end of treatment for more chronic cases (table 1).An effect size to be fluid medicine lasix typically expected after 2 months of antidepressant pharmacotherapy33 or psychotherapy27 34 over the pill placebo condition is 0.3. Given that the average SD of PHQ-9 in the studies was about 6, an effect size fluid medicine lasix of 0.3 corresponds to a difference by two points on PHQ-9. The differences in fluid medicine lasix EQ-5D scores corresponding with the end-of-treatment PHQ-9 scores of x versus x+2, where x is between 5 and 15 (table 1), ranges between 0.08 and 0.13, producing an approximate average of 0.1 EQ-5D scores. If we assume that the same difference would continue for the ensuing 10 months, the gain in QALY per year would be equal to 0.09 QALY.
If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be expected in the control group, the gain in QALY per year would fluid medicine lasix be equal to 0.05 QALY. (See figure 3 fluid medicine lasix for a schematic drawing to help understand the calculation of QALYs based on changing EQ-5D scores. In reality, the changes will be more smoothly curvilinear but the calculation will be similar.) Since one QALY is typically valuated at US$50 000 or 3000 Stirling pounds,35 such therapies would be cost-effective if they cost US$2500 to US$4500 (150 to 270 pounds) or less. If a 1 day fill fluid medicine lasix of generic selective serotonergic reuptake inhibitor antidepressants costs 1â3 dollars and a 1-year prescription costs US$400â1200 dollars, or if 8â16 sessions of psychotherapy cost US$1600â3200 dollars, both therapies would be deemed largely cost-effective.
An individualâs decision, by contrast, will fluid medicine lasix and should be more variable and no one can categorically reject nor require such treatments for all patients.A schematic graph showing gains in QALY due to typical pharmacotherapies or psychotherapies. A patient may start with PHQ-9 fluid medicine lasix of 20, corresponding with EQ-5D index value of 0.5. Then they may improve after 2 months of antidepressant therapy to EQ-5D score of 0.9 (solid line), while they may improve to EQ-5D score of 0.8 even if on placebo (dashed line). If we fluid medicine lasix assume that the same difference would continue for the ensuing 10 months while showing slow gradual improvement in both cases, the gain in QALY per year would be equal to 0.09 QALY.
If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be fluid medicine lasix expected in the control group, the gain in QALY per year would be equal to 0.05 QALY. Please note that this is a schematic drawing for illustrative purposes. In reality, the changes will be more smoothly curvilinear but fluid medicine lasix the calculation will be similar. EQ-5D, Euro-Qol fluid medicine lasix Five Dimensions.
PHQ-9, Patient fluid medicine lasix Health Questionnaire-9. QALY, quality-adjusted life years." data-icon-position data-hide-link-title="0">Figure 3 A schematic graph showing gains in QALY due to typical pharmacotherapies or psychotherapies. A patient fluid medicine lasix may start with PHQ-9 of 20, corresponding with EQ-5D index value of 0.5. Then they may improve after 2 months of antidepressant therapy to EQ-5D score of 0.9 (solid line), while they may fluid medicine lasix improve to EQ-5D score of 0.8 even if on placebo (dashed line).
If we assume that the same difference would continue for the ensuing 10 months while showing slow gradual improvement in both cases, the gain in QALY per year would be equal to 0.09 QALY. If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be expected in the control group, the gain in fluid medicine lasix QALY per year would be equal to 0.05 QALY. Please note that this is a schematic drawing for fluid medicine lasix illustrative purposes. In reality, the changes will be more smoothly curvilinear but the calculation will be similar.
EQ-5D,Euro-Qol Five Dimensions fluid medicine lasix. PHQ-9, PatientHealth fluid medicine lasix Questionnaire-9. QALY, quality-adjustedlife years.Several caveats fluid medicine lasix should be considered when interpreting the results. First, our sample was limited to participants of trials of iCBT.
It may be argued that the fluid medicine lasix results, therefore, would not apply to patients with depression undergoing other therapies or in other settings. Second, the correlations between PHQ-9 and EQ-5D were strong enough for total scores at endpoint and for change scores to justify fluid medicine lasix linking but were somewhat weaker at baseline, probably due to limited variability in PHQ-9 scores at baseline because some studies required minimum depression scores. However, the overall correspondence between PHQ-9 scores and EQ-5D had the same shape between baseline and endpoint, which will increase credibility of the linking at baseline as well. Third, we were able fluid medicine lasix to compare PHQ-9 to EQ-5D-3L only.
