Risk factors for urinary tract symptoms in women: beliefs among general practitioners and women and the effect on patient management.

BACKGROUND: Urinary tract symptoms are common in women. A variety of risk factors have been investigated in the past. One of the more likely risk factors for these symptoms is recent sexual intercourse; another is diaphragm use. Morbidity levels are increasing, although effective antibiotic treatment is available. AIM: To study the beliefs of women and their general practitioners (GPs) about urinary tract symptoms and to determine how these may affect management. METHOD: An interview survey with 113 women consulting with urinary tract symptoms and the 22 GPs they consulted. RESULTS: Doctors and women have similar beliefs about the 'causes' of urinary tract symptoms, but the relative importance differs. Both acknowledge the association with sexual intercourse but fail to communicate about this during the consultation. Patients reported being embarrassed on their own and their GP's behalf if sensitive subjects were raised. Doctors failed to ask women what they thought had caused the symptoms and were also unlikely to suggest to them likely causes. They also reported reticence to do more than prescribe, at least in first consultations, and half of the doctors routinely prescribed antibiotics, regardless of a near patient diagnostic urinary stick test result. The advice given was not necessarily evidence based. CONCLUSIONS: GPs need to be more aware of the risk factors associated with urinary tract symptoms in women and should formulate their advice accordingly. The reticence to discuss sensitive subjects by both GPs and patients has implications for the ability to broach sexual matters in any consultation in which they are not the reason or focus for that consultation.     

Vulnerability factors and depressive symptoms among hospitalized women

Previous research has demonstrated that symptoms of depression and anxiety can impede the recovery process of hospitalized medical patients. The purpose of this study was to identify those hospitalized patients who were more likely to be predisposed to these symptoms. Using a sample of 109 hospitalized women, the following hypothesis was tested: Depressive symptoms will be more prevalent among those who (a) had experienced the loss of their mother at 17 years of age or younger, (b) have been experiencing low marital companionship, or (c) have three or more children 17 years of age or younger at home. A contingency analysis revealed a significant relationship between early loss of mother and the development of depressive symptoms. Although marital companionship failed to differentiate between depressive symptom levels, a two-way analysis of variance yielded a significant inverse relationship between marital companionship and depression in general. The number of children at home was not a significant predictor, either as a main effect or interactively with marital companionship. Implications for interventions are discussed.     

Care of vaginal symptoms among HIV-infected women

OBJECTIVE: Gynecologic disease is common in HIV-infected women. We examine the sociodemographic, clinical, and provider factors associated with the care of women with vaginal symptoms. METHODS: Women enrolled in the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults, were interviewed between January 1996 and April 1997. Women with vaginal symptoms who sought medical attention were asked, "Did your health care provider examine your vaginal area?" Women were also asked if they received medication for their symptoms. RESULTS: Among 154 women with vaginal symptoms, 127 sought care for their symptoms. Of those who sought care, 48% saw a gynecologist and 52% sought care from nongynecologists, most often their usual HIV care provider. Women who saw a gynecologist for their symptoms were more likely to have received a pelvic examination (92% versus 76%; p =.06) and vaginal fluid collection (98% versus 88%; p =.06) than those who saw their regular HIV provider. Fifteen percent of women received medication for their symptoms without having a pelvic examination; gynecologists were less likely to prescribe without an examination (8% versus 21%; p =.12). CONCLUSION: Gynecologists are more likely to provide adequate care of vaginal symptoms among HIV-infected women than nongynecologists who were HIV care providers. This specialty difference is consistent with quality of care studies for other medical conditions, but the potential gynecologic complications of inadequate evaluation and treatment warrants further investigation.     

Menopausal symptoms among Thai women in Bangkok

A random probability cluster area sampling of 614 women living in Bangkok was conducted to determine the prevalence of abnormal symptoms related to the menopause. Women interviewed were aged 40 and above currently registered as living in the Bangkok Metropolitan area. Sixty-nine percent of the women interviewed experienced abnormal symptoms. Eighty-two percent of those with abnormal symptoms reported having hot flushes. Palpitation, increased heat intolerance and emotional liability were common symptoms. Minor abnormalities included insomnia, weakness, anxiety and urinary symptoms. Changes related to sexual function were difficult to elicit due to cultural limitations. Economic and cultural factors might play important roles in the way these women perceived symptoms related to the menopause and sought medical assistance.     

