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Caira-Chuquineyra B, Fernandez-Guzmán D, Garayar-Peceros H, Benites-Zapata VA, Pérez-López FR, Blümel JE, Mezones-Holguín E. Efficacy and safety of visnadine in the treatment of symptoms of sexual dysfunction in heterosexual women: a systematic review of randomized clinical trials. Gynecol Endocrinol 2024; 40:2328619. [PMID: 38528806 DOI: 10.1080/09513590.2024.2328619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To synthesize the primary evidence on the efficacy and safety of visnadine on symptoms of sexual dysfunction (SD) in heterosexual women. METHODS We conducted a systematic review of randomized clinical trials (RCTs) with a primary search without language restriction in PubMed/Medline, Scopus, Embase, Web of Science, Cochrane Library, and international clinical trial registries. Trials reporting the use of visnadine by any route in women with SD were eligible. We performed screening, data extraction, and risk of bias assessment in a double-blind approach. The primary outcomes were the Female Sexual Function Index (FSFI) and its domains. Secondary outcomes were safety, arousal, lubrication, pleasure, orgasm, negative sensations, duration, and overall satisfaction. RESULTS Initially, 242 records were retrieved. We selected nine papers for full-text reading and finally included two RCTs: one with a parallel design and one with a crossover design with a total of 96 patients. One study compared visnadine aerosol with a placebo, while the other compared different frequencies of visnadine aerosol use. Visnadine use showed a statistically significant improvement (p < 0.05) in overall FSFI scores, regardless of the frequency of use. A meta-analysis was not possible due to the high clinical and methodological heterogeneity between available studies. CONCLUSION RCTs regarding the use of visnadine for the Female SD are scarce and methodologically limited. This preliminary evidence shows visnadine as a potentially effective and safe option to alleviate some of the clinical symptoms of SD in heterosexual women. However, future better-designed randomized studies with larger sample numbers are required.
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Affiliation(s)
| | | | | | - Vicente A Benites-Zapata
- Research Unit for the Generation and Synthesis of Health Evidence, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Juan E Blümel
- Faculty of Medicine, Universidad de Chile, Santiago de Chile, Chile
| | - Edward Mezones-Holguín
- Centre of Excellence for Social and Economic Studies in Health, Universidad San Ignacio de Loyola, Lima, Perú
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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 2024:1-6. [PMID: 38308574 DOI: 10.1080/13697137.2024.2306278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Blümel JE, Aedo S, Murray N, Vallejo MS, Chedraui P. Health screening of middle-aged women: what factors impact longevity? Menopause 2022; 29:1008-1013. [PMID: 35969889 DOI: 10.1097/gme.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The aim of this study was to measure the impact of different risk factors in middle-aged women on longevity evaluated after three decades of an initial health screening. METHODS Women who received an annual check-up between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2021. RESULTS A total of 1,158 women aged 40 to 60 were studied. At 30.9 years of follow-up, the Kaplan-Meier overall survival was 75.6% (95% confidence interval, 72.6-78.3). The main causes of the 260 deaths observed were the following: cancer ( n = 88; 33.8%), cardiovascular disease ( n = 55; 21.2%), and infectious disease ( n = 41; 15.8%). The following hazard ratios were found with the flexible parametric survival model: personal history of fracture (hazard ratio, 2.55; 95% confidence interval, 1.29-5.02; P = 0.007), type 2 diabetes mellitus (2.14; 1.18-3.88; P = 0.012), personal history of heart disease (1.85; 1.09-3.13; P = 0.022), chronic arterial hypertension (1.65; 1.25-2.17; P < 0.001), postmenopausal status (1.60; 1.13-2.26; P = 0.008), unskilled jobs (1.56; 1.17-2.07; P = 0.002), cigarette smoking (1.51; 1.17-1.94; P = 0.002), age (1.06; 1.03-1.09; P < 0.001), body mass index (1.04; 1.01-1.07; P = 0.004), multiparous (0.72; 0.56-0.93; P = 0.012), and active sexual intercourse (0.68; 0.52-0.87; P = 0.003). Lipid disorders did not reach statistical significance as a risk factor. CONCLUSIONS In this cohort, it was observed that most of the classic risk factors for mortality were present. However, a history of fracture appears in middle-aged women as a strong predictor of mortality, surpassing diabetes and arterial hypertension. Multiparity, on the other hand, was a protective factor.
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Affiliation(s)
- Juan E Blümel
- From the Department of Internal Medicine South, Clínica Quilín, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Sócrates Aedo
- School of Medicine, University Finis Terrae, Santiago de Chile, Chile
| | - Nigel Murray
- School of Medicine, University Finis Terrae, Santiago de Chile, Chile
| | - María S Vallejo
- From the Department of Internal Medicine South, Clínica Quilín, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
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Vallejo MS, Blümel JE, Bencosme A, Calle A, Dextre M, Díaz K, López M, Miranda C, Ñañez M, Ojeda E, Rey C, Rodrigues MA, Salinas C, Tserotas K, Pérez-López FR. Factors affecting climacteric women with SARS-CoV-2 infection: A multinational Latin America study (REDLINC XI). Maturitas 2022; 165:33-37. [PMID: 35905570 PMCID: PMC9303064 DOI: 10.1016/j.maturitas.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/02/2022] [Accepted: 07/09/2022] [Indexed: 01/08/2023]
Abstract
Objective To evaluate the association between factors, especially those linked to the climacteric, and a history of COVID-19 infection. Methods This was an observational, cross-sectional, and analytical study in which women from ten Latin American countries, aged 40–64, who attended a routine health check-up were invited to participate. A positive history for COVID-19 was based on reverse transcription-polymerase chain reaction reports. We evaluated sociodemographic, clinical, lifestyle, anthropometric variables, and menopausal symptoms using the Menopause Rating Scale (MRS). Results A total of 1238 women were included for analysis, of whom 304 (24.6 %) had a positive history for COVID-19. The median [interquartile range: IQR] age of participants was 53 [IQR 12] years, duration of formal education was 16 [6] years, body mass index 25.6 [5.1] kg/m2, and total MRS score 10 [13]. In a logistic regression model, factors positively associated with COVID-19 included postmenopausal status and having a family history of dementia (OR: 1.53; 95 % CI: 1.13–2.07, and 2.40; 1.65–3.48, respectively), whereas negatively associated were use of menopausal hormone therapy (current or past), being a housewife, and being nulliparous (OR: 0.47; 95 % CI: 0.30–0.73; 0.72; 0.53–0.97 and 0.56; 0.34–0.92, respectively). Smoking, being sexually active, and use of hypnotics were also factors positively associated with COVID-19. Conclusion Postmenopausal status and a family history of dementia were more frequent among women who had had COVID-19, and the infection was less frequent among current or past menopause hormone therapy users and in those with less physical contact.
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Affiliation(s)
- María S Vallejo
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Juan E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile.
| | - Ascanio Bencosme
- Ginecología Obstetricia, Hospital Metropolitano de Santiago, Santiago de los Caballeros, Dominican Republic
| | - Andrés Calle
- Centro Integral de Salud Obstétrica y Femenina-CISOF, Quito, Ecuador
| | - Maribel Dextre
- Ginecología Obstetricia, Clínica Internacional-Clínica Javier Prado, Lima, Peru
| | - Karen Díaz
- Centro Ciudad Mujer, Ministerio de Salud, Asunción, Paraguay
| | - Marcela López
- Clínica Alemana y Hospital Militar, Santiago de Chile, Chile
| | - Carlos Miranda
- Hospital Central FAP-Instituto Médico Miraflores, Lima, Peru
| | - Mónica Ñañez
- II Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eliana Ojeda
- Departamento Académico de Medicina Humana, Universidad Andina del Cusco, Cusco, Peru
| | - Claudia Rey
- Medicina Ginecológica Consultorios Médicos, Buenos Aires, Argentina
| | - Marcio A Rodrigues
- Department Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Faustino R Pérez-López
- Instituto Aragonés de Ciencias de la Salud, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
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Mezones-Holguín E, Arriola-Montenegro J, Cutimanco-Pacheco V, Al-Kassab-Córdova A, Niño-García R, Zeta LA, Urrunaga-Pastor D, Blümel JE, Chedraui P, Pérez-López FR. Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection. Menopause 2022; 29:317-326. [PMID: 35213519 DOI: 10.1097/gme.0000000000001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection. METHODS We carried out a cross-sectional study of 221 sexually active HIV-infected women ages 40 to 59 years, based on a secondary analysis of a three-hospital survey in Lima, Perú. We classified menopausal status according to Stages of Reproductive Aging Workshop criteria (STRAW+10); this exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and-for exploratory analysis-as multinomial (pre-, peri-, and postmenopausal). We defined low sexual function (LSF) using the 6-item Female Sexual Function Index (total score ≤19). Socio-demographic and clinical variables were assessed, including age, used highly active antiretroviral therapy scheme, disease duration, depressive symptoms, and co-morbidities. We performed Poisson generalized linear models with a robust variance to estimate 95% confidence interval (CI), crude prevalence ratios (cPRs), and adjusted prevalence ratios (aPRs) by epidemiological and statistical approaches using nonparametric method of bias-corrected and accelerated bootstrap resampling with 1,000 repetitions. RESULTS Studied women had a median age of 47.0 years (interquartile range: 7.5); 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal. Also, 64.3% had LSF. The frequency of LSF was 53.6% in non-postmenopausal and 75.0% in postmenopausal women. Postmenopausal status was associated with LSF in both the crude (cPR = 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR = 1.38; 95% CI: 1.12-1.71). CONCLUSIONS HIV-infected postmenopausal women have a higher prevalence of LSF than those non-postmenopausal ones, even when adjusting for multiple potential confounders.
