Menopause-specific quality of life across varying menopausal populations with conjugated estrogens/bazedoxifene

Objective

Describe the effects of conjugated estrogens/bazedoxifene (CE/BZA), a new treatment for vasomotor symptoms (VMS) and osteoporosis prevention, on menopause-specific quality of life (MSQOL) across different patient population types in phase 3 clinical trials.

Design

MSQOL was prospectively evaluated in 4 randomized, double-blind, placebo-controlled studies. The populations studied included healthy, non-hysterectomized postmenopausal women with symptomatic VMS or vulvar–vaginal atrophy (VVA) and general postmenopausal women (eligible regardless of symptoms). Menopause-specific Quality of Life (MENQOL) questionnaire total and domain scores for CE 0.625 mg/BZA 20 mg and CE 0.45 mg/BZA 20 mg were evaluated and compared with established thresholds for clinically important differences (CID).

Results

Significant improvements compared with placebo were found with both CE/BZA doses in MENQOL vasomotor domain (−0.61 to −2.23 over 3–24 months) and total scores (−0.24 to −0.94) in the general and symptomatic VMS/VVA populations. Significant improvement compared with placebo in sexual domain (−0.11 to −0.72) was observed with the higher dosage for all populations, and with the lower dosage in the VVA (−0.71 at month 3) and general populations (−0.4 at months 12 and 24). Improvements in vasomotor domain exceeded the CID with both doses in symptomatic VMS populations and with the higher dosage in women with symptomatic VVA; for total MENQOL, the CID was exceeded with the higher dose in symptomatic VMS populations.

Conclusions

CE/BZA significantly improved overall and vasomotor-related MSQOL across populations of postmenopausal women with varying baseline symptom statuses. Women with greater menopausal symptoms at baseline were more likely to experience clinically meaningful changes.     

Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life

Objective

To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study.

Methods

Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40–65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL.

Results

Scores for each domain were: vasomotor: 3.2 ± 2.2; psycho-social: 3.3 ± 1.8; physical: 3.5 ± 1.5; sexual: 2.9 ± 2.1. There were significant differences in the MENQOL scores by age, smoking, exercise, education, employment status and BMI. Women aged 60–65 years (p < 0.0001), with a bachelor’s degree or higher level of education (p < 0.0001), who exercised at least 3 days a week (p < 0.0001), who had never smoked (p < 0.0001), with a body mass index ≤25 kg/m² (p < 0.0001), and who had significantly lower scores indicating better quality of life. Hot flashes affected work (46.0%), social activities (44.4%), leisure activities (47.6%), sleep (82.0%), mood (68.6%), concentration (69.0%), sexual activity (40.9%), total energy level (63.3%) and overall quality of life (69.3%).

Conclusion

Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.     

Assessment of subjective sleep disturbance and related factors during female mid-life with the Jenkins Sleep Scale

Objective

To assess sleep disturbance and related factors among mid-aged women.

Methods

This was a cross-sectional study in which 288 women (40–59 years) were requested to complete the Jenkins Sleep Scale (JSS), the 12-item General Health Questionnaire (GHQ-12), the Menopause Rating Scale (MRS) and a general socio-demographic questionnaire containing female and partner data.

Results

Median [interquartile range] age of the whole sample was 47 [8] years. A 62.2% of women were rural residents, 21.2% were postmenopausal, 20.1% were receiving psychotropic drugs, 64.2% had abdominal obesity (waist ≥ 88 cm), and 9.7% reported intimate violence. A 12.8% had an abnormal GHQ-12 score (total score ≥ 3) whereas 14.2% had severe menopause-related symptoms (total MRS score ≥ 17). The prevalence of disturbed sleep (JSS score ≥ 12) was 37.5%. JSS scores displayed significant differences in relation to menopausal status, presence of stress urinary incontinence, use of psychiatric treatment, intimate partner violence, self-perception of healthiness, and partner factors (perception of healthiness, educational level, and regular exercise). Higher JSS scores (disturbed sleep) positively correlated with GHQ-12 and MRS scores, number of co-morbid conditions, body mass index, and female and partner age. Multiple linear regression analysis found that JSS scores correlated positively with somatic MRS scores and with intimate violence, and inversely with partner educational level (r² = 0.375, p < 0.05).

Conclusion

In this mid-aged female sample, disturbed sleep was related to somatic menopause-related symptoms, intimate violence and partner educational level.     

Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial

ObjectiveTo evaluate the effects of escitalopram 10–20 mg/day on menopause-related quality of life and pain in healthy menopausal women with hot flashes.Study designA double-blind, placebo-controlled randomized trial of escitalopram 10–20 mg/day vs. identical placebo was conducted among 205 women ages 40–62 years with an average of ≥4 daily hot flashes recruited at 4 clinical sites from July 2009 to June 2010.Main outcome measuresThe primary trial outcomes, reported previously, were the frequency and severity of vasomotor symptoms at 8 weeks. Here, we report on the pre-specified secondary endpoints of total and domain scores from the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the pain intensity and interference scale (PEG).ResultsOutcome data were collected on 97% of randomized women and 87% of women took at least 70% of their study medication. Treatment with escitalopram resulted in significantly greater improvement in total MENQOL scores (mean difference at 8 weeks of −0.41; 95% confidence interval (CI) −0.71 to −0.11; p < 0.001), as well as Vasomotor, Psychosocial, and Physical domain scores with the largest difference seen in the Vasomotor domain (mean difference −0.75; 95% CI −1.28 to −0.22; p = 0.02). There was no significant treatment group difference for the Sexual Function domain. Escitalopram treatment resulted in statistically significant improvements in PEG scores compared to placebo (mean treatment group difference at 8 weeks of −0.33; 95% CI −0.81 to 0.15; p = 0.045).ConclusionsTreatment with escitalopram 10–20 mg/day in healthy women with vasomotor symptoms significantly improved menopause-related quality of life and pain.     

A comparison of health-related quality of life (HRQOL) after natural and surgical menopause

Objective

To compare the health-related quality of life (HRQOL) of women at surgical menopause with that of women at natural menopause, utilizing the Menopause Rating Scale (MRS-II).

Study design

An institution-based cross-sectional study design was used, with 32 participants in each of two groups: women who had undergone surgical menopause of 9–12 months previously; and women who were more than 40 years of age and had had oligomenorrhoea for at least 1 year. The MRS-II was used to assess HRQOL. None of the women had received any hormonal therapy before assessment.

Main outcome measures

Total MRS-II scores along with the scores on the somato-vegetative, psychological and urogenital sub-scales were compared between the two groups.

Results

HRQOL was rated as worse by the surgical menopause group than by the natural menopause group: the total MRS-II scores were much higher for the surgical menopause group (mean = 29.4, SD = 6.7) than for natural menopause group (mean = 20.7, SD = 6.5), and this difference was significant (p < 0.0001). Similar results were obtained on the three sub-scales—somato-vegetative (p = 0.030), psychological (p < 0.0001) and urogenital (p < 0.0001).

Conclusion

HRQOL is worse after surgical than in natural menopause. Routine surgical castration at hysterectomy should be avoided because of adverse short-term effects and, potentially, long-term consequences.     

Health literacy and physical and psychological wellbeing in Japanese adults

Objective

To determine the prevalence of low health literacy and investigate the relationship between low health literacy and physical and psychological wellbeing in the Japanese general population.

Methods

A web-based cross-sectional survey was conducted in a national sample of Japanese adults. Health literacy was measured by self-report using the validated single-item screening question, “How confident are you filling out forms by yourself?” Wellbeing was measured with the physical and psychological domains of the World Health Organization Quality of Life Assessment-BREF. Effect sizes were computed by dividing the mean difference in scores by the standard deviation of the scores of all participants.

Results

In 1040 adult enrollees (mean age, 57-year-old; women, 52%), there were 161 (15.5%; 95% confidence interval [CI], 13.3–17.7%) with low health literacy. Individuals with low health literacy reported lower physical wellbeing (60.6 vs. 71.7, p < 0.001) and psychological wellbeing (59.7 vs. 68.3, p < 0.001) compared with those with adequate health literacy. After adjusting for sociodemographic characteristics, health risk behaviors and chronic conditions, these differences were still significant (physical wellbeing, p < 0.001; psychological wellbeing, p < 0.001). The effect sizes of the difference of scores were moderate for physical wellbeing (−0.55) and also for psychological wellbeing (−0.44).

Conclusion

The prevalence of self-reported low health literacy in Japanese adults is substantial and it is independently associated with poorer physical and mental wellbeing.

Practice implications

Efforts to monitor health literacy and to evaluate causal pathways to poor wellbeing should be encouraged in the Japanese population.     

