Lactase persistence-related genetic variant: population substructure and health outcomes

Lactase persistence is an autosomal-dominant trait that is common in European-derived populations. A basic tendency for lactase persistence to increase from the southeast to the northwest across European populations has been noted, but such trends within countries have not been extensively studied. We genotyped the C/T(-13910) variant (rs4988235) that constitutes the putatively causal allele for lactase persistence (T allele representing persistence) in a general population sample of 3344 women aged 60-79 years from 23 towns across Britain. We found an overall frequency of 0.253 for the C (lactase non-persistence) allele, but with considerable gradients of decreasing frequency from the south to the north and from the east to the west of Britain for this allele. Daily sunlight was positively related to C (non-persistence) allele prevalence. However, sunlight exposure and latitude are strongly correlated, and it was not possible to identify which is the primary factor statistically underlying the distribution of lactase persistence. The C/T(-13910) variant (rs4988235) was not related to drinking milk or bone health (although drinking milk itself was protective of bone health), and was essentially unrelated to a wide range of other lifestyle, health and demographic characteristics. One exception was general health being rated as being poor or fair, for which there was an odds ratio of 1.38 (1.04, 1.84) for women homozygous for the C allele; on adjustment for latitude and longitude of place of birth, this attenuated to 1.19 (0.87, 1.64). The lactase persistence variant could contribute to the examination of data for the existence of, and then statistical control for, population substructure in genetic association studies.     

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

OBJECTIVES: The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. METHODS: This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey. RESULTS: The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores. CONCLUSIONS: A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.     

Decision support for women choosing mode of delivery after a previous caesarean section: a developmental study

OBJECTIVE: To examine the impact of a decision support intervention designed for women choosing mode of delivery after one previous caesarean section. METHODS: A decision support intervention was developed comprising of an informational DVD/video and a home visit by a midwife. 16 women received standard clinical care and 16 women additionally received the intervention. Pilot questionnaire data was collected at 12, 28 and 37 weeks gestation from all participants. 18 of the 32 participants also participated in semi-structured interviews after they had decided mode of delivery at 37 weeks gestation. RESULTS: Four themes were identified in the qualitative data relating to decision-making: informational support, emotional support, participation and involvement in decision-making, and the way in which decision support was used. CONCLUSION: The difficulties experienced by women in this decision-making scenario were confirmed. The intervention was welcomed by the participants and both qualitative and quantitative findings suggest the intervention improved decision-making experiences. PRACTICE IMPLICATIONS: This intervention offers an accessible method of decision support which effectively targets the needs of women choosing mode of delivery after a previous caesarean delivery. Using easily reproducible informational materials, and the pre-existing skills of midwives, it would be relatively straightforward to introduce this intervention into current clinical practice.     

Systematic review of the association between chronic social stress and telomere length: A life course perspective

Our aim was to examine whether chronic social stress is associated with telomere length throughout the life course, following our protocol published in 2014. Structured searches were conducted in MEDLINE (PubMed interface), EMBASE (OVID interface), Cochrane Central (OVID interface) and grey from their start date onwards. Reference lists of retrieved citations were hand searched for relevant studies. Eighteen studies published until May 1, 2015 investigating the association between chronic social stress (as defined by poverty, exposure to violence, or family caregiving) and telomere length in healthy or diseased adults and children were independently selected by 2 reviewers. Sixteen of those studies were cross-sectional and two had a longitudinal design. Studies differed in type of stress exposure, method to measure telomere length and cell type. As meta-analysis could not be conducted, the data were synthesized as a narrative review. Based on this comprehensive review, chronic social stress accompanies telomere shortening in both early and adult exposures, with most eligible studies showing a significant relationship. We discuss the significance of chronic stress of social origin and the potential for social interventions through public policies and we recommend methodological improvements that would allow for future meta-analysis.     

Pregnancy-induced hypertension is associated with maternal history and a risk of cardiovascular disease in later life: A Japanese cross-sectional study

Objective

To clarify the associations between pregnancy-induced hypertension (PIH) with heritability of PIH from mother to daughter and the risk of cardiovascular disease in later life in Japanese women.

