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Static and Acoustic Characteristics of Various Compressive Strength Concrete ...journal ijrtem
ABSTRACT:Steel fiber reinforced concrete (SFRC) was developed in volume fraction up to 1.5%. The static and acoustic behaviors of these composites under various loads were investigated. The mechanical properties such as: compressive and flexural strength were enhanced up by reinforcing with steel fiber. Moreover sonic parameters of these composites such as pulse velocity weredetermined usingultra sonic technique. The results showed that pulse velocity inversely proportional to subjected load, and enhanced with curing age. Keywords:Acoustic, Characteristics, Concrete Composites, Compressive Strength, Static
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
Female sexual dysfunction (FSD) is defined as any distress that is the result of sexual pain, orgasm
difficulties, and/or altered sexual interest or arousal.
Static and Acoustic Characteristics of Various Compressive Strength Concrete ...journal ijrtem
ABSTRACT:Steel fiber reinforced concrete (SFRC) was developed in volume fraction up to 1.5%. The static and acoustic behaviors of these composites under various loads were investigated. The mechanical properties such as: compressive and flexural strength were enhanced up by reinforcing with steel fiber. Moreover sonic parameters of these composites such as pulse velocity weredetermined usingultra sonic technique. The results showed that pulse velocity inversely proportional to subjected load, and enhanced with curing age. Keywords:Acoustic, Characteristics, Concrete Composites, Compressive Strength, Static
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
Female sexual dysfunction (FSD) is defined as any distress that is the result of sexual pain, orgasm
difficulties, and/or altered sexual interest or arousal.
Factors affecting quality of life in patients with diabetesFrank Reynold
Diabetes affects the quality of life of patients, and these effects differ from patient to another. So, how diabetes affects quality of life of diabetic patients and what are the factors behind that?
Magnitude of Vascular Symptoms among Pregnant Women with Pregnancy Induced Hy...ijtsrd
Pregnancy is considered as a normal physiological event and is typically, a time of joy and anticipation. Identifying the symptoms will help to screen the high risk cases at booking. It will help the health professionals to plan the suitable surveillance routine to detect preeclampsia for the rest of the pregnancy Methodology Descriptive research design was used to assess the presence of vascular symptoms among pregnant women with Pregnancy Induced Hypertension PIH . Pregnant women who diagnosed with pregnancy induced hypertension, belongs to hilly area, primigravida, gestational age between 26 - 30 weeks and experiencing at least three vascular symptoms, were included in the study. One hundred and six 106 women with pregnancy induced hypertension were selected for study by using purposive sampling technique. The tools used to collect the data were 1. Demographic questionnaire, 2. Scale to assess the Vascular Symptoms. To assess the magnitude of edema 4 point edema scale was used. To assess the head ache and epigastric pain numerical pain scale was used. Informed written consent was taken from each participant. Results Half of the women 50 had moderate BP, highest percentage 58.50 of women had moderate proteinuria, almost half of the participants 56.60 had moderate edema, more than one third of the participants 69.81 had normal weight gain. Head ache depicts that highest percentage 40.57 of women had mild head ache, one third 38.68 of women had mild pain, two third 68.87 of women had normal fetal growth or no IUGR, and 65.09 of women verbalized that they are experiencing Insomnia and 20.75 of the women verbalized that they are experiencing depression. Conclusion The symptoms underlying evidence base can be used to assess risk at booking especially in hilly area. High quality antenatal care can be provided for those cases in order to minimize the complications in both mother and the fetus. B. Gomathi | Anuchitra R | Ruchira Nautiyal ""Magnitude of Vascular Symptoms among Pregnant Women with Pregnancy Induced Hypertension (PIH) in Hilly Areas of Uttarakhand"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-2 , February 2020,
URL: https://www.ijtsrd.com/papers/ijtsrd30064.pdf
Paper Url : https://www.ijtsrd.com/medicine/nursing/30064/magnitude-of-vascular-symptoms-among-pregnant-women-with-pregnancy-induced-hypertension-pih-in-hilly-areas-of-uttarakhand/b-gomathi
Epidemiology of Hypertension among Adults in Al-Azhary Area in Khartoum-State...inventionjournals
Hypertension (HT) is one of the most important risk factors in cardiovascular disease which causes early death in adults. Hypertension is a common disease associated with high mortality and morbidity. Hypertension a silent killer as it is symptomless and remains undiagnosed, and not controlled if diagnosed. This is a descriptive cross - sectional community based study was conducted in Al-Azhary area in Khartoum StateSudan, with aim to estimate the prevalence of hypertension and to identify the possible risk factors associated with hypertension among adults. Data were collected from 303 participants (53.5% females and 46.5% males) using structured pretested questionnaire and blood pressure. The prevalence of hypertension was 19.1% (95% CI 0.61-1.93).There was no significant sex difference in the prevalence rate OR 1.09 (95% CI 0.61-1.93, P = 0.767). The results showed there was strong association between age group and hypertension (P = 0.0001), also there was statistical association between marital status, family history and hypertension positivity P.values =(0.0001 and 0.027) respectively. There was a significantly higher prevalence of hypertension among participants with diabetes, Vascular diseases and kidneys problems OR= (5.44(95% CI 1.89- 15.69, P = 0.017), 4.4(95% CI 0.86 - 2.39, P = 0.074) and 3.56 (95% CI 0.92-13.68, P = 0.05) respectively. Conclusion: one out of every five respondents of the study had hypertensive (19.1%). Age group, marital status, family history, history of (diabetes, vascular diseases and kidneys problems)were statistically significant predictors of hypertension positivity.