Posttraumatic stress symptoms and victimization among Japanese American women

This study of Japanese American women and immigrant women from Japan investigated the relationship between posttraumatic stress (PTS) symptoms and the perceived abusiveness of partners' emotional and physical violence, with a community-based randon sample. Women who experienced injuries and/or fear for their lives, in addition to partners' emotional and physical violence, had significantly higher PTS symptom counts than those with no lifetime experience of partners' violence. Victimization by nonintimates also increased PTS symptom counts. Satisfaction with social support significantly mitigated the negative effect of childhood abuse for reexperiencing and avoidance symptoms.     

Causal explanations for common somatic symptoms among women and men

The purpose of this study was to examine categories of causal attributions assessed by women and men regarding common somatic symptoms. A questionnaire was sent out to a randomly selected sample of 1,500 persons followed by a screening of respondents with symptom experience. To identify groups of individuals considering different causes or causal categories as important, separate cluster analyses were made of ratings for neck/shoulder problems and sore/upset stomach. The results showed similarities between assessed causal categories for the two types of symptoms and that women in this sample were overrepresented, particularly in considering psychological explanations for their symptoms, whereas the men were overrepresented in not considering any of the causes as particularly important. This was discussed in terms of illness severity and an association between psychological and somatic distress in people’s experience, such as stress and total workload, and in their subsequent explanatory models suggesting differences in beliefs about a connection between body and mind.     

Cross-sectional community survey of menopause symptoms among Japanese women

Objectives

To determine the prevalence and characteristics of climacteric symptoms and related factors among 50-year-old Japanese women.

Methods

A self-administered questionnaire was mailed to all 50-year-old women (n = 3166) in three northern wards of Kawasaki City regarding 10 menopausal symptoms (hot flashes, sweats, insomnia, depression, palpitation, chills, irritation, headache, fatigue, and stiff shoulders) as well as demographic, lifestyle, psychological, socio-economic and physical factors. The questionnaire included closed-ended questions about symptoms over a 1-year recall time frame. The response rate was 55%, and women with current illness, a history of gynecological or endocrinological disorders and those on HRT were eliminated. We finally analyzed data from 1169 (37%) women.

Results

The prevalence of hot flashes was 36.9%. These, together with sweats, insomnia and depression, were associated with menstrual status. All four symptoms were also associated with lifestyle and socio-psychological factors. Psychological stress (unease or anxiety) was associated with all 10 symptoms investigated. The two most prevalent symptoms, namely, fatigue (64.7%) and stiff shoulders (75.4%) were associated with psychological and lifestyle factors.

Conclusions

Hot flashes were experienced by more women in the present community-based study than in most previous studies of Japanese women. We found that hot flashes (‘hoteri’ in Japanese) are related to menstrual status. Symptoms both related and unrelated to menstrual status were associated with lifestyle, psychological factors and BMI.     

A qualitative study of delay among women reporting symptoms of breast cancer.

BACKGROUND: Delayed presentation of symptomatic breast cancer of three months or more is associated with lower survival rates from the disease, yet 20% to 30% of women wait at least three months before consulting their general practitioner (GP) with breast symptoms. AIM: To explore the factors that influence GP consultation by women with breast cancer symptoms. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: Forty-six women with newly diagnosed breast cancer, selected from 185 women recruited to a larger study. METHOD: Interviews were conducted eight weeks after diagnosis of breast cancer, comparing two groups of women divided according to the extent of delay between onset of symptoms and seeking medical care. Fifteen women had sought advice from their GP within two weeks of symptom discovery ('non-delayers' and 31 had waited 12 weeks or more before seeing their doctor ('delayers'). RESULTS: Women with breast symptoms who presented promptly to GPs recognised the seriousness of the symptom they had discovered more quickly than delayers. Perception of seriousness was influenced by the nature of the initial symptom and how far it matched the individual's expectations of breast cancer as a painless breast lump. Other factors affecting help-seeking included attitudes to GP attendance, beliefs about the consequences of cancer treatment, and perceptions of other priorities taking precedence over personal health. CONCLUSIONS: This analysis suggests that women need further information about the different types of breast cancer symptoms to assist symptom recognition, as well as encouragement to seek medical advice if a symptom is ambiguous. In addition, women may benefit from greater awareness of the benefits of early detection and reassurance about the improvements in quality of breast cancer care.     

