Sexual function,satisfaction with life and menopausal symptoms in middle-aged women

Purpose

To assess sexual function, satisfaction with life (SWL), and menopause-related symptoms among mid-aged Spanish women.

Materials and methods

Cross-sectional study of 260 women, aged 40–59, attending the public gynecology consultations completed the 14-item Changes in Sexual Functioning Questionnaire (CSFQ-14), the SWL Scale (SWLS), the Menopause Rating Scale (MRS), and a socio-demographic questionnaire.

Results

Median [inter quartile range] age was 47 [8.0] years, 87.7% had a stable partner, 27.0% were postmenopausal, and 53.9% had increased body mass index (BMI). The prevalence of sexual dysfunction was 46.5% (CSFQ-14 score ≤ 41). Postmenopausal status was associated with lower CSFQ-14 scores (worse sexual function) and severe menopausal symptoms whereas there were not significant differences in SWLS scores. CSFQ-14 scores correlated with SWLS (p < 0.04), and inversely correlated with menopausal symptoms (p < 0.02). Multiple linear regression analysis model predicted 26.6% of the total CSFQ-14 score variance, and higher scores (better sexual function) were correlated with better SWL, and inversely correlated to female age and worse menopausal symptoms. A second model predicted 38.4% of the SWLS score variance. The SWLS score correlated with the total CSFQ-14 score and BMI, and inversely correlated with economical problems, female tobacco use, lack of healthiness, menopausal symptoms, not having a partner, and partner's lack of healthiness.

Conclusions

Lower sexual function was related to low SWL, age and menopausal symptoms while low SWLS score was related with economical problems, smoking, menopausal symptoms, and partner factors.     

The role of health literacy in perceived information provision and satisfaction among women with ovarian tumors: A study from the population-based PROFILES registry

Objective

To assess the association of subjective health literacy (HL) and education with perceived information provision and satisfaction.

Methods

Women (N = 548) diagnosed with an ovarian or borderline ovarian tumor between 2000 and 2010, registered in the Eindhoven Cancer Registry, received a questionnaire including subjective HL, educational level, perceived information provision, and satisfaction with the information received. Multiple linear and logistic regression analyses were performed, controlled for potential confounders.

Results

Fifty percent of the women responded (N = 275). Thirteen percent had low and 41% had medium subjective HL. Women with low HL reported less perceived information provision about medical tests, and were less satisfied with the information received compared to women with high HL. Low educated women reported that they received more information about their disease compared to highly educated women.

Conclusion

Low subjective HL among women with ovarian tumors is associated with less perceived information provision about medical tests and lower information satisfaction, whereas low education is associated with more perceived information provision about the disease.

Practice implications

HL should not be overlooked as a contributing factor to patients’ perceived information provision and satisfaction. Health care providers may need training about recognizing low HL.     

Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women

Background and aim of the study

The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI).

Material and methods

Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45–64 years (n = 1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status).

Results

Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms.

Conclusion

Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials.     

医护人员工作满意度与组织承诺关系研究

目的了解医护人员工作满意度和组织承诺现状并探讨两者之间关系。方法采用工作满意度量表和组织承诺量表对150名山东省潍坊市3所医院医护人员进行调查。结果医护人员的总体工作满意度和组织承诺均处于中等略偏上水平；相关分析表明，工作满意度总体及各维度与组织承诺均显著正相关；回归分析表明，工作关系、晋升、单位经营管理满意度对组织承诺具有显著的正向预测作用，同时发现工作环境满意度对价值承诺：年口努力承诺具有负向预测作用。结论医护人员工作满意度与组织承诺具有显著相关。     

Yoga Effects on Physical Activity and Sexual Satisfaction Among the Iranian Women With Multiple Sclerosis: A Randomized Controlled Trial

Background

Multiple Sclerosis (MS) is a chronic and disabling disease resulting in disabilities in young and middle-aged persons. In this study, researchers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS.

Materials and Methods

In this study, 60 Iranian women with multiple sclerosis (MS) were placed in two equally divided control and case groups through random selection to assess pre-and post-effects of yoga exercises on their physical activities and sexual satisfaction levels. Women in case group were offered a series of yoga training and exercises for 3 months, which consisted of 8 sessions per month for 60 to 90 minutes at each session. Yoga training program included the 3 principles of slow motions (Hatayoga), respiratory exercises (Pranayama) and centralization to control mind via meditation, expansion and stasis (Rajayoga). After 3 months both groups were surveyed using the initial questionnaire to evaluate and compare findings with the base-line data.

Results

Researchers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group (P=0.001). Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms.

Conclusion

Yoga techniques may improve physical activities and sexual satisfaction function of women with MS.     