The EQ-5D-5L, which measures health in five levels instead of three, has been developed to be more sensitive to change and to milder conditions.36 When data become available, we will need to link PHQ-9 and EQ-5D-5L fluid medicine lasix to examine if we can obtain similar conversion values.Our study also has several important strengths. First, our fluid medicine lasix sample included patients with subthreshold depression and major depression and from the community or workplace and the primary care. Furthermore, they encompassed mild through severe major depression in approximately equal proportions. Second, all the patients in our sample received iCBT or control interventions including care as fluid medicine lasix usual.
Potential side effects of different antidepressants, repetitive brain stimulation, electroconvulsive therapy and other more aggressive therapies must of course be taken into consideration fluid medicine lasix when evaluating their impacts, but our estimates, arguably independent of major side effects, can better inform such considerations. Finaly, unlike any prior studies, we were able to link specific PHQ-9 scores and their changes scores to EQ-5D-3L index values.Conclusion and clinical implicationsIn conclusion, we constructed a conversion table linking the EQ-5D, the representative generic preference-based measure of health status, and the PHQ-9, one of the most popular depression severity rating scale, for both its total scores and change scores. The table will enable fine-grained assessment of burden of depression at its various levels of severity and of impacts of its various treatments which may bring various degrees of improvement at the expense of some potential side effects.Data availability statementData are available upon reasonable request fluid medicine lasix. The overall database used for this IPD is restricted fluid medicine lasix due to data sharing agreements with the research institutes where the studies were conducted.
IPD from individual studies are available from the individual study authors.Ethics statementsPatient consent for publicationNot required..
When we how to buy cheap lasix online took the editorship of Evidence-Based Mental Health (EBMH) at the end of 2013, we set two reference main objectives. To promote and embed an evidence-based medicine (EBM) how to buy cheap lasix online approach into daily mental health clinical practice, and to get an impact factor (IF) for EBMH. Both aims have been big challenges and we have learnt a lot.EBM has been around for about 30 years now, shaping and changing the way we practice how to buy cheap lasix online medicine. When Guyatt and colleagues published their seminal paper in 1992,1 EBM was described as the combination of three intersecting domains. The best available evidence, the clinical state and circumstances, how to buy cheap lasix online and patientâs preferences and values.
EBM and how to buy cheap lasix online EBMH have since continuously evolved to deepen our understanding of these three domains.The best available evidenceWe keep complaining about the poor quality of studies in mental health. To properly assess the effects of interventions and devices before and after regulatory approval, we all know that randomised controlled trials are the best study design.2 3 However, real-world data are crucial to shed light on key clinical questions,4 especially when adverse events5 or prognostic factors6 are investigated. It necessarily â¦IntroductionQuality-adjusted life years (QALYs) have been increasingly used in general medicine and in psychiatry to evaluate the impact of a disease on both the quantity and quality of life.1 One QALY is equal to 1 year in how to buy cheap lasix online perfect health, can range down to zero (death) or may take negative values (worse than death). QALYs can be used to compare the burdens of various diseases, to appreciate the impact of their interventions, to help set priorities in resource allocations across different diseases and interventions and to inform personal decisions.The representative method to evaluate QALYs is the generic, preference-based measure of health including the Euro-Qol five dimensions (EQ-5D)2 how to buy cheap lasix online 3 and the SF-6D based on Short Form Survey-36 (SF-36).4 5 Of these, the EQ-5D is the most frequently used and is the preferred instrument by the National Institute of Health and Care Excellence in the UK. While the responsiveness of such generic measures to various mental conditions, especially severe mental illnesses, has been questioned,6 its validity and responsiveness to common mental disorders including depression and anxiety have been generally established.7 8However, the traditional focus of measurements in how to buy cheap lasix online mental health has centred mainly on symptoms.