Undernutrition and Mortality Risk Among Hospitalized Childrenasclepiuspdfs
Background: Malnutrition remains one of the most common causes of morbidity and mortality among children in low- and middle-income countries, being responsible for 45% of deaths among children younger than 5 years. Objectives: This study aimed to assess the frequency of undernutrition and to evaluate the effect of simultaneous presence of underweight, wasting, and stunting on child mortality. Methods: A retrospective observational review of files for patients admitted from September 1, 2015, to February 29, 2016, in a single ward treating children with diarrheal diseases and severe acute malnutrition (SAM).
Factors affecting quality of life in patients with diabetesFrank Reynold
Diabetes affects the quality of life of patients, and these effects differ from patient to another. So, how diabetes affects quality of life of diabetic patients and what are the factors behind that?
Magnitude of Vascular Symptoms among Pregnant Women with Pregnancy Induced Hy...ijtsrd
Pregnancy is considered as a normal physiological event and is typically, a time of joy and anticipation. Identifying the symptoms will help to screen the high risk cases at booking. It will help the health professionals to plan the suitable surveillance routine to detect preeclampsia for the rest of the pregnancy Methodology Descriptive research design was used to assess the presence of vascular symptoms among pregnant women with Pregnancy Induced Hypertension PIH . Pregnant women who diagnosed with pregnancy induced hypertension, belongs to hilly area, primigravida, gestational age between 26 - 30 weeks and experiencing at least three vascular symptoms, were included in the study. One hundred and six 106 women with pregnancy induced hypertension were selected for study by using purposive sampling technique. The tools used to collect the data were 1. Demographic questionnaire, 2. Scale to assess the Vascular Symptoms. To assess the magnitude of edema 4 point edema scale was used. To assess the head ache and epigastric pain numerical pain scale was used. Informed written consent was taken from each participant. Results Half of the women 50 had moderate BP, highest percentage 58.50 of women had moderate proteinuria, almost half of the participants 56.60 had moderate edema, more than one third of the participants 69.81 had normal weight gain. Head ache depicts that highest percentage 40.57 of women had mild head ache, one third 38.68 of women had mild pain, two third 68.87 of women had normal fetal growth or no IUGR, and 65.09 of women verbalized that they are experiencing Insomnia and 20.75 of the women verbalized that they are experiencing depression. Conclusion The symptoms underlying evidence base can be used to assess risk at booking especially in hilly area. High quality antenatal care can be provided for those cases in order to minimize the complications in both mother and the fetus. B. Gomathi | Anuchitra R | Ruchira Nautiyal ""Magnitude of Vascular Symptoms among Pregnant Women with Pregnancy Induced Hypertension (PIH) in Hilly Areas of Uttarakhand"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-2 , February 2020,
URL: https://www.ijtsrd.com/papers/ijtsrd30064.pdf
Paper Url : https://www.ijtsrd.com/medicine/nursing/30064/magnitude-of-vascular-symptoms-among-pregnant-women-with-pregnancy-induced-hypertension-pih-in-hilly-areas-of-uttarakhand/b-gomathi
Epidemiology of Hypertension among Adults in Al-Azhary Area in Khartoum-State...inventionjournals
Hypertension (HT) is one of the most important risk factors in cardiovascular disease which causes early death in adults. Hypertension is a common disease associated with high mortality and morbidity. Hypertension a silent killer as it is symptomless and remains undiagnosed, and not controlled if diagnosed. This is a descriptive cross - sectional community based study was conducted in Al-Azhary area in Khartoum StateSudan, with aim to estimate the prevalence of hypertension and to identify the possible risk factors associated with hypertension among adults. Data were collected from 303 participants (53.5% females and 46.5% males) using structured pretested questionnaire and blood pressure. The prevalence of hypertension was 19.1% (95% CI 0.61-1.93).There was no significant sex difference in the prevalence rate OR 1.09 (95% CI 0.61-1.93, P = 0.767). The results showed there was strong association between age group and hypertension (P = 0.0001), also there was statistical association between marital status, family history and hypertension positivity P.values =(0.0001 and 0.027) respectively. There was a significantly higher prevalence of hypertension among participants with diabetes, Vascular diseases and kidneys problems OR= (5.44(95% CI 1.89- 15.69, P = 0.017), 4.4(95% CI 0.86 - 2.39, P = 0.074) and 3.56 (95% CI 0.92-13.68, P = 0.05) respectively. Conclusion: one out of every five respondents of the study had hypertensive (19.1%). Age group, marital status, family history, history of (diabetes, vascular diseases and kidneys problems)were statistically significant predictors of hypertension positivity.
Undernutrition and Mortality Risk Among Hospitalized Childrenasclepiuspdfs
Background: Malnutrition remains one of the most common causes of morbidity and mortality among children in low- and middle-income countries, being responsible for 45% of deaths among children younger than 5 years. Objectives: This study aimed to assess the frequency of undernutrition and to evaluate the effect of simultaneous presence of underweight, wasting, and stunting on child mortality. Methods: A retrospective observational review of files for patients admitted from September 1, 2015, to February 29, 2016, in a single ward treating children with diarrheal diseases and severe acute malnutrition (SAM).