Course of normal and abnormal fatigue in patients with chronic obstructive pulmonary disease, and its relationship with domains of health status

Objective

To examine the difference between patients with normal and patients with abnormal fatigue on aspects of health status, and investigate the natural course of fatigue in patients with Chronic Obstructive Pulmonary Disease (COPD).

Methods

Fatigue, physiological functioning, functional impairment, symptoms, and Quality of Life (QoL) were measured in 168 patients with COPD, and longitudinal data on fatigue of 77 patients were collected.

Results

Fifty percent of patients had abnormal fatigue. Patients with abnormal fatigue reported significantly more problems on the sub-domains of functional impairment (except actual physical activity), symptoms, and QoL as compared to patients with normal fatigue. With respect to physiological functioning patients with normal fatigue scores had better exercise capacity. Four years later the percentage of patients with abnormal fatigue was increased to 64%. In 1/3 of the patients an increase of more than the minimal clinically important difference was found.

Conclusion

Many COPD patients suffer from abnormal fatigue. Patients with abnormal fatigue have more limitations on many aspects of health status, especially on symptoms, functional impairment, and QoL.

Practice implications

Fatigue should be evaluated in usual care with a questionnaire that corrects for normal fatigue in order to tailor treatment to patients’ need.     

The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men

ObjectivesGay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients’ perceptions of their provider’s sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients’ disclosure of sexual orientation to providers.MethodsData were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18–26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance.ResultsParticipants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics.ConclusionsFindings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men’s health.Practice implicationsDyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients’ sexual minority statuses.     

Functional status and use of health care services: longitudinal study on the older adult population in Spain

BACKGROUND: Follow-up studies on the association between functional status and use of health care services among the older people are scarce and have studied only a few types of service. OBJECTIVE: To examine prospectively the relationship between limitation in instrumental activities of daily living (IADL) and utilization of a wide variety of health care services among older adults in Spain. METHODS: Prospective study from 2001 to 2003 of a cohort of 2806 persons, representative of the non-institutionalized Spanish population aged 60 years and over. Limitation in IADL was measured in 2001 using the Lawton and Brody's test. Data on the use of health care services were collected in 2003 and classified into home services (home visits by physicians and nurses) and non-home services (visits to primary care physicians, visits to hospital specialists, hospital admissions, emergency care, and influenza vaccination). Analyses were performed with logistic regression and adjusted for the main confounders. RESULTS: Compared to men with no limitation in IADL, a higher percentage of those with limitation in one IADL in 2001 made use of both home (odds ratio [OR] 2.64; 95% confidence interval [95% CI] 1.73-4.03) and non-home services (OR 2.02; 95% CI 1.04-3.93) in the period 2001-2003. Limitation in one IADL among women was associated with a greater utilization of home services (OR 1.50; 95% CI 1.05-2.14) and visits to hospital specialists (OR 1.61; 95% CI 1.21-2.15). In women, however, a greater number of limited IADL at baseline was inversely associated with visits to primary care physicians in the 2-year follow-up (p for linear trend <0.001). CONCLUSION: Population aging will increase the demand for health services in general, and for home services in particular.     

Cognitive impairment no dementia and associations with health literacy,self-management skills,and functional health status

ObjectivesTo determine the prevalence of cognitive impairment no dementia (CIND) among a diverse, community-based population, and establish associations between CIND and health literacy, chronic disease self-management and functional health status.Methods863 primary care adults without dementia aged 55–74. Adjusted logistic and linear regressions were used to assess associations between CIND (None, Mild, Moderate/Severe) and outcomes.Results36 % participants exhibited CIND. It was strongly associated with limited health literacy (Newest Vital Signs: Mild [OR 3.25; 95 % CI 1.93, 5.49], Moderate/Severe [OR 6.45; 95 % CI 3.16, 13.2]; Test of Functional Health Literacy in Adults: Mild [OR 3.46; 95 % CI 2.08, 5.75], Moderate/Severe [OR 8.82; 95 % CI 4.87, 16.0]; all p’s < 0.001) and poor chronic disease self-management (Mild [B = −11.2; 95 % CI −13.5, -8.90], Moderate/Severe CI [B = −21.0; 95 % CI −23.6, −18.4]; both p’s < 0.001). Associations between CIND and functional health status were non-significant.ConclusionsCIND was prevalent in this cohort, and strongly associated with requisite skills for managing everyday health needs.Practice ImplicationsAttention to subtle declines in chronic disease self-care may assist with CIND identification and care management within this population. When CIND is observed, clinicians should also expect and address difficulties with self-management.     