Many trials have, therefore, not administered the generic health-related quality of life measures. This has hindered comparison of impacts of mental disorders vis-Ã -vis other medical conditions on the one hand and also evaluation of values of their interventions on the other.9 10We have been collecting individual participant-level data from how to buy cheap lasix online randomised controlled trials of internet cognitive-behavioural therapies (iCBT) for depression,11 several of which administered both symptomatologic scales and generic health status scales simultaneously. This study, therefore, attempts to link the depression-specific measure onto the generic measure of health how to buy cheap lasix online in order to enable estimation of QALYs for depressive states and their changes. Such cross-walking should facilitate assessment of burden of depression at its various severity and of the impacts of its various treatments.MethodsDatabaseWe have been accumulating a data set of individual participant data of randomised controlled trials of iCBT among adults with depressive symptoms, as established by specified cut-offs on self-report scales or by diagnostic interviews.11 For this study, we have selected studies that have administered the EQ-5D and depression severity scales at baseline and at end of treatment. We excluded patients if they had missing data how to buy cheap lasix online in either of the two scales at baseline or at endpoint.
We excluded studies that focused on patients with general medical disorders (eg, diabetes, glioma) how to buy cheap lasix online and depressive symptoms.MeasuresEQ-5D-3LThe EQ-5D-3L comprises five dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each rated on three levels corresponding with 1=no problems, 2=some/moderate problems or 3=extreme problems/unable to do. This produces 3Ë5=243 different health states, ranging from no problem at all in any dimension (11111) to severe problems how to buy cheap lasix online on all dimensions (33333). Each of these 243 states is provided with a preference-based score, as determined through the time trade-off (TTO) technique in a sample of the general population. In TTO, respondents are asked to give the relative length of time in full health that they would be willing to sacrifice for the poor health how to buy cheap lasix online states as represented by each of the 243 combinations above. The EQ-5D scores range between 1=full how to buy cheap lasix online health and 0=death to minus values=worse than death bounded by â1.
The scoring algorithm for the UK is based on TTO responses of a random sample (n=2997) of noninstitutionalised adults. Over the years, value sets for EQ-5D-3L have been produced how to buy cheap lasix online for many countries/regions.2 3 7Depression severity scalesWe included any validated depression severity measures. The scale scores were converted into the most frequently used how to buy cheap lasix online scale, namely, the Patient Health Questionnaire-9 (PHQ-9),12 using the established conversion algorithms13 14 for the Beck Depression Inventory, second edition (BDI-II)15 or the Centre for Epidemiologic Studies Depression Scale (CES-D).16The PHQ-9 consists of the nine diagnostic criteria items of major depression from the DSM-IV, each rated on a scale between 0 and 3, making the total score range 0â27. The instrument has demonstrated excellent reliability, validity and responsiveness. The cut-offs how to buy cheap lasix online have been proposed as 0â4, 5â9, 10â14, 15â19 and 20- for no, mild, moderate, moderately severe and severe depression, respectively.12Statistical analysesWe first calculated Spearman correlation coefficients between PHQ-9 and EQ-5D total scores at baseline, at end of treatment and their changes, to establish if the linking is justified.
Correlations were considered weak if scores were <0.3, moderate if scores were â¥0.3 and<0.7 and strong if scores were â¥0.7.17 Correlations how to buy cheap lasix online â¥0.3 have been recommended to establish linking.18 We then applied the equipercentile linking procedure,19 which identified scores on PHQ-9 and EQ-5D or their changes with the same percentile ranks and allows for a nominal translation from PHQ-9 to EQ-5D by using their percentile values. This approach has been used successfully for scales in depression, schizophrenia or Alzheimerâs disease.14 20â22 We analysed all trials collectively rather than by trial to maximise the sample size, ensure variability in the included populations and attain robust estimates.We conducted a sensitivity analysis by excluding studies that require the conversion of various depression severity scores into PHQ-9.All the analyses were conducted in R V.4.0.2, with the package equate V.2.0.7.23Ethics statementThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with how to buy cheap lasix online the Helsinki Declaration of 1975, as revised in 2008. Ethical approval was not required for this study as it used only deidentified patient data.FindingsIncluded studiesWe identified seven RCTs of iCBT (total n=2457), which administered validated depression scales and EQ-5D both at baseline and at endpoint (online supplemental eTable 1). Three studies included only patients with major depressive disorder (MDD), one only patients with subthreshold depression and how to buy cheap lasix online the remaining three included both. All the studies how to buy cheap lasix online administered EQ-5D-3L.