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Affiliation(s)
- Edward Mezones-Holguín
- Universidad San Ignacio de Loyola, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Perú
- Epi-gnosis Solutions, Piura, Perú
| | - José Arriola-Montenegro
- University of Minnesota, Internal Medicine, Minneapolis, MN
- Universidad Peruana de Ciencias Aplicadas, Facultad de Ciencias de la Salud, Lima, Perú
| | | | - Ali Al-Kassab-Córdova
- Universidad Peruana de Ciencias Aplicadas, Facultad de Ciencias de la Salud, Lima, Perú
| | - Roberto Niño-García
- Universidad Nacional de Piura, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Piura, Perú
| | - Ludwing A Zeta
- Universidad Nacional de Piura, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Piura, Perú
| | | | - Juan E Blümel
- Universidad de Chile, Facultad de Medicina Sur, Santiago de Chile, Santiago, Chile
| | - Peter Chedraui
- Universidad Católica de Santiago de Guayaquil, Facultad de Ciencias Médicas, Instituto de Investigación e Innovación en Salud Integral, Guayaquil, Ecuador
| | - Faustino R Pérez-López
- University of Zaragoza, Faculty of Medicine, Department of Obstetrics and Gynecology, Zaragoza 50009, Spain
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Blümel JE, Aedo S, Arteaga E, Vallejo MS, Chedraui P. Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas. Rev Med Chil 2022; 150:46-53. [DOI: 10.4067/s0034-98872022000100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
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Blümel JE, Arteaga E, Vallejo MS, Ojeda E, Meza P, Martino M, Rodríguez-Vidal D, Ñañez M, Tserotas K, Rojas J, Rodrígues MA, Espinoza MT, Salinas C, Párraga-Párraga J, Chedraui P. Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study. Climacteric 2021; 25:195-202. [PMID: 34323137 DOI: 10.1080/13697137.2021.1951203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women. OBJECTIVE This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI). METHOD The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA). RESULTS Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m2, respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46). CONCLUSION Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.
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Affiliation(s)
- J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Arteaga
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - M S Vallejo
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Ojeda
- Departamento de Obstetricia y Ginecología, Universidad Andina, Cusco, Perú
| | - P Meza
- Departamento de Medicina Familiar, Universidad San Martin de Porres, Lima, Perú
| | - M Martino
- Departamento de Obstetricia y Ginecología, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Rodríguez-Vidal
- Departamento de Obstetricia y Ginecología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - M Ñañez
- Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - K Tserotas
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja del Seguro Social, Panamá, Panamá
| | - J Rojas
- Departamento de Ginecología Obstetricia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - M A Rodrígues
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M T Espinoza
- Unidad de Climaterio, Clínica Los Ángeles, Cochabamba, Bolivia
| | - C Salinas
- Servicio de Obstetricia y Ginecología, Hospital Ángeles Puebla, Puebla, México
| | - J Párraga-Párraga
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - 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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Carrillo-Larco RM, Di Cesare M, Hambleton IR, Hennis A, Irazola V, Stern D, Ferreccio C, Lotufo P, Perel P, Gregg EW, Ezzati M, Danaei G, Miranda JJ, Aguilar-Salinas CA, Alvarez-Váz R, Amadio MB, Baccino C, Bambs C, Bastos JL, Beckles G, Bernabe-Ortiz A, Bernardo CDO, Bloch KV, Blümel JE, Boggia JG, Borges PK, Bravo M, Brenes-Camacho G, Carbajal HA, Castillo Rascon MS, Ceballos BH, Colpani V, Confortin SC, Cooper JA, Cortés-Valencia A, Cortes S, Cunha RS, d'Orsi E, Dow WH, Espeche WG, Fuchs FD, Fuchs SC, Gimeno SGA, Gomez-Velasco D, Gonzalez-Villalpando C, Gonzalez-Villalpando ME, Gonzalez-Chica DA, Grazioli G, Guerra RO, Gutierrez L, Herkenhoff FL, Horimoto ARVR, Huidobro A, Koch E, Lajous M, Lima-Costa MF, Lopez-Ridaura R, Maciel ACC, Manrique-Espinoza BS, Marques LP, Mill JG, Moreira LB, Ono LM, Muñoz OM, Oppermann K, Peixoto SV, Pereira AC, Peres KG, Peres MA, Rodriguez NI, Rojas-Martinez R, Rosero-Bixby L, Rubinstein A, Ruiz-Morales A, Salazar MR, Salinas-Rodriguez A, Sanchez RA, Schneider IJC, Silva TLN, Silva NAS, Smeeth L, Spritzer PM, Tartaglione F, Tartaglione J. Cohort Profile: The Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Int J Epidemiol 2020; 49:1437-1437g. [PMID: 32888015 PMCID: PMC7746413 DOI: 10.1093/ije/dyaa073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022] Open
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Blümel JE, Carrillo-Larco RM, Vallejo MS, Chedraui P. Multimorbidity in a cohort of middle-aged women: Risk factors and disease clustering. Maturitas 2020; 137:45-49. [PMID: 32498936 PMCID: PMC7284304 DOI: 10.1016/j.maturitas.2020.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We aimed to evaluate which risk factors in middle-aged women are associated with higher risk of multimorbidity in older age. STUDY DESIGN We conducted a prospective cohort study from 1990 to 1993 in Santiago de Chile, Chile among women aged 40-59 (at baseline). Diagnosed illnesses were retrieved from national health records in 2020. MAIN OUTCOME MEASURES Clinical and laboratory evaluation was conducted. RESULTS 1066 women were followed-up for a mean of 27.8 years, after which 49.7% presented multimorbidity. These women, as compared with those without multimorbidity, were more likely at baseline to have had obesity (20.4% vs. 8.6%, p < 0.001); be post-menopause (47.2% vs. 40.5%; p < 0.03); have jobs that did not require a qualification (74.2% vs. 56.0%, p < 0.001); arterial hypertension (19.8% vs 14.4%, p < 0.018); lower HDL-cholesterol (51.3 ± 12.9 vs. 53.6±12.7 mg/dL, p < 0.005); and higher triglyceride levels (136.0 ± 65.0 vs. 127.0 ± 74.0 mg/dL, p = 0.028). Hypertension was associated in 22.0% of women with diabetes, in 20.9% with osteoarthritis and 14.0% with depression. Osteoarthritis was also associated with diabetes mellitus (8.3%) and depression (7.8%). Diabetes mellitus, in addition to hypertension and osteoarthritis, was associated with depression (6.4%). In a logistic regression model, we observed that obesity in middle-aged women was the strongest risk factor for multimorbidity in the elderly (OR: 2.48; 95% CI, 1.71-3.61), followed by having a job that did not require a qualification (OR: 2.18; 95% CI, 1.67-2.83) and having a low HDL-cholesterol level (OR: 1.31; 95% CI, 1.02-1.68). CONCLUSIONS Multimorbidity was highly prevalent in this older female population. Obesity in middle-aged women was the strongest risk factor for multimorbidity at older age. These results are relevant for Chile and other countries with similar population profiles.
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Affiliation(s)
- Juan E Blümel
- Departamento De Medicina Interna Sur, Facultad De Medicina, Universidad De Chile, Santiago De Chile, Chile.
| | - Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - María S Vallejo
- Clínica Quilín, Facultad De Medicina, Universidad De Chile, Santiago De Chile, Chile
| | - Peter 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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10
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Vallejo MS, Blümel JE, Arteaga E, Aedo S, Tapia V, Araos A, Sciaraffia C, Castelo-Branco C. Gender differences in the prevalence of vitamin D deficiency in a southern Latin American country: a pilot study. Climacteric 2020; 23:410-416. [PMID: 32367772 DOI: 10.1080/13697137.2020.1752171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: This study aimed to study the prevalence of vitamin D deficiency, assessing the influence of sex, age, and season of the year.Methods: A cross-sectional study was conducted with 1329 healthy subjects (668 women and 661 men) aged 18-89 years in Santiago, Chile. Age (years), body mass index, medical history, working status, sex, and date of blood sample were collected.Results: Men were slightly older than women (53.1 ± 18.2 vs. 50.0 ± 15.6 years; p < 0.01) and a higher percentage worked outside the home (73.1% vs. 51.9%, p < 0.001). The mean serum concentration of 25-hydroxyvitamin D (25(OH)-D) was 23.3 ± 9.3 ng/ml in women and 20.9 ± 9.5 ng/ml in men (p < 0.001). The levels of 25(OH)-D by season were 26.7 ± 9.0, 23.6 ± 9.7, 19.4 ± 8.5, and 19.1 ± 9.5 ng/ml (for summer, fall, winter, and spring, respectively; p < 0.05). The prevalence of vitamin D deficiency increases with age, rising from 36.5% under 40 years to 48.0% over 60 years (p < 0.004). Male sex, winter and spring, and age showed negative correlation with levels of 25(OH)-D (p < 0.05). Multivariate linear regression showed a final model that incorporates: age (coefficient: -0.06; 95% confidence interval [CI]: -0.09 to -0.03; p < 0.001), male sex (coefficient: -2.00; 95% CI: -2.96 to -1.05; p < 0.001), summer (coefficient: 7.30; 95% CI: 6.17 to 8.43; p < 0.001), and fall (coefficient: 4.27; 95% CI: 3.04 to 5.50; p < 0.001).Conclusions: Vitamin D deficiency is more prevalent in men than in women, in the elderly, and during the winter and spring seasons.
