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Salazar-Pousada D, Ortega-Uscocovich V, Ramírez-Morán C, Chedraui P. Menopausal symptoms and the awareness of menopausal-related information in low-income mid-aged women from Guayaquil, Ecuador. Gynecol Endocrinol 2024; 40:2333418. [PMID: 38563054 DOI: 10.1080/09513590.2024.2333418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To assess menopausal symptoms and determine awareness of menopausal related information in mid-aged women. METHODS This was a cross-sectional study in which 140 women aged 40 to 60 years from Guayaquil, Ecuador were surveyed with the short 10-item Cervantes Scale (CS-10) and a questionnaire containing personal data and questions assessing awareness of menopause related information. RESULTS The mean age of the sample was 48.0 ± 5.6 years. More than half of surveyed women had low education and non-urban residency, none were on menopausal hormone therapy, 33.6% had hypertension, 35% were postmenopausal, 78.6% had an increased body mass index (overweight/obese) and 92.9% had abdominal obesity (waist > 88 cm). The average CS-10 score was 15.3 ± 9.0 with a median of 14.0. The three most frequent menopausal symptoms were muscle-joint pain (75.0%), changes in skin texture (74.3%) and vaginal dryness (71.4%). Regarding awareness of information related to the menopause, it was found that 98.6% of women had no idea about what the menopause is and the average age of its onset. Interestingly, although 61.4% knew that during the menopause there is weight gain, 57.9% were sedentary. Married, postmenopausal, older and less educated women presented higher mean total CS-10 scores. Contrarily, those with less awareness of menopause related information present lower scores. CONCLUSION In this low-income mid-aged female sample there was a high rate of non-awareness regarding information related to the menopause, including an unhealthy cardiometabolic profile. There is a need for educational programs aimed to increase awareness in this high-risk population in relation to the surveyed aspects in order to improve their health status and prevent chronic conditions.
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Affiliation(s)
- Danny Salazar-Pousada
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Valeria Ortega-Uscocovich
- Investigador Médico Asociado al Proyecto C.O.S.M.E, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Cecibel Ramírez-Morán
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
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Blümel JE, Chedraui P, Vallejo MS, Dextre M, Elizalde A, Escalante C, Monterrosa-Castro A, Ñañez M, Ojeda E, Rey C, Rodríguez D, Rodrigues MA, Salinas C, Tserotas K. Genitourinary symptoms and sexual function in women with primary ovarian insufficiency. Climacteric 2024; 27:269-274. [PMID: 38308574 DOI: 10.1080/13697137.2024.2306278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition. METHODS This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis. RESULTS Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25). CONCLUSION POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.
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Affiliation(s)
- J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - P Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
- Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
| | - M S Vallejo
- Servicio de Obstetricia y Ginecología, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
| | - M Dextre
- Ginecología Obstetricia, Clínica Internacional, Lima, Perú
| | - A Elizalde
- Departamento de la Mujer, Niñez y Adolescencia, Facultad de Medicina de la Universidad Nacional del Nordeste, Corrientes, Argentina
| | - C Escalante
- Departamento de Ginecología, Facultad de Medicina, Universidad de Costa Rica, Costa Rica
| | - A Monterrosa-Castro
- Grupo de Investigación Salud de la Mujer, Universidad de Cartagena, Cartagena, Colombia
| | - M Ñañez
- II Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - E Ojeda
- Departamento Académico de Medicina Humana, Universidad Andina del Cusco, Cusco, Perú
| | - C Rey
- Asociación Argentina para el Estudio del Climaterio, Buenos Aires, Argentina
| | - D Rodríguez
- Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M A Rodrigues
- Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C Salinas
- Obstetricia y Ginecología, Hospital Ángeles, Puebla, México
| | - K Tserotas
- Clínica Tserotas, Ciudad de Panamá, Panamá
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Sánchez-Zarza SC, Armeni AK, Chedraui P, Pérez-López FR, Gavilanes AWD. Prevalence of menopausal symptoms and severity related factors among mid-aged Paraguayan women as measured with the 10-item Cervantes Scale. Gynecol Endocrinol 2023; 39:2235427. [PMID: 37478894 DOI: 10.1080/09513590.2023.2235427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/10/2023] [Indexed: 07/23/2023] Open
Abstract
Objective: To determine the prevalence of menopausal symptoms and factors related to severity in mid-aged women.Methods: Cross-sectional study in which 216 urban-living women from Asunción-Paraguay (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire (personal and partner data).Results: Median (interquartile range [IQR]) age of the sample was 48 [9] years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. Median total CS-10 score was 8.5 [9.75]. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Partner educational level was inversely correlated (rho Spearman coefficient) with CS-10 total scores. However, multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse.Conclusion: Menopausal symptoms in this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.
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Affiliation(s)
- Sandra C Sánchez-Zarza
- Instituto de Previsión Social (IPS), Hospital Central, Dr. Emilio Cubas, Asunción, Paraguay
- Facultad de Ciencias de la Salud, Universidad Católica "Nuestra Señora de la Asunción", Asunción, Paraguay
| | - Anastasia K Armeni
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School Greece, Researcher Mentee for the EMAS Junior Mentorship Programme
| | - Peter Chedraui
- Facultad de Ciencias de la Salud, Universidad Católica "Nuestra Señora de la Asunción", Asunción, Paraguay
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Antonio W D Gavilanes
- School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Singh P, Vyas S, Vallabh V, Nautiyal R, Srivastava A, Semwal J. A Study to Assess the Prevalence and Factors Affecting Menopausal Symptoms among Middle-Aged Females in the Garhwal Region of Uttarakhand. J Midlife Health 2023; 14:237-245. [PMID: 38504740 PMCID: PMC10946681 DOI: 10.4103/jmh.jmh_198_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/29/2023] [Accepted: 02/11/2023] [Indexed: 03/21/2024] Open
Abstract
Background Middle age is a link between adulthood and old age, which requires special attention. During middle age among females, changes like menopause occur, which is responsible for causing various physical, vasomotor, psychological, and social changes, which may affect overall well-being and positive mental health status. Hence, the present study has been planned to assess the prevalence of menopausal symptoms among middle-aged females. Materials and Methods The present study was a cross-sectional study carried out in rural and urban areas of district Dehradun among 400 females. A stratified systematic random sampling technique method was used. All the females fulfilling the inclusion criteria and aged 40-60 years were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Results A total of 400 women were recruited in the study, 200 from rural and urban areas each. The mean age of the total study participants was 50.00 ± 0.32 years. Among 400 middle-aged women, 189 were premenopausal and 211 were postmenopausal. The frequencies of occurrence of menopausal symptoms were explored in 189 premenopausal and 211 postmenopausal women. The mean age of premenopausal women was 44.21 ± 2.35 and postmenopausal was 54.39 ± 4.21. Females experienced varying grades of MENQOL symptoms. Conclusions It was found that majority of the females' quality of life were found to be affected with different grades of menopausal symptoms. With increasing age, symptoms also increase and are significantly high among postmenopausal women.