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women

This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one-third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.     

Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria

BACKGROUND/OBJECTIVE: To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. METHODS: Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. RESULTS: Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = < 0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). CONCLUSIONS: Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.     

Endogenous hormones, participant characteristics, and symptoms among midlife women

OBJECTIVES: The primary aim of this study was to examine the associations between endogenous hormone levels and symptoms other than hot flashes in a sample of midlife women. METHODS: Data from a community-based sample of 603 women aged 45-54 years who had never used hormone therapy were analyzed. Each participant completed a questionnaire to obtain data on demographic and lifestyle characteristics as well as symptoms, including headache, insomnia, vision problems, vaginal discharge and dryness, irritability, and incontinence. In addition, each participant provided a blood sample that was used to measure estrogen, androgen, and sex hormone binding globulin (SHBG) concentrations by enzyme-linked immunosorbent assay. RESULTS: Prevalence rates of symptoms ranged from 51.4% (irritability) to 18.6% (vision problems). In adjusted analyses, the free estradiol index (FEI) was significantly and positively associated with the reporting of insomnia (odds ratio (OR) 1.28; 95% confidence interval (CI) 1.01-1.61). Further, higher SHBG levels were significantly associated with lower odds of reporting vision problems (OR 0.44; 95% CI 0.23-0.81). CONCLUSIONS: This study provides evidence that hormones are associated with insomnia and visual problems during midlife. However, some of these results conflict with previous findings. Given the overall paucity of literature on these issues, more investigation is warranted.     

Stigma, concealment and symptoms of depression as explanations for sexually transmitted infections among gay men

This study examined how perceived sociocultural factors influenced the relationship between psychosocial variables and sexually transmitted infections (STIs) among gay men. A cross-sectional brief street-intercept survey was administered to 594 gay men. Analyses examined how well stigma, concealment and symptoms of depression explained variation in participants' histories of STIs. Results suggested that concealment partially mediated the relationship between stigma and depression and depression partially mediated the relationship between concealment and STIs. Controlling for sociodemographic factors, symptoms of depression explained more varied histories of STIs; however, concealment was negatively related to STIs. Implications for STI and HIV interventions are discussed.     

Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii

OBJECTIVE: The Hilo Women's Health Survey was designed and administered to gather baseline data on women's health in Hilo, HI. This randomized, cross-sectional study allowed for a focus on ethnic differences in symptom reporting. The results presented here focus on hot flash and night sweat experience among Japanese-American and European-American women. DESIGN: Survey packets were mailed to street addresses associated with parcel numbers pulled randomly from Hilo tax maps. Of the 6,401 survey packets delivered to households, 1,824 questionnaires were completed and returned. The results reported here are based on 869 women aged 40 to 60, of whom 249 described themselves to be 100% Japanese and 203 described themselves to be 100% European-American. Logistic regression analyses were used to examine whether the relationship between ethnicity and vasomotor symptoms persisted after controlling for other variables. RESULTS: European-American participants were more likely to have ever experienced a hot flash as compared with Japanese-American participants (72% vs 53%, P<0.01). During the 2 weeks before the survey, European-American participants were more likely to have experienced hot flashes (P<0.05) and night sweats (P<0.01). In logistic regression analyses, after controlling for age, body mass index, menopause status, level of education, financial comfort, smoking habits, alcohol intake, exercise, use of hormone therapy, and soy intake, European-American women were still significantly more likely to have experienced hot flashes (odds ratio=1.858) and night sweats (odds ratio=2.672). CONCLUSIONS: The results, based on self-reporting of menopausal symptoms, indicate that Japanese-American women report fewer hot flashes and night sweats than European-American women. Japanese-American women reported a higher intake of soy, but soy intake was not associated with fewer vasomotor symptoms.     

Physical symptoms and depressive symptoms among individuals with HIV infection.