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Affiliation(s)
- M S Vallejo
- Clínica Quilín, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - J E Blümel
- Department of Medicine South, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - E Arteaga
- Department of Endocrinology and CETREN, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - S Aedo
- School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - V Tapia
- Clínica Quilín, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - A Araos
- Clínica Quilín, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - C Sciaraffia
- Clínica Quilín, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - C Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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11
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Blümel JE, Arteaga E, Aedo S, Arriola-Montenegro J, López M, Martino M, Miranda C, Miranda O, Mostajo D, Ñañez M, Ojeda E, Pilnik S, Rojas J, Salinas C, Sosa L, Spritzer PM, Tserotas K, Vallejo MS, Belardo A, Fighera TM, Chedraui P. Metformin use is associated with a lower risk of osteoporosis in adult women independent of type 2 diabetes mellitus and obesity. REDLINC IX study. Gynecol Endocrinol 2020; 36:421-425. [PMID: 31994945 DOI: 10.1080/09513590.2020.1718092] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metformin may decrease cell senescence, including bone; hence we aimed at evaluating the association between metformin use and osteoporosis. This was a cross-sectional study carried out in 1259 Latin American adult women aged 40 or more who were not on anti-osteoporotic drugs, were on metformin and had a bone densitometry performed. Of the whole sample, 40.3% reported being on metformin (at least 1 year), 30.2% had type 2 diabetes mellitus and 22.6% had osteoporosis. Median (interquartile range) body mass index (BMI) for the whole cohort was 27.7 (4.6) kg/m2 and 30.2% had type 2 diabetes mellitus. Current use of hormone therapy, calcium, and vitamin D corresponded respectively to 10.7%, 47.7%, and 43.1% of all surveyed women. A logistic regression model was used to analyze the association of osteoporosis with various covariates incorporated into the model such as age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 0.92, 95% CI: 0.89-0.96) and metformin use (OR: 0.44, 95% CI: 0.32-0.59). Metformin use, regardless of the presence of type 2 diabetes or obesity, was associated with a lower risk of osteoporosis in adult women. We propose that one explanation for this observation could be the effect of the drug over cellular senescence.
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Affiliation(s)
- Juan E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Eugenio Arteaga
- Departamento de Endocrinología and CETREN, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Sócrates Aedo
- Escuela de Medicina, Facultad de Medicina, Universidad Finis Terrae, Santiago de Chile, Chile
| | | | - Marcela López
- Departamento de Endocrinología, Hospital Militar, Santiago de Chile, Chile
| | - Mabel Martino
- Red Latinoamericana de Investigación en Climaterio, Rosario, Argentina
| | | | | | - Desireé Mostajo
- Red Latinoamericana de Investigación en Climaterio, Santa Cruz, Bolivia
| | - Mónica Ñañez
- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eliana Ojeda
- Departamento de Obstetricia y Ginecología, Universidad Andina del Cusco, Cusco, Perú
| | | | - José Rojas
- Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Lida Sosa
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Poli M Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas, Porto Alegre, Brazil
| | - Konstantinos Tserotas
- Departamento de Gineco-Obstetricia, Complejo Hospitalario Dr. Arnulfo Arias Madrid de la Caja del Seguro Social de Panamá, Ciudad de Panamá, Panamá
| | - María S Vallejo
- Clínica Quilín, Universidad de Chile, Santiago de Chile, Chile
| | - Alejandra Belardo
- Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Tayane M Fighera
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas, Porto Alegre, Brazil
| | - Peter Chedraui
- Facultad de Ciencias Médicas, Instituto de Investigación e Innovación en Salud Integral, 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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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Aedo S, Blümel JE, Carrillo-Larco RM, Vallejo MS, Aedo G, Gómez GG, Campodónico I. Association between high levels of gynoid fat and the increase of bone mineral density in women. Climacteric 2019; 23:206-210. [PMID: 31736370 DOI: 10.1080/13697137.2019.1679112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: In women, bone mineral density (BMD) is related to age, estrogenic action, and appendicular skeletal muscle mass (ASMM). The gynoid fat distribution is linked to estrogenic action.Objective: This study aimed to assess whether an increase of gynoid fat is associated with high BMD independent of age and ASMM.Methods: An observational study was performed in women aged between 20 and 79 years. Fat mass, ASMM, and BMD were measured with dual-energy X-ray absorptiometry. The binned scatterplots and multivariate linear regression models were used to study the relationship between hip BMD and age, height, android fat, gynoid fat, and ASMM.Results: Of 673 women invited, 596 accepted to participate. Their mean age was 55.4 ± 12.8 years, weight 63.4 ± 9.4 kg, height 1.61 ± 0.06 m, body mass index 24.54 ± 3.59 kg/m2, average hip BMD 0.914 ± 0.122 g/cm2, android fat 2.12 ± 0.83 kg, gynoid fat 4.54 ± 1.07 kg, and ASMM 15.15 ± 1.97 kg. The final regression model included age (linear coefficient -0.004; 95% confidence interval [CI]: -0.005 to -0.003; p < 0.001), ASMM (linear coefficient 0.013; 95% CI: 0.009 to 0.018; p < 0.001), and gynoid fat (linear coefficient 0.013; 95% CI: 0.005 to 0.022; p < 0.002).Conclusion: Gynoid fat is associated with BMD in the hip independently of age and ASMM.
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Affiliation(s)
- S Aedo
- Escuela de Medicina, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - R M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - M S Vallejo
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - G Aedo
- Department of Obstetrics and Gynecology, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - G G Gómez
- Escuela de Medicina, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - I Campodónico
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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14
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Abstract
Objectives: This study aimed to evaluate muscle strength and related factors in Hispanic women.Methods: We studied 593 women between 40 and 89 years old. The women were asked about personal and clinical information. The following instruments were applied: dynamometer (strength), Short Physical Performance Battery (physical performance), SARC-F (sarcopenia), International Physical Activity Questionnaire (physical activity), Menopause Rating Scale (quality of life), 36-item Short Form (general health), and Frailty (Fried's criteria).Results: Low muscle strength rises from 7.1% of women in their 40s to 79.4% in their 80s. Physical performance is low in 0.5% of the first group and rises to 60.5% in the second. The risk of sarcopenia increases significantly from 6.7% in younger women to 58.1% in older women. Frailty, which affects less than 1% of women under age 60 years, increases to 39.5% in their 80s. Sedentary lifestyle rises from 26% to 68.3%. Fragility impairs the quality of life and the perception of health (p < 0.0001). The deterioration of different tests of muscle function is significantly associated with age >70 years (OR 5-20) and with osteoarthritis (OR 4-9). Menopause before the age of 45 years increases the risk of sarcopenia (odds ratio 2.2; 95% confidence interval 1.2-4.0).Conclusion: With aging there is a decrease in muscle strength and an increase in frailty. This entails a decrease in the quality of life.
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Affiliation(s)
- J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C Salinas
- Servicio de Obstetricia y Ginecología, Hospital Ángeles Puebla, Puebla, México
| | - L Danckers
- Obstetricia y Ginecología, Clínica Centenario, Lima, Perú
| | - K Tserotas
- Departamento de Ginecologia y Obstetricia, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja del Seguro Social de Panamá, Panamá City, Panamá
| | - E Ojeda
- Departamento de Obstetricia and Ginecología, Universidad Andina del Cusco, Cusco, Peru
| | - M S Vallejo
- Obstetricia y Ginecología. Clínica Quilín, Universidad de Chile, Santiago, Chile
| | - E Arteaga
- Departamento de Endocrinología and CETREN, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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15
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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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16
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Abstract
OBJECTIVE This study aimed to evaluate the impact of different risk factors on long-term mortality in middle-aged women. METHODS Women who received preventive health care control between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2017. RESULTS We studied 1197 women aged between 40 and 60 years. We observed 183 deaths (survival 84.0%; 95% confidence interval [CI], 81.7-86.1, Kaplan-Meier survival analysis). The main causes of death were cancer (39.9%; 95% CI, 32.7-47.1), cardiovascular disease (22.9%; 95% CI, 16.8-29.1), infectious disease (13.7%; 95% CI, 8.6-18.7), other causes (7.1%, 95% CI, 3.4-10.9), and unspecified cause (6.6%; 95% CI, 2.9-10.2). The final Cox regression model showed the following hazard ratios for mortality: diabetes mellitus 2.51 (95% CI, 1.40-4.51), history of fracture 2.47 (95% CI, 1.15-5.30), history of heart illness 2.06 (95% CI, 1.15-3.72), arterial hypertension 1.51 (95% CI, 1.08-2.11), age 1.07 (95% CI, 1.04-1.10), body mass index 1.06 (95% CI, 1.02-1.09), and sexual intercourse 0.94 (95% CI, 0.89-0.98). Lipid disorders did not reach statistical significance as a risk factor. CONCLUSION Diabetes, a history of fractures, and cardiovascular risk factors, except lipids, are markers of long-term mortality in middle-aged women. Physicians should pay special attention to these risk factors.
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Affiliation(s)
- J E Blümel
- a Departamento de Medicina Interna Sur, Facultad de Medicina , Universidad de Chile , Santiago de Chile , Chile
| | - S Aedo
- b Escuela de Medicina, Facultad de Medicina , Universidad Finis Terrae , Santiago de Chile , Chile
| | - E Arteaga
- c Departamento de Endocrinología, Facultad de Medicina , Pontificia Universidad Católica de Chile , Santiago de Chile , Chile
| | - M S Vallejo
- d Clínica Quilín, Facultad de Medicina , Universidad de Chile , Santiago de Chile , Chile
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17
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Danckers L, Blümel JE, Witis S, Vallejo MS, Tserotas K, Sánchez H, Salinas C, Saavedra J, Rojas JA, Onatra W, Ojeda E, Mostajo D, Morera F, Monterrosa A, Montaño A, Meruvia N, Martino M, Martínez J, Lima S, González E, Gómez G, Espinoza MT, Castillo O, Campostrini B, Calle A, Broutin G, Bencosme A, Arteaga E, Ayala F, Chedraui P. Personal and professional use of menopausal hormone therapy among gynecologists: A multinational study (REDLINC VII). Maturitas 2016; 87:67-71. [PMID: 27013290 DOI: 10.1016/j.maturitas.2016.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE To determine the use of MHT and perceived related risks among gynecologists. METHODS A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.