PHQ-9 scores were converted from the BDI-II in three studies24â26 and from the CES-D in one study.27 The mean age of the participants was 41.8 (SD=12.3) years, 66.0% (1622/2457) were women and they scored 14.0 (5.4) on PHQ-9 and 0.74 (0.20) on EQ-5D at baseline and 9.1 (6.0) and 0.79 (0.21), respectively, at endpoint. When using the standard cut-offs of the PHQ-9,12 2.4% (60/2449) suffered from no depression (PHQ-9 scores <5), 20.2% (492/2449) from subthreshold depression (5â¤PHQ-9 scores <10), 33.5% (820/2449) from mild depression (10â¤PHQ-9 scores <15), 26.5% (649/2449) from moderate depression (15â¤PHQ-9 scores <20) and 17.3% (424/2449) from severe depression (20â¤PHQ-9 scores) at baseline.Supplemental materialEquipercentile linkingSpearmanâs correlation coefficient between the PHQ-9 and the EQ-5D scores was r=â0.29 at baseline, increased how to buy cheap lasix online to r=â0.50 after intervention and was r=â0.38 for change scores.Figure 1 shows the equipercentile linking between PHQ-9 and EQ-5D total scores at baseline and at endpoint. Figure 2 shows the same between how to buy cheap lasix online their change scores. Table 1 how to buy cheap lasix online summarises the correspondences between the two scales.PHQ-9 and EQ-5D total scores at baseline and endpoint. EQ-5D,Euro-Qol Five Dimensions.
PHQ-9, PatientHealth how to buy cheap lasix online Questionnaire-9." data-icon-position data-hide-link-title="0">Figure 1 PHQ-9 and EQ-5D total scores at baseline and endpoint. EQ-5D,Euro-Qol Five Dimensions how to buy cheap lasix online. PHQ-9, PatientHealth Questionnaire-9.PHQ-9 change scores and EQ-5D change scores. EQ-5D, Euro-Qol Five how to buy cheap lasix online Dimensions. PHQ-9, Patient Health Questionnaire-9." data-icon-position how to buy cheap lasix online data-hide-link-title="0">Figure 2 PHQ-9 change scores and EQ-5D change scores.
EQ-5D,Euro-Qol Five Dimensions how to buy cheap lasix online. PHQ-9, PatientHealth Questionnaire-9.View this table:Table 1 Conversion table from PHQ-9 to EQ-5D total and change scoresSensitivity analysisWhen we limited the samples to the three studies28â30 that administered PHQ-9 (total n=1375), the linking results were replicated (online supplemental eFigure 1).DiscussionThis is the first study to link a depression severity measure with the EQ-5D-3L both for total and change scores. To summarise, subthreshold depression corresponded with EQ-5D-3L index values of 0.9â0.8, mild major depression how to buy cheap lasix online with 0.8â0.7, moderate depression with 0.7â0.5 and severe depression with 0.6â0.0. A five-point improvement in PHQ-9 corresponded approximately with an increase in EQ-5D-3L index values by 0.03, and a ten-point improvement can lead to an increase by approximately 0.25.A systematic review of utility values for depression31 found that the pooled mean (SD) utilities based on studies using the standard gamble as a direct valuation method were 0.69 (0.14) for mild, 0.52 (0.28) for moderate and 0.27 (0.26) for severe how to buy cheap lasix online major depression. The estimates based on studies using EQ-5D as an indirect valuation method were 0.56 (0.16) for mild, 0.52 (0.28) for moderate and 0.25 (0.15) for severe depression.