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Affiliation(s)
- Pragya Singh
- Department of Community Medicine, RBBSU, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Shaili Vyas
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Vidisha Vallabh
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Ruchira Nautiyal
- Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Abhay Srivastava
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Jayanti Semwal
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
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Misiker B, Kashala K, Misker D. The severity of menopause and associated factors among middle-aged women residing in Arba Minch, DHSS, Ethiopia, 2022. BMC Womens Health 2023; 23:287. [PMID: 37231489 DOI: 10.1186/s12905-023-02442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Menopause is a common practice in women, and it is recognized as a complete pause of menses for more than twelve months. A decrease in sex hormone levels particularly estrogen in the blood is associated with different types of menopausal symptoms. Those symptoms include different psychological, vasomotor, physical, and sexual symptoms. They are among the major public health problems of middle-aged women. Particularly severe forms of menopausal symptoms are bothersome for middle-aged women. However, little is known about the severity status and associated factors of menopausal symptoms among middle-aged women in the study area. OBJECTIVE The main aim of the present study was to assess the severity of menopausal symptoms and associated factors among middle-aged women residing in Arba Minch DHSS. METHODS AND MATERIALS Community-based crossectional study was employed. A single population proportion formula was used to determine the sample size. A total of 423 study participants were recruited to conduct the study. A simple random sampling technique was used to employ study participants. Proportional sample size allocation formula was used to allocate study participants in each Kebele of Arba Minch DHSS (demographic and health surveillance site). A menopausal rating scale was used to assess the severity status of Menopausal symptoms. The collected data were analyzed by using SPSS version 20. A descriptive analysis was made to describe the Sociodemographic characteristics of the study participants. Moreover, binary and ordinal logistic regressions were used to identify the factors associated with the severity of menopausal symptoms among middle-aged women. On binary logistic regression variables with p-value < 0.25 were eligible for ordinal logistic regression. Variables with a p-value < 0.05 were considered statistically significant. RESULT The present study revealed that the prevalence of menopausal symptoms was 88.7%. According to the Menopausal rating scale, 91.7% of the study participants were Asymptomatic, 6.6% of them were mild in severity, 1.4% of them were moderate and the remaining 0.23% individuals were severe menopausal symptoms. The most severe menopausal symptom was the sexual problem. The factors that have a significant association with the severity of menopausal symptoms were Age with [AOR = 1.46(95%CI: 1.27-1.64)] and history of chronic disease with [AOR = 2.56(95%CI: 1.78-3.4)] and p < 0.001. CONCLUSION AND RECOMMENDATION Generally, menopausal symptoms among middle-aged women were common. Asymptomatic and mild forms are the dominant severity forms of menopausal symptoms. Age and history of chronic diseases have statistically significant associations with the severity of menopausal symptoms. The ministry of health, researchers, and different stakeholders are recommended to be concerned about this neglected issue.
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Affiliation(s)
- Begosew Misiker
- Biomedical Science Department, Arba Minch University, Arba Minch, Ethiopia.
| | - Kefita Kashala
- Biomedical Science Department, Arba Minch University, Arba Minch, Ethiopia
| | - Direslgne Misker
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
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Baral S, Kaphle HP. Health-related quality of life among menopausal women: A cross-sectional study from Pokhara, Nepal. PLoS One 2023; 18:e0280632. [PMID: 36662806 PMCID: PMC9858775 DOI: 10.1371/journal.pone.0280632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Menopause is the permanent cessation of menstruation. Quality of life is a broad concept affected by an individual's physical health, psychological state, level of independence, societal relationship, and environmental features. During the menopausal period, women can experience various symptoms affecting their quality of life. This study assesses the factors associated with health-related quality of life among menopausal women. MATERIALS AND METHODS A community-based cross-sectional study was carried out among 249 menopausal women to assess their health-related quality of life, associated factors, and self-reported health problems. A pre-tested structured interview schedule was used to conduct face-to-face interviews to obtain the information per the study's objective. The Menopausal Rating Scale (MRS) was used to assess the health-related quality of life. Data was entered in Epi-data, and analysis was done using the Statistical Package for Social Sciences (SPSS). Univariate, bivariate, and multivariate analyses were carried out to obtain results per our objectives. RESULTS The study found that 51.4% of menopausal women had poor quality of life. The mean and standard deviation of the total MRS score was found to be 9.5±5.3. Ultimately, the factors such as educational attainment {Adjusted Odds Ratio (AOR) = 5.779, 95% Confidence Interval (CI): 2.029-16.459}, medication/treatment of the health problems (AOR = 4.828, 95% CI: 1.662-14.023), alcohol intake status (AOR = 8.006, 95% CI: 2.016-31.785) and physical activity (AOR = 5.746, 95% CI: 1.144-28.872) were significant determinants of quality of life among menopausal women. CONCLUSION There is a need to pay proper attention to factors affecting the quality of life to improve the status of menopausal women.
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Affiliation(s)
- Samjhana Baral
- School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki, Nepal
| | - Hari Prasad Kaphle
- School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki, Nepal
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Kim S, Kim SM, Kim DS, Han S, Hong JS, Seo JS. Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women. Psychiatry Investig 2023; 20:18-26. [PMID: 36721882 PMCID: PMC9890039 DOI: 10.30773/pi.2022.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores. METHODS Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the "all unimpaired" and "all impaired" groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the "all impaired" group as a dependent variable. RESULTS Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the "all impaired" group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the "all impaired" group. CONCLUSION The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.
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Affiliation(s)
- Soyeon Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Da Seul Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Seunga Han
- Department of Political Science, Vanderbilt University, Nashville, TN, USA
| | - Ji Sun Hong
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Singh P, Vyas S, Vallabh V, Nautiyal R, Srivastava A. Age at natural menopause and factors affecting its onset: A cross-sectional study among postmenopausal females in District Dehradun. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Menopause has become a popular topic of study as life expectancy rises around the world. The average age at menopause in both developed and developing countries ranges from 45 to 53 years. Factors influencing the extent of ovarian follicle reserve dwindling, such as sociodemographic, menstrual, reproductive, and dietary factors. Aim and Objective: The present study aimed to determine the mean age of menopause and to find out the various factors affecting menopause onset. Methods: A community based cross-sectional study conducted in rural and urban areas of District Dehradun for a period of 1 year starting 1st August 2020 to 31st July 2021. Data were collected using multistage stratified random sampling from 211 cases of natural menopause. Chi-square was applied as statistical test of significance and p < 0.05 was considered statistically significant. Results: According to current study, average age menopausal age is 46 years. Variables like sociodemographic characteristics, lifestyle habits, reproductive and menstrual factors were found to have a significant relationship with onset of menopause. Conclusion: Menopause, whether it occurs early or late in life, several factors are responsible for deciding its onset. As a result, it is critical to identify the factors influencing the onset of menopause.
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Sharami SH, Faraji Darkhaneh R, Ghanami Gashti N, Mansour-Ghanaei M, Bab Eghbal S. The association between reproductive history and menopausal symptoms: an evidence from the cross-sectional survey. BMC Womens Health 2022; 22:136. [PMID: 35477386 PMCID: PMC9044690 DOI: 10.1186/s12905-022-01715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background During menopause, women experience annoying symptoms which may affect their daily activities and quality of life. This study aimed to determine whether reproductive history, an important indicator of estrogen exposure across the lifetime, is associated with the severity of menopausal symptoms in women. Methods This study was a cross-sectional study conducted on 214 women aged 35–65 who were randomly selected, and data was collected by a predesigned structured questionnaire. Each item was graded by subjects and a total score was obtained by summing all subscale scores. Results There was a significant association between the somatic, psychological, and urogenital menopausal symptoms and reproductive characteristics. Women with a history of abortion had greater total (β = 0.194, p = 0.009), and psychological (β = 0.230, p = 0.002) symptoms score. Women with higher number of children were more likely to have higher somatic (β = 0.212, p = 0.005) symptoms than others. Conclusions Our findings showed reproductive factors may have an influence on the severity of menopausal symptoms. After confirmation by further studies, these findings may help target women at risk of more severe menopausal symptoms at later ages. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01715-z.
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Affiliation(s)
- Seyedeh Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran
| | - Roya Faraji Darkhaneh
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran.
| | - Nasrin Ghanami Gashti
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran
| | - Mandana Mansour-Ghanaei
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran
| | - Sedighe Bab Eghbal
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran
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Female orgasmic dysfunction and severe climacteric symptomatology in women aged 40 to 59 years. Menopause 2022; 29:654-663. [DOI: 10.1097/gme.0000000000001973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boushehri SN, Farazmand M, Zar A. Dietary assessment and effect of Pilates exercises on quality of life, body composition, and physical fitness in Iranian postmenopausal women. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Menopause is an important period of life for women, all of whom experience this natural state. However, awareness of the bodily changes during this period is of great significance. Hence, not paying attention to the dietary, physical, and psychological criteria can reduce the quality of women’s lives. This study aimed to evaluate health-related quality of life (HRQoL), body composition, and physical fitness in postmenopausal women after Pilates exercises. Thirty postmenopausal Iranian women were randomly divided into Pilates (performed for 8 weeks) and control groups. The HRQoL Questionnaire (SF-12) was filled out, and a three-day record of food intake was also kept for dietary assessment. The diet of the women consisted of mean values of 1,923 Kcal daily energy, 16% protein, 72% carbohydrate, 12% fat, and 11.32 mg iron. Calcium, zinc, vitamin D, and vitamin E intake were respectively 73, 87.5, 81.7 and 83.53% of the recommended daily allowance. Pilates exercises had a significant effect on flexibility (P=0.002), endurance (P=0.001), muscle strength (P=0.001), body mass index (P=0.001), lean mass (P=0.003), body fat percentage (P=0.001), and quality of life (P=0.001). Therefore, Pilates is an appropriate training to increase body fitness and improve body composition, lean mass, and quality of life in postmenopausal women.