ARTICLENight-shift work and incident diabetes among Africa.docxdavezstarr61655
ARTICLE
Night-shift work and incident diabetes among African-American
women
Varsha G. Vimalananda & Julie R. Palmer & Hanna Gerlovin &
Lauren A. Wise & James L. Rosenzweig & Lynn Rosenberg &
Edward A. Ruiz Narváez
Received: 15 August 2014 /Accepted: 5 December 2014 /Published online: 14 January 2015
#
Abstract
Aims/hypothesis The aim of this study was to assess shift
work in relation to incident type 2 diabetes in African-
American women.
Methods In the Black Women’s Health Study (BWHS), an
ongoing prospective cohort study, we followed 28,041 partic-
ipants for incident diabetes during 2005–2013. They an-
swered questions in 2005 about having worked a night shift.
We estimated HR and 95% CIs for incident diabetes using
Cox proportional hazards models. The basic multivariable
model included age, time period, family history of diabetes,
education and neighbourhood socioeconomic status. In fur-
ther models, we controlled for lifestyle factors and BMI.
Results Over the 8 years of follow-up, there were 1,786
incident diabetes cases. Relative to never having worked the
night shift, HRs (95% CI) for diabetes were 1.17 (1.04, 1.31)
for 1–2 years of night-shift work, 1.23 (1.06, 1.41) for 3–
9 years and 1.42 (1.19, 1.70) for ≥10 years (p-trend<0.0001).
The monotonic positive association between night-shift work
and type 2 diabetes remained after multivariable adjustment
(p-trend=0.02). The association did not vary by obesity sta-
tus, but was stronger in women aged <50 years.
Conclusions/interpretation Long duration of shift work was
associated with an increased risk of type 2 diabetes. The
association was only partially explained by lifestyle factors
and BMI. A better understanding of the mechanisms by which
shift work may affect the risk of diabetes is needed in view of
the high prevalence of shift work among workers in the USA.
Keywords African-American . Black . Circadian .
Diabetes . Shift work . Sleep
Abbreviations
BWHS Black Women’s Health Study
FFQ Food frequency questionnaire
NHS Nurses’ Health Study
SES Socioeconomic status
Introduction
Over 8 million Americans are employed in shift work [1],
which is that occurring outside of typical daytime work hours.
Shift workers may have working hours that change periodi-
cally or they may have a permanent work pattern that occurs at
unusual times of the day, such as afternoon or night. These
atypical work patterns may perturb the circadian system,
which is entrained most powerfully by the solar light–dark
cycle and modulates daily rhythms in alertness, core body
temperature, heart rate, blood pressure and neurotransmitter
Electronic supplementary material The online version of this article
(doi:10.1007/s00125-014-3480-9) contains peer-reviewed but unedited
supplementary material, which is available to authorised users.
V. G. Vimalananda (*)
Center for Health Organization and Implementation Research
(CHOIR), Edith Nourse Rogers Memorial VA Medical Center (152),
200 Springs Road, Bedford, MA.
Implementation of the trend marker protocol results in a unique graphical presentation when a hormone and a symptom are plotted as per the day of menstrual cycle. This presentation will indicate behavior of the hormone in relation to the disease independent of whether the hormone levels are normal or abnormal as per the set laboratory limits.
Prediction of the Syndrome Premature Ovarian Insufficiencyijtsrd
Premature ovarian failure syndrome is a symptom complex characterized by hypergonodotropic amenorrhea in women under 40. Known causes include 1. Genetic aberrations that can affect the X chromosome or autosomes. 2. Autoimmune damage to the ovaries, as evidenced by the observed association of POF with other autoimmune disorders. 3. Iatrogenic after surgery, radiotherapy or chemotherapy, as in malignant neoplasms. 4. Environmental factors such as viral infections and toxins, the mechanism of action of which is not known. Tangirova Yulduz Alimovna | Yusupov Shokhruh "Prediction of the Syndrome Premature Ovarian Insufficiency" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49766.pdf Paper URL: https://www.ijtsrd.com/biological-science/other/49766/prediction-of-the-syndrome-premature-ovarian-insufficiency/tangirova-yulduz-alimovna
A Study to Asess the Health Seeking Behaviour and Quality of Life among Multi...ijtsrd
Background A women or a mother faces a lot of problems as she goes through the period of pregnancy and childbirth. Urinary Incontinence UI is a relatively common condition in middle aged and older women. Although it is not a life threatening condition, UI negatively impacts health related quality of life QOL by affecting daily living activities, sexual and interpersonal relationship, psychological wellbeing and social interaction. UI affects from 15 50 of community dwelling women of all ages. Women who undergo repeated vaginal delivery have a great risk for developing Urinary incontinence. Hence the investigator had taken up a study to assess the health – seeking behaviour and quality of life among multipara women having urinary incontinence at selected community of Gwalior. Objectives To identify the health seeking behaviour of multipara women having urinary incontinence. To determine the quality of life of multipara women having urinary incontinence. To find the association of health seeking behaviour scores with selected demographic variables. To find the association of quality of life scores with selected demographic