Contextual influences on women's health concerns and attitudes toward menopause

Social factors that affect women's attitudes toward menopause were examined in a sample of 1,037 baby boomer women who took part in two waves of the Midlife in the United States survey. Survey data were collected in 1996 and 2005 from a nationally representative sample of women born between 1946 and 1964 residing in the United States. Women's attitudes toward the effects of menopause on fertility, health, and attractiveness were examined. Analyses supported a two-factor model ofwomen's adaptation to menopause: attitudes concerning the effects of menopause on fertility and the cessation of menstruation had different antecedents than attitudes concerning the impact of menopause on health and attractiveness. Women who had more positive attitudes regarding loss of fertility occupied more roles, were older, less educated, yet more secure financially. Women who had more positive views of the effects of menopause on health and attractiveness reported fewer symptoms of menopause. These analyses were replicated in waves 1 and 2 of the data set. Results may be helpful to social work practitioners and social work policy advocates.     

Does Pregnancy Increase Use and Awareness of Nutrition Information in Food Labels?

Objectives This study aims to examine food label use, specific reading behaviors and the awareness of dietary recommendations among U.S. pregnant women in comparison to non-pregnant women. Methods A cross-sectional data analysis was conducted using a representative national sample of U.S. women aged 16 to 44 years from the National Health and Nutrition Examination Survey 2005–2006 (n?=?1875). Food label users were defined as woman who used the Nutrition Facts panel when making a food choice in the frequency of always, most of the time, or sometimes. Pregnancy status was assessed in relation to food label use, specific reading behaviors and the awareness of dietary recommendations by conducting hierarchical multivariable logistic regression models including covariates of SES and perceived health and weight variables. Results The prevalence of using food labels at purchase greatly differs by SES, perceived health and weight variables, and awareness of dietary recommendations but not by pregnancy: 68.6% of pregnant and 66.1% of non-pregnant women used food labels in the U.S. However, after controlling for SES and perceived health and weight status, pregnant women are more likely to read food labels than their counterparts (OR?=?1.43, 95% CI?=?1.07–1.89). Pregnant women were less likely to check cholesterol (OR?=?0.58, 95% CI?=?0.44–0.77) and calories from fat content (OR?=?0.61, 95% CI?=?0.42–0.89), after adjusting for SES variables. Pregnant women may not have a higher awareness of dietary recommendations compared to non-pregnant women in the U.S. Conclusions While pregnancy itself is a factor that appears to encourage the reading of food labels, pregnancy does not encourage positive reading behaviors. The findings suggest a great need for prenatal nutrition education programs in the U.S.     

健康教育对提高更年期妇女保健知识知晓率的效果分析

目的:探讨影响广州市区更年期妇女保健态度、知识、行为的相关因素。方法:在该市各企业、事业单位进行更年期保健知识讲座,并对班前班后调查问卷进行统计学处理。结果:班前班后对更年期妇女保健态度、知识、行为的相关知识有明显的影响。结论:更年期妇女保健态度、知识、行为的知晓率有待进一步普及,以提高更年期妇女生活质量。     

城市女性生殖健康知识现状调查

目的 了解城市女性卫生保健知识及相关行为、避孕知识及行为、性观念／行为和生殖健康服务需求。方法采用互联网调查的方式,对共25055名城市女性进行匿名问卷调查,应用SPSS11．5进行数据统计分析。结果对女性生殖道的生理特点、常见阴道炎（如霉菌、滴虫等）的预防保健知识“非常了解”的比例仅为14．21％和8．78％;在回答避孕知识相关问题的调查对象中,仅有16．13％的人对各种避孕知识和方法都“非常了解”;对于性行为,表示“一定要结婚才可以”的人只占回答此问题的调查对象的17．52％;面对生殖健康问题,受调查女性的就医意识和就医行为普遍偏低。结论城市女性拥有一定的生殖健康知识,但多停留在一般常识阶段,自我保健意识也有待提高,故医疗保健工作者在加大健康教育力度、倡导健康行为的同时,也要注意改进工作方式,提供更具优势的服务,以促使其主动利用正规的生殖健康保健服务。     

