Health education intervention in early and late postmenopausal Brazilian women

Postmenopausal women's cognitive function and performance of virtual reality tasks

OBJECTIVE

This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance.

METHOD

This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used.

RESULTS

Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks.

CONCLUSION

Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.

Effectiveness of Educational Intervention Based on Transtheoretical Model on Physical Activity and Menopausal Symptoms

Introduction

Menopause is an inevitable part of women's lives. Physical activity as nonhormonal therapy can decrease the symptoms of menopause. This study is aimed at investigating the effect of educational intervention based on the transtheoretical model (TTM) on physical activity and menopausal symptoms of female clients of the health center in Pasargad City, Iran.

Methods

This quasi-experimental study was performed on 140 females admitted to health center of Pasargad City, Fars Province, Iran (intervention = 70 and control = 70). The data collection tool consisted of demographic data, menopause rating scale, international physical activities questionnaire, and TTM questionnaire (stages of change, processes of change, decision-making balance, and self-efficacy) that were completed before and two months after intervention. For intervention group, the educational program was implemented during 5 sessions of 50-55 min. Data were analyzed by SPSS 25 and by using Chi-square test, independent t-test, and paired t-test.

Results

After intervention, the mean scores of physical symptoms are sleep problems, muscle problems and discomfort, psychological symptoms, depression, irritability, and anxiety of intervention group decreased significantly post intervention (p < 0.001). Analysis showed that psychological symptoms, mental fatigue, somatic, and urogenital symptoms, and vaginal dryness increased 2 months after the intervention. Also, the mean score of cons, pros, decision balance, self-efficacy, consciousness raising, dramatic relief, environmental reevaluation, and self-reevaluation have significant changed in intervention group (p < 0.05). In addition, the top percent of progress can be seen in contemplation (31. 5%).

Conclusion

This study showed the effectiveness of educational intervention based on TTM to reduce menopausal symptoms and promote physical activity in postmenopausal women.

Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

BACKGROUND AND AIMS

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women.

METHODS

The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach.

RESULTS

-The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight.

CONCLUSION

These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

BACKGROUND

Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD.

OBJECTIVE

To evaluate the effects of group CBT on women with HSDD.

METHOD

Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison.

MAIN OUTCOME MEASURES

demographics, education, sexual history, FSQQ and its domains for sexual function assessment.

RESULTS

Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001).

CONCLUSION

Group CBT was shown to be an effective tool for treating HSDD.

Executive summary of evidence and consensus-based clinical practice guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study

OBJECTIVE

The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors.

METHODS

A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test.

RESULTS

Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV).

CONCLUSIONS

The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Effect of Health-Promoting Lifestyle Modification Education on Knowledge, Attitude, and Quality of Life of Postmenopausal Women

Limited knowledge and negative attitudes about menopause among postmenopausal women (PMW) create a multitude of health-related issues leading to impaired quality of life (QOL) among them. This study evaluated the impact of a health-promoting lifestyle education intervention (HPLEI) on knowledge, attitude, and QOL in a group of PMW in Sri Lanka. A quasi-experimental study was conducted with 72 PMW, matched for sociodemographic status of the community from two geographically separated areas in Galle, and they were allocated to intervention (n = 37) and control (n = 35) groups. HPLEI is comprised of health education sessions focused on postmenopausal health management with lifestyle modifications provided only for the intervention group for 8 weeks and follow-up for 6 months. The control group was not given any planned education programme and was allowed to proceed with the usual lifestyle during this period. Knowledge, attitude, menopause-specific QOL (MENQOL), and overall QOL were evaluated in both groups with self-administered questionnaires at the baseline, after 8 weeks of education sessions and at the end of 6 months of follow-up. The mean (SD) ages of the intervention and control groups were 54.6 (4.5) and 56.5 (3.4) (p = 0.06) years, respectively. All evaluated variable scores were not different between the intervention and control groups (p > 0.05) at the baseline. In the intervention group, knowledge (mean ± SD; 21.70 ± 1.05) and attitude (mean ± SD; 44.02 ± 5.33) scores increased at the end (p < 0.001). In the control group, a marginal increase in all dimensions of knowledge scores (mean ± SD; 9.71 ± 2.21) and unchanged attitude scores (mean ± SD; 23.91 ± 7.56) were seen. All MENQOL scores decreased during the follow-up in the intervention group (mean ± SD; 138.51 ± 18.47) (p < 0.001) except the sexual domain (p = 0.32). MENQOL scores were increased in the control group (mean ± SD; 92.05 ± 28.87) (p < 0.001) with time. Overall QOL scores increased (mean ± SD; 74.85 ± 9.71) (p < 0.001) in the intervention group during the study period and in the control group overall QOL (mean ± SD; 51.03 ± 13.61) showed a reduction (p < 0.001) at the end. Health education focused on health-promoting lifestyle modifications was effective in improving knowledge, attitude, MENQOL, and overall QOL of PMW.