variable. Method Descriptive design was used for the study. The study was carried out in selected rural community at Mangalore. A sample consisted of 60 multipara women who met the inclusive criteria and the sample was selected using purposive sampling technique. Formal written permission was obtained from the authorities of the concerned PHC informed was obtained from multipara women a conduct the study. The health seeking behaviour score was obtained using structured questionnaire and quality of life of women with urinary incontinence was determined be a structured rating scale. The data collection was analysed using descriptive and inferential statistics. An information pamphlet is given to subject after data collection. Result The demographic data revealed that majority of the women 46 were in the age group of 51 or above years. Around half of women 46 had delivered more than tree and some 30 delivered thrice, majority of women 54 had primary school education, and most of the women 70 were unskilled workers. Majority of the women 64 had normal vaginal delivery. Most of the women 55 had a family income of 2000. The health –seeking behaviour was average 53.3 for majority of the women, about 25 had good health seeking behaviour, and the rest had poor health seeking behaviour. The overall health seeking behaviour was average with SD1.873. Most of the women 71 had mild urinary incontinence with mean 5.28, median 4.00, and SD 13.99. There was no significant association of quality of life score with selected demographic variables like age, number of deliveries, educational status, occupation, and monthly income. Interpretation and Conclusion finding of the study showed that multipara women had average health seeking behaviour and average quality of life. The findings of this study suggest that awareness programmes should be conducte
Do Anxiety Scores of Pregnant Women Correlate with Doppler Indices of Uterine...semualkaira
In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
or stressor for all individuals who experience it
Similar to Những dấu hiệu trong thời kì tiền mãn kinh | Venus Global (20)
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Kính chào tất cả mọi người. Hướng dẫn 11 cách làm ngũ cốc giảm cân đơn giản tại nhà giúp bổ sung đủ dinh dưỡng mà vẫn giảm cân hiệu quả
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#cách_làm_ngũ_cốc_giảm_cân
#cách_làm_bột_giảm_cân
#VENUSGLOBAL
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Kính chào tất cả mọi người. Nhập môn cùng các bài tập yoga giảm cân đơn giản, lấy lại thân hình thon gọn, vóc dáng chuẩn nhanh chóng. Tìm hiểu ngay bài viết để biết cụ thể hơn.
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#bài_tập_yoga_giảm_cân_hiệu_quả
#VENUSGLOBAL
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Detox giảm cân
Kính chào tất cả mọi người. Bạn muốn giảm cân? Lưu ngay 21 loại nước detox đào thải mỡ thừa, làm đẹp da an toàn và hiệu quả tại nhà.
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Kính chào tất cả mọi người. Thực phẩm giàu chất xơ giảm cân được nhiều gymer ưa chuộng. Bạn đang muốn lên kế hoạch ăn kiêng? Xem ngay bài viết để giải quyết vấn đề này.
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#thực_phẩm_giàu_chất_xơ_giảm_cân
#VENUSGLOBAL
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Kính chào tất cả mọi người. Bạn đang cần tìm một giải pháp giảm cân an toàn nhưng vẫn đảm bảo dưỡng chất cho cơ thể? Cùng Venus tìm hiểu ngay một số loại sinh tố giảm cân
ngon- bổ- rẻ.
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#sinh_tố_giảm_cân
#các_loại_sinh_tố_giảm_cân_đẹp_da
#VENUSGLOBAL
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Kính chào tất cả mọi người. Uống nước cũng có thể giảm cân? Những loại nước uống giảm cân thần thánh mà bạn không biết sẽ được Venus tổng hợp và chia sẻ trong bài viết.
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#nước_uống_giảm_cân
#nước_uống_giảm_cân_đẹp_da
#VENUSGLOBAL
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Kính chào tất cả mọi người. Ăn kiêng nên dùng rau gì? Bạn đang cần tìm những thực phẩm đảm bảo dưỡngchất nhưng không lo tăng cân. Tìm hiểu các loại rau giảm cân an toàn qua
bài viết ngay!
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#rau_giảm_cân
#các_loại_rau_giảm_cân_hiệu_quả
#VENUSGLOBAL
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Kính chào tất cả mọi người. Bạn đã biết đến 6 bài tập giảm cân cực hiệu quả này hay chưa? Hãy tham khảo ngay để nhanh chóng sở hữu vóc dáng mong muốn cùng Venus
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#bài_tập_giảm_cân
#the_duc_giam_can_hieu_qua
#VENUSGLOBAL
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Kính chào tất cả mọi người. Ăn chay có gây mập không? Tìm hiểu cách ăn chay giảm cân đẹp da hiệu quả cao? Gợi ý thực đơn chay ngon miệng, giảm cân hiệu quả trong 1 tuần
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#ăn_chay_giảm_cân_đẹp_da
#VENUSGLOBAL
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Giảm cân hiệu quả bằng mật ong
Kính chào tất cả mọi người. Bạn đang muốn giảm mỡ bụng? Hướng dẫn cách giảm cân hiệu quả bằng mật ong và nguyên liệu thiên nhiên, uống vào buổi sáng hoặc trước khi ngủ.
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#giảm_cân_hiệu_quả_bằng_mật_ong
#VENUSGLOBAL
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Kính chào tất cả mọi người. Chia sẻ kinh nghiệm giảm cân bằng yến mạch hiệu quả, no lâu, không gây ngán, cho chị em và các gymer chỉ trong 1 tuần giảm 2 - 3kg. Xem ngay!
