Women's knowledge about menopause, hormone replacement therapy (HRT), and interactions with healthcare providers: an exploratory study

This community mail-based survey received responses from 665 women to questions in three areas: (1) sources of information about menopause, (2) knowledge of health risks associated with menopause, and (3) knowledge about hormone replacement therapy (HRT). Women received information from many sources, including healthcare providers, friends, and mothers, but the number one source of information about menopause was women's magazines (76%). Over half of women surveyed said they had left healthcare appointments with unanswered questions about menopause and HRT. Although women seemed to have a basic understanding of the symptoms of menopause, their knowledge of the long-term health risks affected by menopause was poor. For example, women were much more likely (60%) to know that osteoporosis risk increased with menopause than to know that heart disease risk increased (30%) despite the much higher prevalence and severity of heart disease as a health problem of menopausal women. Many women thought that menopause itself (independent of aging) increased the risk of breast cancer. This finding may help explain the low percentage of women who take HRT for menopause despite proven health benefits. It is clear that better education about menopause needs to be accomplished regarding the long-term risk associated with menopause and the pros and cons of HRT. Strategies for improving education and interactions with healthcare providers are suggested.     

Changing epidemiology of human brucellosis, Germany, 1962-2005

Trends in the epidemiology of human brucellosis in Germany were investigated by analyzing national surveillance data (1962-2005) complemented by a questionnaire-based survey (1995-2000). After a steady decrease in brucellosis incidence from 1962 to the 1980s, a persistent number of cases has been reported in recent years, with the highest incidence in Turkish immigrants (0.3/100,000 Turks vs. 0.01/100,000 in the German population; incidence rate ratio 29). Among cases with reported exposure risks, 59% were related to the consumption of unpasteurized cheese from brucellosis-endemic countries. The mean diagnostic delay was 2.5 months. Case fatality rates increased from 0.4% (1978-1981) to a maximum of 6.5% (1998-2001). The epidemiology of brucellosis in Germany has evolved from an endemic occupational disease among the German population into a travel-associated foodborne zoonosis, primarily affecting Turkish immigrants. Prolonged diagnostic delays and high case fatality call for targeted public health measures.     

Subjective health, aging, and menopause among native and immigrant Jewish women in Israel

This study compared the perceptions and practices of health between native Israeli women and recent immigrants from the former Soviet Union. A total of 315 respondents (aged 45-65 years, of Ashkenazi, that is, European, origin and middle-class background) were recruited through their workplaces and completed a structured questionnaire, followed by personal interviews (the latter not reported here). While "objective" health profiles of Russian and native Israeli women were rather similar, immigrant women typically perceived themselves as sicker and reported greater health-related damage to their lives than their native Israeli coworkers. More Russian women also reported mental disturbances and family problems, reflecting their vulnerable condition as immigrants. Israeli women were more aware of the "health promotion" discourse, but did not necessarily pursue healthier lifestyles (e.g., more of them smoked). Israeli-socialized women reported a higher number of perimenopausal symptoms and more often adopted the medicalized view of the menopause. The results imply that health interventions aimed at middle-aged women should be specifically tailored, accounting for different cultural constructions of aging and menopause.     

Prevalence of type 2 diabetes mellitus, other cardiovascular risk factors, and cardiovascular disease in Turkish and Moroccan immigrants in North West Europe: a systematic review

BACKGROUND: The prevalence of diabetes, other cardiovascular risk factors, and cardiovascular morbidity and mortality varies between immigrant groups in Western societies, but epidemiological data on these topics are scarce for Turks and Moroccan immigrant living in North West Europe. METHODS: Medline and Embase were systematically searched for studies containing data on the prevalence of diabetes, cardiovascular risk factors, and cardiovascular morbidity and mortality in Turkish or Moroccan immigrants living in Northwestern European countries. RESULTS: Eighteen studies were identified. Corresponding findings were a high prevalence of type 2 diabetes in Turkish and Moroccan immigrants, a high prevalence of smoking among Turkish men, and a very low prevalence of smoking in Moroccan women compared to the indigenous population. Because of lack of valid studies, no definite conclusions could be drawn for in particular blood pressure and lipids. One German study showed exceptionally lower cardiovascular mortality rates in Turkish immigrants. CONCLUSION: The reviewed studies yielded insufficient evidence for a good quality comparison of the cardiovascular risk profile between Turkish and Moroccan immigrants and indigenous populations. Diabetes mellitus was more prevalent in Turkish and Moroccan immigrants, smoking more prevalent in Turkish males, and very rare in Moroccan females.     