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Affiliation(s)
- S. Najafpour Boushehri
- Department of Nutrition, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Salman Farsi Street, 75146-33341 Bushehr, Iran
| | - M. Farazmand
- Department of Exercise Physiology, Islamic Azad University, Varzesh Street, 7515895496 Bushehr, Iran
| | - A. Zar
- Department of Sport Science, Persian Gulf University, Mahini Street, 7516913817 Bushehr, Iran
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Gebretatyos H, Ghirmai L, Amanuel S, Gebreyohannes G, Tsighe Z, Tesfamariam EH. Effect of health education on knowledge and attitude of menopause among middle-age teachers. BMC WOMENS HEALTH 2020; 20:232. [PMID: 33046075 PMCID: PMC7552533 DOI: 10.1186/s12905-020-01095-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate knowledge and positive attitude toward menopause are important for women to tackle changes related to menopause. Even though all women experience menopause at some stage in their life, teachers face more difficulties more than other female employees due to the nature of their roles do. In Eritrea, menopause has been given little attention hence gaps exist concerning women's knowledge, attitude, and the effects of health education on the same subject. This study aimed at assessing the effect of health education on knowledge and attitude of menopause among middle-aged teachers in elementary, junior, and secondary schools of Asmara, Eritrea. METHOD A semi-experimental design with pre-intervention, immediate post-intervention, and three-month follow up test was used in this study. The data was collected from 99 middle age teachers using stratified random sampling. The intervention was done using lectures, group discussions, brochures, and handouts. Data on socio-demographics, knowledge, and attitude was collected using a pre-designed questionnaire. The effect of educational training at the three-time points was evaluated by repeated measure ANOVA using SPSS version 22. RESULTS The mean scores of correct knowledge at pre-intervention, immediate post-intervention, and 3-months follow-up were 12.3/22 (SD = 3.06), 17.3/22 (SD = 3.21), and 16.5/22 (SD = 2.52) respectively. A significant difference in scores of knowledge at the three-time points was observed due to the educational intervention with a statistical significance of (p < 0.0001). Post-hoc analysis revealed that knowledge score immediately after intervention was significantly greater than that of pre-intervention (p < 0.0001), and 3-months follow-up (p = 0.004). The mean scores of attitude at the three-time points were 27.9/45 (SD = 5.14), 28.3/45(SD = 5.25), 28.32/45(SD = 5.12). The educational intervention had brought a change in the mean scores of attitude at the three-time point with a statistical significance of (p < 0.0001). Post-hoc analysis revealed that attitude scores at immediate post-intervention were also significant (p = 0.001) with the 3-months follow up at (p < 0.0001) were higher than that of pre-intervention. CONCLUSION The structured educational intervention was beneficial to the studied women in intensifying their knowledge and tuning them toward a positive attitude. Hence, proper health education programs regarding menopause are strongly recommended.
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Affiliation(s)
- Helen Gebretatyos
- Department of Midwifery, School of Nursing, Asmara College of Health Sciences, Asmara, Eritrea.
| | - Lidia Ghirmai
- Department of Midwifery, School of Nursing, Asmara College of Health Sciences, Asmara, Eritrea
| | - Soliana Amanuel
- Department of Midwifery, School of Nursing, Asmara College of Health Sciences, Asmara, Eritrea
| | - Ghidey Gebreyohannes
- Dean of Asmara College of Health Sciences, Asmara, Eritrea.,Higher Education administration and International Linkages, NHERI, Asmara, Eritrea
| | - Zemenfes Tsighe
- Dean of Asmara College of Health Sciences, Asmara, Eritrea.,Higher Education administration and International Linkages, NHERI, Asmara, Eritrea
| | - Eyasu H Tesfamariam
- Department of Statistics, Biostatistics and Epidemiology Unit, College of Science, Mai Nefhi, Eritrea
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Larroy C, Quiroga-Garza A, González-Castro PJ, Robles Sánchez JI. Symptomatology and quality of life between two populations of climacteric women. Arch Womens Ment Health 2020; 23:517-525. [PMID: 31650282 DOI: 10.1007/s00737-019-01005-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study is to compare climacteric symptomatology and sociodemographic conditions and their effect on quality of life in two populations: Monterrey (Mexico) and Madrid (Spain). METHODS 469 women from Monterrey (mean age 50.5 + 4.3 years) and 452 (mean age 51.7 + 3.7 years) from Madrid participated in the study. Descriptive analyses of sociodemographic and clinics characteristics of the sample were performed. A cross-sectional design and a regression analysis were performed to establish the sociodemographic and clinical variables that would be used as predictors of quality of life. Data was collected using the Menopause-Specific Quality of Life, MENQOL, the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), the Quality of Life Scale for Women Aged From 45 to 64 (QLS), and a sociodemographic and clinical interview designed ad hoc. RESULTS Approximately 60% of both Spanish and Mexican women present symptoms during climacteric that impairs their quality of life. Spanish women suffer more intense symptoms and for a longer period of time than Mexican women, with the exception of anxiety. Mexican women report better quality of life than Spanish women and it is moderated by educational, socioeconomical, and marital status. Women's knowledge about menopause is also related to a better quality of life. CONCLUSIONS Our study confirms the differences in climacteric symptomatology between populations and the impact of educational level and knowledge about menopause as predictors of a better quality of life in climacteric women.
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Affiliation(s)
- Cristina Larroy
- Department Clinical Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, 28223, Madrid, Spain.
| | - Angélica Quiroga-Garza
- Center of Treatment and Research of Anxiety, School of Psychology, Universidad de Monterrey, San Pedro Garza García, Mexico
| | - Paola J González-Castro
- Center of Treatment and Research of Anxiety, School of Psychology, Universidad de Monterrey, San Pedro Garza García, Mexico
| | - José I Robles Sánchez
- Department Clinical Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, 28223, Madrid, Spain
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Morowatisharifabad MA, Yoshany N, Sharma M, Bahri N, Jambarsang S. Readability and suitability assessment of educational materials in promoting the quality of life for postmenopausal women. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:80-89. [PMID: 32802018 PMCID: PMC7422284 DOI: 10.5114/pm.2020.97850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Educational materials are frequently used by health providers to inform postmenopausal women about menopause acceptance behavior. However, little attention has been paid to the readability and suitability of these educational materials. The study aimed to determine the readability and suitability of educational materials in promoting the quality of life for postmenopausal women. MATERIAL AND METHODS Multiple instructional materials and books were used for the design and preparation of educational materials and were then tailored to the target group. Readability was measured by using the readability assessment of materials (RAM); and suitability was determined by the suitability assessment of materials (SAM) that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness. Twenty reviewers, including 10 postmenopausal women, 5 postmenopausal women family members, and 5 health experts scored the educational materials. RESULTS The mean readability score ±standard deviation (SD) of the educational materials was10 ±1.6 and 8 ±1.4, for the pamphlet and daily activities' booklets, respectively, which were increased to 14 ±0.6 and, 16 ±1.3, after tailoring the content. The average SAM scores before and after tailoring the content were 45% for the pamphlet, which was increased to 81%; 45% for the daily activities' booklets, which was increased to 86%. The increase in all scores was significant (p < 0.001). The final tailored educational material was rated "superior media" on the SAM ratings. CONCLUSIONS Given that most of the printed materials are suitable for people with higher education levels, health providers are strongly advised to prepare simple and understandable education materials that may increase the likelihood of consumer perception and recall.