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#kinh_nghiệm_giảm_cân_bằng_yến_mạch
#VENUSGLOBAL
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Kính chào tất cả mọi người. Buổi sáng nên ăn gì để giảm cân hiệu quả? Gợi ý 25 món ăn sáng giúp tan mỡ bụng nhanh, ngon miệng và dinh dưỡng, tiết kiệm thời gian chuẩn bị
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#bữa_sáng_giảm_cân
#sáng_ăn_gì_giảm_cân
#VENUSGLOBAL
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Kính chào tất cả mọi người. Cách giảm cân bằng chanh như thế nào cho hiệu quả? Có nên uống nước chanh buổi tối để giảm cân không? Làm detox chanh giảm cân trong 3 ngày
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#VENUSGLOBAL
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Kính chào tất cả mọi người. Các mẹ bỉm mong muốn lấy lại vóc dáng thon gọn thuở ban đầu? Xem ngay cách giảm cân hiệu quả sau sinh và kinh nghiệm lên thực đơn sau sinh mổ
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
2. healthcare. Moreover, clinicians do not have access to data
about the meanings women assign to their experiences.
The purpose of this article is to examine published evi-
dence of the prevalence of menopause-related symptoms
reported by participants in longitudinal studies of the meno-
pausal transition to address the following questions: (1)
Which symptoms do women report during the perimeno-
pause, and how prevalent are these symptoms as women
traverse the menopausal transition? (2) How severe are
symptoms and for how long do they persist? (3) To what do
women attribute their symptoms, and do their attributions
match findings from epidemiologic studies of community-
based populations? (4) How significant are these symptoms
in women’s lives?
Methods
Data from published community-based longitudinal studies
of the menopausal transition were reviewed for evidence
bearing on each of the questions presented above.1–12
Where possible, the Staging Reproductive Aging Workshop
(STRAW) criteria were used to approximate the stage of
menopausal transition and to promote comparison of data
specific to menopausal transition stages across multiple
studies.13
The STRAW stages are based on menstrual cycle
patterns and include the following: (1) late reproductive
stage, denoted by minor changes in cycle length, particu-
larly decreasing length of the cycle; (2) early menopausal
transition stage, indicated by increasing irregularity of men-
ses without skipping periods (⬎7 days’ difference from the
beginning of a given cycle to the next, experienced after
previously regular cycles); (3) late menopausal transition
stage, characterized by skipping periods (amenorrhea ⬎60
days); and (4) postmenopause, spanning the time from a
woman’s final menstrual period (FMP) to the end of her life.
Classification of the menopausal transition stages for most
studies was based on retrospective histories of menses, al-
though some recent studies have incorporated daily diary re-
cordings.7,12
Findings from studies of community-based
populations
Prevalence of symptom reporting
Women at midlife report hot flashes and sweats, depressed
mood, sleep disturbances, sexual concerns or problems,
cognitive symptoms, vaginal dryness, urinary incontinence,
and somatic or bodily pain symptoms. Because women
experience these symptoms at many other points in their
lives (as do men, with the exception of the vaginal symp-
toms), none can be said to be specific to the perimenopause.
Hot flashes
The prevalence of hot flashes among women who had not
begun the menopausal transition (STRAW late reproductive
stage) ranges from 6%4
to 13%.14
As women progress from
the early to late menopausal transition stages (from noting
changes in their cycle regularity to skipping menstrual peri-
ods), the prevalence of hot flashes increased (late reproductive,
4% to 46%; late menopausal transition, 33% to 63%).1,14
For
women who had completed menopause (STRAW postmeno-
pause, defined as ⱖ1 year with no menses), the prevalence rose
as high as 79%14
(Table 14–6,10,14–20
).
The peak prevalence of hot flashes occurs during the late
menopausal transition stage (labeled “late perimenopause”
in several of the studies) and during the early postmeno-
pause. Because many studies have not included follow-up
beyond the first 1 or 2 years of postmenopause, it is difficult
to discern when or whether hot flashes cease.
Depressed mood
Where reproductive stage measures are available, the prev-
alence of depressed mood symptoms (e.g., feeling sad or
blue) ranged from 19% to 29%. For women in the early or
late menopausal transition stages, prevalence estimates
ranged from 28% to 29%; for those who had completed
menopause, the prevalence of depressed mood symptoms
ranged from 24.5% to 29% (late reproductive) to 23% to
28% (late MT) to 23% to 34% (postmenopause)4,21–27
(Table 24,5,19,22–24,28–32
).
