Factors associated with general and health-related quality of life in menopausal transition among women from Serbia

ABSTRACT

This study assessed factors associated with quality of life (QOL) among Serbian peri- and postmenopausal women using two menopause-specific scales. This cross-sectional study included 500 women aged 40–65 years who had a gynecologic check-up in one of two Community Health Centers in Belgrade during February 2014 to January 2015. Women completed: a questionnaire about socio-demographics, habits, and health status; a menopause-specific questionnaire, Utian’s Quality of Life Scale (UQOL); and a Women’s Health Questionnaire (WHQ) and Beck’s Depression Inventory (BDI). Higher education was associated with better occupational UQOL and memory/concentration, but with lower emotional UQOL and more anxiety/fears. City center residency was associated with better occupational and sexual UQOL. Being employed was associated with better occupational UQOL and lower anxiety/fears. Higher income was associated with better emotional UQOL. Not having uterine prolapse, insomnia, or tachycardia was associated with better occupational UQOL and fewer sleep problems. Higher parity was associated with better sexual UQOL. Having regular recreation was associated with better health and sexual UQOL but with more frequent vasomotor symptoms. Leaner women felt more attractive. QOL during the menopausal transition does not entail only somatic symptoms and therefore requires a more comprehensive approach that includes psychosocial underpinnings.     

Oral contraceptives usage patterns: study of knowledge, attitudes and experience in Belgrade female medical students

Purpose

The purpose of this survey was to quantify oral contraceptive pill (OCP) use and to analyze attitudes and knowledge about the pill in a sample of female medical students.

Methods

A cross-sectional study, conducted between November 28 and December 20, 2011, included 464 female participants from the Faculty of Medicine, University of Belgrade. Data were collected before the start of compulsory practical sessions in the classrooms through a 37-item questionnaire and assessed statistically.

Results

Prevalence of OCP use was 11.3 %. Highest proportion of the pill use was in the third year (15.4 %). Approximately, 61 % used the pill as a therapy for dysmenorrhea. Difference in knowledge scores was observed between users and non-users (t = 3.596, p < 0.001). Advancing year at the faculty was highly statistically significantly associated with greater knowledge about health effects of the pill (ρ = 0.506, p < 0.001). There was no difference regarding attitude score among users and non-users (t = ?0.9, p = 0.369). In the multivariate regression model the knowledge score was the only predictor of pill use.

Conclusion

The results of our survey indicate that oral contraceptive pill requires further promotion and reproductive health education in a broader context.     

Factors associated with sexual quality of life among midlife women in Serbia

Purpose

To assess factors associated with better sexual quality of life (QOL) in midlife period among women who are and are not sexually active.

Methods

Participants were 500 women aged 40–65 years from Belgrade, Serbia. Data were collected through general questionnaire (regarding socio-demographic characteristics, lifestyle habits, general medical, and gynecological history) in which one item investigated having partnered sexual activity (heterosexual intercourses). The sexual domain of the Utian Quality of Life Scale was used to assess the sexual QOL. The sexual QOL consisted of reflections on the satisfaction with frequency of sexual interactions, as well as sexual and romantic life in general. Higher scores indicated better sexual QOL.

Results

Most women were sexually active in midlife (81.6%). The mean sexual QOL score for the overall sample was 9.99 (range 3–15). The level of sexual QOL did not differ between sexually active and non-active women. Factors associated with better sexual QOL in sexually active menopausal women were being married or coupled, being physically active, having more children, having hot flushes, and not having tachycardia. Factors associated with better sexual QOL in sexually inactive menopausal women were drinking alcohol, being physically active, not having insomnia or skin rash.

Conclusions

Sexual QOL among Serbian urban midlife women was good and did not differ between women who were sexually active and those who were not. Further studies are needed to determine in what manner women who are not sexually active in midlife achieve high level of satisfaction with their sexual QOL.

     

Ready to work or not quite? Self-perception of practical skills among medical students from Serbia ahead of graduation