更年期门诊患者的社会人口统计学调查

通过对 1998年 7月～ 2 0 0 0年 7月 5 0 3名在我院更年期门诊就诊的围绝经期、绝经后期妇女进行问卷式社会人口统计学调查 ,并参照其他国家和地区的调查报告进行分析 ,以了解我国的现状及为围绝经期和绝经后期妇女保健工作提供参考。被调查者的年龄为 3 5～ 82岁 (包括外科手术绝经和卵巢早衰绝经者 ) ,平均年龄为 5 1.9± 7岁。4 1.0 %小于 5 0岁 ;3 5 .0 %为 5 0～ 5 4岁 ;12 .0 %为 5 5～ 5 9岁 ;12 .0 %超过 60岁。绝经年限 :5 1%处于绝经过渡期 ;4 9%为绝经后期 ,其中绝经 1～ 5年者为 18% ,6～ 10年者和超过 10年者分别为 16%、15 %。其中有 3 8.8%为手术绝经。教育水平 :5 5 .5 %为大学毕业 ;4 0 .0 %为高中毕业 ,4 .5 %的教育水平相当于或低于小学水平。     

Menstrual and reproductive characteristics and age at natural menopause

Data from women who enrolled between 1935 and 1939 in a long-term prospective study of menstrual and reproductive health, in which menstrual cycles and other events were recorded as they occurred, were analyzed to examine factors associated with age at natural menopause. Analysis was restricted to 561 women who enrolled before age 25 years and recorded data through at least age 44 years. Women with a median cycle length that was less than 26 days at ages 20-35 years reached menopause 1.4 years earlier than those with cycles between 26 and 32 days. The difference in mean menopausal age between women with short cycle length (less than 26 days) and women with long cycle length (33 days or longer) was 2.2 years. Women who had ever been pregnant reached menopause slightly, but statistically significantly, later than women who had never been pregnant. Similarly, women who had ever had a live birth had a slightly later age at menopause compared with nulliparous women. A trend of later age at menopause with increasing parity was also observed. There was no association with age at menarche. Certain of these observations are consistent with proposed mechanisms of cessation of menstrual function.     

Health inequalities based on ethnicity in individuals aged 15 to 64, Brazil, 1998

This study aimed to analyze inequalities in health status and utilization of medical consultations and hospital services by Brazilian young and adult populations according to ethnicity. The survey analyzes a representative sample of the Brazilian population aged 15 to 64 years, except those living in the rural area of the Amazon. The prevalence of fair or poor health status was substantially higher among black men, white women, and black women. The influence of gender and ethnicity remains significant after adjusting for age and socioeconomic conditions (OR = 1.11; 1.49 and 1.86 respectively). Differences between blacks and whites decrease with age, but increase with socioeconomic status. There were 10% more medical consultations among white individuals. The differences were more striking among young people who reported good health status. For individuals with fair or poor health, no differences were observed in frequency of medical consultations between blacks and whites. There were no significant differences in hospitalization rates. With regard to health status, differences between blacks and whites were striking. However, the same was not true for utilization of health services.     

Prospective study of factors influencing the onset of natural menopause

Late or early menopause has been implicated in risk of several chronic diseases in women. To study factors influencing the onset of natural menopause, the authors analyzed the follow-up data of 4694 premenopausal women who enrolled in the New York University Women Study at ages 34–61. In an average of 5.4 years of observation, there were 2035 incidences of menopause, with the median age of 51.3 years. Current smokers experienced menopause 0.75 years earlier than never-smokers. Those who smoked more than 10 cigarettes per day had a 40% increase in risk of earlier menopause. In contrast, women who had three or more children experienced menopause 0.86 years later than nulliparous women, and Jewish women, 0.66 years later than Catholic women. There was also a modest increase in the age at menopause with increasing body mass index. This prospective study provides solid epidemiologic evidence that several factors other than cigarette smoking have impact on the onset of natural menopause.     

A prospective study of factors affecting age at menopause

This paper describes a multivariate analysis of a 3-year prospective study of the covariates of age at menopause among women who were randomly sampled from a general population. This approach avoids three problems that may account for the inconsistent results of prior studies: recall bias in retrospectively collected data, failure to control confounding in data analyses, and self-selection in the target populations. At baseline, the 2014 subjects in this study were 46.5-56.5 years old and still menstruating. Median age at last menstruation estimated from a model of the marginal distribution of age at menopause, was 50.7 years. When covariates were considered singly, age at menopause varied with smoking, education and income but not with marital status, parity, location, height, weight or use of either oral contraceptives or menopausal estrogens. Multivariate analyses showed that education and income were confounded with smoking status. The results indicate that many previously identified sources of variation in age at menopause reflect confounding with smoking and self-selection in target populations, rather than real effects.     