Several investigators have used the Center for Epidemi-
ologic Studies Depression Scale (CES-D) to obtain esti-
mates of depressed mood. Using a cut point of 16 to identify
women with scores resembling those of patients with major
depressive disorders, investigators estimated that the prev-
alence of depressed mood for women in the reproductive
stage ranged from 11.6% to 15%.28,32
Estimates ranged
from 1% to 19% for women in the early menopausal tran-
sition stage, from 13% to 18% for those who were in the late
menopausal transition stage, and from 1% to 17% for those
who were postmenopausal.5,23,26,28,32
As a basis of compar-
ison, 22.4% of women in the Harvard Study of Moods and
Cycles had CES-D scores ⬎16, with 8.6% having scores
⬎24.11
In the Seattle Midlife Women’s Health Study, over-
all prevalence estimates of women with CES-D scores ⬎16
ranged from 26% to 28%. Estimates from SWAN were that
24% of the total sample had scores ⬎16.22,27
Few studies have incorporated clinical diagnosis of de-
pression using the Diagnostic and Statistical Manual of
Mental Disorders–4th Edition (DSM-IV) criteria. The re-
cent exceptions are the Penn Ovarian Aging Study,32
in
which women were interviewed to identify cases of major
depressive disorder (MDD), and the Harvard Study of
Moods and Cycles,11
in which women between the ages of
36 and 45 years were interviewed for evidence of DSM-IV
criteria for past or current major depression. In the Penn
15S
Woods and Mitchell Symptoms during perimenopause: prevalence, severity, trajectory, and significance
3. Table 1 Prevalence of vasomotor symptoms from selected longitudinal studies
Study Study Population Measures
STRAW MT Stage
Late
Reproductive Early MT Late MT Postmenopause
Healthy Women Study4
460 women, aged 42–50 yr
(19 black, 183 white), randomly
selected from drivers’ licenses and
census lists
Checklist of 27 symptoms administered
in follow-up clinical examination
6% NA NA 43%
Manitoba Project on
Women and Their
Health in the Middle
Years5,16
469 women, aged 45–55 yr, selected
from nonrandom mail survey,
145 with hysterectomy
Checklist of symptoms19
Hot flashes,
13.8%
NA 39.7% 41.5%
Night sweats,
10.6%
NA 27.6% 22.2%
Norwegian Menopause
Project6
200 women, aged 45–55 yr (of
1,886 women studied in 1981),
followed annually for 5 yr
Symptoms reported in interview, as
well as frequency and whether
troubled by symptoms
Hot flashes,
Very
troubled,
12%
NA
NA
46%
NA
67% (1 yr)
61% (2 yr)
18% (1 yr)
12% (2 yr)
Melbourne Women’s
Midlife Health
Project14
453 women, aged 45–55 yr, from a
population-based Australian
sample
Symptoms over past 2 wk, frequency/
day, and bother20
Hot flashes
(⬎1/day),
13%
NA 37%
Bothered, 6% NA 26%
172 women who had made a
transition to perimenopause or
postmenopause (in 2000)
As above Hot flashes,
10%
15% 42% 42% (1 yr)
41% (2 yr)
Sweats, 10% 14% 30% 35% (1 yr)
24% (2 yr)
SWAN15,17
16,065 women, aged 40–55 yr, from
multiracial/ethnic sample, 7 sites,
community-based sampling
strategies to include African
American, Chinese American,
Japanese American, Hispanic, and
European American women
Self-reported questionnaires, asked
whether they had hot flashes/sweats
over the past 2 wk
19.4% 36.9% 56.8% 48.8%
Penn Ovarian Aging
Study10,18
Women, aged 35–47 yr, randomly
selected from community (African
Americans ⫽ 219; European
Americans ⫽ 217)
Standardized menopause symptoms
checklist regarding hot flashes over
the past month/severity
Hot flashes
(6 yr), 37%
48% 63% 79%
MT ⫽ menopausal transition; NA ⫽ estimate not available from published literature; STRAW ⫽ Staging Reproductive Aging Workshop; SWAN ⫽ Study of Women’s Health Across the Nation.
16S
The
American
Journal
of
Medicine,
Vol
118
(12B),
December
19,
2005
4. Table 2 Prevalence of depressed mood symptoms from selected longitudinal studies
Study Study Population Measures
STRAW MT Stage
Late
Reproductive Early MT Late MT Postmenopause
Massachusetts Women’s
Health Study22–24
2,352 white women, aged 45–
55 yr, randomly selected from
from Massachusetts state
census lists
Asked if sad or blue/depressed over
past 2 wk (symptom checklist)
29.1% NA 28.1% 33.8%
Healthy Women Study4
460 women, aged 42–50 yr
(19 black and 183 white),
randomly selected from
drivers’ licenses and census
lists
Beck Depression Inventory 4.5% NA NA 5.9%
National Health
Examination Follow-up
Study28
394 women, aged 40–58 yr,
selected using stratified
probability sample of adult,
noninstitutionalized civilian
population
CES-D measures repeated 10 yr
apart; cut point, ⬎16
13% NA 19% 17%
Manitoba Project on
Women and Their
Health in the Middle
Years5,19,29
469 women, aged 45–55 yr,
selected from nonrandom
mail survey, 145 with
hysterectomy
Questionnaire asking whether
depressed or blue
24.5% NA 23.2% 23.0%
SWAN30,31
3,015 of 3,302 women selected
from 7 sites
Persistent mood symptoms included
dysphoric mood, feeling blue or
depressed, irritable or grouchy,
tense or nervous, and frequent
mood changes ⬎6 days/wk
8%–12% 14.9%–18.4% NA NA
16,065 women, aged 40–55 yr Psychologic distress (feeling tense,
depressed, and irritable in the
previous week)
20.9% NA 28.9% 22%
Penn Ovarian Aging
Study32
Women, aged 35–47 yr,
randomly selected from
community (African
Americans ⫽ 219, European
Americans ⫽ 217)
Interviews using CES-D conducted
at baseline and 4 yr later
CES-D ⬎16
12%–15%
1.4%–7.8% 13.1%–18.3% 1%–13.8%
Interviews to identify MDD MDD 10%–13% 1%–4% ⬍1% ⬍1%
CES-D ⫽ Center for Epidemiologic Studies Depression Scale; MDD ⫽ major depressive disorder; MT ⫽ menopausal transitron; NA ⫽ estimate not available from published literature; STRAW ⫽ Staging
Reproductive Aging Workshop; SWAN ⫽ Study of Women’s Health Across the Nation.