Study design

The Japan Nurses’ Health Study (JNHS) is a cohort study of Japanese women's health. Data from the JNHS baseline survey between 2001 and 2007 were used to conduct a cross-sectional analysis. Of the 49,927 respondents in the baseline survey, 10,456 parous women who were ≥45 years old at baseline were included in the analysis.

Main outcome measures

The age-adjusted odds ratio (OR) of PIH in women whose mother had a history of PIH, and the age-adjusted OR of PIH in participants for hypertension, hypercholesterolemia and diabetes mellitus (DM).

Results

The age-adjusted OR of PIH was 2.72 (95% confidence interval [CI]: 2.14–3.46) in women whose mother had a history of PIH compared with those whose mother did not have PIH. PIH was a risk factor for hypertension (age adjusted OR: 2.85, 95% CI: 2.45–3.11), hypercholesterolemia (age-adjusted OR: 1.49, 95% CI: 1.29–1.72) and DM (age-adjusted OR: 1.53, 95% CI: 1.11–2.11), as determined by logistic regression analysis.

Conclusions

In Japanese women, the risk of PIH is approximately 2.7-fold greater in those whose mothers also had PIH compared with those whose mothers did not. PIH is a risk factor for hypertension, hypercholesterolemia, and diabetes mellitus in later life.     

A narrative review on women and cardiac rehabilitation: Program adherence and preferences for alternative models of care

Despite the preponderance of evidence on the numerous benefits of CR, it remains largely under-utilized in women. The objective of this narrative review was to summarize and synthesize the literature on women and CR with regard to outcomes, adherence, and preferences for alternative models of CR. Studies of the effectiveness of CR have generally revealed no major differences between men and women. However, female-specific data are lacking on the effect of CR on mortality and morbidity. Research suggests that women and men may be equally likely to prefer home-based to hospital-based CR services. Women's preferences for and outcomes in, women-only CR are beginning to be uncovered. Discussing program model options with female cardiac patients and referring to preferred types may be the appropriate approach until further evidence is available.     

A scoping systematic review of social stressors and various measures of telomere length across the life course

Numerous studies examine the relationship between social stressors and telomere length (TL). Beyond considering methods and major findings, this scoping systematic review takes a novel approach as it groups studies according to the types of social stressor considered and by age groups. Following PRISMA guidelines, we searched PubMed, Web of Science, Embase, and Scopus. We included all English-language human subject research articles that modeled any measure of TL as a dependent variable and exposure to a social stressor as an independent variable. For the sample of 105 articles, we summarized methods and findings by type of social stressor (socioeconomic stressors, stressful life events, work-related stressors, and neighborhood stressors) and by age of the study population (infants/children, middle-aged adults, older adults, and mixed samples of middle-aged and older adults). We found more variation in TL measurement methodology in studies of infants/children and older adults than in studies focusing on middle-aged adults. The most consistent finding was a relationship between early-life stressors and shorter TL. Work and neighborhood stressors, and older populations, are currently understudied. Across all stressors, limited evidence suggests that the stress-TL relationship may be moderated by characteristics such as age, sex, and race/ethnicity. We conclude with specific suggestions for future research.     

Feeling that life is not worth living (death thoughts) among middle-aged,Australian women providing unpaid care

Objective

To identify the proportion of female carers who experience death thoughts and the factors associated with these thoughts, using data from the Australian Longitudinal Study on Women's Health (ALSWH).

Methods

A cross-sectional analysis of the fifth ALSWH survey was conducted. 10,528 middle-aged women provided data on caring and death thoughts, 3077 were carers and 2005 of those were included in the multivariate analysis.