围绝经期妇女就诊及激素替代治疗态度调查

目的了解广东省围绝经期妇女的医疗保健行为，为有针对性地开展更年期预防保健工作提供依据。方法对广东省珠江三角地区、山区、东西两翼地区的地市级、县级的围绝经期妇女4489人进行问卷调查，用SPSS软件进行分析。结果我省围绝经期妇女有更年期症状的比例较高，但自我保健意识薄弱，就诊率仅为19．9％，其中36．2％的妇女就诊于内科，34.1％的妇女就诊于中医科，仅20．3％的妇女就诊于妇产科；在被调查人群中使用激素替代(HRT)治疗的比例仅1．496；围绝经期妇女的医疗保健行为受文化程度、职业、经济发展、是否绝经及不同地域等因素的影响。结论需要进一步提高围绝经期妇女的自我保健意识，尤其要加强对农村、山区等地围绝经期妇女健康教育。     

Employment, attitudes toward employment, and women's health

The relationships between self-reported general health, employment, and attitudes toward the employment of married women have been analyzed for a representative sample of married, middle-aged women in the United States. The cross-sectional data indicate that women who were in the labor force had better health than women who were out of the labor force. In addition, women whose labor force status was compatible with their attitudes toward employment tended to have better health than women for whom there was a discrepancy between labor force status and attitudes. Analysis of the longitudinal data indicate that several causal mechanisms contributed to the relationships observed in the cross-sectional data. For the women with favorable attitudes toward employment, it appears that being a housewife had more detrimental effects on health than being employed. In contrast, for the women with unfavorable or neutral attitudes toward employment, it appears that employment status did not affect health. For healthy women, being employed may have contributed to more favorable attitudes toward employment. Healthy women were more likely than unhealthy women to stay in the labor force. Thus, it appears that there are multiple causal relationships linking employment status, attitudes toward employment and women's health.     

Reproducibility and validity of self-reported menopausal status in a prospective cohort study

The reproducibility and validity of self-reported menopausal status were evaluated among the 121,700 female US registered nurses aged 30-55 years in 1976 who are participants in the Nurses' Health Study, a prospective cohort study of diseases in women. When questioned in 1978, 6,591 of the women who were premenopausal in 1976 reported that their menses had ceased and provided their age at menopause. Two years later, in 1980, 98.8 per cent of the 6,591 women again reported that they were postmenopausal and again gave the reasons for menopause (natural or surgical). Among those women who reported surgical menopause during the 1976-1978 follow-up interval, age at menopause was reported to within one year on both the 1978 and 1980 questionnaires by 95 per cent of women. Among those reporting natural menopause during the 1976-1978 period, 82 per cent of women reported their age at menopause to within one year on the two follow-up questionnaires. A random sample of 255 women reporting surgical menopause between 1982 and 1984 was identified and medical records were obtained for 200. For all but two women, there was complete agreement between self-report and medical record for details of hysterectomy and extent of ovarian surgery. The reproducibility of self-reported age at menopause was assessed among 31,405 women who were menopausal in 1976. Reported age at menopause on consecutive questionnaires showed increasing within-person variance with increasing duration since menopause.(ABSTRACT TRUNCATED AT 250 WORDS)     

Midlife women making hormone therapy decisions.

This study focuses on midlife women aged 40-65 years who were in transition to menopause, were menopausal or had a hysterectomy, to examine and better understand hormone therapy (HT) choices women make. Among the nationally representative sample of women in the Commonwealth Fund 1998 Survey of Women's Health (n = 884), 39% of the menopausal women reported current HT use. The two primary reasons for initiating HT are following a doctor's recommendation and seeking relief of menopausal symptoms. Age, education, race, hysterectomy status, having health insurance, use of calcium supplements and comfort in communicating with a doctor are important factors associated with HT use. This study underscores the importance of physicians and other health professionals providing accurate HT information to assist women in making HT decisions.     

THE OHIO MIDLIFE WOMEN'S STUDY

The Ohio Midlife Women's Study was longitudinal with measurements occurring at three, 9-month intervals. Our purpose in doing this research was to examine predictors, moderators, and outcome variables associated with the transition to midlife in Caucasian and African American women. Predictor variables included loss and gain of resources. Moderators included menopause symptoms, menopausal status, attitude toward menopause, coping, and demographic characteristics. Outcome variables included anxiety, depression, and health promoting activities. To obtain the proposed final sample of 160 midlife women, an initial sample of 103 African American and 105 Caucasian "healthy" women were recruited in the community. Consistent predictors of anxiety were loss of resources, coping effectiveness, and education. Consistent predictors of depression were loss of resources and education. Health promoting activities were consistently predicted by attitude toward menopause and coping effectiveness. Stress is a better predictor of negative health outcomes than menopausal status.     