Ethnicity, acculturation, and self reported health. A population based study among immigrants from Poland, Turkey, and Iran in Sweden

STUDY OBJECTIVE: To analyse the association between ethnicity and poor self reported health and explore the importance of any mediators such as acculturation and discrimination. DESIGN: A simple random sample of immigrants from Poland (n = 840), Turkey (n = 840), and Iran (n = 480) and of Swedish born persons (n = 2250) was used in a cross sectional study in 1996. The risk of poor self reported health was estimated by applying logistic models and stepwise inclusion of the explanatory variables. The response rate was about 68% for the immigrants and 80% for the Swedes. Explanatory variables were: age, ethnicity, educational status, marital status, poor economic resources, knowledge of Swedish, and discrimination. MAIN RESULTS: Among men from Iran and Turkey there was a threefold increased risk of poor self reported health than Swedes (reference) while the risk was five times higher for women. When socioeconomic status was included in the logistic model the risk decreased slightly. In an explanatory model, Iranian and Turkish women and men had a higher risk of poor health than Polish women and men (reference). The high risks of Turkish born men and women and Iranian born men for poor self reported health decreased to non-significance after the inclusion of SES and low knowledge of Swedish. The high risks of Iranian born women for poor self reported health decreased to non-significance after the inclusion of low SES, low knowledge of Swedish, and discrimination. CONCLUSIONS: The strong association between ethnicity and poor self reported health seems to be mediated by socioeconomic status, poor acculturation, and discrimination.     

怀柔区企事业单位女职工更年期症状与保健需求调查

目的:了解怀柔区妇女更年期症状及保健需求,为妇幼保健机构开展更年期健康教育提供依据。方法:随机抽取怀柔区部分企事业单位更年期女职工330人,采用自行设计的封闭式问卷进行调查,对所得资料录入SPSS 10.0统计软件对数据进行分析。结果:妇女更年期症状主要为记忆力减退、潮热盗汗、烦躁易激动、月经紊乱、犹豫焦虑、心悸多疑等,约20%的妇女症状明显;更年期妇女获取健康知识的途径主要为电视、报刊杂志和健康讲座,分别占63.5%、59.8%和57.6%。78%的妇女对更年期保健知识具有强烈的需求,并希望获得医疗保健机构医务人员的帮助和指导。结论:妇女更年期保健知识亟待提高,医疗保健机构应加强妇女更年期的健康教育,以提高妇女更年期健康知识水平和生活质量。     

Health-Related Quality of Life,Subjective Health Complaints,Psychological Distress and Coping in Pakistani Immigrant Women With and Without the Metabolic Syndrome

The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.     

What Turkish-speaking women expect in a German hospital and how satisfied they are with health care during their stay in a gynaecological hospital in Berlin - a comparative approach

Although cultural diversity in German metropolises is rapidly increasing, immigrant patients are rarely included in clinical studies. Specific needs of these patients are hardly known. In a comparative study, 320 German and 262 Turkish immigrant women, respectively, were interviewed via bilingual questionnaires to assess their expectations from and their satisfaction with provided health care services. While no significant differences could be found between basic expectations concerning anticipated health care standards between the two study groups, women of Turkish origin were markedly less satisfied with provided health care services. High expectations of immigrant patients towards information during their stay, communication with doctors and nurses and psychosocial services were only insufficiently met. The results indicate that specific health-relevant factors, such as social and educational status, knowledge of German language and health knowledge together with structural deficiencies of a health care service that is not prepared to correspond properly to patients of different social and cultural backgrounds, have a negative impact on patient satisfaction for migrant women.     

Subjektiv erlebte Barrieren von Personen mit Migrationshintergrund bei der Inanspruchnahme von Gesundheitsma?nahmen

Aim

Analysis of barriers regarding attendance at the health care system under consideration of cultural and migration-related factors.