The nuclear factor-kB functional promoter polymorphism is associated with endometriosis and infertility

Introduction

An aberrant immunologic mechanism has been suggested to be involved in the pathogenesis of endometriosis. Nuclear factor-kB (NF-kB) plays a key role in the immune and inflammatory response and modulates cell proliferation, apoptosis, adhesion, invasion, and angiogenesis in many cell types involved in the development of endometriosis. We hypothesized a possible relationship between the NFKB1 promoter regulatory polymorphism and endometriosis and/or infertility.

Methods

A genetic association study comprising 172 infertile women with endometriosis, 77 women with idiopathic infertility and 189 controls was performed. Detection of the −94 insertion/deletion ATTG (rs28362491) polymorphism in the NFKB1 gene was done using the RFLP–PCR (Restriction Fragment Length Polymorphism–Polymerase Chain Reaction) technique. The results were statistically analyzed, and a p-value <0.05 was considered significant.

Results

Single-marker analysis revealed a significant association between the −94 insertion/deletion ATTG polymorphism and endometriosis-related infertility (p = 0.014, OR = 1.47, 95% CI = 1.09–1.97), especially in moderate/severe disease cases. Considering the idiopathic infertility group, a significant association was also found (p = <0.001, OR = 2.01, 95% CI = 1.35–2.98), suggesting that the −94 insertion/deletion ATTG polymorphism is associated with endometriosis and/or infertility.

Conclusion

In the population sample studied, the −94 insertion/deletion ATTG polymorphism in the NFKB1 gene was positively associated both with moderate/severe endometriosis and idiopathic infertility.     

Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

Objectives

To investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment.

Study design

Women with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires.

Main outcome measures

The differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women.

Results

Eighty-five women with OAB (tolterodine, n = 42; solifenacin, n = 43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P < 0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient = 0.21), obsessive–compulsive symptoms (0.69 vs. 0.44, coefficient = 0.25), anxiety symptoms (0.42 vs. 0.27, coefficient = 0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient = 0.14), neuroticism (9.23 vs. 5.17, coefficient = 3.73), and extroversion–introversion (13.64 vs. 15.25, coefficient = −1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P < 0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient = −0.39), low hostility score (coefficient = 2.11), and high additional symptoms score (coefficient = −1.46) were associated with good therapeutic effect (all P < 0.05).

Conclusions

OAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.     

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.     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

Objectives

This study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.

Methods

We use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.

Results

Results show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.

Conclusion

These results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.

Practice implications

We therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Relationship of stimulated saliva 17β-estradiol and oral dryness feeling in menopause

Objectives

The aim of this study was to compare stimulated whole saliva 17β-estradiol of menopausal women with/without oral dryness (OD) feeling, and evaluate the relationship between saliva 17β-estradiol and severity of OD feeling.

Methods

A case-control study was carried out in 76 selected menopausal women aged 41–77 years with or without OD feeling (38 as case and 38 as control) conducted at the Clinic of Oral Medicine, Tehran university of medical sciences. Paraffin-stimulated saliva samples were obtained by expectoration. Xerostomia inventory (XI) score was used as an index of OD feeling severity. The saliva 17β-estradiol concentration was measured by ELISA. Statistical analysis of Student's t-test and Spearman correlation was used.

Results

No significant difference was found in stimulated whole saliva flow rate between the two groups, but the mean concentration and output of saliva 17β-estradiol were significantly lower in case than control. There was significant negative correlation between XI score and stimulated whole saliva concentration (r = −0.391, P = 0.004) and output (r = −0.302, P = 0.002) of 17β-estradiol in menopausal women.

Conclusions

It seems that there is a negative correlation between OD feeling severity and stimulated whole saliva 17β-estradiol in menopausal women.     

Patient use of weight-management activities: A comparison of patient and physician assessments

Objective

Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.

Methods

Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient–physician communication (41 physicians and 274 of their patients).

Results

A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28 (range 0.15 to 0.40) and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa −0.14 (range −0.26 to −0.01). Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p < 0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p < 0.05).

Conclusions

Primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.

Practice implications

These results highlight the importance of improving patient–provider communication about weight-management activities, particularly among obese patients.     

Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: Development of a scale

Objective

Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient–provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC.

Methods

Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters. After factor analysis, we created a 7-item Positive Provider Attitudes toward Sickle Cell Patients Scale (PASS); higher scores indicate more positive attitudes. We assessed internal consistency and evidence of construct validity, exploring bivariate relationships between provider or patient characteristics and the PASS score using multilevel modeling.