Results

7.1% of female carers had felt life was not worth living in the previous week and were classified as having experienced death thoughts, compared with 5.7% of non-carers (p = .01). Carers with death thoughts had poorer physical and mental health, higher levels of anxiety, lower levels of optimism, and reported less social support (p < .01). In a multivariate model social support, mental health, carer satisfaction, and depressive symptoms significantly predicted death thoughts. Carers with clinically significant depressive symptoms were four times more likely to experience death thoughts than those without. Carers who were satisfied with their role were 50% less likely to have experienced death thoughts than those who were dissatisfied.

Conclusions

A small but significant proportion of female carers experience death thoughts and may be at risk for suicide. These findings add to the growing body of evidence on suicide-related thoughts and behaviours in carers and have implications for health professionals and service providers.     

Caring for Somali women: implications for clinician-patient communication

OBJECTIVE: We sought to identify characteristics associated with favorable treatment in receipt of preventive healthcare services, from the perspective of resettled African refugee women. METHODS: Individual, in-depth interviews with 34 Somali women in Rochester, NY, USA. Questions explored positive and negative experiences with primary health care services, beliefs about respectful versus disrespectful treatment, experiences of racism, prejudice or bias, and ideas about removing access barriers and improving health care services. Analysis was guided by grounded theory. RESULTS: Qualities associated with a favorable healthcare experience included effective verbal and nonverbal communication, feeling valued and understood, availability of female interpreters and clinicians and sensitivity to privacy for gynecologic concerns. Participants stated that adequate transportation, access to healthcare services and investment in community-based programs to improve health literacy about women's preventive health services were prerequisite to any respectful health care system. CONCLUSION: Effective communication, access to healthcare services with female interpreters and clinicians, and community programs to promote health literacy are themes associated with respectful and effective healthcare experiences among Somali women. PRACTICE IMPLICATIONS: Adequate interpreter services are essential. Patient-provider gender concordance is important to many Somali women, especially for gynecological concerns.     

The multifaceted nature of access to compounded progesterone: A cross-sectional study from Australia

Objective

To explore the influences on accessibility of compounded progesterone therapy for Australian women.

Study design

A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the ‘Perspectives on Progesterone’ questionnaire.

Main outcome measures

Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups.

Results

Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged.The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines.

Conclusion

Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it.     

The development and validation of a tool to assess nurse performance in dual protection counseling

Objective

To present preliminary evidence for the reliability and validity of the Dual Protection Counseling Checklist (DPCC), an instrument designed to evaluate nurses’ fidelity to high quality dual protection counseling in a family planning setting.

Methods

During a trial comparing a dual protection (DP) nurse counseling intervention to standard of care (SOC), client-counselor sessions were audiotaped. Following good inter-rater reliability, 78 audiotaped interviews were coded from the two conditions using the DPCC. We constructed indices from a subset of codes to capture three domains: Promotion of DP (PDP), Relapse prevention counseling (RPC), and Quality of Nurse–Client Interaction (QNCI). The association between scores on these indices and client outcomes was evaluated using logistic regression.

Results

The DPCC and indices were reliable. Construct validity of indices was supported by greater frequency of target behaviors by the DP nurse. Validity of the QNCI was further supported by its association with clients’ sexual risk reduction 6 months post-counseling.

Conclusion

The DPCC and indices hold practical utility for evaluation, monitoring, and supervision of nurse–client counseling sessions.

Practice implications

The Dual Protection Counseling Checklist provides a user-friendly tool for assessing nurses’ and other providers’ counseling behaviors in dual protection.     

Female genital mutilation and cutting: An anatomical review and alternative rites