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Affiliation(s)
- Mohammad Ali Morowatisharifabad
- Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nooshin Yoshany
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Manoj Sharma
- Environmental & Occupational Health, School of Public Health, University of Nevada, Las Vegas, United States
| | - Narjes Bahri
- Department of Midwifery, Faculty of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Sara Jambarsang
- Department of Bio-Statistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Weidner K, Bittner A, Beutel M, Goeckenjan M, Brähler E, Garthus-Niegel S. The role of stress and self-efficacy in somatic and psychological symptoms during the climacteric period - Is there a specific association? Maturitas 2020; 136:1-6. [PMID: 32386660 DOI: 10.1016/j.maturitas.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/20/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the influence and specificity of sociodemographic and psychological factors on the perception of symptoms associated with menopause. STUDY DESIGN Data are based on a nationwide cross-sectional survey study in Germany. A representative sample of 1350 females aged 14-95 years was examined. Sociodemographic factors, perceived stress, and self-efficacy were assessed. Women were divided into three age groups (young women ≤ 44 years; perimenopausal women 45-60 years; older women ≥ 61 years), and the Menopause Rating Scale (MRS) was used over the entire life span. MAIN OUTCOME MEASURES Total score on the Menopause Rating Scale (MRS) and hot flushes/sweating assessed via the MRS. RESULTS The MRS total score increased with age. Both MRS total score and hot flushes were positively associated with perceived stress in all three age groups. The MRS total score was negatively associated with self-efficacy; for hot flushes, this association could be shown for perimenopausal women only. Furthermore, interaction effects between perceived stress and self-efficacy were found: in perimenopausal and older women, the association between perceived stress and the MRS total score was stronger the lower self-efficacy was. This interaction effect was not observed in younger women. No interaction effect was found in any age group for hot flushes. CONCLUSIONS Our data indicate that self-efficacy influences the severity of symptoms measured with the MRS. Interventions aimed to reduce stress and strengthen self-efficacy could lead to a lower symptom burden in perimenopausal women.
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Affiliation(s)
- Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Antje Bittner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany.
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maren Goeckenjan
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
OBJECTIVE Although menopause is a natural event in a woman's life, some of its symptoms can be severe enough to adversely affect her health. There is some evidence to suggest that diet has an influence on menopausal symptoms, but less attention has been paid to dietary patterns. The purpose of this study is to determine the association of dietary patterns with physical, mental, and genitourinary menopausal symptoms. METHODS A cross-sectional study design was applied using a sample of 400 postmenopausal women who attended health centers in the south of Tehran, Iran. The menopausal symptoms were assessed by a Menopause Rating Scale (MRS) questionnaire; a 147-item, semi-quantitative food-frequency questionnaire was used to collect dietary information, and major dietary patterns were identified by principal component analysis. Linear regression was used to evaluate the relationship between menopausal symptoms and dietary patterns. RESULTS Three major dietary patterns were identified: vegetables and fruits (VF); mayonnaise, liquid oils, sweets, and desserts (MLSD); and solid fats and snacks (SFS). It has been found that the VF dietary pattern is inversely associated with general (β = -1.37; SE = 1.08; P for trend <0.001), physical (β = -1.54; SE = 1.09; P for trend <0.001), and mental (β = -1.58; SE = 1.11; P for trend <0.001) symptoms. A stronger adherence to the MLSD dietary pattern was directly associated with general (β = 1.15; SE = 1.08; P for trend <0.001) and genitourinary symptoms (β = 1.54; SE = 1.1; P for trend <0.001). Moreover, the SFS dietary pattern was directly related to the general (β = 1.23; SE = 1.09; P for trend = 0.01), physical (β = 1.24; SE = 1.09; P for trend = 0.04), and mental (β = 1.29; SE = 1.12; P for trend < 0.001) symptoms. CONCLUSION The present study demonstrated that there is an inverse association between VF dietary pattern and menopausal symptoms. In contrast, the MLSD and SFS dietary patterns were correlated to an increased risk of these symptoms.
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18
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Mazloomy Mahmoodabad SS, Yoshany N, Bahri N, Moori MK, Hanna F. Association between Lifestyle and Severity of Menopausal Symptoms in Postmenopausal Women. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Song Y, Kwon M, Kim SA. Distorted body weight perception and its gender differences in middle-aged adults: population based study. BMC Public Health 2020; 20:280. [PMID: 32122348 PMCID: PMC7053103 DOI: 10.1186/s12889-020-8358-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/16/2020] [Indexed: 01/15/2023] Open
Abstract
Background Increasing interest in appearance and the growing preference for a beautiful body can lead to physical and psychological problems due to an inappropriate body image perception. As such, there is a need to identify what factors may contribute to an inappropriate body image. The purpose of this study was to examine the presence of distorted body weight perception among middle-aged Koreans and identify gender differences and other factors that contribute to a distorted body image regarding body weight. Methods Data on 8363 middle-aged adults (aged 45–64 years) from the Korea National Health and Nutrition Examination Survey were analyzed using complex samples analysis considering weight, stratification variables, and cluster variables. The difference between perceived body image regarding body weight and actual body mass index was used to assess distorted body weight perception. Socioeconomic status, health behaviors, daily energy consumption, and psychological status (depression and stress) were assessed for their relationship to distorted body weight perception. Results Results showed that a distorted body image regarding body weight was more prevalent among middle-aged men (45.3%) than women (25.7%). Age, income, perceived health status, and health behaviors were significantly associated with distorted body weight perception in middle-aged men, whereas psychological factors were associated with distorted body weight perception in middle-aged women. Conclusions Further research on distorted body weight perception is needed to gain understanding of the gender differences between middle-aged men and women in Korea. Furthermore, to the results of the study can be used as a basis for developing various education, health mediation, and public health promotion interventions and programs to address body weight perception in middle-aged adults.
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Affiliation(s)
- Youngshin Song
- College of Nursing, Chungnam National University, Jung-gu, Munhwa-ro 266, Daejeon, 35015, Republic of Korea
| | - Myoungjin Kwon
- Department of Nursing, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon, 34520, Republic of Korea.
| | - Sun Ae Kim
- Department of Nursing, Korea National University of Transportation, 61 Daehak-ro, Yonggang-ri, Jeungpyeong-eup, Jeungpyeong-gun, Chungcheongbuk-do, 27909, Republic of Korea.
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20
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Effects of an educational intervention based on the multi-theory model on promoting the quality of life in postmenopausal women: a protocol. MENOPAUSE REVIEW 2020; 18:153-160. [PMID: 31975982 PMCID: PMC6970419 DOI: 10.5114/pm.2019.90808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
Introduction Menopause is associated with symptoms and complications that can affect women's quality of life. Therefore, acceptance of the symptoms and complications can improve quality of life during this period. In this regard, the purpose of this study was to design an educational program based on the multi-theory model (MTM) to deal with complications of the menopausal period and improve the women's quality of life. Material and methods In designing this study, four phases are considered. In the first phase, the questionnaire of menopausal symptom acceptance behaviors will be designed based on the MTM using literature review and a panel of experts' viewpoints. The validity and reliability of the questionnaire will be confirmed at this stage. In the second phase, a descriptive study will be conducted by administering the questionnaire designed in the first phase along with the Menopause-Specific Quality of Life questionnaire. The third phase includes the curriculum design based on the findings of the descriptive study, investigations of various studies, and viewpoints of the experts' panel. Therefore, the main components of the intervention will be identified. These components will determine the influential constructs of the MTM according to the descriptive research. Later, the related interventions and messages will be produced and designed from different sources. Intervention strategies will include group discussion, lectures, confidence-building skills, movie screenings, role play, preparation of daily activities booklets for postmenopausal women, and training classes for husbands and children to improve social support for women. The interventions, contents, and messages designed with the presence of health professionals and members of the target community will be pre-tested by examining factors such as audience perception of the message, appropriateness of the education to the audience's literacy and culture, as well as attractiveness, credibility, and acceptance of the materials. Finally, the fourth phase will be the implementation of the pre-test/post-test educational intervention using the intervention and control groups. Results and conclusions The present study provides good information about the needs and strategies to enhance the quality of life in postmenopausal women by utilizing a menopausal acceptance training program. Therefore, designing a program to increase the menopausal acceptance in postmenopausal women can be effective in improving the quality of life and reducing the treatment and medical care costs.