Results

We collected 121 surveys from 84 health care providers for 47 patients. Patients averaged 30.3 years in age, and 60% were women. Among providers, 79% were nurses, and 70% worked in inpatient settings. PASS scores averaged 24.1 (S.D. 6.7), ranged 7–35, and had high internal consistency (Cronbach's alpha = 0.91). As hypothesized, inpatient vs. emergency department providers (Δ = 4.65, p < 0.001) and nurses vs. other providers (Δ = 0.95, p < 0.001) had higher PASS scores. Higher patient educational attainment (Δ per year = 2.74, p < 0.001) and employment (Δ = 5.62, p = 0.001) were associated with higher PASS scores. More frequent hospitalizations (Δ per episode = −0.52, p < 0.001) and prior disputes with staff (Δ = −7.53, p = 0.002) were associated with lower PASS scores.

Conclusion

Our findings provide preliminary evidence for the reliability and construct validity of the PASS score in measuring provider attitudes toward patients with VOC.

Practice implications

Future studies should examine the validity of PASS in other cohorts of patients with SCD and their providers. With further evidence, PASS may prove useful for investigating the impact of provider attitudes on the quality of communication and care provided to these patients.     

Association between functional Fc receptor-like 3 (FCRL3) −169 C/T polymorphism and susceptibility to seropositive rheumatoid arthritis in Asians: A meta-analysis

Objective

The aim of this study was to determine whether the functional Fc receptor like-3 (FCRL3) −169 C/T polymorphism confers susceptibility to rheumatoid arthritis (RA).

Methods

A meta-analysis was conducted on the associations between the FCRL3 −169 C/T polymorphism and RA.

Results

A total of 17 comparison studies including 11,170 patients and 11,142 controls were considered in the meta-analysis. The meta-analysis showed no association between RA and the FCRL3 −169 C allele in study subjects (OR = 1.046, 95% CI = 0.997–1.098, p = 0.068). Stratification by ethnicity indicated an association between the FCRL3 −169 C allele and RA in Asians (OR = 1.101, 95% CI = 1.035–1.174, p = 0.002), but not in Europeans. Stratification of patients according to the presence of rheumatoid factor (RF) revealed a different significant association between the C allele and RA in RF-positive and RF-negative RA patients. Stratification by ethnicity indicated an association between the FCRL3 −169 C allele and RF-positive RA in Asians (OR = 1.093, 95% CI = 1.004–1.189, p = 0.040), but not in Europeans.

Conclusions

This meta-analysis demonstrates that the FCRL3 −169 C/T polymorphism may confer susceptibility to seropositive RA in Asians.     

Disease stigma and intentions to seek care for stress urinary incontinence among community-dwelling women

Objectives

Urinary incontinence (UI) threatens women's physical and mental health, but few women seek healthcare for their incontinence. Evidence is substantial that stigma may be associated with health service utilization for such diseases as mental illness, but sparse for UI. We examine the relationship between disease stigma and intentions to seek care for UI.

Design and setting

A cross-sectional community-based study was used. A purposive sample of 305 women aged 40–65 years in a Chinese city who had stress urinary incontinence (SUI) was enrolled from May to October in 2011.

Measurements

Data were collected on socio-demographic characteristics, UI symptoms, disease stigma and intentions to seek care.

Results

Social rejection was positively linearly related to intentions to seek care for UI (β = 0.207; 95% CI = 0.152, 0.784), indicating that more social rejection predicted stronger intentions to seek care. Significant curvilinear association between internalized shame and intentions to seek care was observed (β = −0.169; 95% CI = −0.433, −0.047). Compared to women with the low and high levels of internalized shame, those with the moderate level of internalized shame reported stronger intentions to seek care.

Conclusion

The impact of stigma on intentions to seek care varies by aspects and levels of stigma. Social rejection enhances intentions to seek care while internalized shame influences intentions to seek care in a quadratic way. The crucial step of targeted interventions will be to disentangle subgroups of SUI women with different aspects and levels of stigma.     

Assessment of self-esteem in mid-aged women

Objective

To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES).

Study design

This was a cross-sectional study in which 149 women (40–59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data.

Results

Mean age of sample was 47.6 ± 5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6 ± 3.1 (median 26, range 17–35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem.

Conclusions

In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects.     

Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong

Background

Substantial evidence shows that psychological factors are associated with cardiovascular diseases. However, data on the association between psychological factors and subclinical atherosclerosis is lacking in postmenopausal Chinese women.

Objectives

To examine the associations of perceived stress and trait anxiety with subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Their relationships with biological and behavioral risk factors were also examined.

Methods

Between 2002 and 2004, we recruited 518 postmenopausal women aged 50–64 years. Perceived stress and trait anxiety were evaluated by the perceived stress scale and the state-trait anxiety inventory, respectively. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque using B-mode ultrasonography.

Results

Perceived stress and trait anxiety showed no significant association with IMT or plaque. Multivariate analyses showed high perceived stress scores were associated with an increased risk of elevated total cholesterol (OR = 2.10; 95% CI = 1.17–3.77) and elevated low-density lipoprotein cholesterol (LDL-C) (OR = 2.39; 95% CI = 1.36–4.21). High trait anxiety scores were associated with a 2.7-fold risk of elevated LDL-C (OR = 2.74; 95% CI = 1.56–4.80). Women with high perceived stress or trait anxiety scores were more likely to be physically inactive.

Conclusions

Perceived stress and trait anxiety were associated with atherogenic lipid levels, but not subclinical atherosclerosis. Maintaining high physical activity may help alleviate psychological stress and anxiety.     

Vascular endothelial growth factor gene polymorphisms and vasculitis susceptibility: A meta-analysis

Objective

The aim of this study was to explore whether vascular endothelial growth factor (VEGF) polymorphisms are associated with susceptibility to vasculitis.

Methods

Meta-analyses were conducted on the associations between the −634 C/G, +936 C/T, −1154 A/G, and −2578 A/C polymorphisms of VEGF and vasculitis.

Results

Eight studies on VEGF polymorphisms and vasculitis involving 2740 subjects (vasculitis 834, controls 1906) were included in this meta-analysis. The meta-analysis showed no association between vasculitis and the VEGF −634 C allele (OR = 1.161, 95% CI = 0.921–1.464, p = 0.207) among study subjects. Meta-analysis showed no association between vasculitis and the VEGF + 936 T allele (OR = 1.121, 95% CI = 0.905–1.390, p = 0.295). However, stratification by ethnicity indicated a significant association between the VEGF + 936 T allele and vasculitis in Europeans, but not in Asians (OR = 1.486, 95% CI = 1.038–2.128, p = 0.030; OR = 0.958, 95% CI = 0.773–1.253, p = 0.755). Meta-analysis showed no association between vasculitis and the VEGF −1154 A/G and 2578 A/C polymorphisms.

Conclusions

This meta-analysis suggests that the VEGF + 936 T allele is associated with susceptibility to vasculitis in Europeans, but not in Asians.     

Structured shared decision-making using dialogue and visualization: A randomized controlled trial

Objective

The aim of this study is to evaluate a method, “Counseling in Dialogue” (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making.

Methods

94 children aged 2–12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N = 133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N = 20). 81 children had follow-up data.

Results

Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: −0.38 (95%CI −0.56; −0.19), p < .001; fathers: −0.22 (95%CI −0.44; −0.01), p = .045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p < 0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: −0.03 (95%CI −0.19; 0.14), p = .741).

Conclusion

The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.     

Childhood adversity and pubertal timing: Understanding the origins of adulthood cardiovascular risk

Objective

To determine whether greater childhood adversity relates to younger menarcheal age; whether younger menarcheal age relates to increased CVD risk; and whether greater childhood adversity relates to increased CVD risk, directly or indirectly (mediated by menarcheal age).

Methods

Among 650 pre-menopausal women (ages 25–45; M = 34.9[5.6]), SEM was performed to estimate relations between childhood adversity, menarcheal age, and CVD risk.

Results

Results supported a covariate-adjusted model (RMSEA = 0.035; CFI = 0.983) in which greater childhood adversity was related to younger menarcheal age (β = −.13, p < .01) and younger menarcheal age was related to greater CVD risk (β = −.18, p < .05). Direct and indirect effects of childhood adversity on CVD risk were non-significant. Re-evaluation of the same model with additional covariate-adjustment for adulthood body composition showed the relation between menarcheal age and CVD risk attenuated (β = −.03, p = .376).

Conclusions

Cross-sectional evidence suggests family-related adversity experiences in childhood confer risk for earlier menarche which, in turn, relates to increased CVD risk in adulthood, possibly via post-pubertal body size.