17S
Woods
and
Mitchell
Symptoms
during
perimenopause:
prevalence,
severity,
trajectory,
and
significance
5. Ovarian Aging Study, the prevalence of MDD was 10% to
13% of women classified as being in reproductive stages
and 1% to 4% of those in the early menopausal transition.32
Follow-up with this population can yield important findings
on the progression/persistence of MDD. To date there is a
single published report from a small-sample (n ⫽ 29) lon-
gitudinal study of initial onset of depression during the
menopausal transition.33
These findings are being replicated
in the SWAN cohort.34
Persistence of depressed mood from reproductive
stages to postmenopause has received minimal attention.
Bromberger and colleagues27
defined persistence of de-
pressed mood as having dysphoric mood (feeling blue or
depressed, irritable or grouchy, tense or nervous) and
frequent mood changes for ⬎6 days per week. In the
SWAN population, cross-sectional estimates of persistent
depressed mood ranged from 8% to 12% among women
in the late reproductive stage and 14.9% to 18.4% for
women in the early menopausal transition stage.35
Woods
and Mitchell26
reported data on the persistence of high
CES-D scores (⬎16) among women who were in the
early menopausal stage or in a reproductive stage. Over a
1-year period they found that 60% of these women scored
⬍16, but 13% scored ⬎16 during both years.
The Seattle Midlife Women’s Health Study investiga-
tors identified clusters of women based on their CES-D
scores (level and trajectory) over a 10-year period.25
The
most prevalent cluster included women who had nonde-
pressed scores (4 to 7) and low-level scores (8 to 10).
Other clusters included women with moderate-level
scores (10 to 19) that remained constant, improved, or
worsened over time and a cluster of women with high
scores (most ⬎24) that remained constant over time.
There was no evidence of a relation between progression
through the menopausal transition stages and CES-D
scores in this cohort.25
Sleep symptoms
Estimates of sleep disturbances range from 31% for
women in the reproductive stage to 45% for women who
are 3 years postmenopausal.14
SWAN found that 4,632 of
⬎16,000 women reported difficulty sleeping.15
The odds
of reporting difficulty sleeping were greater for women
who were in the early or late menopausal transition stages
or who were postmenopausal compared with those in the
reproductive stage. Unfortunately, data from ongoing
longitudinal studies are not yet available (e.g., SWAN,
Seattle Midlife Women’s Health Study, Penn Ovarian
Aging Study) about the prevalence of sleep difficulty as
women progress through the menopausal transition
stages (Table 3).14,35
Sexual symptoms
Data from the Massachusetts Women’s Health Study36
revealed that menopausal status (being classified as in the
menopausal transition or postmenopause) was related to
experiencing lowered sexual desire, believing that inter-
est in sexual activity declines with age, and that being
postmenopausal was associated with decreased arousal
when compared with women’s own experiences in their
40s. Postmenopausal women reported a lower degree of
desire and less arousal than women who were in repro-
ductive stages or in a menopausal transition stage. Low
estradiol levels were associated with dyspareunia.36
Mel-
bourne Women’s Midlife Health Project (MWMHP)
scores on the Shortened Personal Experiences Question-
naire (SPEQ) indicated that the prevalence of any type of
sexual dysfunction rose from 42% to 88% as women
became postmenopausal.37,38
There was a significant de-
crease in total SPEQ score, sexual interest, responsivity,
and frequency of sex as well as a significant increase in
dyspareunia and reports of partners’ problems in sexual
Table 3 Prevalence of sleep disturbance symptoms from selected longitudinal studies
Study Study Population Measures
STRAW MT Stage
Late
Reproductive
Early
MT
Late
MT Postmenopause
Melbourne Women’s
Midlife Health
Project14
438 women observed for
7 yr; 172 women
advanced from
premenopause to
perimenopause or to
postmenopause
33-item symptom checklist
administered annually:
subjects indicated
whether they had trouble
sleeping
31% 32% 38% 38% (1 yr)
43% (2 yr)
SWAN35
12,603 women, aged
40–55 yr
Self-reported questionnaire:
subjects asked whether
they had experienced
difficulty sleeping in past
2 wk
31.4% 39.6% 45.5% 43.2%
MT ⫽ menopausal transition; STRAW ⫽ Staging Reproductive Aging Workshop; SWAN ⫽ Study of Women’s Health Across the Nation.
18S The American Journal of Medicine, Vol 118 (12B), December 19, 2005
6. performance as women moved through the menopausal
transition.15,37
Prior sexual functioning and decreasing
estradiol levels, but not androgen levels, were associated
with sexual dysfunction as measured on the SPEQ (Table
4).15,37,38
When participants in the Penn Ovarian Aging
Study described libido (i.e., interest in sex) in the past
month, 27% reported decreased libido. Fluctuating tes-
tosterone levels—but not the testosterone, dehydroepi-
androsterone sulfate (DHEAS), estradiol, or follicle-
stimulating hormone (FSH) levels measured over the
study period—were associated with reports of decreased
libido.39
These findings suggest that fluctuation may be
more important than the level of estrogens and androgens
during the menopausal transition.