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Cutimanco-Pacheco V, Arriola-Montenegro J, Mezones-Holguin E, Niño-Garcia R, Bonifacio-Morales N, Lucchetti-Rodríguez A, Ticona-Chávez E, Blümel JE, Pérez-López FR, Chedraui P. Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women. Climacteric 2019; 23:229-236. [PMID: 31809600 DOI: 10.1080/13697137.2019.1664457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection.Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR).Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39-2.29; PR: 1.76, 95% CI: 1.38-2.23; and PR: 2.07, 95% CI: 1.64-2.61, respectively) and the adjusted model.Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.
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Affiliation(s)
- V Cutimanco-Pacheco
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - J Arriola-Montenegro
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Sociedad Nacional de Capacitación (SONACAP), Lima, Peru
| | - E Mezones-Holguin
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Epi-gnosis Solutions, Piura, Peru
| | - R Niño-Garcia
- Epi-gnosis Solutions, Piura, Peru.,Facultad de Ciencias de la Salud, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Universidad Nacional de Piura, Piura, Peru
| | - N Bonifacio-Morales
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
| | - A Lucchetti-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - E Ticona-Chávez
- Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Peru
| | - J E Blümel
- Facultad de Medicina, Departamento de Medicina Interna Sur, Universidad de Chile, Santiago, Chile
| | - F R Pérez-López
- Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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López-Baena MT, Pérez-Roncero GR, Pérez-López FR, Mezones-Holguín E, Chedraui P. Vitamin D, menopause, and aging: quo vadis? Climacteric 2019; 23:123-129. [PMID: 31736391 DOI: 10.1080/13697137.2019.1682543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Menopause and aging are associated with changes in circulating gonadal steroid hormones, insulin sensitivity, body composition, and also lifestyle and social coordinates. Vitamin D status influences different metabolic adjustments, aside from calcium-phosphorus and bone metabolism. The main blood marker used to measure endogenous vitamin D status is 25-hydroxyvitamin D. Aging is associated with increases in serum parathyroid hormone and alkaline phosphatase, and a decrease of serum calcium, phosphorus, and vitamin D metabolites. 25-Hydroxyvitamin D status is also influenced by the circannual rhythm of sun irradiation. Results of clinical association studies have not correlated with intervention trials, experimental studies, and/or meta-analyses regarding the role of vitamin D on different outcomes in women during their second half of life and the vitamin D supplementation dose needed to improve clinical endpoints. Discordant results have been related to the method used to measure vitamin D, the studied population (i.e., sociodemographics and ethnicity), study designs, and biases of analyses. Vitamin D supplementation with cholecalciferol or calcifediol may improve some metabolic variables and clinical outcomes in young postmenopausal and older women. Studies seem to suggest that calcifediol may have some advantages over other forms of vitamin D supplementation. Further studies are needed to define interventions with supplements and effective food fortification.
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Affiliation(s)
- M T López-Baena
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - G R Pérez-Roncero
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - F R Pérez-López
- Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - E Mezones-Holguín
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Perú.,Epi-gnosis Solutions, Piura, Perú
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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Bagnoli VR, Fonseca AMD, Massabki JOP, Arie WMY, Azevedo RS, Veiga ECDA, Soares Junior JM, Baracat EC. Gynecological cancer and metabolic screening of 1001 elderly Brazilian women. ACTA ACUST UNITED AC 2019; 65:1275-1282. [PMID: 31721959 DOI: 10.1590/1806-9282.65.10.1275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/01/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate gynecological cancer and metabolic screening of Brazilian women aged 65 years or older. METHODS This retrospective descriptive study was conducted by including 1,001 Brazilian patients of the gynecological geriatric outpatient office of our institution to evaluate the influence of age on gynecological cancer and metabolic screening parameters at the first clinical visit. All patients were divided into three groups: a) 65 to 69 years; b) 70 to 74 years; c) ≥ 75 years. We considered clinical, laboratorial, and image data as variables of this study. The Chi-square test was used to assess the proportion of differences among the age groups, and Kruskal-Wallis was used for quantitative variables. RESULTS The values of BMI and height in the group over 75 years was lower than that of the 65 to 69 years (p = 0.001). Regardless of the age group, high arterial blood pressure levels were found in 85.45% of participants. Also, many patients had glucose intolerance in the blood. The pelvic ultrasonography showed abnormal endometrial echo thickness (> 5 mm) in 6.14% of patients, but with no significant statistical difference between the age groups. A total of 4.04% of patients had ovaries with high volume values ( > 6.1 mL). Abnormal mammography (BI-RADS 3 or 4) was observed in 12.21%. CONCLUSIONS our data suggest that a great reduction in BMI and stature is more frequent in the group over 75 years. Also, systemic arterial hypertension and carbohydrate disturbance are frequent morbidities in women over 65 years.
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Affiliation(s)
- Vicente Renato Bagnoli
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Angela Maggio da Fonseca
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Josefina Odete Polak Massabki
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Wilson Maça Yuki Arie
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Raymundo Soares Azevedo
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Eduardo Carvalho de Arruda Veiga
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - José Maria Soares Junior
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Edmund Chada Baracat
- Setor do Climatério, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
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The impact of perimenopausal symptomatology, sociodemographic status and knowledge of menopause on women’s quality of life. Arch Gynecol Obstet 2019; 301:1061-1068. [DOI: 10.1007/s00404-019-05238-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/02/2019] [Indexed: 12/11/2022]
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Bakhtiari S, Paki S, khalili A, Baradaranfard F, Mosleh S, Jokar M. Effect of lavender aromatherapy through inhalation on quality of life among postmenopausal women covered by a governmental health center in Isfahan, Iran: A single-blind clinical trial. Complement Ther Clin Pract 2019; 34:46-50. [DOI: 10.1016/j.ctcp.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/01/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
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Abstract
For 15 years, the Collaborative Group for Research of the Climacteric in Latin America (REDLINC) has been conducting research on several topics including age of menopause, metabolic syndrome, quality of life and climacteric symptoms, sexual dysfunction, poor quality of sleep and insomnia, and use of menopausal hormone therapy (MHT) in the general population and among gynecologists. Examples of data to have emerged for this region include the age of menopause (49 years), a high prevalence of metabolic syndrome (42.9%), and a new waist circumference cut-off value for the Latin American population (88 cm). Sexual dysfunction, poor quality of life, and sleep disorders have a prevalence of over 50%, with obesity and sedentary lifestyles affected importantly. MHT use is still low (12.5%), lack of prescription the most important reason for not using it, and gynecologists use MHT for themselves but do not recommend it often to their patients. The prevalence of alternative therapy use, recommended by physicians, is high.