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Affiliation(s)
- Luis Danckers
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Juan E Blümel
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile; Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Silvina Witis
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - María S Vallejo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Konstantino Tserotas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Hugo Sánchez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Carlos Salinas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Javier Saavedra
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - José A Rojas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - William Onatra
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Eliana Ojeda
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Desireé Mostajo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Flory Morera
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Alvaro Monterrosa
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Armando Montaño
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Nelva Meruvia
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Mabel Martino
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Jaime Martínez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Selva Lima
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Erik González
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Gustavo Gómez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - María T Espinoza
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Olivia Castillo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Blanca Campostrini
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Andrés Calle
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Gerardo Broutin
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Ascanio Bencosme
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Eugenio Arteaga
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Félix Ayala
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile
| | - Peter Chedraui
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago, Chile; Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
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Blümel JE, Chedraui P, Aedo S, Fica J, Mezones-Holguín E, Barón G, Bencosme A, Benítez Z, Bravo LM, Calle A, Flores D, Espinoza MT, Gómez G, Hernández-Bueno JA, Laribezcoa F, Martino M, Lima S, Monterrosa A, Mostajo D, Ojeda E, Onatra W, Sánchez H, Tserotas K, Vallejo MS, Witis S, Zúñiga MC. Obesity and its relation to depressive symptoms and sedentary lifestyle in middle-aged women. Maturitas 2014; 80:100-5. [PMID: 25459364 DOI: 10.1016/j.maturitas.2014.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND The prevalence of obesity increases during female mid-life and although many factors have been identified, data from Latin America is lacking. OBJECTIVE To assess factors related to obesity among middle-aged women and determine the association with depressive symptoms, sedentary lifestyle and other factors. METHODS A total of 6079 women aged 40-59 years of 11 Latin American countries were asked to fill out the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index and a general questionnaire containing personal socio-demographic data, anthropometric measures and lifestyle information. Obesity was defined as a body mass index (BMI) ≥30 kg/m(2). RESULTS Obesity was observed in 18.5% and sedentary lifestyle in 63.9%. A 55.5% presented vasomotor symptoms, 12.2% had severe menopausal symptoms and 13.2% used hormone therapy for the menopause. Prevalence of depressive symptoms was 46.5% and anxiety 59.7%. Our logistic regression model found that significant factors associated to obesity included: arterial hypertension (OR: 1.87), depressive symptoms (OR: 1.57), sedentary lifestyle (OR: 1.50) diabetes mellitus (OR: 1.34), higher number of individuals living at home (OR: 1.31), sleep problems (OR:1.22), anxiety (OR: 1.21), having a stable partner (OR: 1.20), parity (OR: 1.16) and vasomotor symptoms (OR:1.14). A lower risk for obesity was found among women using hormonal contraceptives (OR: 0.69). CONCLUSION Obesity in middle-aged women is the consequence of the interaction of multiple factors. It was associated to hypertension, depressive symptoms, sedentary lifestyle, climacteric symptoms and other factors.
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Affiliation(s)
- Juan E Blümel
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile; Departamento Medicina Sur, Facultad de Medicina, Universidad de Chile Orquídeas 1068, Dpto 302 PO Box 7510258, Providencia, Santiago de Chile, Chile.
| | - Peter Chedraui
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile; Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Av. Carlos J Arosemena km 1.5, PO Box 09-01-4671, Guayaquil, Ecuador
| | - Sócrates Aedo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile; Departamento Medicina Sur, Facultad de Medicina, Universidad de Chile Orquídeas 1068, Dpto 302 PO Box 7510258, Providencia, Santiago de Chile, Chile
| | - Juan Fica
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Edward Mezones-Holguín
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Germán Barón
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Ascanio Bencosme
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Zully Benítez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Luz M Bravo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Andrés Calle
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Daniel Flores
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - María T Espinoza
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Gustavo Gómez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - José A Hernández-Bueno
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Fiorella Laribezcoa
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Mabel Martino
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Selva Lima
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Alvaro Monterrosa
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Desiree Mostajo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Eliana Ojeda
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - William Onatra
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Hugo Sánchez
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Konstatinos Tserotas
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - María S Vallejo
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - Silvina Witis
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
| | - María C Zúñiga
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Santiago de Chile, Chile
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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] [What about the content of this article? (0)] [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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Blümel JE, Chedraui P, Barón G, Benítez Z, Flores D, Espinoza MT, Gomez G, González E, Hernández L, Lima S, Martino M, Montaño A, Monterrosa A, Mostajo D, Ojeda E, Onatra W, Robles C, Saavedra J, Sánchez H, Tserotas K, Vallejo MS, Vallejo C. A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI). Climacteric 2014; 17:433-41. [PMID: 24443950 DOI: 10.3109/13697137.2014.882305] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use. OBJECTIVE To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed. METHOD This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use. RESULTS The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users. CONCLUSION The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.
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Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K, Vallejo MS. Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women. Maturitas 2013; 75:94-100. [DOI: 10.1016/j.maturitas.2013.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 01/01/2023]
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Blümel JE, Cano A, Mezones-Holguín E, Barón G, Bencosme A, Benítez Z, Bravo LM, Calle A, Flores D, Espinoza MT, Gómez G, Hernández-Bueno JA, Laribezcoa F, Martino M, Lima S, Monterrosa A, Mostajo D, Ojeda E, Onatra W, Sánchez H, Tserotas K, Vallejo MS, Witis S, Zúñiga MC, Chedraui P. A multinational study of sleep disorders during female mid-life. Maturitas 2012; 72:359-66. [PMID: 22717489 DOI: 10.1016/j.maturitas.2012.05.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors. OBJECTIVE To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed. METHODS A total of 6079 women aged 40-59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire. RESULTS Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40-44 to 45.2% in those aged 55-59, p<0.0001) and menopausal stage (from 39.5% in premenopausal aged 40-44 to 46.3% in late postmenopausal ones, p<0.0001). "Awakening during the night" (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6-8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality. CONCLUSION Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause.
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Affiliation(s)
- Juan E Blümel
- Collaborative Group for Research of the Climacteric in Latin America (REDLINC)
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Escajadillo-Vargas N, Mezones-Holguín E, Castro-Castro J, Córdova-Marcelo W, Blümel JE, Pérez-López FR, Chedraui P. Sexual Dysfunction Risk and Associated Factors in Young Peruvian University Women. J Sex Med 2011; 8:1701-9. [DOI: 10.1111/j.1743-6109.2011.02259.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Chedraui P, Pérez-López FR, Blümel JE, Hidalgo L, Barriga J. Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints. Gynecol Endocrinol 2010; 26:86-92. [PMID: 19908936 DOI: 10.3109/09513590903184092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Postmenopausal metabolic changes increase cardiovascular risk and impair quality of life (QoL). Despite this, few reports have addressed the association of these changes with female sexuality. OBJECTIVE To determine the association between the metabolic syndrome (METS), and its components, and female sexuality. METHODS Data of sexually active postmenopausal women who participated in a METS screening program who filled out the menopause-specific quality of life questionnaire (MENQOL) were assessed. Specifically the sexual domain of the MENQOL was analyzed in regard to mean total and item scores (decreased libido, vaginal dryness, and sexual avoidance). Criteria of the Third Adult Treatment Panel (ATP III) were used to identify women with the METS. RESULTS Two hundred six women fulfilled inclusion criteria. Mean age of participants was 54 ± 6.9 years (median: 54 years). Prevalence of the METS in this sexually active postmenopausal series was 39.8%. About 52.9% of them presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia, and 59.7% decreased high density lipoprotein cholesterol (HDL-C). Women with the METS as compared with those without the syndrome displayed no significant differences in MENQOL sexual scorings (total or of its composing items). Equally there were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia who significantly displayed a higher total sexual domain score (5.6 ± 2.1 vs. 4.8 ± 2.3, p < 0.05) in association to a higher mean score in the decreased libido item (6.0 ± 2.3 vs. 4.8 ± 2.6, p < 0.01). After controlling for several confounding factors, logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido (higher item score, OR 2.4, CI 95%: 1.0-5.7, p < 0.05) and more impaired sexuality (higher total MENQOL sexual domain score: OR, 2.5, CI 95%: 1.1-5.4, p < 0.05). CONCLUSION Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.
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Affiliation(s)
- Peter Chedraui
- Facultad de Ciencias Médicas, Institute of Biomedicine, Universidad Católica de Guayaquil, Guayaquil, Ecuador.