One recent study regressed PHQ-9 on SF-6D scores among 394 patients in theimproving Access to Psychological how to buy cheap lasix online Therapies (IAPT) cohort7 32 and estimated none/mild depression on PHQ-9 to be worth 0.73 SF-6D scores, moderate depression 0.65 and severe depression 0.56. Our results are largely in line with how to buy cheap lasix online these aforementioned studies.There was a consistent difference of about 0.07 EQ-5D scores for the same PHQ-9 score if it represented the baseline or endpoint measurements (figure 1). This is understandable because a patient would rate their health status less satisfactory if they stayed equally symptomatic as before after the treatment and also because it means that they continued to suffer from depression for longer. It is, therefore, reasonable to use the conversion table at baseline for relatively new cases of depression and that at end of treatment for more chronic cases (table 1).An effect size to be typically expected after 2 months of how to buy cheap lasix online antidepressant pharmacotherapy33 or psychotherapy27 34 over the pill placebo condition is 0.3. Given that the average SD of PHQ-9 in the studies was about 6, an effect size of 0.3 corresponds to how to buy cheap lasix online a difference by two points on PHQ-9.
The differences in EQ-5D scores corresponding with the end-of-treatment PHQ-9 scores of x versus x+2, where how to buy cheap lasix online x is between 5 and 15 (table 1), ranges between 0.08 and 0.13, producing an approximate average of 0.1 EQ-5D scores. If we assume that the same difference would continue for the ensuing 10 months, the gain in QALY per year would be equal to 0.09 QALY. If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be expected in the how to buy cheap lasix online control group, the gain in QALY per year would be equal to 0.05 QALY. (See figure 3 how to buy cheap lasix online for a schematic drawing to help understand the calculation of QALYs based on changing EQ-5D scores. In reality, the changes will be more smoothly curvilinear but the calculation will be similar.) Since one QALY is typically valuated at US$50 000 or 3000 Stirling pounds,35 such therapies would be cost-effective if they cost US$2500 to US$4500 (150 to 270 pounds) or less.
If a 1 day fill of generic selective serotonergic reuptake inhibitor antidepressants costs 1â3 dollars and a 1-year prescription costs US$400â1200 dollars, how to buy cheap lasix online or if 8â16 sessions of psychotherapy cost US$1600â3200 dollars, both therapies would be deemed largely cost-effective. An individualâs decision, by contrast, will and should be more variable and no one can categorically reject nor require such treatments for all patients.A how to buy cheap lasix online schematic graph showing gains in QALY due to typical pharmacotherapies or psychotherapies. A patient may start how to buy cheap lasix online with PHQ-9 of 20, corresponding with EQ-5D index value of 0.5. Then they may improve after 2 months of antidepressant therapy to EQ-5D score of 0.9 (solid line), while they may improve to EQ-5D score of 0.8 even if on placebo (dashed line). If we assume that the same difference would continue for the ensuing 10 months while showing slow gradual improvement in both how to buy cheap lasix online cases, the gain in QALY per year would be equal to 0.09 QALY.
If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be expected in the control group, the gain in QALY per year would be equal to 0.05 how to buy cheap lasix online QALY. Please note that this is a schematic drawing for illustrative purposes. In reality, the changes will be more smoothly curvilinear but the calculation will be how to buy cheap lasix online similar. EQ-5D, Euro-Qol Five how to buy cheap lasix online Dimensions. PHQ-9, Patient Health Questionnaire-9 how to buy cheap lasix online.
QALY, quality-adjusted life years." data-icon-position data-hide-link-title="0">Figure 3 A schematic graph showing gains in QALY due to typical pharmacotherapies or psychotherapies. A patient may start with PHQ-9 of how to buy cheap lasix online 20, corresponding with EQ-5D index value of 0.5. Then they may improve after 2 months of antidepressant therapy to EQ-5D score how to buy cheap lasix online of 0.9 (solid line), while they may improve to EQ-5D score of 0.8 even if on placebo (dashed line). If we assume that the same difference would continue for the ensuing 10 months while showing slow gradual improvement in both cases, the gain in QALY per year would be equal to 0.09 QALY. If we assume that the difference would eventually wear out over the course of the year due to naturalistic improvements to be expected in how to buy cheap lasix online the control group, the gain in QALY per year would be equal to 0.05 QALY.
Please note how to buy cheap lasix online that this is a schematic drawing for illustrative purposes. In reality, the changes will be more smoothly curvilinear but the calculation will be similar. EQ-5D,Euro-Qol Five how to buy cheap lasix online Dimensions. PHQ-9, PatientHealth how to buy cheap lasix online Questionnaire-9. QALY, quality-adjustedlife years.Several caveats should be considered when interpreting how to buy cheap lasix online the results.