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Affiliation(s)
- K Tserotas
- a Departamento de Ginecologia y Obstetricia, Complejo Hospitalario Dr. Arnulfo Arias Madrid , Caja del Seguro Social de Panama , Panama City , Panama
| | - J E Blümel
- b Departamento de Medicina Interna Sur, Facultad de Medicina , Universidad de Chile , Santiago , Chile
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Rouhbakhsh M, Kermansaravi F, Shakiba M, Navidian A. The effect of couples education on marital satisfaction in menopausal women. J Women Aging 2018; 31:432-445. [DOI: 10.1080/08952841.2018.1510244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mahdieh Rouhbakhsh
- Department of Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatihe Kermansaravi
- Department of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Shakiba
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Navidian
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Asgari P, Bahramnezhad F, Narenji F, Askari M, Shiri M. Comparison of the Effects of Licorice and Aerobic Exercise on the Quality of Life of Postmenopausal Women. JOURNAL OF HOLISTIC NURSING AND MIDWIFERY 2018. [DOI: 10.29252/hnmj.28.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Nappi RE, de Melo NR, Martino M, Celis-González C, Villaseca P, Röhrich S, Palacios S. Vaginal Health: Insights, Views & Attitudes (VIVA-LATAM): results from a survey in Latin America. Climacteric 2018; 21:397-403. [DOI: 10.1080/13697137.2018.1461826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - N. R. de Melo
- Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil
| | - M. Martino
- Asociacion de Obstetricia y Ginecologia de Rosario (ASOGIR), Rosario, Argentina
| | - C. Celis-González
- Hospital de Ginecología y Obstetricia No.4 “Luis Castelazo Ayala”, Mexican Institute of Social Security, Mexico City, Mexico
| | - P. Villaseca
- Department of Endocrinology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S. Röhrich
- Novo Nordisk Health Care AG, Zurich, Switzerland
| | - S. Palacios
- Palacios Institute of Women’s Health, Madrid, Spain
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Does obesity increase the risk of hot flashes among midlife women?: a population-based study. Menopause 2018; 24:1065-1070. [PMID: 28562488 DOI: 10.1097/gme.0000000000000884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between vasomotor symptoms and obesity in climacteric women. METHODS We conducted a cross-sectional population-based study of 749 women aged 45 to 60 years. The dependent variable was intensity of menopausal symptoms evaluated by the menopause rating scale questionnaire. Independent variables were sociodemographic and clinical characteristics, and obesity evaluated by body mass index. RESULTS There was no significant difference in the majority of clinical and sociodemographic characteristics between the body mass index groups. Obese women had less physical activity (P = 0.019) and a higher prevalence of hypertension (P < 0.001), diabetes (P = 0.002), urinary incontinence (P < 0.001), and urge incontinence (P = 0.0006). The total mean menopause rating scale score was 9.7. Scores for hot flashes increased progressively and were higher for participants with body mass index greater than 30 kg/m (P = 0.027). Joint and muscle pain scores also increased with increased body mass index (P < 0.001). Regarding urogenital symptoms, there was a significant difference in urinary problems only, which were more intense in obese women (body mass index >30 kg/m) (P < 0.0001). There was no significant difference in any psychological symptoms on the menopause rating scale. Factors associated with hot flash scores were higher body mass index, presence of urinary urgency, and vaginal dryness. CONCLUSIONS We found that menopausal symptoms, including vasomotor, joint, and urinary symptoms, were related to obesity. Hot flashes were associated with higher body mass index, urinary urgency, and vaginal dryness. Understanding this relationship may contribute to the development of healthcare strategies aimed at minimizing the impact of obesity on several health issues of climacteric women.
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Evaluation of depressive symptoms in mid-aged women: report of a multicenter South American study. Menopause 2017; 24:1282-1288. [DOI: 10.1097/gme.0000000000000924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia. Menopause 2017; 24:1392-1401. [PMID: 28697042 DOI: 10.1097/gme.0000000000000931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia. METHODS In a cross-sectional study, interviews were conducted with 542 postmenopausal Saudi women, comprising sociodemographic history, social support, and the Menopause-specific Quality of Life questionnaire. RESULTS The mean age of participants was 58 (±7.0) years, and the mean age at menopause was 49 (±4.7) years. We found that 41% (n = 224), 14.4% (n = 78), 57% (n = 307), and 12.7% (n = 69) of women reported severe/moderate impact of vasomotor, psychosocial, physical, and sexual symptoms, respectively. Multivariate logistic regression revealed that lacking emotional support was associated with severe/moderate vasomotor (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1, 2.3), psychosocial (aOR 2.0, 95% CI 1.2, 3.4), and physical (aOR 1.7, 95% CI 1.2, 2.6) symptoms. Lack of tangible social support was associated with severe/moderate sexual symptoms (aOR 1.9, 95% CI 1.0, 3.4). In addition, women who worked (aOR 1.8, 95% CI 1.1, 3.2), were obese (aOR 2.0, 95% CI 1.0, 4.1), lived in rented accommodations (aOR 3.9, 95% CI 1.2, 13.1), or had a retired spouse (aOR 1.6, 95% CI 1.0, 2.4) had higher odds for moderate/severe menopausal symptoms. CONCLUSIONS Establishing educational and counseling programs for postmenopausal women, their spouses, and other family members could improve social support and hence quality of life of postmenopausal women. Effective preventive strategies to deal with modifiable risk factors, such as obesity and work stress, should also be implemented.
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ASSOCIATION OF AGE AT MENOPAUSE WITH POST-MENOPAUSAL SYMPTOMS, MENARCHE AGE AND OTHER REPRODUCTIVE FACTORS AMONG RURAL FEMALES IN SHIMLA, HIMACHAL PRADESH. J Biosoc Sci 2017; 50:19-25. [DOI: 10.1017/s0021932016000730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryThis study analysed the association between menopause, menarche and number of live births using cross-sectional primary data for 75 post-menopausal rural women from Shimla in the Indian state of Himachal Pradesh. The mean/median ages at menarche of the 75 women were 14.23/14 years, and those at menopause 45.35/45 years. There were no significant differences in these values between women in the age groups 40–55 and 56–65 years. Age at menopause was found to be significantly associated with age at menarche and maternal age at birth of the first and last child, but not with menopausal symptom severity score. The majority of the 75 post-menopausal women (70.7%) had very mild or no menopausal symptoms. Three principal components were identified that explained 72.43% of the underlying variation in menopausal symptoms.
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Association between anxiety and severe quality-of-life impairment in postmenopausal women: analysis of a multicenter Latin American cross-sectional study. Menopause 2017; 24:645-652. [DOI: 10.1097/gme.0000000000000813] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sánchez-Rodríguez MA, Castrejón-Delgado L, Zacarías-Flores M, Arronte-Rosales A, Mendoza-Núñez VM. Quality of life among post-menopausal women due to oxidative stress boosted by dysthymia and anxiety. BMC WOMENS HEALTH 2017; 17:1. [PMID: 28049464 PMCID: PMC5209897 DOI: 10.1186/s12905-016-0358-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/15/2016] [Indexed: 02/08/2023]
Abstract
Background Menopause is the onset of aging in women. During this process, some women experience physical changes that may impact upon their psychological and social status, also affecting their quality of life. Furthermore, several psychological changes following menopause have been shown to act as pro-oxidant, but the association between the psychological status that modify the quality of life and oxidative stress in postmenopausal women is still unclear. The aim of this study was to determinate the relationship between oxidative stress with psychological disturbances, low self-esteem, depressive mood and anxiety, and quality of life in the postmenopausal women. Methods We carried out a cross-sectional study with101 premenopausal and 101 postmenopausal women from Mexico City. As markers of oxidative stress we measured plasma lipoperoxide levels, erythrocyte superoxide dismutase and glutathione peroxidase activities, and total antioxidant status. We calculate a stress score as global oxidative stress status, with cut-off values for each parameter; this score range from 0 to 6, representing the severity of markers modifications. All the women were rated using the Coopersmith Self-Esteem Inventory, the Zung Self-Rating Anxiety and the Zung Self-Rating Depression Scales, and the WHO Quality of Life-brief. Results The postmenopausal women with low quality of life in the WHO Quality of Life-brief and their subscales had higher stress score compared with premenopausal women with high quality of life (p < 0.05). We found a positive correlation among lipoperoxide levels and Zung Self-Rating Anxiety and Zung Self-Rating Depression score (r = 0.226 and r = 0.173, respectively, p < 0.05), and a negative correlation with WHO Quality of Life-brief scores (r = −0.266, p < 0.01) in postmenopausal women. Multiple linear regression analysis revealed that average lipoperoxide levels increase by 0.0007 μmol/L for every 1-point increase in the Coopersmith Self-Esteem Inventory and by 0.001 μmol/L for every 1-point decrease in the WHO Quality of Life-brief, after adjusted for pro-oxidant factors. Zung Self-Rating Anxiety and Zung Self-Rating Depression Scales scores also contribute to increase lipoperoxides levels, but not significant. Conclusion Our findings suggest that oxidative stress is increased in postmenopausal women with psychological disturbances and low quality of life.