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Royer M, Castelo-Branco C, Blümel JE, Chedraui PA, Danckers L, Bencosme A, Navarro D, Vallejo S, Espinoza MT, Gómez G, Izaguirre H, Ayala F, Martino M, Ojeda E, Onatra W, Saavedra J, Tserotas K, Pozzo E, Manriquez V, Prada M, Grandia E, Zuniga C, Lange D, Sayegh F. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III): prevalence of the metabolic syndrome in postmenopausal Latin American women. Climacteric 2009; 10:164-70. [PMID: 17453865 DOI: 10.1080/13697130701258895] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Metabolic syndrome (METS) is a strong predictor of cardiovascular risk. Since the prevalence of METS increases after menopause, gynecological routine consultation offers an excellent screening opportunity. OBJECTIVES To assess the prevalence of METS in Latin American postmenopausal women and factors modifying its risk; as well as to assess the role of simple routine care measurements in the diagnosis of the METS. METHODS A total of 3965 postmenopausal women, aged 45-64 years, seeking health care at 12 gynecological centers in major Latin American cities were included in this cross-sectional study. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) guidelines were applied to assess METS. This was present if three or more of the following conditions were present: waist circumference > or = 88 cm; blood pressure > or = 130/85 mmHg; fasting plasma triglycerides > or = 150 mg/dl; high density lipoprotein (HDL) cholesterol < 50 mg/dl; glucose > or = 110 mg/dl or subjects were receiving treatment for their condition. RESULTS The prevalences of having at least two, three, four or five components were 62.5, 35.1, 13.5 and 3.2%, respectively. The prevalence increased from 28.1% in those aged 40-44 years to 42.9% in those aged 60-64 years. The risk of METS detection (multivariate analysis) increased with age (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.03-1.43), time elapsed since menopause (OR 1.18, 95% CI 1.00-1.38), smoking cigarettes (OR 1.40, 95% CI 1.19-1.65), obesity (OR 13.01, 95% CI 10.93-15.49) and hypertension (OR 9.30, 95% CI 7.91-10.94). In contrast, hormone therapy reduces this risk (OR 0.59, 95% CI 0.51-0.70). CONCLUSION There is a high prevalence of the metabolic syndrome in postmenopausal Latin American women seeking gynecologic health care. Age, years since menopause, obesity and hypertension are strong predictors of this condition.
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Blümel JE, Chedraui P, Gili SA, Navarro A, Valenzuela K, Vallejo S. Is the Androgen Deficiency of Aging Men (ADAM) questionnaire useful for the screening of partial androgenic deficiency of aging men? Maturitas 2009; 63:365-8. [PMID: 19481382 DOI: 10.1016/j.maturitas.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/13/2009] [Accepted: 04/25/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Androgen serum levels significantly decrease in older men, causing quality of life impairment and increasing the risk of chronic disease. This disorder is defined as PADAM (Partial Androgen Deficiency of Aging Men). OBJECTIVE To evaluate a PADAM screening tool and determine the prevalence of this disorder in healthy adult men. METHODS This was a cross-sectional study in which 96 men aged 40 or more of the South Metropolitan Region of Santiago de Chile were surveyed with the Androgen Deficiency of Aging Men (ADAM) questionnaire of the Saint Louis University and sampled for the serum determination of total testosterone, sexual hormone binding globulin (SHBG) and albumin. Also free and bioavailable testosterone were calculated. PADAM was considered present if items 1 or 7 or any 3 other questions of the ADAM questionnaire were positive. An available testosterone of <198.4 ng/dL was used as a gold standard for the diagnosis of PADAM. RESULTS A total of 78 men (81.3%) were identified as possible PADAM according to the ADAM questionnaire. Total testosterone levels fell from 503.6+/-180.1 ng/dL in men aged 40 to 54 years to 382.1+/-247.3 in those >70 years; however this was not statistically significant (ANOVA, p=0.06). In the same age groups, SHBG significantly increased (31.0+/-15.0 to 47.5+/-15.0 nmol/L, p<0.001) whereas free and available testosterone significantly decreased (10.6+/-3.2 to 6.4+/-3.6 ng/dL and 266.6+/-81.2 to 152.2+/-97.6 ng/dL, respectively, p<0.0001). Overall (n=96), available testosterone confirmed PADAM diagnosis in 27 cases (28.1%). The ADAM tool rendered a 83.3% sensitivity and 19.7% specificity in the detection of PADAM. Item 1 (decreased sexual desire) was a better predictor of hypogonadism than the complete questionnaire (63.3% sensitivity and 66.7% specificity). CONCLUSION In this series, in accordance to available testosterone, the prevalence of PADAM was determined to be high, in which the ADAM questionnaire rendered a low diagnostic efficiency. PADAM diagnosis could be clinically suspected when symptoms of sexual dysfunction are present.
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Affiliation(s)
- Juan E Blümel
- Facultad Medicina, Universidad de Chile, Santiago de Chile, Chile
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Jara D, Fuenzalida A, Figueroa R, del Prado M, Flores D, Blümel JE, Chedraui P. Is the Menopause Rating Scale accurate for diagnosing sexual dysfunction among climacteric women? Maturitas 2009; 62:321-3. [PMID: 19217728 DOI: 10.1016/j.maturitas.2009.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/11/2008] [Accepted: 01/14/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although several tools have been designed to assess quality of life (QoL) among middle-aged women their capacity to specifically assess sexual dysfunction (SD) remains uncertain. Moreover, if SD impairs QoL within this population, then sexual assessment becomes a key issue. OBJECTIVES To evaluate the accuracy of the Menopause Rating Scale (MRS) in diagnosing SD among climacteric women. METHODS In this cross-sectional study 370 women aged 40-59 years filled out the MRS and the Female Sexual Functioning Index (FSFI) simultaneously. SD among surveyed women was defined as those obtaining a total FSFI score of <or=26.55. A receiver-operator curve (ROC) was used to plot and measure the diagnostic accuracy of one MRS item (item 8, assessing sexual problems) using the FSFI total score as a gold standard. RESULTS Mean age of surveyed women was 49.3+/-5.8 years. A 56.5% of them were married, 44.3% were postmenopausal, 66.8% were sexually active and 57% had SD (FSFI total score <or=26.55). ROC curve determined a score >or=1 in the MRS item 8 as a cut-off value for discriminating women with SD (78% sensitivity and 62% specificity with an area below the curve of 0.70 Swett). CONCLUSIONS The MRS was moderately accurate for diagnosing SD among climacteric women. More research is warranted in this regard.
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Blümel JE, Del Pino M, Aprikian D, Vallejo S, Sarrá S, Castelo-Branco C. Effect of androgens combined with hormone therapy on quality of life in post-menopausal women with sexual dysfunction. Gynecol Endocrinol 2008; 24:691-5. [PMID: 19172538 DOI: 10.1080/09513590802454919] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM To evaluate with validated instruments changes in quality of life and sexuality in women receiving hormonal replacement therapy (AHT). DESIGN Randomised, double-blind, double-dummy study with two parallel treatment arms. PATIENTS AND METHODS Forty-seven healthy post-menopausal women, aged 45-64 years, were evaluated using the Female Sexual Function Index (FSFI) and the menopause-specific quality of life questionnaire (MENQOL). Of them, 40 diagnosed with sexual dysfunction were randomised (1:1) to receive daily 0.625 mg of conjugated estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised progesterone or placebo. After 3 months follow-up, FSFI and MENQOL questionnaires were administered for a second time. RESULTS Quality of life was unchanged in the placebo group whereas AHT significantly improved scores of vasomotor, psychological, physical and sexual symptoms. As expected, FSFI was not modified in the placebo group while in AHT group the FSFI score improved significantly. In addition, at the end of the study, 68.7% of subjects of the AHT group did not fit did not fit the criteria for sexual dysfunction as per the FSFI (p < 0.0001). CONCLUSIONS Adding methyl-testosterone to hormone therapy improves quality of life and sexuality in post-menopausal women with sexual dysfunction.
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Affiliation(s)
- J E Blümel
- Facultad Medicina, Departamento Medicina Sur, Universidad de Chile, Santiago de Chile, Chile
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Chedraui P, Blümel JE, Baron G, Belzares E, Bencosme A, Calle A, Danckers L, Espinoza MT, Flores D, Gomez G, Hernandez-Bueno JA, Izaguirre H, Leon-Leon P, Lima S, Mezones-Holguin E, Monterrosa A, Mostajo D, Navarro D, Ojeda E, Onatra W, Royer M, Soto E, Tserotas K. Impaired quality of life among middle aged women: A multicentre Latin American study. Maturitas 2008; 61:323-9. [DOI: 10.1016/j.maturitas.2008.09.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/23/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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Castelo-Branco C, Blümel JE, Chedraui P, Calle A, Bocanera R, Depiano E, Figueroa-Casas P, Gonzalez C, Martino M, Royer M, Zuñiga C, Dulon A, Espinoza MT, Futchner C, Mostajo D, Soto E, Albernaz MA, Marco AA, Aravena H, Busquets M, Campodonico I, Germain A, Alba A, Baron G, Gomez G, Monterrosa A, Onatra W, Broutin G, Manzano B, Gabriela A, Hidalgo L, Leon P, Orbea M, Sanchez H, Vallejo S, Vallecillo G, Hernandez-Bueno J, Hernandez-Bueno JA, Motta E, Andrade R, Tserotas K, Gonzalez MC, Gonzalez CM, Benitez Z, Calle E, Danckers L, Del Castillo A, Izaguirre H, Ojeda E, Rojas J, Bencosme A, Lima S, Motta E, Figueroa-Casas P. Age at menopause in Latin America. Menopause 2006; 13:706-12. [PMID: 16837893 DOI: 10.1097/01.gme.0000227338.73738.2d] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the age at menopause (AM) in Latin America urban areas. DESIGN A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis. RESULTS The mean age of the entire sample was 49.4 +/- 5.5 years. Mean educational level was 9.9 +/- 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P < 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P < 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P < 0.001) were more prone to an earlier onset of menopause. CONCLUSIONS The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause.
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Affiliation(s)
- Camil Castelo-Branco
- Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic Provincial, Villarroel, Barcelona, Spain [corrected]
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Abstract
BACKGROUND Pressure ulcers are a common complication among elderly patients confined to bed for long periods. The Braden scale is a commonly used risk assessment tool. AIM To evaluate the use of Braden scale. PATIENTS AND METHODS Seventy women aged 61 to 96 years, admitted to the Internal Medicine Service of Barros Luco-Trudeau Hospital, were studied. Their risk was evaluated using the Braden scale. The presence of pressure ulcer was diagnosed according to the National Pressure Ulcer Advisory Panel on admission, two weeks later and at discharge. RESULTS On admission, mean Braden scale score was 16.6+/-2.8 and 34 women had a score of 16 or less, that is considered of risk. Twenty five women (20 with a score of 16 or less) developed pressure ulcers, mostly superficial. The odds ratio of a score of 16 or less for the development of ulcers was 4.2 (95% CI 1.8-11.7, p <0.001). The sensitivity and specificity of such score were 80 and 69% respectively. CONCLUSIONS The Braden scale predicts the risk of developing pressure ulcers with a good sensitivity and specificity in female elderly patients.