Utilization of Preventive Medical Services in the United States: A Comparison Between Rural and Urban Populations

Differences between rural and urban residents in their utilization of three clinical preventive services--Papanicolaou screening tests (Pap smears) for women aged 18 to 65, mammograms for women aged 50 to 69 and flu shots for people aged 65 or older--were examined using a nationally representative sample from the 1994 U.S. National Health Interview Survey. Eighty-two percent of urban women and 79 percent of rural women (P = 0.11) had Pap smears. Sixty-eight percent of urban women and 61 percent of rural women (P = 0.01) had mammograms. Flu shots were received by 55 percent of urban and 58 percent of rural elderly residents (P = 0.11). Of women aged 50 to 69 who had a high school education or whose annual household income was between $15,000 and $34,999, significantly fewer rural than urban women had mammograms (P < 0.01). However, the proportion of rural women receiving mammograms was not significantly different from that of urban women after adjusting for their education, household income and health insurance status. Education level, house-hold income and health insurance coverage were positively associated with utilizing mammograms. These results suggest that differences in the utilization of preventive services between rural and urban women vary by services. Improving socioeconomic status and health insurance coverage of rural women may reduce the disparity in mammogram use between rural and urban women. Mechanisms of how a woman's socioeconomic status affects her utilization of mammograms needs further study.     

Psychosocial Predictors of Mental Health Service Utilization Among Women During their Mid-Sixties

This prospective study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N?=?511) who were followed from young adulthood (mean age?=?32) to late midlife (mean age?=?65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services by women in the mid-sixties.     

Cigarette smoke and the hormonal receptors status in breast cancer

This paper describes 188 cases of early breast cancer in which age, menopause status, smoking, and pathological characteristics of the tumor were investigated, as well as status and levels of estrogen and progesterone hormone receptors.Estrogen and progesterone receptor status did not seem to differ between smokers and non-smokers.The data of this study does not confirm the observation of a larger number of cases among women who smoke. However, the proportion of estrogen-receptor-negative cases is slightly higher in pre-menopause smokers and in those patients more exposed to smoke both in terms of intensity (cigarette per day) and duration (years of exposure).Corresponding author.     

Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care

The empirical evidence concerning the relationship of psychiatric disorders to health care utilization and costs is mixed and primarily retrospective. Therefore, a case-control study was conducted to prospectively examine the association of psychiatric disorders with health care utilization in an adult primary care internal medicine patient population, controlling for the effects of medical morbidity, adverse events, age, race, gender, employment status, and health insurance coverage. Samples of primary care high utilizer (HU; 125 men, 125 women with primary care visits in 1998 above the 95th percentile) vs. mid-range utilizer (MU; 125 men, 125 women; two primary care visits in 1998) patients were compared using archival automated medical record data from the index year (1998), and from the following year (1999) for prospective analyses. HU (compared to MU) participants were younger, had higher medical and psychiatric morbidity, and had higher levels of outpatient specialty medical care utilization. In multivariate analyses, (a) anxiety disorder diagnoses uniquely contributed to identifying HU patients, and (b) after controlling for initial primary care utilization status, anxiety, depressive and addictive disorders were prospectively associated with medical illness complexity and primary, specialty, and emergency medical care utilization. Although behavioral health disorders (including addictive as well as depressive and anxiety diagnoses) and high utilization of primary health care services are related, these prospective findings suggest that behavioral health disorders make an independent contribution to non-psychiatric health care utilization.     

Insurance and the utilization of medical services

Most data sets indicate a positive correlation between having health insurance and utilizing health care services. Yet the direction of causality is not at all clear. If we observe a positive correlation between the utilization of health care services and insurance status, we do not know if this is because people who anticipate poor health buy more insurance (or take jobs with generous medical coverage), or because insurance lowers the cost of health care, increasing the quantity demanded. While a few attempts have been made to implement an instrumental variables (IV) strategy to deal with endogeneity, the instruments chosen have not been entirely convincing. In this paper we revisit the IV estimation of the reduced form relationships between insurance and health care utilization taking advantage of what we argue is a good instrument-the individual's self-employment status. Our main finding is that a positive and statistically significant effect of insurance continues to obtain even after instrumenting. Indeed, instrumental variables estimates of the impact of insurance on utilization of a variety of health care services are larger than their non-instrumented counterparts. The validity of this exercise depends on the extent to which self-employment status is a suitable instrument. To argue this case, we analyze panel data on transitions from wage-earning into self-employment and show that individuals who select into self-employment do not differ systematically from those who remain wage-earners with respect to either the utilization of health care or health status. While this finding does not prove that self-employment status is an appropriate instrument, it is encouraging that there appear to be no underlying differences that might lead to self-employment per se affecting health services utilization.     

Change in psychological and vasomotor symptom reporting during the menopause

There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.