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Affiliation(s)
- Martha A Sánchez-Rodríguez
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Av. Guelatao No. 66, Iztapalapa, CP 09230, México, D.F., México.
| | - Lizett Castrejón-Delgado
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Av. Guelatao No. 66, Iztapalapa, CP 09230, México, D.F., México
| | - Mariano Zacarías-Flores
- Hospital Gustavo Baz Prada, Instituto de Salud del Estado de México, Av. Adolfo López Mateos / Bordo Xochiaca S/N, Ciudad Nezahualcóyotl, CP 57300, Estado de México, México
| | - Alicia Arronte-Rosales
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Av. Guelatao No. 66, Iztapalapa, CP 09230, México, D.F., México
| | - Víctor Manuel Mendoza-Núñez
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Av. Guelatao No. 66, Iztapalapa, CP 09230, México, D.F., México
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Loja-Chango R, Pérez-López FR, Simoncini T, Escobar GS, Chedraui P. Increased mood symptoms in postmenopausal women related to the polymorphism rs743572 of the CYP17 A1 gene. Gynecol Endocrinol 2016; 32:827-830. [PMID: 27117436 DOI: 10.1080/09513590.2016.1177015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Menopausal and depressive symptoms are highly prevalent after the menopause; but may vary from one population to another and genetics play a key role. OBJECTIVE To analyze the intensity of these symptoms in relation to the genetic variants of the rs743572 polymorphism of the CYP17 A1 gene in postmenopausal women. METHODS DNA was extracted from the whole blood of 168 natural postmenopausal women (40-65 years) and tested for the rs743572 polymorphism of the CYP17 A1 gene. Intensity of menopausal (Menopause Rating Scale, MRS) and depressive symptoms (Hospital Anxiety and Depressive Scale, HADS) were correlated to polymorphism genotypes. RESULTS Women with the GG genotype of the rs743572 polymorphism displayed significantly higher scores for the MRS (items 5 and 6 [irritability and anxiety] and the psychological subscale) and the HADS (total and subscales). CONCLUSION The intensity of menopausal symptoms related to mood was found higher among postmenopausal women presenting the GG genotype of the rs743572 polymorphism of the CYP17 A1 gene. There is a need for more research in this regard.
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Affiliation(s)
- Rita Loja-Chango
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
| | - Faustino R Pérez-López
- b Department of Obstetrics and Gynecology , Facultad de Medicina, Universidad de Zaragoza, Lozano Blesa University Hospital , Zaragoza , Spain , and
| | - Tommaso Simoncini
- c Department of Clinical and Experimental Medicine , Division of Obstetrics and Gynecology, University of Pisa , Pisa , Italy
| | - Gustavo S Escobar
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
| | - Peter Chedraui
- a Facultad de Ciencias Médicas , Institute of Biomedicine, Research Area for Women's Health, Universidad Católica de Santiago de Guayaquil, Enrique C. Sotomayor Obstetrics and Gynecology Hospital , Guayaquil , Ecuador
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Cortés-Bonilla M, Alonso-Campero R, Bernardo-Escudero R, Francisco-Doce MT, Chavarín-González J, Pérez-Cuevas R, Chedraui P. Improvement of quality of life and menopausal symptoms in climacteric women treated with low-dose monthly parenteral formulations of non-polymeric microspheres of 17β-estradiol/progesterone. Gynecol Endocrinol 2016; 32:831-834. [PMID: 27187320 DOI: 10.1080/09513590.2016.1183628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the short term effect over menopausal symptoms and quality of life (QoL) of monthly parenteral formulations of 17β-estradiol (E)/progesterone (P) non-polymeric microspheres. METHODS This is a secondary analysis of a multicenter, randomized, single-blinded study that included peri- and post-menopausal symptomatic women assigned to receive a monthly intramuscular injection of 0.5 mg E + 15 mg P (Group A, n = 34), 1 mg E + 20 mg P (Group B, n = 24), or 1 mg E + 30 mg P (Group C, n = 26) for 6 months. Intensity of menopausal symptoms was assessed before and after treatment with the Greene Climacteric Scale (GCS) and QoL with the Utian Quality of Life Scale (UQoLS). RESULTS Menopausal symptoms improved for all groups at six months evidenced by lower cluster/sub-cluster GCS scores. Equally, there was an overall trend for QoL improvement for all groups evidenced by higher domain UQoLS scores at six months; but only significant for the emotional (Groups A and B) and occupational domains (Groups A and C). CONCLUSION The three low-dose continuous sequential intramuscular monthly formulations of E/P microspheres exerted a positive effect over menopausal symptoms and QoL. Long-term research is warranted with these formulations. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov Identifiers NCT 00775242.
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Affiliation(s)
- Manuel Cortés-Bonilla
- a Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , Ciudad de México , México
| | - Rosalba Alonso-Campero
- b Centro A.F. de Estudios Tecnológicos , S.A. de C.V. (CAFET), Ciudad de México , México
| | | | - María T Francisco-Doce
- b Centro A.F. de Estudios Tecnológicos , S.A. de C.V. (CAFET), Ciudad de México , México
| | - Juan Chavarín-González
- b Centro A.F. de Estudios Tecnológicos , S.A. de C.V. (CAFET), Ciudad de México , México
| | - Ricardo Pérez-Cuevas
- c Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social , Ciudad de México , México , and
| | - Peter Chedraui
- d Facultad de Ciencias Médicas , Instituto de Biomedicina, Área de Investigación para la Salud de la Mujer, Universidad Católica de Santiago de Guayaquil , Guayaquil , Ecuador
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The effects of menopausal health training for spouses on women's quality of life during menopause transitional period. Menopause 2016; 23:183-8. [PMID: 26783984 DOI: 10.1097/gme.0000000000000588] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Spouses' support during menopausal transition has an important role for improving the quality of life in postmenopausal women. Since the first step in providing support is having adequate knowledge, this study aimed to investigate the effects of an educational program on menopause health for spouses on women's quality of life during the menopausal transition. METHODS This clinical trial was conducted in Yazd, Iran. A hundred healthy women aged 45 to 60 years were recruited by random sampling. The spouses in the intervention group (n = 50) attended three training sessions about the management and health of menopausal transition. The spouses in the control group (n = 50) did not receive any intervention. Knowledge and performance about menopausal health were assessed in all spouses before and 3 months after intervention. All women were assessed by the Menopause Rating Scale, and the Menopause Quality of Life questionnaire before and 3 months after educational intervention. Analyses were carried out using SPSS 16 software. The level of significance was set at P less than 0.05. RESULTS The knowledge and performance of spouses in the intervention group were significantly higher 3 months after intervention (P < 0.0001). The quality of life in women in the intervention group was higher 3 months after intervention (P < 0.0001). The mean scores of psychological and physical domains were significantly lower in the intervention group (P = 0.002 and P = 0.001, respectively). CONCLUSIONS The training of menopausal health for spouses improves the quality of life in women during menopausal transition. We suggest integrating such educational programs in menopausal management programs.
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Sorpreso ICE, Soares Júnior JM, Fonseca AMD, Baracat EC. Female aging. Rev Assoc Med Bras (1992) 2016; 61:553-6. [PMID: 26841166 DOI: 10.1590/1806-9282.61.06.553] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 12/21/2022] Open
Abstract
Female aging is a process that involves hypoestrogenism time, the individual impact on each woman, and what we can do as experts to reduce morbidity and provide quality of life. This natural process in the female life cycle has been of concern to women after menopause. Changes in different biophysical and psychosocial aspects, and their individual experiences, have repercussions on the lives of patients seeking specialized and multidisciplinary support to reduce the harmful effects of prolonged hypoestrogenism. Overweight and obesity, inadequate living habits and the presence of multi-morbidities cause damage to the quality of life and impact the functional capacity. Behavioral prescription and hormone therapy are among the treatments given to ease symptoms and reduce morbidity. A better understanding of these factors can help identify groups that require more care after menopause.
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Affiliation(s)
- Isabel Cristina Esposito Sorpreso
- Division of Gynecology, Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Edmund Chada Baracat
- Division of Gynecology, Department of Obstetrics and Gynecology, FM, USP, São Paulo, SP, Brazil
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Relationship between sociodemographic, reproductive, and lifestyle factors and the severity of menopausal symptoms among Egyptian women in Alexandria. Menopause 2016; 23:888-93. [PMID: 27219833 DOI: 10.1097/gme.0000000000000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During menopause, women often experience some symptoms which may affect their daily activities. Information about menopausal experiences among different racial and ethnic groups is important for healthcare personnel to provide appropriate and specific interventions. The aim of the present study was thus to determine the frequency and determinants of severity of menopausal symptoms among Egyptian women using the Menopause Rating Scale as a screening tool for identification of menopausal symptoms. METHODS A total of 540 women (aged 40-65 y) were recruited in this cross-sectional study. Demographic information was collected, and the Menopause Rating Scale questionnaire was administered. RESULTS Most frequently reported symptoms were joint and muscular discomfort (501, 92.8%) followed by urogenital symptoms (460, 85.2%). A significant association was found between the number of menopausal symptoms and working status of participants (r = 0.504, P = 0.005), number of children (r = 0.474, P = 0.042), and body mass index (r = 0.544, P = 0.006). Women who reported urogenital symptoms and self-perceived general health as poor were more frequently referred to a gynecologist for moderate-to-severe menopausal symptoms. CONCLUSIONS Participant-related information such as working status, which was shown to increase the frequency of psychological symptoms in our ethnic group, should be noted by the physician, and a suitable approach should be adopted to achieve better therapy outcomes. Counseling about the importance of maintaining an ideal body weight and exercise should be emphasized to reduce menopausal symptoms. Appropriate advice and support in improving the overall state of the postmenopausal women is essential.
