Health-related quality of life in women with polycystic ovary syndrome, a self-administered questionnaire, was validated

OBJECTIVE: We examined the measurement properties of a questionnaire (PCOSQ) measuring health-related quality of life (HRQOL) in women with the polycystic ovary syndrome (PCOS). STUDY DESIGN: This multicenter prospective randomized placebo-controlled blinded study enrolled 393 patients with PCOS at tertiary care sites. Participants were randomized to placebo or troglitazone (150 mg/d, 300 mg/d, or 600 mg/d). At baseline (n=393) and after 44 weeks of treatment (n=284) the proportion of normal menstrual cycles, the free testosterone (T) level, four objective measures of facial hair growth (hair density and hair growth rate by photography, and hair diameter and hair growth rate using plucked hairs), and a subjective assessment of the degree of hirsutism, the modified Ferriman-Gallwey (F-G) score, were determined. At both visits, patients also completed the PCOSQ. Since the trial was conducted, troglitazone has been removed from the market because of toxic effects. The PCOSQ includes 26 questions (items) that address five areas of concern (domains), including emotions, body hair, body weight, fertility, and menstruation rated on a seven-point scales in which lower scores denote higher degrees of patient concern and a lower HRQOL. RESULTS: Cronbach's alpha was >0.7 for four of five domains. Factor analysis provided moderate to strong support for the five-domain structure of the PCOSQ. Cross-sectional correlations were weak with all measures but the F-G score and hair growth (r=-.46, P < .01). The change in the F-G score showed a statistically significant (P < .01) correlation with changes in PCOSQ hair growth (r=-.22), weight (r=-.17), infertility (r=-.20), and menstruation (r=-.20). Changes in the proportion of normal menstrual cycles correlated with change in the infertility domain (r=.14, P < .03) and with the change in the menstruation domain (r=.31, P < .001). The PCOSQ proved as responsive as the F-G, and more responsive than the objective measures of hair growth, to effects of troglitazone. CONCLUSIONS: Our data provides some support for the discriminative and longitudinal validity, and appreciable support for the responsiveness, of the PCOSQ.     

Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): development and psychometric properties

Purpose

The determinants of the health-related quality of life of women with polycystic ovary syndrome are not fully understood. The aim of this study was to develop a comprehensive instrument to assess the health-related quality of life of Iranian women with PCOS and to assess its psychometric properties.

Methods

We used a mixed-method, sequential, exploratory design including both qualitative [in-depth interview to define the components of health-related quality of life questionnaire (PCOSQ)] and quantitative approaches (to assess the psychometric properties of PCOSQ).

Results

A preliminary questionnaire was developed including 147 items which emerged from the qualitative phase of the study. Considering the optimum cutoff points for content validity ratio (CVR), content validity index (CVI), and impact score, items of the preliminary questionnaire were reduced from 147 to 88 items. Finally, by excluding highly correlated items using the exploratory factor analysis, a 50-item questionnaire was obtained. The Kaiser criteria (eigenvalues >1) and Scree plot tests demonstrated that six factors were optimum with an estimated 47.3 % of variance. Assessment of the psychometric properties of the questionnaire demonstrated a mean CVI = 0.92, CVR = 0.91, Cronbach’s alpha for whole questionnaire = 0.88 (0.61–0.88 for subscales), Spearman’s correlation coefficients of test–retest = 0.75, and the intra-class correlation coefficient for the PCOS questionnaire subscales ranging from 0.57 to 0.88. Eventually the final questionnaire included 50 items in six domains, ‘psychosocial and emotional,’ ‘fertility,’ ‘sexual function,’ ‘obesity and menstrual disorders,’ ‘hirsutism,’ and ‘coping’ and rated on a 5-point Likert scale.

Conclusion

The PCOSQ-50 is a valid and reliable instrument for the assessment of quality of life of women with PCOS, capable of assessing some obscure aspects overlooked by previous HRQL questionnaires.

     

多囊卵巢综合征胰岛素抵抗的临床研究

目的:研究多囊卵巢综合征妇女的临床特征与胰岛素抵抗之间的关系。方法:选择76名PCOS女性进行人体测量学指标的检查和测定、性激素水平检测并进行口服葡萄糖耐量试验及胰岛素释放试验。结果:76例PCOS患者中除3例合并糖尿病外,73例PCOS患者中存在胰岛素抵抗者46例,占63%,无胰岛素抵抗者27例,占37%。与无胰岛素抵抗者比较,胰岛素抵抗者体重、BMI、腰围和腰臀比及黑棘皮征明显增高,而两组间性激素6项指标的差异不明显。结论:PCOS妇女中胰岛素抵抗发生率较高;PCOS合并IR患者的体重、BMI、腰围和腰臀比、黑棘皮征明显高于无胰岛素抵抗者;性激素水平与糖代谢异常及胰岛素抵抗无关。     