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Affiliation(s)
- Juan E Blümel
- Departamento Medicina Sur, Universidad de Chile, Santiago de Chile
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Castelo-Branco C, Sanjuán A, Casals E, Ascaso C, Colodrón M, Vicente JJ, Mercader I, Escaramís G, Blümel JE, Ordi J, Vanrell JA. Raloxifene inhibits cholesterol aortic content but not atherosclerotic plaque size in oophorectomised cholesterol-fed rabbits. J OBSTET GYNAECOL 2004; 24:47-51. [PMID: 14675981 DOI: 10.1080/01443610310001620297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Raloxifene, a selective oestrogen receptor modulator, is effective in the treatment of osteoporosis without stimulating the breast and the endometrium. Although it is associated with a decrease of cardiovascular risk markers the effect of these changes on atherogenesis, is not clear. In this study, we aimed to investigate the effect of raloxifene on aorta atherogenesis. A total of 32 cholesterol-fed New Zealand white rabbits were studied for 4 months. Twenty-four rabbits underwent bilateral ovariectomy; of these eight received raloxifene (group OR), eight received oestradiol valerate (group OE) and eight received placebo after sterilisation (group OP). Finally, another eight were sham-operated (non-ovariectomised) and received placebo with a hypercholesterolaemic diet (group SP). After the diet, total levels of cholesterol increased in group SP from 111.25 +/- 34.8 mg/dl to 1112.25 +/- 364.2, in group OP from 122.62 +/- 27.7 mg/dl to 1367.37 +/- 348.4, in group OE from 65.25 +/- 17.01 to 1710.5 +/- 356.2 and in group OR from 108.88 +/- 15.54 mg/dl to 1407.86 +/- 397.7 (no significant differences). At 4 months, in both treated and untreated rabbits, the cholesterol-rich diet caused atherosclerotic lesions affecting 24.51 +/- 16.1% for group SP, 30.47 +/- 12.2% for group OP, 30.31 +/- 18.07% for group OR and 17.91 +/- 10.19 for group OE (P<0.05) of the aortic surface, respectively. Aortic cholesterol expressed as mg of cholesterol/mg aortic weight was found to decrease in raloxifene-treated rabbits: 3.82 +/- 2.14 mg col/aortic mg versus 8.55 +/- 4.63 (group OP) and 11.97 +/- 11.33 (group SP). P<0.001. Raloxifene reduced aortic cholesterol content but not the atherosclerotic plaque extension in cholesterol-fed ovariectomised rabbits.
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Affiliation(s)
- C Castelo-Branco
- Menopause Clinic, Department of Gynecology and Obstetrics, Public Health Department, Hospital Clínic Provincial, University of Barcelona, Spain.
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Castelo-Branco C, Blümel JE, Roncagliolo ME, Haya J, Bolf D, Binfa L, Tacla X, Colodrón M. Age, menopause and hormone replacement therapy influences on cardiovascular risk factors in a cohort of middle-aged Chilean women. Maturitas 2003; 45:205-12. [PMID: 12818466 DOI: 10.1016/s0378-5122(03)00140-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the prevalence of obesity and other cardiovascular risk factors (RF) in middle-aged women, to correlate them with each other, and to describe the prevalence of such a RF and their changes with aging, menopause and Hormone Replacement Therapy (HRT) in a cohort of Chilean workers. MATERIAL AND METHOD In 1991-1992 cardiovascular RFs were assessed in 467 women between 40 and 59 who were not taking HRT at that time. Five years later these women were re-evaluated. RESULTS Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the more prevalent RF. These RF become more prevalent with age. In the second control, 5 years later, hypertension (20.9%), obesity (27.3%), smoking (20.8%) and diabetes (5.9%) were observed increased. Dyslipidemia did not changed, although triglyceride levels rose from 125.9+/-56.4 to 136.8+/-63.5 mg/dl (P<0.01). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5-years follow-up from 3.8 to 35%, and related to its use a decrease in LDL-cholesterol and an increase in HDL-cholesterol levels were detected. CONCLUSION Middle-aged women included in this cohort have a high prevalence of RF; these deteriorate with age, but no with menopause. HRT improves the lipid profile.
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Affiliation(s)
- Camil Castelo-Branco
- Department of Gynecology and Obstetrics, Menopause Clinic, Hospital Clinic Provincial, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
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Blümel JE, Castelo-Branco C, Kerrigan N, Cancelo MJ, Blümel B, Haya J, Flores M, Carvajal MC, Sarrá S. Influences of hormone replacement therapy on postmenopausal women's health perceptions. Menopause 2003; 10:235-40. [PMID: 12792296 DOI: 10.1097/00042192-200310030-00011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the beliefs of climacteric women regarding their health, menopause, and hormone replacement therapy (HRT). DESIGN Medical students asked to interview 526 healthy women, ranging from 40 to 64 years of age, between January and February of 2002. Of that number, 26 (4.9%) declined to participate in the interview. Thus, 500 women were interviewed about their beliefs and perceptions regarding their quality of life and health risks, as well as their opinions on menopause and HRT. RESULTS The mean age of the sample was 53.3 +/- 6.2 years; 83.4% were postmenopausal, and 18.8% were HRT users. Of the women interviewed, 38.6% believed that their health was good. Although 78.8% thought that cancer is the main cause of death, 64% of them considered themselves to be at high risk for cardiovascular disease and osteoporosis. Most (64%) believed that menopause deteriorates the quality of life and that it increases cardiovascular risk (52.4%) and osteoporosis (72.0%). The HRT users perceived that they had better health status (48.9% v 36.2%, P < 0.02) and smaller cardiovascular risk (54.3% v 66.3%, P < 0.04) than did the nonusers; however, they ignored the preventive effect of estrogens in osteoporosis. CONCLUSIONS Women believe that menopause deteriorates their health. The HRT users perceived themselves to be healthier and to have a smaller risk for cardiovascular disease.
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Affiliation(s)
- Juan E Blümel
- Fundación PROSAM, Hospital Barros Luco-Trudeau, Departmento Medicina Sur. Facultad Medicina, Universidad de Chile, Santiago, Chile
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Blümel JE, Castelo-Branco C, de la Cuadra G, Maciver L, Moreno M, Haya J. Alendronate daily, weekly in conventional tablets and weekly in enteric tablets: preliminary study on the effects in bone turnover markers and incidence of side effects. J OBSTET GYNAECOL 2003; 23:278-81. [PMID: 12850861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Bisphosphonates are now in the vanguard of osteoporosis treatment. Frequently, gastro-oesophageal symptoms are associated with these drugs. The objective of this study was to compare side effects and bone turnover markers in postmenopausal women who had received alendronate daily or weekly in tablets with or without enteric coating. We conducted a randomised, double-blind, 3-month trial. The trial involved 75 volunteers, aged 45-58 with moderate to severe osteopenia (T-score lower than -2 SD) assessed by quantitative ultrasound. Women were assigned randomly to receive: (a) alendronate 10mg/day: (b) alendronate 70 mg once a week: or (c) enteric alendronate 70 mg per week. We recorded side effects, C-telopeptide, osteocalcin and urine hydroxyproline at the start of the study and at 3 months. After 3 months, pyrosis (heartburn) was noted by seven women in group A (28%), three in group B (12%) and two in group C (8%); nausea: by one woman in group B; and headache by one patient in each group. C-telopeptide (A: 40.7%; B: 34.1% and C: 38.5%); hydroxyproline (A: 31.1%;B: 25.3% and C: 31.5%) and osteocalcin (A: 27.0%; B: 25.4% and C: 25.1%) decreased similarly in the three groups. Weekly intake of alendronate, whether conventional or enteric-coated; is associated with less heartburn and nausea. Enteric alendronate has a similar action to the conventional tablets on biochemical markers.
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Affiliation(s)
- J E Blümel
- Climacteric Unit Barros Luco-Tradeau Hospital, Santiago, Chile
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Blümel JE, Castelo-Branco C, Leal T, Gallardo L, Saini J, Ferron S, Haya J. Effects of transdermal estrogens on endothelial function in postmenopausal women with coronary disease. Climacteric 2003; 6:38-44. [PMID: 12725663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Oral estrogens improve endothelial function, and for this reason may be considered cardioprotective; however, in women with coronary heart disease there may also be an increase in the risk of thrombosis. Although transdermal estrogen administration may decrease this adverse effect, there are few data on endothelial function in women with coronary heart disease treated using such therapy. This study aimed to report the endothelial response in postmenopausal women with coronary heart disease treated with transdermal estrogen. MATERIALS AND METHODS This was a double-blind, prospective, randomized study. Eighteen patients with a history of acute coronary syndrome and nine healthy women were studied over 4 weeks. Coronary patients were assigned at random to receive a patch containing either 50 microg estradiol or placebo on a weekly basis. Endothelial function was assessed by flow-mediated vasodilatation of the brachial artery. Baseline blood flow (brachial artery diameter) was measured after 30 min rest and following ischemia, prior to treatment and after 4 weeks. RESULTS Flow-mediated vasodilatation in normal patients was 17.8%, whereas in women with coronary disease it was 1.2% (p = 0.0001). Arterial diameter for the resting period in coronary disease subjects increased from 4.22 +/- 0.59 to 4.41 +/- 0.56 mm (p < 0.004) after 4 weeks of estrogen therapy, whereas, in women receiving placebo, it did not change. Flow-mediated vasodilatation in the estrogen group was 3.4% and in the placebo group was 0.5% (p = 0.05). CONCLUSIONS Transdermal estrogen may improve endothelial function in women with coronary heart disease.