婚姻、家庭与心理健康——对118对年轻知识分子的调查分析

本文采用 scl-90量表、locke-wallance 婚姻调适测定及家庭评定设计问卷等对118对较高文化层次的年轻夫妇进行了调查研究,结果表明,在正常人群中的丈夫和妻子均可存在轻度的心理损害,且有女性重于男性的倾向;家庭角色功能不良、家庭沟通不良、家庭行为控制功能不良及情感介入功能不良等对夫妇产生不尽一致的心理反应;夫妇之间的心理症状可交互影响;心理健康仅与其自评的婚姻幸福度有关,与配偶评定的婚姻幸福度无关,提示在人群中开展家庭心理卫生工作的重要性。     

Analysis of the relationship among health awareness and health literacy,patient satisfaction levels with primary care in patients admitting to primary care health centers

Objective

The aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers).

Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors

Objective

Social determinants, such as socioeconomic status (SES) and race/ethnicity are linked to striking health disparities across the cancer continuum. One important mechanism linking social determinants and health disparities may be communication inequalities that are caused by differences in accessing, processing and utilizing cancer information. In this context, we examined health information-seeking/avoidance as a potential mediator between social determinants and self-rated health (SRH) status among cancer survivors.

Methods

Data came from the 2008 well-informed, thriving and surviving (WITS) study of post-treatment cancer survivors (n = 501). We examined the mediating effect of health communication-related behavior between SES and disparities in SRH.

Results

The likelihood of belonging to the Low SRH group was higher among patients who had avoided health information and whose family members had not sought health information on behalf of the survivor, those in the lowest household income bracket, and those who had high school or less education after adjusting for potential confounders.

Conclusion

Differences in SRH among cancer survivors are associated with SES as well as communication inequalities.

Practice implications

It is necessary to provide a supportive environment in which health information is made available if disparities in health-related quality of life among cancer survivors are to be reduced.     

Adapting a patient satisfaction instrument for low literate and Spanish-speaking populations: comparison of three formats

Objective

To compare responses to print versions of the Consumer Assessment of Healthcare Providers and Systems 2.0 survey (CAHPS™) to those for an illustration enhanced format and a telephone based interactive voice response format.

Methods

First, 2015 adult patients awaiting primary care visits completed: demographic information, Test of Functional Health Literacy (S-TOFHLA), CAHPS in one of three formats: print, illustrated, or interactive voice. A second sample of 4800 active patients was randomized to receive alternative formats.

Results

Response rates for the illustrated (31.3%) and print (30.4%) formats were significantly higher than for the interactive voice format (18.1%). The results of the illustrated format were comparable to the traditional text version, but required about 2 min more to complete by both low and high literacy groups. There were almost no invalid responses for the interactive voice format, but the format was associated with lower CAHPS satisfaction scores.

Conclusion

Despite extensive efforts to produce formats tailored to individuals with limited literacy, surprisingly we found no consistent advantages to either alternative format. In fact, the interactive voice format yielded lower satisfaction scores and lower response rates.

Practice implications

Practitioners need to ensure the health instruments they use are aligned with literacy skills and delivery preferences of their consumers. The lack of benefit of the illustrated form does not support investment of resources in these formats to measure satisfaction. The interactive voice response deserves more study—do lower scores register limited access to or use of telephones, irritation or true signal?     

Measurement of functional ability and health status in the arthritic patient

Chronic arthritis may have great impact on the patient but also on his or her family, relatives and friends. The assessment of the consequences of chronic arthritis and the effect of therapy not only in terms of physical, but also psychological and social dimensions deserves more attention. Functional ability and health status can be measured using a questionnaire or ‘instrument’, high-lighting important aspects not quantified with more traditional measurements. In this paper, arguments to apply such instruments more frequently are given. Health status instruments can be used not only to assess beneficial but also deleterious (side-)effects of therapeutic interventions. The properties are summarized of the most frequently used instruments assessing functional ability and health status. Many of these instruments have been evaluated sufficiently for validity and reliability; their sensitivity to detect change seems to be satisfactory. Therefore it is advisable to choose an internationally accepted, frequently used instrument, reflecting the area of interest.     

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.     

Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation—An exploratory study

Objective

To evaluate developments in health status (HS) and overall quality of life (QOL), and the impact of self-efficacy on HS and QOL in relation to COPD pulmonary rehabilitation (PR).

Methods

A longitudinal study of 100 COPD patients before and up to 3 months after COPD PR. Self-efficacy was measured by the COPD self-efficacy scale, HS by the St. George Respiratory Questionnaire and QOL by the Quality of Life Scale. Mixed effect models were used.