AimTo assess final year medical students’ self-perception of their practical skills.MethodsThe study was conducted at the Faculty of Medicine in Belgrade during compulsory practical sessions in the period December 2-9, 2013 and 390 students agreed to participate (response rate 77.8%). The questionnaire included questions on demographic characteristics, 21 questions on students'' self-perception of their practical skills, and 1 question on students’ self-perceived readiness to start working with patients.ResultsCronbach’s α for the entire scale was 0.891. Students felt most confident about measuring arterial pulse and blood pressure and taking patients'' history (average score 10 for all three skills) and least confident about placing a urinary catheter (average score 1) and suturing a wound (average score 2). They rated their readiness to work with patients with 5.0 out of 10.0 points. The total score did not correlate with students’ average mark (Spearman''s ρ = 0.039; P = 0.460) and the average mark did not correlate with the self-perceived readiness to work with patients (Spearman''s ρ = -0.048; P = 0.365).ConclusionOur study suggests that medical students lack confidence to perform various clinical procedures, particularly those related to surgical interventions. To improve students’ confidence, clinical curriculum should include either more hours of practical work or ensure closer supervision of practical training in wards.The ability to adequately perform patients’ examination, make a diagnosis, or prescribe appropriate therapy are crucial competencies that medical undergraduates have to attain (1). They are also indispensable for decreasing the incidence of adverse events in hospitals that are most commonly related to medical interventions and drug prescribing (2,3).Recent studies have shown that clinical skills are most efficiently attained through implementation of technologies such as e-learning and video recorded simulations, and real time patient simulation (4-7). It has also been shown that students tend to underestimate their abilities and feel unconfident about performing the acquired skills (8). For example, observers and simulated patients rated medical students'' skills better than the students themselves (9). Another study found that students did not significantly over- or underestimate their skills, but overestimated their ability to communicate with the patient (10). Additionally, students with low self-confidence and self-efficacy at performing certain clinical tasks were more likely to avoid these tasks in their daily work, while students with higher self-efficacy were more likely to persevere in difficult situations (11).Medical education in Serbia has been entirely restructured since 2005 according to the Bologna Process principles (12). The aim of the reform was to improve medical curriculum and make students active participants in the patients’ treatment. Medical studies now last for 6 years (12 semesters) – first 3 years of preclinical and last 3 years of clinical training. Students start to work with patients in the clinical years, when they practice taking medical histories and performing clinical examinations under supervision of teaching assistants. When it comes to procedures such as wound suturing, blood sampling, placing of urinary catheters, cardio-pulmonary resuscitation, and patient immobilization, students mostly observe these procedures rather than performing them themselves. The reform aimed to create small-size teaching groups in which students would benefit from more interactions with teachers. Still, each year the Faculty admits a relatively high number of students (on average around 600 freshmen), which might influence the quality of teaching and learning.Perception of clinical skills in an undergraduate setting should be evaluated in order to highlight potential weak points not only of individual students but of the training process as a whole. Therefore, the aim of this study was to evaluate the final year medical students’ perception of their own practical skills.     

Climacteric women at work: What lurks behind poor occupational quality of life?

ABSTRACT

Physical and psychological changes during menopausal transition may affect various aspects of everyday functioning including women's work ability and work productivity. Presence of menopausal symptoms has been well-acknowledged to negatively affect quality of life (QOL). However, data on factors associated with occupational QOL among women at this period of life are lacking. The authors' purpose in this study was to evaluate factors affecting occupational QOL in a sample of employed mid-life women who are experiencing menopause. The authors performed a cross-sectional study among 335 employed women aged 40 to 65 years from Serbia. Socio-demographic questionnaire, Utian's Quality of Life Scale, and Beck's Depression Inventory were used in data collection. Women's average monthly household income and educational level were positively correlated, while having uterine prolapse was negatively associated with occupational QOL. Significant regression models assessing impact of gynecological illnesses and menopause-specific symptoms on occupational QOL (direct value and categories—below vs. above mean) showed that having insomnia, uterine prolapse, and genital inflammations may differentiate “good” from “poor” occupational QOL. Uterine prolapse, genital inflammation, and insomnia were associated with worse occupational QOL among working women in menopausal transition.     

Hormonal therapy in menopausal transition: implications for improvement of health-related quality of life

Abstract

The study aim was to assess scores of the Menopause Rating Scale (MRS) among women who use and desire to use hormonal therapy (HT), as well as to evaluate factors contributing to HT use and desire to use HT among women in menopausal transition. A total of 513 mid-aged women participated in the study. Data were collected using socio-demographic questionnaire, MRS and Beck Depression Inventory. The prevalence of current HT use was 9.7%, while 4.5% of women who did not use HT expressed a desire to start using HT. The MRS cutoff score for HT use was 10.5 and 11.5 among those who desire to use HT. Living in the central city districts, having lower body mass index, younger age at menopause, more gynecological illnesses, and worse MRS were associated with HT use. Living in the central city districts, having fewer births, more gynecological and chronic illnesses and having more depressive symptoms were associated with the desire to use HT. Mid-aged women who perceive their quality of life as poor due to climacteric symptoms should be advised to consider HT to improve their health status and everyday functioning.     