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Affiliation(s)
- J E Blümel
- Climacteric Unit, Barros Luco-Tradeau Hospital, Santiago, Chile
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Blümel JE, Castelo-Branco C, Riquelme R, Araya H, Jaramillo P, Tacla X, Colodrón M, Lavín P. Use of hormone replacement therapy among Chilean women: a comparison between socioeconomic levels. Menopause 2002; 9:377-80. [PMID: 12218727 DOI: 10.1097/00042192-200209000-00011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the use of hormone replacement therapy (HRT) among Chilean women according to their socioeconomic level. METHODS A total of 540 women between 50 and 79 years of age were interviewed in Santiago, Chile. Women were allocated into two groups (H, high; L, low), according to their socioeconomic status. RESULTS Each group consisted of 270 women. The mean age and percentage of menopausal women were similar in both groups. Of the interviewed women, 47% had taken HRT at some time; marked differences between the two groups were observed (L, 15%; H, 79%; < 0.0001). In group H, the percentage of women who had been advised about HRT was close to 88%, whereas, in group L, the percentage was only 24%. Among the women who were informed about HRT, 83% ( = 253) had used it at some time. The percentage of women who used HRT for >2 years was similar in both groups. The main reason for not taking HRT in group H was fear of adverse effects, whereas the main reason for not taking it in group L was the lack of medical advice. CONCLUSIONS The percentage of women in the low socioeconomic group who use HRT is low. Medical advice is fundamental to increasing HRT use in this group.
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Affiliation(s)
- Juan E Blümel
- Hospital Barros Luco-Trudeau, Department of Medicine, Universidad de Chile, Santiago de Chile, Chile
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Blümel JE, Castelo-Branco C, Sanjuán A, González P, Moyano C, Iturriaga TM, Gonzalez R, Romero S, Cano A. A simplified method to quantitate atherosclerosis in the rabbit aorta. Maturitas 2001; 39:265-71. [PMID: 11574187 DOI: 10.1016/s0378-5122(01)00195-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A simple method to quantitatively evaluate atherosclerosis in the rabbit aorta by measuring macroscopic lesion areas (%) was attempted in the present study. Ten female New Zealand white rabbits were fed on a cholesterol-rich diet (5/1000 g of food) during 4 months. Five of them were oophorectomized at the beginning and all were sacrificed at the end. Total levels of cholesterol increased from 50.7+/-14.7 mg/dl to 782.8+/-296.0. No significant differences were observed between oophorectomized and intact rabbits. At 4 months, the cholesterol-rich diet caused in both, intact and oophorectomized rabbits, atherosclerotic lesions affecting 17 and 46% of the aortic surface, respectively. This method may be more practical, easy and useful for quantitative evaluation of aortic atherosclerosis in a large number of rabbits, than histological observations of serial sections of rabbit's aortas.
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Affiliation(s)
- J E Blümel
- Climacteric Unit, Barros Luco-Tradeau Hospital, Santiago, Chile
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Blümel JE, Prieto JC, Leal T, Cruz MN, Gallardo L. [Cardiovascular risk factors in middle-age women with acute coronary syndromes]. Rev Med Chil 2001; 129:995-1002. [PMID: 11725480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND In Chile, 40% of deaths due to acute myocardial infarction occur in women. AIM To assess the presence of cardiovascular risk factors in women with acute coronary syndromes. PATIENTS AND METHODS Thirty four women aged 46 to 55 years old, admitted to the hospital due to an acute coronary syndrome and 102 age matched healthy women were studied. A clinical history was obtained, blood pressure and fasting serum lipids were measured. RESULTS A history of high blood pressure was present in 65 and 16% of patients and healthy controls respectively. Seventy seven percent of patients and 36% of controls smoked, 76% of patients and 48% of controls were postmenopausal, 21% of patients an 5% of controls were diabetic. In patients and controls respectively serum total cholesterol was 230.1 +/- 36.2 and 211.2 +/- 34.8 mg/dl, serum triacylglycerol was 213.4 +/- 109.4 and 143.2 +/- 76.9 mg/dl and serum HDL cholesterol was 44.1 +/- 10.8 and 49.8 +/- 13.3 mg/dl (p < 0.001 or less). In univariate analysis, the risk of acute coronary syndrome increased with high blood pressure (OR: 9.3, CI: 2.5-18.6), menopause (OR: 8.3, CI: 2.2-31:5), smoking (OR: 6.9, CI: 2.5-18.6), diabetes mellitus (OR: 5.0, CI: 1.4-17.5), a high total cholesterol/HDL cholesterol ratio (OR: 6.6, CI: 1.8-12.5) and hypertriglyceridemia (OR: 3.6, CI: 1.5-8.5). Logistic regression analysis showed that hypertension and menopause had the higher predictive values for acute coronary syndrome. CONCLUSIONS In this group of women with acute coronary syndromes, the main coronary risk factors were high blood pressure and menopause.
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Affiliation(s)
- J E Blümel
- Hospital Barros Luco-Trudeau, Facultad de Medicina, Universidad de Chile.
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Abstract
OBJECTIVE To evaluate the influence of menopause and hormone replacement therapy (HRT) on weight and the effect of weight gain on coronary risk factors. DESIGN From 1991 to 1992 cardiovascular risk factors were assessed in 271 premenopausal women between the ages of 40 and 53 years. The women were not receiving HRT at that time. Five years later, these women were reevaluated. RESULTS Weight and body mass index (BMI) increased steadily with age. During the observation period there was an average increase of 4.0 kg +/- 4.6 (p < 0.0001). Women who experienced menopause and those who did not experience menopause had a similar weight increase (3.8 +/- 4.4 kg vs. 4.3 +/- 4.8, p = 0.37). Likewise, weight gain was similar in those who did or did not use HRT (nonusers, 4.3 +/- 4.6 kg; users, 3.5 +/- 3.7 kg; ex-users, 3.4 +/- 5.8 kg). At their first checkups, overweight women and obese women already had significant differences in their risk factors, including higher systolic pressure (p < 0.02), diastolic pressure (p < 0.01), glucose (p < 0.02) and triglycerides (p < 0.0001), and lower high-density lipoprotein cholesterol (p < 0.004) as compared with women of normal weight. Unexpectedly, women of normal weight who became overweight or obese during the monitoring period did not show any deterioration in their risk factors. CONCLUSIONS During the perimenopausal period there is a weight gain that does not seem to depend on the menopause or HRT. Being overweight or obese during the menopausal transition is not necessarily associated with deterioration in coronary risk factors. This seems to imply the existence of different metabolic populations within this group of women.
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Affiliation(s)
- J E Blümel
- 1Hospital Barros Luco-Trudeau, Fac Medicina, Universidad de Chile, Santiago de Chile
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Abstract
OBJECTIVE To study whether the addition of estrogen to the 7 hormone-free days of a combined oral contraceptive (OC) cycle improves the symptomatology in perimenopausal women with climacteric complaints. DESIGN A total of 56 women in their forties presenting with mood disorders and/or hot flashes were included in this randomized double-blind study. Symptoms were evaluated using the Greene test. Subjects were allocated into two groups: 23 women received an OC containing 20 microg of ethinyl-estradiol and 150 mg of desogestrel for 21 days and then 7 placebo tablets (placebo group); the other 33 women received 21 tablets with the same hormone combination, followed by 2 placebo tablets and 5 ethinyl-estradiol tablets of 10 microg each (estrogen group). After three cycles, symptoms were reassessed. RESULTS Symptoms were similar in the two groups at the start of the study. Three months later, vasomotor symptoms in the placebo group dropped from 3.3 +/- 1.7 to 1.7 +/- 1.8, and in the estrogen group, from 3.0 +/- 1.7 to 0.7 +/- 0.9 (p < 0.04). Similarly, symptoms of depression fell from 8.8 +/- 4.0 to 6.7 +/- 3.9 in the placebo group and from 10.3 +/- 3.5 to 3.8 +/- 2.9 in the estrogen group (p < 0.002). Somatic symptoms fell with placebo from 10.9 +/- 5.3 to 7.4 +/- 5.4, and with estrogen, from 9.7 +/- 4.9 to 4.0 +/- 2.5 (p < 0.03). Sexual dysfunction as measured by the Greene Scale (loss of sexual interest) also improved more in women who received additional estrogen: 2.0 +/- 0.9 to 0.5 +/- 0.9 vs. 1.8 +/- 1.2 to 1.2 +/- 1.2, p < 0.03. Anxiety symptoms improved in both groups but without any significant difference between them. CONCLUSIONS Adding 5 days of estrogen to the classic contraceptive scheme improves the climacteric symptoms of perimenopausal women who use OCs.