Results

Patients reported significantly reduced psychosocial impact of disease (estimate = −4.05, p = 0.019) immediately after the PR programme. Higher levels of self-efficacy at baseline predicted significantly reduced psychosocial impact of disease and improved physical activity, total HS and QOL (p < 0.05). Better exercise capacity at baseline predicted significantly reduced psychosocial impact of disease, improved physical activity and QOL (p < 0.05). Older age at baseline predicted significantly fewer respiratory symptoms and improved total HS (p < 0.05).

Conclusions

Patients reported significantly reduced psychosocial impact of disease immediately after a COPD PR, and better exercise capacity and higher self-efficacy at baseline predicted significantly improved HS and QOL.

Practice implications

Increasing self-efficacy is suggested to be an important aim in relation to COPD PR.     

Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services

Objectives: To examine the rates and correlates of treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Method: We used data from the Canadian Community Health Survey‐Mental Health and Well‐Being (CCHS‐1.2), which includes 12,792 individuals aged ≥55 years. The average age of these participants was 67 years and 53.2% were female. We examined the rates of treatment satisfaction, perceived treatment effectiveness, and dropout for those who had used mental health services in the past year, and used logistic regression to examine the correlates of these outcomes. Results: Of the older adults included in the CCHS‐1.2, 664 (5.3%) had used mental health services in the past year. The majority of these were satisfied with services (88.5%) and perceived treatment to be effective (83.6%), which is likely why only 15.5% dropped out in the past year. In logistic regression models, social support was significantly and positively related to both treatment satisfaction and perceived effectiveness. Perceived treatment effectiveness was the only variable related to dropout, with lower levels of perceived effectiveness associated with greater odds of dropping out of treatment. Conclusions: Results from this study indicate that older adults have very good self‐reported treatment outcomes. The modest influence of individual characteristics on treatment outcomes suggests the potential importance of contextual characteristics. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1197–1209, 2011.     

Predictors of health status in women with fibromyalgia: A prospective study

Although cross-sectional studies have identified correlates of dysfunction in fibromyalgia (FM) patients (e.g., psychological distress and pain), predictors of health status have not been previously investigated using a longitudinal research design. We gathered data from 156 women who met American College of Rheumatology criteria for primary FM recruited from both tertiary care and community settings. Stepwise multiple linear regression analysis indicated that poorer health status (p < .0001) and more comorbidity (p = .0089) at baseline were predictors of poorer health status 6 months later. After controlling for these covariates, psychological distress contributed significantly to the model (p = .01). There was a trend indicating that palliative coping styles (i.e., self-care, energy conservation) altered the impact of pain on 6-month health status (p = .06). These findings highlight the need for multidisciplinary interventions that target psychological distress, coping, and comorbidity in patients with FM. This study was made possible by funds received from The Canadian Arthritis Society. Salary support for Patricia L. Dobkin was provided by Fonds de la recherche en santé du Québec (FRSQ) as a Senior Scientist; Mirella De Civita by a Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR); Michal Abrahamowicz as a James McGill Professor; Sasha Bernatsky from the CIHR as a Postgraduate Fellow. The following physicians examined patients: Drs. Martin Cohen, Mary-Ann Fitzcharles, Michael Starr, Jan Schulz, Murray Baron, Pierre Dagenais, Suzanne Mercille, Anne St-Pierre, Sasha Bernatsky and Harbhajan Kang. We thank Ms. Natalie Dayan who served as the Project Coordinator, Ms. Roxane du Berger for her assistance with statistical analyses, and Ms. Tammy Allan for excellent secretarial support. We also thank the women with FM who agreed to participate in the study.     

Increase of interleukin 6 and decrease of interleukin 2 production during the ageing process are influenced by the health status

The ageing process is accompanied by the disregulation of interleukin 2 (IL2) and interleukin 6 (IL6) production. In our paper, we asked whether the age between 60 and 70 years is a turning point for the disregulation of both IL2 and IL6 production. Fifty volunteers 60–70 years old, 25 aged 36–59, and 50 of 20–35 years old were enrolled into the study. Their health status was graded according to the criteria of the Senieur Protocol (SP) as ‘healthy' and ‘almost-healthy'. The cytokines level was determined in the sera of the volunteers. Moreover, the spontaneous release of IL6 by peripheral blood mononuclear cells (PBMC) and the activity of the IL6 gene in non-stimulated PBMC were also analysed. Cytokine levels were measured by biological assays, mRNA for IL6 was detected by RT-PCR method. The results showed that the production of IL2 is not disregulated in the ‘healthy' people until the age of 60–70. People not fulfilling all SP criteria are characterised by a lower level of IL2 in the sera. The overproduction of IL6 into the sera and supernatants from non-stimulated PBMC and PBL as well as the activation of IL6 gene start between the ages 36 and 59 and is more pronounced in the ‘almost-healthy'.