The World Health Organization reports that more than 200 million women currently alive have been subjected to female genital mutilation/cutting (FGM/C) worldwide, and three million girls continue to be at risk each year. FGM/C today is women's business. The vulva is formed by the labia majora and the vestibule, with its erectile apparatus. These structures are located under the urogenital diaphragm, behind the pubic symphysis in the anterior perineal region. The clitoris is entirely an external genital organ: the glans and body covered by the prepuce are visible/free while the roots are hidden. FGM/C procedures are classified into four types. Infibulation is the narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning of the labia minora and/or the labia majora, with or without removal of the clitoris. Deinfibulation is necessary to improve health and well‐being and to allow intercourse or facilitate childbirth. Clitoral reconstruction is feasible for genitally mutilated patients. Female genital cosmetic surgery should be classed as FGM/C type IV. Both immediate and long‐term complications are associated with FGM/C. It remains primarily a cultural rather than a religious practice. Different interventions have been used to persuade communities to abandon it. Alternative rites of passage are seen as an important strategy for eliminating this harmful practice. Such alternative rituals avoid genital cutting and involve educating girls about family life and women's roles, exchange of gifts, celebration, and a public declaration for community recognition. FGM/C is a violation of human rights and must be abandoned. Clin. Anat. 30:81–88, 2017. © 2016 Wiley Periodicals, Inc.     

A health literacy pilot intervention to improve medication adherence using Meducation technology

Objective

To determine whether antihypertensive medication adherence could improve using a Meducation^® technology health literacy intervention.

Methods

We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation^® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months.

Results

There was a 42% enrollment rate (n = 23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients’ average systolic blood pressure (0.5 mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p > 0.05).

Conclusions

A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes.

Practice implications

Health literacy interventions may improve adherence while requiring relatively few resources to implement.     

The role of counseling for obstetric fistula patients: Lessons learned from Eritrea

Objective

The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea.

Methods

To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling.

Results

Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem.

Conclusion

Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem.

Practical implications

Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair.     

Relationship between Mammographic Findings and Breast Abnormalities in a Nigerian Population

PurposeThis study aims to describe the mammographic findings in a population of Nigerian women and to explore the relationships between abnormal mammographic findings, breast malignancy, and breast composition.MethodologyThis was a retrospective study of consecutive mammograms carried out at Union Diagnostics and Clinical Services in Lagos, Nigeria from 2016 to 2018. Demographic information, indications for and findings on mammographic evaluation were obtained. A logistic regression fit model was used to establish the correlation between mammographic findings, breast density, and suspicion for breast malignancy (higher BIRADS scores). P ≤ 0.05 represented a statistically significant result.ResultsA total of 304 patients were involved in this study (age range 20-80 years, mean age 49.0 ± 10.5 years). The patients between 40 and 49 years formed the largest age group with 128 patients (42.4%). Most patients were referred for a breast mass/lump (115/304-38.6%); 56 patients (18.8%) presenting for routine screening. The most common finding on the mammograms was BIRADS 4 in both breasts in 96 patients (31.6%). Most patients had heterogeneous breast density (195 patients - 64.1%). Multivariate logistic regression analysis showed a significant correlation between history of mass, poorly defined margins, and suspicion of malignancy. There was no statistically significant association between abnormal mammographic findings and higher breast density.ConclusionPoorly defined margins were positively correlated with BIRADS ratings suspicious for malignancy. The presence of a breast mass was positively correlated with a higher BIRADS score when other possible cofounding variables were not accounted for. Patient age did not correlate with breast density in this study.     

Sex hormones, appetite and eating behaviour in women

Sex hormones play essential roles in the regulation of appetite, eating behaviour and energy metabolism and have been implicated in several major clinical disorders in women. Estrogen inhibits food intake, whereas progesterone and testosterone may stimulate appetite. This review describes recent findings concerning interactions between sex hormones and neuroendocrinological mechanisms in the control of appetite and eating in women. Furthermore, we are gaining insights into the roles played by sex hormones in the development of eating disorders and obesity. For instance, androgens may promote bulimia by stimulating appetite and reducing impulse control, a proposal supported by the observation that antiandrogenic treatment attenuates bulimic behaviour. Androgens are also involved in the pathophysiology of abdominal obesity in women. On the other hand, hormone replacement therapy with estrogen counteracts the weight gain and accumulation of abdominal fat associated with the menopausal transition. In conclusion, sex hormones and/or agents that exhibit similar activities may provide novel strategies for the treatment of eating disorders and android obesity, two of the most serious health problems for women today.