Metabolic disturbances in women with polycystic ovary syndrome

The AIM of the study was to characterize the metabolic syndrome in lean and overweight women with polycystic ovary syndrome (PCOS). The study included 142 premenopausal women distributed into 2 subgroups according to the body mass index: Group 1 with normal weight (n = 39) and Group 2 with overweight (n = 103). The following parameters were measured: basal and oral glucose tolerance test (oGTT)-induced glucose, insulin and triglycerides (TG1), glycated hemoglobin, total, HDL- and LDL-cholesterol; HOMA index and 2 indices of atherogenic risk (total/HDL-cholesterol and atherogenic index) were calculated. The results were compared with those of 35 clinically healthy women allocated also to 2 subgroups: Group 3 with normal weight (n = 18) and Group 4 with overweight (n = 17). Group 1 differed from group 3 in significantly higher fasting, 120-minute insulin, 180-minute insulin during the oGTT, fasting and stimulated TG1, and atherogenic index. Group 2 did not differ from group 4 in the lipid parameters, but 60-minute, and 120-minute glucose, the area under the curve (AUC) of glucose, and stimulated insulin were significantly higher at similar levels of fasting insulin, homeostasis model assessment (HOMA) index and glucose-to-insulin ratio. Fasting glucose did not differ between the two subgroups of PCOS women, but 60-minute, and 120-minute glucose, AUC glu, fasting, 60-minute, and 180-minute insulin, AUC ins and HOMA index were significantly higher in group 2 where the lipid parameters were significantly unfavourable. Our data confirmed the presence of insulin resistance of various degree and an increased lipid atherogenic risk in PCOS while obesity appeared as an additional factor aggravating the metabolic disturbances.     

An observational study of Yasmin in the management of women with polycystic ovary syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS) is the commonest endocrine disturbance affecting women in the reproductive age group and encompasses signs of hyperandrogenism, menstrual cycle disturbances and obesity. Some of the symptoms of PCOS may be ameliorated by the combined oral contraceptive pill (COCP). METHODS: A pilot observational study was carried out in a university teaching hospital setting to determine whether the clinical and biochemical features of PCOS are ameliorated by a new COCP, Yasmin, which contains a new progestogen, drosperinone. Treatment with Yasmin was given for 6 months to 17 patients. RESULTS: Thirteen patients (76%) completed 6 months of therapy. Good cycle control was achieved in all patients. Percentage body fat increased, with no overall change in body mass index. Fasting insulin and triglyceride concentrations rose significantly. Serum total testosterone concentrations fell with a concomitant rise in sex hormone binding globulin levels. Hirsutism scores did not change significantly in the 12 women who were clinically hirsute. There was, however, a significant improvement in the acne scores. Four of the 17 patients dropped out of the trial between Cycles 3 and 5 due to side effects. CONCLUSIONS: Yasmin provides good cycle control for women with PCOS, with an improvement in acne over 6 months but not in other symptoms of the syndrome.     

Abnormal expression of TLRs may play a role in lower embryo quality of women with polycystic ovary syndrome

Toll-like receptors (TLRs) localize in mammalian ovary, including granulosa cells, cumulus cells, and theca cells. Previous studies demonstrated that TLRs may be important for the cumulus-oocyte complex expansion and fertilization. There is no evidence to indicate that the deletion of TLRs will induce infertility; however, the abnormal expression of TLRs may decrease oocyte quality and fertility rate. In the present study, we investigated the effects of polycystic ovary syndrome (PCOS) on the expression of TLRs in cumulus cells by using western-blot and quantitative real-time PCR (qRT-PCR) analyses. We found that the expression of TLR4 and 9 in cumulus cells was influenced significantly by PCOS. We also observed that overweight/obesity changed the expression of TLR2 and 5 in cumulus cells of PCOS subjects. In addition, we found that the rate of available embryos of women with PCOS was slightly lower. These results indicate that the abnormal expression of TLRs in cumulus may be a reason for the lower embryo quality of women with PCOS.