Combined effects of electromagnetic field and low-level laser increase proliferation and alter the morphology of human adipose tissue-derived mesenchymal stem cells

In recent years, electromagnetic field (EMF) and low-level laser (LLL) have been found to affect various biological processes, the growth and proliferation of cells, and especially that of stem cells. The aim of this study was to investigate the effects of EMF and LLL on proliferation of human adipose tissue-derived mesenchymal stem cells (hAT-MSCs) and thus to examine the impact of these therapeutic physical modalities on stem cell engraftment. hAT-MSCs were isolated from subcutaneous adipose tissue of six persons ranging in age from 21 to 56 years. EMF was applied for a period of 7 days, once a day for 30 min, via a magnetic cushion surface at a frequency of 50 Hz and an intensity of 3 mT. LLL was applied also for 7 days, once a day for 5 min, at radiation energies of 3 J/cm², with a wavelength of 808 nm, power output of 200 mW, and power density of 0.2 W/cm². Nonexposed cells (control) were cultivated under the same culture conditions. Seven days after treatment, the cells were examined for cell viability, proliferation, and morphology. We found that after 7 days, the number of EMF-treated hAT-MSCs was significantly higher than the number of the untreated cells, LLL-treated hAT-MSCs were more numerous than EMF-treated cells, and hAT-MSCs that were treated with the combination of EMF and LLL were the most numerous. EMF and/or LLL treatment did not significantly affect hAT-MSC viability by itself. Changes in cell morphology were also observed, in terms of an increase in cell surface area and fractal dimension in hAT-MSCs treated with EMF and the combination of EMF and LLL. In conclusion, EMF and/or LLL treatment accelerated the proliferation of hAT-MSCs without compromising their viability, and therefore, they may be used in stem cell tissue engineering.     

Mesenchymal stem cells attenuate liver fibrosis by suppressing Th17 cells – an experimental study

This study investigates molecular and cellular mechanisms involved in mesenchymal stem cell (MSC)‐mediated modulation of IL‐17 signaling during liver fibrosis. Mice received CCl₄ (1 μl/g intraperitoneally) twice/week for 1 month. MSCs (1 × 10⁶), or MSC‐conditioned medium (MSC‐CM), were intravenously injected 24 h after CCl₄ and on every 7th day. Liver fibrosis was determined by macroscopic examination, histological analysis, Sirius red staining, and RT‐PCR. Serum levels of cytokines, indoleamine 2,3‐dioxygenase (IDO), and kynurenine were determined by ELISA. Flow cytometry was performed to identify liver‐infiltrated cells. In vitro, CD4⁺ T cells were stimulated and cultured with MSCs. 1‐methyltryptophan was used for inhibition of IDO. MSCs significantly attenuated CCl₄‐induced liver fibrosis by decreasing serum levels of inflammatory IL‐17, increasing immunosuppressive IL‐10, IDO, and kynurenine, reducing number of IL‐17 producing Th17 cells, and increasing percentage of CD4⁺IL‐10⁺ T cells. Injection of MSC‐CM resulted with attenuated fibrosis accompanied with the reduced number of Th17 cells in the liver and decreased serum levels of IL‐17. MSC‐CM promoted expansion of CD4⁺FoxP3⁺IL‐10⁺ T regulatory cells and suppressed proliferation of Th17 cells. This phenomenon was completely abrogated in the presence of IDO inhibitor. MSCs, in IDO‐dependent manner, suppress liver Th17 cells which lead to the attenuation of liver fibrosis.     

Pharmacotherapy and over-the-counter drug use among elderly in Belgrade,Serbia

From November 2012 to January 2013, 480 seniors were recruited at the Pubic Health Center in Belgrade, Serbia. The patients' records were validated by four independent investigators. Data on over-the-counter (OTC) drug use were collected through a questionnaire. Polypharmacy, an intake of ≥5 prescribed medications, reported in 10.4% of seniors, was associated with cardiovascular (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.12–8.39) and endocrine diseases (OR = 2.25; 95% CI = 1.05–4.84) as well as with the number of treated chronic conditions (OR = 2.45; 95% CI = 1.75–3.44). The most frequently used OTC drugs were analgesics (metamizole, diclofenac and acetaminophen) and vitamins (vitamin C and vitamin B complex). The number of treated chronic conditions was associated with use of OTC drugs (OR = 1.17; 95% CI = 1.01–1.36). Multiple chronic conditions correlated with multiple OTC drug use (ρ = 0.125, p = 0.019). Our analysis indicated that the prevalence of polypharmacy and OTC drug use in the elderly are comparable to those in industrialized countries.