First, our sample was limited to participants of trials of iCBT. It may be argued that how to buy cheap lasix online the results, therefore, would not apply to patients with depression undergoing other therapies or in other settings. Second, the how to buy cheap lasix online correlations between PHQ-9 and EQ-5D were strong enough for total scores at endpoint and for change scores to justify linking but were somewhat weaker at baseline, probably due to limited variability in PHQ-9 scores at baseline because some studies required minimum depression scores. However, the overall correspondence between PHQ-9 scores and EQ-5D had the same shape between baseline and endpoint, which will increase credibility of the linking at baseline as well. Third, we were able to compare PHQ-9 to how to buy cheap lasix online EQ-5D-3L only.
The EQ-5D-5L, which measures health in five how to buy cheap lasix online levels instead of three, has been developed to be more sensitive to change and to milder conditions.36 When data become available, we will need to link PHQ-9 and EQ-5D-5L to examine if we can obtain similar conversion values.Our study also has several important strengths. First, our sample included patients with subthreshold depression and major depression and from the community or workplace how to buy cheap lasix online and the primary care. Furthermore, they encompassed mild through severe major depression in approximately equal proportions. Second, all how to buy cheap lasix online the patients in our sample received iCBT or control interventions including care as usual. Potential side effects of different antidepressants, repetitive brain stimulation, electroconvulsive therapy and other more aggressive therapies must of course be taken into consideration when evaluating their impacts, but our estimates, arguably independent of major how to buy cheap lasix online side effects, can better inform such considerations.
Finaly, unlike any prior studies, we were able to link specific PHQ-9 scores and their changes scores to EQ-5D-3L index values.Conclusion and clinical implicationsIn conclusion, we constructed a conversion table linking the EQ-5D, the representative generic preference-based measure of health status, and the PHQ-9, one of the most popular depression severity rating scale, for both its total scores and change scores. The table will enable fine-grained assessment of burden of depression at its various levels of how to buy cheap lasix online severity and of impacts of its various treatments which may bring various degrees of improvement at the expense of some potential side effects.Data availability statementData are available upon reasonable request. The overall how to buy cheap lasix online database used for this IPD is restricted due to data sharing agreements with the research institutes where the studies were conducted. IPD from individual studies are available from the individual study authors.Ethics statementsPatient consent for publicationNot required..
Visit your doctor or health care professional for regular checks on your progress. Check your blood pressure regularly. Ask your doctor or health care professional what your blood pressure should be, and when you should contact him or her. If you are a diabetic, check your blood sugar as directed.
You may need to be on a special diet while taking Lasix. Check with your doctor. Also, ask how many glasses of fluid you need to drink a day. You must not get dehydrated.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.
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NCHS Data Brief lasix medication for dogs No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40â59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40â59 were more likely than premenopausal women aged 40â59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40â59 (55.1%) were more likely than premenopausal women aged 40â59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated lasix medication for dogs with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is âthe permanent cessation of lasix medication for dogs menstruation that occurs after the loss of ovarian activityâ (3).
This data brief describes sleep duration and sleep quality among nonpregnant women aged 40â59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% lasix medication for dogs of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep lasix medication for dogs less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40â59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).
Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 lasix medication for dogs. Percentage of nonpregnant women aged 40â59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant lasix medication for dogs quadratic trend by menopausal status (p <.
0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no lasix medication for dogs longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data lasix medication for dogs table for Figure 1pdf icon.SOURCE.
NCHS, National Health Interview Survey, 2015. The percentage of women aged 40â59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40â59 had trouble falling asleep four times or more in the past week lasix medication for dogs (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 lasix medication for dogs.
Percentage of nonpregnant women aged 40â59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by lasix medication for dogs menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had lasix medication for dogs a menstrual cycle and their last menstrual cycle was 1 year ago or less.
Women were premenopausal if they still had a menstrual cycle. Access data lasix medication for dogs table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40â59 who had trouble staying lasix medication for dogs asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40â59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40â59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.
Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 lasix medication for dogs. Percentage of nonpregnant women aged 40â59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear lasix medication for dogs trend by menopausal status (p <. 0.05).NOTES.
Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their lasix medication for dogs last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data lasix medication for dogs table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.
The percentage of women aged 40â59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40â59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this lasix medication for dogs age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 lasix medication for dogs. Percentage of nonpregnant women aged 40â59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.
United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.
Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40â59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.
In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in womenâs reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.
DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) âHow old were you when your periods or menstrual cycles started?. Â. 2) âDo you still have periods or menstrual cycles?.
Â. 3) âWhen did you have your last period or menstrual cycle?. Â. And 4) âHave you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. Â Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.
Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, âIn the past week, on how many days did you wake up feeling well rested?. ÂShort sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, âOn average, how many hours of sleep do you get in a 24-hour period?.
ÂTrouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, âIn the past week, how many times did you have trouble falling asleep?. ÂTrouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, âIn the past week, how many times did you have trouble staying asleep?. Â Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.
NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondentsâ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40â59 living in households across the United States.
The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.
The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.
Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338â50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.
Management of menopausal symptoms. Obstet Gynecol 123(1):202â16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011â2014pdf icon.
2016.Santoro N. Perimenopause. From research to practice. J Womenâs Health (Larchmt) 25(4):332â9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.
Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591â2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006â2015.
National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.
Suggested citationVahratian A. Sleep duration and quality among women aged 40â59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.
2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.
Blumberg, Ph.D., Associate Director for Science.
NCHS Data you can try this out Brief No how to buy cheap lasix online. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40â59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40â59 were more likely than premenopausal women aged 40â59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40â59 (55.1%) were more likely than premenopausal women aged 40â59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) how to buy cheap lasix online and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is âthe permanent cessation of menstruation how to buy cheap lasix online that occurs after the loss of ovarian activityâ (3).
This data brief describes sleep duration and sleep quality among nonpregnant women aged 40â59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are how to buy cheap lasix online perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, how to buy cheap lasix online National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40â59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).
Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 how to buy cheap lasix online. Percentage of nonpregnant women aged 40â59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p < how to buy cheap lasix online.
0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle how to buy cheap lasix online and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for how to buy cheap lasix online Figure 1pdf icon.SOURCE.
NCHS, National Health Interview Survey, 2015. The percentage of women aged 40â59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40â59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2) how to buy cheap lasix online. The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 how to buy cheap lasix online.
Percentage of nonpregnant women aged 40â59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant how to buy cheap lasix online linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 how to buy cheap lasix online year ago or less.
Women were premenopausal if they still had a menstrual cycle. Access data how to buy cheap lasix online table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40â59 who had trouble staying asleep four times or how to buy cheap lasix online more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40â59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40â59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.
Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 how to buy cheap lasix online. Percentage of nonpregnant women aged 40â59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p how to buy cheap lasix online <. 0.05).NOTES.
Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if how to buy cheap lasix online they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data how to buy cheap lasix online table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.
The percentage of women aged 40â59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40â59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal how to buy cheap lasix online women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 how to buy cheap lasix online. Percentage of nonpregnant women aged 40â59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.
United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.
Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40â59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.
In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in womenâs reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.
DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) âHow old were you when your periods or menstrual cycles started?. Â. 2) âDo you still have periods or menstrual cycles?.
Â. 3) âWhen did you have your last period or menstrual cycle?. Â. And 4) âHave you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. Â Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.
Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, âIn the past week, on how many days did you wake up feeling well rested?. ÂShort sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, âOn average, how many hours of sleep do you get in a 24-hour period?.
ÂTrouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, âIn the past week, how many times did you have trouble falling asleep?. ÂTrouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, âIn the past week, how many times did you have trouble staying asleep?. Â Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.
NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondentsâ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40â59 living in households across the United States.
The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.
The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.
Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338â50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.
Management of menopausal symptoms. Obstet Gynecol 123(1):202â16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011â2014pdf icon.
2016.Santoro N. Perimenopause. From research to practice. J Womenâs Health (Larchmt) 25(4):332â9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.
Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591â2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006â2015.
National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.
Suggested citationVahratian A. Sleep duration and quality among women aged 40â59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.
2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.
Blumberg, Ph.D., Associate Director for Science.
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