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Affiliation(s)
- J E Blümel
- Fundación Prosam, Santiago de Chile, Hospital Clínic, Universitat de Barcelona, Spain
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Blümel JE, Castelo-Branco C, Roncagliolo ME, Guanes PP, Lavin P. Do women using hormone replacement treatment have less pre-existing cardiovascular risk. Maturitas 2001; 38:315-9. [PMID: 11358649 DOI: 10.1016/s0378-5122(01)00175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several studies have suggested that women who choose to use hormone replacement therapy (HRT) already, before starting this therapy, have a better cardiovascular risk profile than those who do not use it. Some of these studies contain factors of confusion and biases, such as HRT users' greater educational achievement or physical activity, which could have led to wrong conclusions. AIM To study a cohort, without confounding factors in order to analyse whether the cardiovascular risk profile is different in women who choose to use HRT. MATERIAL AND METHODS Coronary risk factors of 387 women between 45 and 64 were studied. This study was carried out at the Unit for the Preventive Medical Examination of the South Metropolitan Health Service in Santiago (Chile) during the annual check-up. The first evaluation was in 1991-1992; with a second evaluation 5 years later. Of all the women, 174 (45%) never received hormones (Group A), 124 (32%) were HRT users at the time (Group B), and 89 (23%) were former-users (Group C). RESULTS No differences were found between the three groups for age, body mass index (BMI), educational background, alcohol consumption, smoking or physical activity. Blood pressure was similar in the three groups. No significant differences were found in total cholesterol (A, 221.7+/-42.2; B, 228.2+/-47.0; and C, 227.3+/-44.9 mg/dl); high density lipoprotein (HDL, A, 53.5+/-13.2; B, 51.8+/-12.8; and C, 54.0+/-12.4 mg/dl); low density lipoprotein (LDL, A, 141.7+/-38.9; B, 148.5+/-43.1 and C, 148.3+/-43.8 mg/dl); triglycerides (A, 134.5+/-67.9; B, 141.0+/-66.1; and C, 127.3+/-68.5 mg/dl) and glucose plasma levels (A, 90.5+/-32.2; B, 87.7+/-15.3; and C, 85.0+/-8.8 mg/dl). CONCLUSIONS Our results suggest that women who choose to use HRT have a cardiovascular risk profile, before starting the therapy, similar to those who do not use it.
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Affiliation(s)
- J E Blümel
- Barros Luco-Trudeau Hospital, University of Chile, Santiago, Chile
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Blümel JE, Campodónico I. [Are transdermic estrogens cardioprotective?]. Rev Med Chil 2001; 129:433-40. [PMID: 11413997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Transdermic estrogens share many of the oral estrogens cardiovascular effects, but so far there are no studies proving that they have a cardioprotective effect neither in animals nor in human beings. The doubt is outlined moreover, when most of the investigations performed with oral estrogens in animals show an antiatherogenic effect, while the few experimental studies that hare been carried out with estrogen patches show contradictory results. We will have to wait for more extensive clinical trials to be able to know if the transdermic estrogens are really cardioprotective, however if we want to achieve some cardiovascular risk improvement with the current knowledge we will probably have to support the use of oral estrogens.
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Affiliation(s)
- J E Blümel
- Fundación Prosam y Facultad de Medicina, Universidad de Chile, Santiago de Chile.
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Blümel JE, Castelo-Branco C, González P, Moyano C, Iturriaga M, Videla L, Sanjuán A, Cano A. Transdermal estrogens do not appear to modify the extent of lesional areas of aortic atherosclerosis in oophorectomized rabbits on a cholesterol-rich diet. Atherosclerosis 2000; 148:303-8. [PMID: 10657566 DOI: 10.1016/s0021-9150(99)00277-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in older women in industrialised countries. It has been suggested that it is the cessation of estrogen production by the ovaries that puts postmenopausal women at increased risk of CVD. Estrogen therapy has demonstrated a protective effect against CVD and several reports suggest that diverse mechanisms may be involved. Oral estrogen appears to be associated with a better lipid profile than the use of transdermal estrogens; however, it is assumed that estrogens, oral and non-oral, have direct actions on the blood vessels that may exert an important role in cardiovascular disease prevention. To investigate the effect of transdermal estrogen therapy on aorta atherogenesis, we studied 20 cholesterol-fed New Zealand White rabbits for 4 months. The rabbits were oophorectomized and randomly assigned to two groups. Ten rabbits underwent bilateral ovariectomy followed by treatment with transdermal 17-beta-estradiol (group E) and the other 10 received placebo after sterilization (Group C). After diet total levels of cholesterol increase in group C from 50. 0+/-12.5 to 820.9+/-186.0 mg/dl, and in group E from 52.6+/-9.4 to 811.4+/-213.0 mg/dl (no significant differences were observed between groups). Estrogen therapy increased twofold the total reactive antioxidant potential (TRAP group C: 22.5+/-16.7 mmol of Trolox/l vs. TRAP group E: 43.4+/-22.4 mmol of Trolox/l; P<0.04). At 4 months, the cholesterol-rich diet caused atherosclerotic lesions in both treated and untreated rabbits affecting 18.7+/-14.5 and 21. 6+/-9.7% of the aortic surface respectively. In summary, the principal result from this study was that although treatment with transdermal 17-beta-estradiol in cholesterol-fed ovariectomized rabbits increases the TRAP to pre-surgery values, it does not inhibit aortic cholesterol accumulation.
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Affiliation(s)
- J E Blümel
- Climacteric Unit, Barros Luco-Tradeau Hospital, Santiago, Chile
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Cano A, Blümel JE. [HERS study disturbs hormonal replacement therapy]. Rev Med Chil 2000; 128:98-104. [PMID: 10883529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Cardiovascular protection of hormonal replacement therapy was considered a fact. The effects of estrogens on lipid levels and vascular health gave biological support to estrogen cardioprotection. The recently published HERS study showing no protective effects of estrogen and progesterone replacement therapy on the risk of myocardial infarction or coronary deaths is provoking perplexity. These surprising results may have several causes such as the use of progesterone, the associated use of cardioprotective agents or the short observation period. However, the study results scope is restricted to secondary prevention. These cannot be extrapolated to frequent conditions of postmenopausal women such as primary prevention or sequential schemes. Likewise, this investigation underscores the importance of a critical and continued evaluation of apparently well established therapeutic approaches.
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Affiliation(s)
- A Cano
- Hospital Universitario de Valencia, España
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Gramegna G, Blümel JE, Roncagliolo ME, Aracena B, Tacla X. [Patterns of sexual behavior in Chilean women]. Rev Med Chil 1998; 126:162-8. [PMID: 9659751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sexuality has an individual connotation, is influenced by biological, environmental and cultural factors and is present throughout all life. AM: To assess the sexual behavior of a group of Chilean women. SUBJECTS AND METHODS A specially devised inquiry was applied to 301 women, aged 20 to 70 years old, that consulted in a medical service. RESULTS Seventy seven percent of women were sexually active. These figures ranged from 80% of women aged 40-44 years old to 40% of women over 60. Sixty percent of women living together, 53.7% of single women, 65.6% of divorced women, 94.2% of married women and 100% of widows were sexually active. Women aged 25 to 29 years old had a mean of 8.4 relations per month compared with 3.3 relations among women older than 55. The frequency of sexual intercourse was higher in women living together and lower in widows. The mean age at the first intercourse was 20.6 +/- 4.5 years. Ninety three percent had experienced sexual desire and the percentage of satisfactory sexual relations does not change with age. Less educated women had a lower frequency of orgasms. CONCLUSIONS Age and legal status of women are related to their sexual behavior and less educated women have a less satisfactory sexual life.
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Affiliation(s)
- G Gramegna
- Unidad de Climaterio, Hospital Barros Luco-Trudeau, Santiago, Chile
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Gramegna G, Blümel JE, Jara S, Schiattino I, Lolas F. [Effects of estrogen supplementation on psychological variables in climacteric women]. Rev Med Chil 1996; 124:1240-4. [PMID: 9239913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The beneficial effects of estrogen supplementation in climacteric women are clear. However, their psychological effects are not well documented. AIM To study the effects of estrogen supplementation on psychological variables in climacteric women. SUBJECTS AND METHODS Forty postmenopausal women were divided in two groups to receive a daily dose of 2 mg oestradiol valerate and 2.5 mg medroxyprogesterone acetate or an identical placebo during six months. Initially and at the end of the treatment period, they were subjected to a psychiatric interview and the Graffar, Hamilton and Eysenk personality tests were applied. Also, an Analysis of Verbal Behavior was used, that results in hope and hopeless scores. RESULTS There were no differences in the initial assessment between the two treatment groups. In women receiving hormonal supplementation, the Hamilton score decreased from 11.2 to 4.9 (p < 0.002) and in women receiving placebo from 8.1 to 5.3 (NS). No other significant changes in psychological tests were observed. CONCLUSIONS Hormonal supplementation decreases the Hamilton depression score in postmenopausal women.
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Affiliation(s)
- G Gramegna
- Facultad de Medicina, Universidad de Chile (Campus Sur), Hospital Barros Luco Trudeau, Santiago de Chile
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Blümel JE, Sáez L, Roncagliolo ME, Tacla X, Brandt A. [Decrease of labor absenteeism associated with hormone replacement therapy in postmenopausal women]. Rev Med Chil 1995; 123:948-53. [PMID: 8657962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Absenteeism affects efficiency and costs of health care. Most of health workers are middle age women, whose climacteric symptoms may reduce their work capacity working at a public hospital in Santiago during 1992. Fifty-eight percent were postmenopausal and 34.8% of these were receiving hormone replacement therapy. Global absenteeism rate was 17.1 days/year. These figures were 14.8 days/year for premenopausal and 17.8 days/year for postmenopausal women (NS). Among the latter, those women receiving hormone replacement therapy had a significantly lower absenteeism rate (9.4 days/year compared to 20.4 days/year among those not receiving hormones). Osteoarticular diseases were responsible for 44.3% and psychiatric diseases for 18.1% of sick leaves. No differences in absenteeism were observed between different professional levels. We conclude that hormone replacement therapy is associated with a better working capacity in postmenopausal women.
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Affiliation(s)
- J E Blümel
- Unitad de Climaterio, Facultad de Medicina, Universidad de Chile, (Campus Sur), Hospital Barros Luco Trudeau, Santiago de Chile
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