The authors investigate the importance of physical symptoms as a correlate of depressive symptoms and suicidal thoughts in a large (N = 881) community-based sample of persons infected with human immunodeficiency virus. The study overcomes limitations of prior research by minimizing overlap in measures of affective and physical symptoms, studying a more diverse population, and including correlates such as measures of social support, function, employment, insurance coverage, and cognitive impairment in the analysis. The authors' data support the notion that in diagnosing depression in the medically ill, concern over isolating physical symptoms as either "affective" or "physical" may be exaggerated.     

Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration.

Recently, there has been a resurgence of interest in relations among psychological trauma, dissociative phenomena, and various forms of trauma-related distress that has spawned a prolific amount of research. To date, a relatively comprehensive review of this recent research is lacking. Thus, this paper provides such a review to help summarize and synthesize recent findings, illuminate study limitations, and offer suggestions for future research. In general, findings have revealed fairly strong and consistent relations among the constructs of trauma, dissociation, and trauma-related distress (e.g., posttraumatic stress disorder, borderline personality disorder, bulimia); individuals who have experienced a traumatic event are more likely to dissociate than individuals who have not, and individuals who experience more dissociative phenomena are more likely to also experience higher levels of trauma-related distress. It is theorized here that dissociative phenomena and subsequent trauma-related distress may relate to fears about death and fears about loss or lack of control above and beyond the occurrence of the traumatic event itself. Such fears about death and loss/lack of control may also help differentiate traumatized individuals who psychologically suffer to varying degrees. Possible functions of dissociation in response to trauma and in relation to forms of trauma-related distress are considered and discussed.     

Risk factors associated with endometriosis among infertile Iranian women

Introduction

Endometriosis is defined as overgrowth of endometrial tissue outside the uterine cavity. Endometriosis may be asymptomatic or associated with dysmenorrheal symptoms, dyspareunia, pelvic pain, abnormal uterine bleeding and infertility. The aim of this study was to explore the risk factors related to endometriosis among infertile Iranian women.

Material and methods

In this case control study, infertile women referred for laparoscopy and infertility workup to two referral infertility clinics in Tehran, Iran were studied. According to the laparoscopy findings, women were divided into case (women who had pelvic endometriosis) and control (women with normal pelvis) groups. The case group was divided into two subgroups: stage I and II of endometriosis were considered as mild while stage III and IV were categorized as severe endometriosis. A questionnaire was completed for each patient.

Results

Logistic regression showed that age, duration of infertility, body mass index (BMI), duration of menstrual cycle, abortion history, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors for any type of endometriosis. In addition, it was shown that education, duration of infertility, BMI, amount and duration of menstrual bleeding, menstrual pattern, dyspareunia, pelvic pain and family history of endometriosis are independent predictive factors of severe endometriosis. The AUCs for these models were 0.781 (0.735-0.827) and 0.855 (0.810-0.901) for any type of endometriosis and severe endometriosis, respectively.

Conclusions

It seems that any type of endometriosis and severe ones could be predicted according to demographic, menstrual and reproductive characteristics of infertile women.     

肥胖妇女有孕育神经管缺陷胎儿的危险

为了研究肥胖对妇女孕育神经管缺陷(Neural tube defect NTD)胎儿的危险性 ,我们对加利福亚地区肥胖妇女孕育 NTD胎儿的情况进行了一次大样本调查。从调查结果发现 ,肥胖妇女孕育 NTD胎儿的危险性要高于正常体重的妇女。其中 ,尤以孕育脊柱裂(Spina bifida)、颅脊柱裂 (Cranior     

Longitudinal relations between trauma-related psychological distress and physical aggression among urban early adolescents

There is convincing evidence that trauma-related psychological distress and aggressive behavior are highly related among adolescents. The evidence is less clear regarding the direction of this relation. Objective: The purpose of this study was to examine reciprocal longitudinal relations between trauma-related distress and physical aggression. Method: A predominantly African American sample of early adolescents (N = 2,271; mean age = 12.9) living in an urban, under-resourced community participated in this investigation. The current study used autoregressive cross-lagged models to examine changes across four waves of data within each grade of middle school. Results: Support was found for trauma-related distress uniquely predicting increased levels of physical aggression. This effect was consistent across gender and within and across middle school grades. Conversely, physical aggression did not predict changes in trauma-related distress. Conclusions: Violence prevention efforts should routinely screen for trauma-related distress.