Heart rate variability helps to distinguish the intensity of menopausal symptoms: A prospective, observational and transversal study

Heart Rate Variability (HRV) represents cardiac autonomic behavior and have been related to menopausal symptoms, mainly vasomotor symptoms and their imbalance to cardiovascular risk. It is not clear in the literature which index represents this imbalance and what is their involvement with the menopausal state. The aim of this study was to evaluate HRV in menopausal transition and post-menopausal symptoms with different intensities. This cross-sectional study was conducted in Rio Branco, State of Acre, Brazil from October 2016 to July 2017. We used Kupperman-Blatt Menopausal Index (KMI) to measure menopausal symptoms intensity. HRV analysis was performed based on the guidelines of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. HRV is lower in the group with moderate/intense menopausal symptoms compared to mild symptoms. (RMSSD: p = 0.005, Cohen’s d = 0.53, pNN50: p = 0.0004, Cohen’s d = 0.68; HF: p = 0.024, Cohen’s d = 0.44). There was association between HRV and KMI (RMSSD: r = -1.248, p = 0.004; and pNN50: r = -0.615, p: 0.029) in inverse relation to the intensity of vasomotor symptoms in women in TM. In conclusion, HRV was able to distinguish menopausal symptoms, indicating reduced vagal control in women with more intense symptoms.

Impact of Health-Promoting Lifestyle Education Intervention on Health-Promoting Behaviors and Health Status of Postmenopausal Women: A Quasi-Experimental Study from Sri Lanka

Health promotion through lifestyle education is an important measure to enhance health status of postmenopausal women (PMW). This study evaluated the effectiveness of health-promoting lifestyle education intervention (HPLEI) on adhering to health-promoting behaviors (HPB) and enhancing the health status in a group of Sri Lankan PMW. A quasi-experimental study was conducted with randomly selected, sociodemographic status matched, 72 PMW from two geographically separated areas in Galle District, Sri Lanka, allocated as experimental (n = 37, 54.6 ± 4.5 years) and control (n = 35, 56.5 ± 3.4 years) groups. Education intervention focused on postmenopausal health management including lifestyle modifications was performed only for the experimental group during 8 weeks, and a health education package was provided. The control group was not given any planned education programme. Both groups were followed up for a 6-month period. HPB and menopausal symptoms severity were evaluated by validated Health Promoting Lifestyle Profile-II and Menopause Rating Scale, respectively. Anthropometric adiposity indices (AAIs) including weight, body mass index (BMI), waist (WC) and hip (HC) circumferences, and waist to hip ratio (WHR); cardiovascular disease risk indicators (CVDRI) including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), total cholesterol and triglycerides, muscle strength; hand grip strength (HGS) and physical performance (PP); gait speed (GS) were measured. All parameters were evaluated before the intervention (baseline) and after follow-up of 6 months. All evaluated parameters were not different between experimental and control groups (p > 0.05) at the baseline. In the follow-up evaluation, HPB (p < 0.001), menopausal symptom scores (p < 0.001), AAI (p < 0.001), CVDRI (SBP, DBP, and FBS) (p < 0.05) and HGS and GS (p < 0.001) were significantly improved in the experimental group but not in the control group. Health education intervention focused on health-promoting lifestyle modifications is effective in improving the adherence to HPB and enhances the health status in PMW. This provides positive impact in lifestyle medicine.

Evaluation of the Effectiveness of Health Education on Menopause Symptoms and Knowledge and Attitude in Terms of Menopause

This study was carried out to evaluate the effectiveness of health education on menopausal symptoms, knowledge, and attitudes about menopause. To evaluate the efficacy of a training program, information about menopausal symptoms, knowledge, and attitude toward menopause was collected before and after health education. After the health education intervention, it was determined that there was a decrease in the somatic and psychological subdimensions of the menopausal symptom evaluation scale and in the total score. Positive changes were observed in the levels of knowledge about menopause, and positive and negative emotional subscales of the menopause attitude assessment scale. It is concluded that health education is an effective method to positively change the perceived severity of menopausal symptoms and menopause-related level of knowledge and attitude.

Impact of functional training on geometric indices and fractal correlation property of heart rate variability in postmenopausal women

BACKGROUND

To evaluate the influence of functional training on the geometric indices of heart rate variability (HRV) and fractal correlation properties of the dynamics of heart rate in menopausal women.