Abbreviations: ART: assisted reproductive technology BMI: body mass index COC: cumulus-cell-oocyte complex PCOS: polycystic ovary syndrome qRT-PCR: quantitative real-time PCR TLRs: Toll-like receptors     

多囊卵巢综合征患者的生活质量及健康教育需求调查

目的 调查多囊卵巢综合征(PCOS)患者的生存质量以及对健康教育的需求。 方法 采用中文版PCOS生存质量量表和自制问卷对440例多囊卵巢综合征患者进行调查,调查内容包括患者的一般情况、生存质量情况以及对健康教育的需求情况。 结果 267例(60.7%)多囊卵巢综合征患者生活质量低,其中对生活质量影响较大的维度分别是月经失调、痤疮、肥胖;在所列项目中,PCOS患者对改善月经情况指导、并发症预防知识指导和饮食指导的需求较高。 结论 多囊卵巢综合征患者生活质量整体不佳,健康教育需求呈现多样化;应重视患者健康教育,促进其身心健康的恢复及生活质量的提高。     

Health-related quality of life in Egyptian children with nephrotic syndrome

Quality of Life Research - This research aimed to evaluate Quality of life (QoL) in Egyptian children with idiopathic Nephrotic syndrome (INS) in comparison to healthy children and children with...     

Health-related quality of life of Iranian children with attention deficit/hyperactivity disorder

Background  

The present study aimed to examine the psychometric properties of the Persian version of the 23-item PedsQL™ 4.0 Generic Core Scales in Iranian children with attention deficit hyperactivity disorder (ADHD).     

二甲双胍对多囊卵巢综合征患者的治疗作用

多囊卵巢综合征是生育年龄妇女常见的内分泌及糖代谢异常所导致的病理状态。由于高胰岛素血症和胰岛素抵抗在其发病中起重要作用 ,二甲双胍逐渐被应用于治疗多囊卵巢综合征 ,该文回顾总结近年来二甲双胍对多囊卵巢综合征的治疗作用 ,并探讨其作用机制。     

农村妇女健康生命质量分析

目的了解不同年龄及文化程度农村妇女健康生命质量状况。方法采用分层整群随机抽样方法抽取四川省安岳县、安徽省临泉县、山东省曹县和茌平县妇女1653人,利用欧洲生存质量测定量表(EQ-5D)测定生命质量。结果调查的农村妇女平均健康指数为70.3分,曹县最高,为75.8分,安岳县最低,为62.6分;随着年龄的增长,调查妇女健康指数呈下降趋势,青年组分别比中年组、老年组平均高8分、16分;随着文化程度的提高,农村妇女健康指数升高,不识字/识字少妇女的健康指数为66.6分,而初中及以上文化程度者为77.6分;从健康的5个维度看,差异主要表现在疼痛/不舒服、焦虑/沮丧2个维度,存在问题的比例分别为34.3%和27.5%。结论提高农村妇女文化素质、改善生存环境、进行有效心理干预,有助于改善该人群生命质量。     

Eating frequency and snacking habits in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) affects up to 10% of women of reproductive age in the UK and obesity is a common feature. Food craving has been anecdotally reported by women with PCOS (Herriot et al., 2008) and some studies suggest that increased eating frequency (EF) and snacking may contribute to increased energy intake (Hampl et al., 2003). This study aimed to describe the EF of women with PCOS and investigate the impact of EF on energy intake and body mass index (BMI). Methods: Seven‐day food diaries were posted to and completed by 131 women diagnosed with PCOS, who were also asked to report their age, weight and height. Eating episodes were categorised as drinks, mixed meals, and savoury or sweet snacks (foods consumed between meals). BMI was estimated using self‐reported weight and height and categorised into <25, 25–29.9 and >30 kg m^?2. Results: All participants completed a food diary, with 122 providing self‐reported height and weight. Mean (SD) age was 32.0 (6.1) years, and mean (SD) BMI was 27.9 (7.9) kg m^?2. Of those who provided details of height and weight, 57% (47%) women had a BMI <25 kg m^?2, 24% (20%) had a BMI 25–29.9 kg m^?2 and 41% (33%) had a BMI of >30 kg m^?2. Mean (SD) energy intake was 8259 (1644) kJ day^?1 [1974 (393) kcal day^?1] and mean carbohydrate intake was 226 (58) g/day. A paired t‐test was used to compare consumption of sweet and savoury snacks. A one‐way analysis of variance was used to analyse differences in energy intake, and to compare stratified BMI groups and EF including drinks. Assumption of homogeneity of variance was violated when analysing differences in stratified BMI and mean total EF excluding drinks; therefore, a robust test of equality of means was used instead. A Pearson product–moment correlation was used to explore correlations between energy or macronutrient intake and EF.

Table 1. Energy intake and eating frequency in women with PCOS

多囊卵巢综合征的胰岛素抵抗研究进展

胰岛素抵抗在多囊卵巢综合征的发生及病理生理中起着重要作用 ,认识多囊卵巢综合征与胰岛素抵抗的形成机制及其病理生理 ,有助于我们选择恰当的治疗方法。该文综述了近年来多囊卵巢综合征与胰岛素抵抗的关系及治疗进展 ,旨在为PCOS患者合理化用药提供理论依据