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Palacios S, Arias L, Lavenberg J, Pan K, Mirkin S, Komm BS. Evaluation of efficacy and safety of conjugated estrogens/bazedoxifene in a Latin American population. Climacteric 2016; 19:261-7. [DOI: 10.3109/13697137.2016.1146248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sánchez SC, Chedraui P, Pérez-López FR, Ortiz-Benegas ME, Palacios-De Franco Y. Evaluation of sexuality in a Paraguayan mid-aged female urban population using the six-item Female Sexual Function Index. Climacteric 2016; 19:256-60. [DOI: 10.3109/13697137.2016.1151866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
INTRODUCTION Vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) are recognized as the most frequent and bothersome symptoms associated with menopause. There are different treatments for both groups of symptoms, being necessary to individualize them. AREAS COVERED There are different therapies for VMS including hormonal treatments with estrogen, with and without progestins; the new alternative, tissue-selective estrogen complex (TSEC), tibolone, phytoestrogens and only progestins. Evidence also shows efficacy with selective serotonin reuptake inhibitors. Other nonhormonal alternatives exist as second-line treatments, all with not conclusive results. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, other alternatives as vaginal laser needs to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest selective estrogen receptor modulator (SERM), ospemifene. Therapies with testosterone and dehydroepiandrosterone (DHEA) are still under study. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, and other alternatives as vaginal laser need to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest SERM, ospemifene. Therapies with testosterone and DHEA are still under study. EXPERT OPINION The increasing numbers of therapies for menopausal symptoms open up new options, but we must individualize treatments. New possibilities arise in patients who did not have them and which can improve compliance and is also important to design strategies using combined or sequential treatments.
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Affiliation(s)
- Santiago Palacios
- a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ;
| | - Andrea Mejias
- a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ;
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Jenabi E, Shobeiri F, Hazavehei SMM, Roshanaei G. Assessment of Questionnaire Measuring Quality of Life in Menopausal Women: A Systematic Review. Oman Med J 2015; 30:151-6. [PMID: 26171119 DOI: 10.5001/omj.2015.34] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/06/2015] [Indexed: 02/05/2023] Open
Abstract
Menopause is a natural part of the aging process in women and is defined as occurring 12 months after the last menstrual period marking the end of menstrual cycles. Menopause has a negative impact on the quality of life (QoL). Various generic and specific questionnaires have been used for assessing different dimensions of QoL in menopausal women. The purpose of this systematic review was to identify those general and specific instruments, and to determine the factors that affect QoL in menopausal women. We assessed eight specific and three general tools and found that some general and specific instruments, such as the 36-item short form (SF-36) and the Menopause Specific Quality of Life Questionnaire (MENQOL), were mostly used for assessment. The specific tools available were diverse. Employment status and a high educational level in menopausal women were considered to be protective factors in improving QoL. Identification of predicting factors of QoL, such as body mass index, race, age, duration of menopause, and social and occupational variables can help to improve the QoL of these women allowing planning of psychological consultations and practical interventions.
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Affiliation(s)
- Ensiyeh Jenabi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Shobeiri
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyyed M M Hazavehei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghodratollah Roshanaei
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Salazar-Molina A, Klijn TP, Delgado JB. Sexual satisfaction in couples in the male and female climacteric stage. CAD SAUDE PUBLICA 2015; 31:311-20. [PMID: 25760165 DOI: 10.1590/0102-311x00051214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022] Open
Abstract
The objective was to describe the sexual life satisfaction of couples in the climacteric stage and determine whether there are differences between the perception of satisfaction and the sex life of each partner. We studied 142 couples obtained by stratified sampling of family health centers, Concepción, Chile. 66% of women and 84% of men reported being very or somewhat satisfied with their sex lives. Slight concordance was found between the responses of the partners in relation to satisfaction with their sexual life. Moreover, a slight degree of agreement was found between the sexual life satisfaction reported by women and their partners' perceptions of the women's sexual life satisfaction. Additionally, a slight degree of agreement was reported between the sexual life satisfaction reported by men and their partners' perceptions of the men's sexual life satisfaction. This study provides new information about Chilean couples in the climacteric stage in relation to self-reported sexual satisfaction and perceived satisfaction in couples.
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Kim JS, Kang S. A Study on Body Image, Sexual Quality of Life, Depression, and Quality of Life in Middle-aged Adults. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:96-103. [DOI: 10.1016/j.anr.2014.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 12/16/2014] [Accepted: 12/26/2014] [Indexed: 01/03/2023] Open
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Bagnoli VR, Fonseca AMD, Arie WMY, Das Neves EM, Azevedo RS, Sorpreso ICE, Soares Júnior JM, Baracat EC. Metabolic disorder and obesity in 5027 Brazilian postmenopausal women. Gynecol Endocrinol 2014; 30:717-20. [PMID: 24898135 DOI: 10.3109/09513590.2014.925869] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the frequency of obesity in postmenopausal women and assess the potential effects of increased body mass index (BMI) on lipoprotein profile and on risk factors for arterial hypertension and diabetes. DESIGN A cross-sectional study was conducted with 5027 postmenopausal Brazilian women. Analyses were performed of BMI and cardiovascular factors (systemic blood pressure [BP], total cholesterol, low-density lipoprotein, high-density lipoprotein [HDL-C], triglyceride, and fast glucose). The statistical analysis included the chi-square and Mann-Whitney tests. The significance level was set at 5%. RESULTS Obesity (BMI >30) in our study characterized approximately 30% of the 5027 postmenopausal women. The comparison of patients with normal BMI and those with high BMI showed that high BMI had a significant negative effect on BP, as evidenced by the increased frequency of hypertension in overweight and obese patients (>25) (p < 0.001), that it also negatively and significantly affected triglyceride (p < 0.001) and fast glucose levels (p < 0.001), and that it was linked significantly to low levels of HDL-C. CONCLUSION Our data showed the high frequency of obesity in our population and of the cardiovascular risks (glucose, systemic arterial hypertension, and low HDL-C) associated with high BMI.
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Affiliation(s)
- Vicente Renato Bagnoli
- Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo , Brazil and
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Chedraui P, Pérez-López FR, Sánchez H, Sánchez P, Miranda O, Quispe P, Madero-Trelles T, Hidalgo L, Arboleda D, López G, Quintero JC. Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms. Maturitas 2014; 79:100-5. [PMID: 25085706 DOI: 10.1016/j.maturitas.2014.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture. OBJECTIVE To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10). METHOD This was a cross sectional study in which a total of 451 Ecuadorian women (40-59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data. RESULTS Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores. CONCLUSION In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.
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Affiliation(s)
- Peter Chedraui
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador.
| | - Faustino R Pérez-López
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Hugo Sánchez
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Priscila Sánchez
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Octavio Miranda
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Paulina Quispe
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Teddy Madero-Trelles
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Luis Hidalgo
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Daniela Arboleda
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Gabriela López
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
| | - Juan C Quintero
- Writing Group for the National Research Project sponsored by the Ecuadorian Climacteric and Menopause Society (SECLIM), Ecuador
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Ojeda E, Blümel JE, Vallejo MS, Lavín P. Climacteric symptoms in Quechua and Mestizo women from the Andean region of Cusco, Peru: Effects of altitude and ethnicity. Maturitas 2014; 77:356-60. [DOI: 10.1016/j.maturitas.2014.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 11/15/2022]
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