METHODS

Of 39 women who were in the period of menopause for more than a year and who did not practice any regular physical activity were divided into: Functional training group (FTG = 50 ± 4.5 years; 67.64 ± 11.64 kg; 1.5 ± 0.05 m) that executed the functional training (FT) and all proposals by reviews and the Control group (58.45 ± 4.8 years; 66.91 ± 13.24 kg; 1.55 ± 0.05 m) who performed all assessments but not FT. The training consisted of 18 weeks (three times a week) and the volunteers performed three sets of 11 functional exercises followed by a walk in each of the sessions. The autonomic nervous system modulation was evaluated by analysis of HRV and the indices obtained were: RR intervals, RRTRI, TINN, SD1, SD2, SD1/SD2, qualitative analysis of Poincaré plot and DFA (alfa-1, alfa-2 and alfa-1/alfa-2). The Student's t-test for unpaired samples (normal data) or Mann-Whitney test nonnormal data) were used to compare the differences obtained between the final moment and the initial moment of the studied groups (p < .05).

CONCLUSION

Were observed in the FTG: increased SD1 (CG 0.13 ± 4.00 vs. 3.60 ± 8.43), beat-to-beat global dispersion much greater as an increased in the dispersion of long-term RR intervals and increased fractal properties of short-term (α1) (CG -0.04 ± 0.13 vs. 0.07 ± 0.21). FT promoted a beneficial impact on cardiac autonomic modulation, characterized by increased parasympathetic activity and short-term fractal properties of the dynamics of the heart rate.

The Effect of Educational Program on Quality of Life in Menopausal Women: A Clinical Trial

Objectives

This study aimed to investigate the effect of Educational program on quality of life (QOL) in menopausal women in 2016 in Hamadan, Iran.

Methods

In this clinical trial study, 100 postmenopausal women were randomly selected and allocated to case and control group (50 per group). Data collection tool included questionnaires of demographic information and Menopause QOL, which were completed by the samples before the intervention. In the case group, education program was run during 5 sessions for 45 to 60 minutes. Immediately and Three months after intervention, information were collected using questionnaire in both groups and they were analyzed using SPSS 16 software.

Results

The menopause women in both intervention and control groups had similar demographics. There was not a significant difference in the QOL mean scores in before of the intervention between the two groups of intervention and control in all dimension of QOL. There was a significantly difference in the mean of QOL scores between the two groups in immediately after the intervention and 3 months after the intervention in dimension of vasomotor, psychosocial, sexual and physical (P < 0.001).

Conclusions

This study recommend that a unit in health and treatment centers be established for training menopausal women about health care by holding didactic classes.

The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

Female aging

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.

How to evaluate quality of life in overweight and obese women during climacterium?

Objective: identifying the instruments used to measure quality of life during menopausal transition and post-menopause in women with obesity or overweight. Methods: a systematic search using the Embase, Pubmed and Cochrane databases, and the following key-words: menopause/climacteric, quality of life, overweight/obesity. Nineteen papers that fulfilled the including criteria were found. Results: eighteen studies using generic health questionnaires (global quality of life) were identified, six of them were specific for menopause and one specific for obesity. Eleven studies used generic questionnaires, while only eight questionnaires were specific for menopause. Conclusion: there was no consensus in the literature about the use of quality of life questionnaires in women with overweight and obesity in climacterium, which makes de comparison and reproducibility of the results difficult. This is an alert about the need for standardization to better evaluate this specific population.

Physiotherapeutic approach in early and late post-menopausal Brazilian women

To evaluate changes in joints after physiotherapy in post-menopausal women, specifically to identify clinical responses to the measurements of flexibility, functional capacity and joint pain in early and late post-menopausal women at a multi-disciplinary health education programme. A total of 69 women participated in the Integral Program for the Attention to Climacteric Women at the Department of Gynecology - Federal University of Sao Paulo and were sorted into two groups of early (n = 32) and late (n = 37) post-menopause. The average age of menopause was 47.9 ± 5.6 years. The Blatt Kupperman Menopausal Index scores for the early (baseline = 12.8 ± 6.1) and late (baseline = 14.1 ± 7.7) post-menopausal groups after the programme were 8.4 ± 7.1 and 9.4 ± 8.1, respectively. Both groups presented improvements regarding functional capacity (p < 0.01) and complaints of pain (p < 0.001) after the intervention. The group of early post-menopausal women had better flexibility for hip flexion (p < 0.001), and the late post-menopausal group showed greater improvement in shoulder flexion (p < 0.001), extension (p < 0.001) and elbow flexion (p < 0.001). After multi-disciplinary approach, both early and late post-menopausal groups experienced decrease in intensity of climacteric symptoms, reduction in pain intensity and improvement in functional capacity, but the flexibility was different between both the groups.