Method

Cross-sectional survey with immigrants from Turkey (n?=?77), Spain (n?=?67), Italy (n?=?95) and German resettlers from the former Soviet Union (n?=?196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations.

Results

Spanish and Italian immigrants mainly search for help within their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influencing factors were German language proficiency and the subjective wellbeing in Germany.

Conclusion

The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.     

Cancer mortality patterns among Turkish immigrants in four European countries and in Turkey

The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants’ country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.     

青南地区生态移民生存质量及相关因素研究

目的 了解青南地区生态移民生存质量及影响因素,为提高移民生存质量提供依据.方法 采用多阶段整群抽样的方法,抽取海南州两个县生态移民聚居村和相邻的当地居民,采用SF-36生存质量量表及自编一般情况调查表入户调查.结果 SF-36维度评分男性移民组在生理职能、躯体疼痛、精神健康维度高于非移民组.女性在生理职能、躯体疼痛和社...     

Health status and utilization behavior associated with menopause

Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the "typical" menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45-55 years in Massachusetts. It is demonstrated that menopause itself does not cause poorer health status (either physical or psychologic); menopause itself does not cause an increase in utilization behavior; occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: representative samples of apparently healthy women; and prospective data which elucidate cause-effect relations.     

社区更年期女性自我保健意识现状调查

目的了解社区更年期妇女对更年期症状、更年期保健知识、态度和行为的知晓情况,为开展更年期妇女的保健及健康教育提供参考依据。方法用随机整群抽样的方法,选择200名分别在济南市天桥区、槐荫区及其周边郊区的44—55岁妇女,以问卷形式进行调查,询问有关更年期症状相关了解情况及保健知识。结果平均绝经年龄为45．67岁,以询问法获得的更年期症状发生率51．5％。68．5％的妇女知道有关的更年期保健知识,农村妇女的知晓率明显低于城市妇女,两者差异有显著性（P〈0．05）。在城乡更年期妇女中,有36．3％人去医院就诊,有47．9％人在控制饮食方面较强,48．0％人经常锻炼身体。结论更年期女性缺乏更年期保健知识和保健意识,存在不健康的生活方式。因此,应加强有关更年期保健的健康教育并提高自我保健意识。     

Issues for South Asian Indian patients surrounding sexuality,fertility, and childbirth in the US health care system

BACKGROUND: In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients. METHODS: Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India." RESULTS: Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process. CONCLUSION: Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.     

Access to oral care and attitudes to the dentist by German and Turkish parents

The aim of this study was to collect information on the attitude to dentists and access to dental care by German and Turkish parents. To meet this aim, 829 parents attending a school medical inspection received a questionnaire. 811 (97.8%) questionnaires were returned and 778 (93.8%) could be used for analysis. Compared to German parents Turkish parents had a more negative attitude to the dentist. In particular, communication with the dentist was assessed more negatively by Turkish parents. Clearly more Turkish than German parents agreed that their dentist frequently made them feel guilty because of poor oral hygiene (31.2 vs. 5.6%). 7.7% of German but 23.9% of Turkish parents thought that their dentist did not give them enough information. Among the Turkish interviewees, language problems rather played a minor role in communication problems. 12.6% of German and 19.3% of Turkish interviewees thought they could not believe everything what the dentist said. Only 54.0% of the German and 28.9% of the Turkish parents knew that fissure sealants were paid by the statutory sickness fund. Dentists should be better trained in dealing with patients with a different social or cultural background. Also, dentists should be taught to consider health problems rather from a social than from an individual aspect. To improve cost transparency, dentists should publish the list of services not covered by the statutory sickness fund. Moreover, an independent patient consultation service should be offered.     

Knowledge and practices of obstetricians and gynecologists regarding cytomegalovirus infection during pregnancy--United States, 2007

In the United States, congenital cytomegalovirus (CMV) infection occurs in approximately 1 in 150 live births, leading to permanent disabilities (e.g., hearing loss, vision loss, and cognitive impairment) in approximately 1 in 750 live-born children. A common mode of CMV transmission to a pregnant woman is through close contact with infected bodily fluids such as urine or saliva, especially from young children. Because no vaccine is available and treatment options are limited, renewed attention has been given to prevention of CMV infections among pregnant women through traditional infection-control practices, such as good hand hygiene. These practices have been encouraged by organizations such as CDC and the American College of Obstetricians and Gynecologists (ACOG), which recommend that obstetricians and gynecologists (OB/GYNs) counsel women on careful handling of potentially CMV-infected articles, such as diapers, and thorough hand washing after close contact with young children. Despite this increased emphasis on avoiding infection during pregnancy, few women are aware of CMV infection and how it can be prevented. During March-May 2007, ACOG surveyed a national sample of OB/GYNs to assess their knowledge and practices regarding CMV infection prevention. This report describes the results of that survey, which indicated that fewer than half (44%) of OB/GYNs surveyed reported counseling their patients about preventing CMV infection. These results emphasize the need for additional training of OB/GYNs regarding CMV infection prevention and for a better understanding of the reasons that physician knowledge regarding CMV transmission might not result in patient counseling.     

随州市高血压及行为危险因素调查

目的了解随州市高血压流行病学特征、行为和主要危险因素。方法 培训医务人员逐户调查、检查、复查确诊后登记;对高血压患者进行行为因素和健康知识知晓问卷调查。结果调查随州市35岁以上人群10 449人,高血压患病率为14.66%;女性多于男性（P〈0.01）。各年龄组均有发病,随着年龄的高移构成比重加大,至60岁组达高峰后渐降。高血压病人以1级最多,占43.67%;2级次之,占32.57%;3级最少,占23.76%。超重占27.49%;肥胖占4.65%;吸烟占8.87%;饮酒占8.77%,超重、饮酒、吸烟均为男性高于女性（P〈0.01）,肥胖差异无统计学意义（P〉0.05）。行为因素知晓率为30.54%~80.79%;健康知识知晓率为25.62%~86.70%。结论健康知识知晓和行为及主要危险因素是影响高血压发病的重要原因,也是健康教育的重点;提高发现率、治疗率和控制率,改变民众不良行为和生活方式是降低高血压发病的关键。     

女性性高潮障碍相关因素分析

目的:探讨女性性高潮障碍的相关危险因素,为女性性高潮障碍的防治提供依据。方法:采用回顾性调查方法,对2009年3月～12月在南京医科大学附属南京市妇幼保健院进行健康体检的20岁以上女性及其女性陪护人进行问卷调查,应用女性性功能指数(FSFI)问卷评估性功能,性高潮评分<4.0分为性高潮障碍的诊断标准,采用多因素Logistic回归进行多因素分析。结果:共发放问卷2 658份,有1 856例女性完成问卷,问卷回收率69.8%。剔除性唤起障碍者602例,其余性唤起正常的855例中性高潮障碍者298例,占34.9%(298/855)。Logistic多因素分析表明,年龄(≥40岁)、难产、对居所不满意、绝经、性交疼痛、配偶性功能障碍等是女性性高潮障碍的独立危险因素(P<0.05)。结论:女性性高潮障碍的发生与年龄(≥40岁)、难产、对居所满意度、绝经、性交疼痛、配偶性功能障碍多种因素相关。     

Gender, income and immigration differences in depression in Canadian urban centres

BACKGROUND: Immigrants tend to initially settle in urban centres. It is known that immigrants have lower rates of depression than the Canadian-born population, with the lowest rates among those who have arrived recently in Canada. It is established that women and low-income individuals are more likely to have depression. Given that recent immigration is a protective factor and female gender and low income are risk factors, the aim of this study was to explore a recent immigration-low income interaction by gender. METHODS: The study used 2000-01 Canadian Community Health Survey data. The sample consisted of 41,147 adults living in census metropolitan areas. Logistic regression was used to examine the effect of the interaction on depression. RESULTS: The prevalence of depression in urban centres was 9.17% overall, 6.82% for men and 11.44% for women. The depression rate for recent immigrants was 5.24%, 3.87% for men and 6.64% for women. The depression rate among low-income individuals was 14.52%, 10.79% for men and 17.07% for women. The lowest-rate of depression was among low-income recent immigrant males (2.21%), whereas the highest rate was among low-income non-recent immigrant females (11.05%). CONCLUSIONS: This study supports previous findings about the effects of income, immigration and gender on depression. The findings are novel in that they suggest a differential income effect for male and female recent immigrants. These findings have implications for public health planning, immigration and settlement services and policy development.