Cognitive symptoms
Although cognitive symptoms are prevalent (e.g., problems
remembering names), few women rate their symptoms as
serious.40
When women were asked about their attributions,
they linked their memory problems to increased role burden
and stress, getting older, physical health problems, men-
strual cycle changes, hormone changes, inadequate concen-
tration and emotional changes, but few mentioned meno-
pause.41
Only SWAN has examined changes in cognition in
various stages of the menopausal transition: experiences of
forgetfulness were reported by 31% of participants in the
reproductive stage, 44% in the early menopausal transition
stage, 44.8% in the late menopausal transition stage, and
42% in postmenopause.15
A cross-sectional analysis of data from the MMWHP
indicated that memory did not vary with any variables that
measured estrogen exposures, including menopausal transi-
tion stage, time from the FMP, use of HT, or serum estradiol
concentration.42
The single longitudinal analysis of cogni-
tive assessments to measure working memory and percep-
tual speed indicated that the measures improved for women
in the late reproductive and early menopausal transition
stages over a 2-year period. Significant decreases in Symbol
Digit Modalities Test scores were evidenced only for post-
menopausal women, a pattern consistent with expected
changes related to aging.43
Vaginal symptoms
Vaginal dryness was common as women proceeded through
the menopausal transition. In the MWMHP, symptoms of
vaginal dryness were reported as bothersome by 3% of
women in the reproductive stage, 4% of women in the early
menopausal transition, 21% of women in the late meno-
pausal transition, and 47% of women who are 3 years
postmenopausal.14
In the SWAN cohort, 1,629 of ⬎16,000
women providing baseline data reported vaginal dryness.
Menopausal status (progression through the transition), was
Table 4 Prevalence of sexual, cognitive, vaginal, urinary, and pain symptoms from selected longitudinal studies
Study Study Population Measures
STRAW MT Stage
Late
Reproductive Early MT Late MT Postmenopause
Melbourne Women’s
Midlife Health
Project37,38
172 women who had
made a transition
to perimenopause
or postmenopause
reported on
symptoms
SPEQ scores indicating
sexual dysfunction
NA 42% 88% NA
Vaginal dryness over
past 2 wk, frequency
and bothersomeness;
prevalence of
bothersome symptom
3% 4% 21% 25% (1 yr)
32% (2 yr)
Urine control problems
over the past 2 wk
17% 12% 14% 14%
Aches or stiff joints
over the past 2 wk
41% 47% 53% 53% (1 yr)
57% (2 yr)
SWAN15
16,065 women, aged
40–55 yr,
participating in
baseline survey
Vaginal dryness over
past 2 wk
7.1% 12.9% 18.2% 21.2%
Urine leakage over past
2 wk
12.3% 20.6% 19.6% 17.7%
Stiffness/soreness over
past 2 wk
45.8% 57.9% 58.4% 54.8%
Forgetfulness over the
past 2 wk measured
on symptom
checklist
31.2% 44% 44.8% 42.0%
MT ⫽ menopausal transition; NA ⫽ not available from published literature; SPEQ ⫽ Shortened Personal Experiences Questionnaire; STRAW ⫽ Staging
and Reproductive Aging Workshop; SWAN ⫽ Study of Women’s Health Across the Nation.
19S
Woods and Mitchell Symptoms during perimenopause: prevalence, severity, trajectory, and significance
7. associated with vaginal dryness as was age.15
This symptom
is also related to the reports of sexual dysfunction and is
included in some measures (e.g., in the SPEQ) as an indi-
cator of sexual dysfunction.
Urinary symptoms
In the MWMHP, the prevalence of urinary symptoms was
reported as 17% in women in the late reproductive stage,
12% in women in the early menopausal transition, 14% in
women in the late menopausal transition, and 14% in
women who were postmenopausal.14
Participants in SWAN
(n ⫽ 2,135 of ⬎16,000) reported leaking urine over the past
2 weeks. Menopausal transition stage and age were corre-
lated.15
In a more complete assessment of symptoms of
incontinence, frequency, and severity completed at the be-
ginning of the longitudinal phase of SWAN, 57% of women
reported incontinence, with 15% rating it as moderate and
10% as severe. Being in a menopausal transition stage
versus in a late reproductive stage and being older were both
associated with symptoms of incontinence.44
Somatic symptoms
The MWMHP is the only source of prevalence estimates of
aches or stiff joints for women in the various menopausal
transition stages, with prevalence increasing from 41% in
the late reproductive stage to 47% in early menopausal
transition, to 53% in late menopausal transition, and to 57%
at 2 years postmenopause.14
SWAN participants (n ⫽ 6,620
of ⬎16,000) reported stiffness and soreness.15
Both increas-
ing age and progression through the menopausal transition
stages were associated with these symptoms.15
Severity and persistence of symptoms
A minority of women report severe symptoms.14
In the
Norwegian Menopause Project, 67% of participants re-
ported any hot flashes during the menopausal transition,
58% reported an increase in frequency from the reproduc-
tive stage to postmenopause, and 54% reported an increase
in distress related to hot flashes.6
In the MWMHP, 39% of
participants reported frequency and bothersomeness of hot
flashes, with 29% of women in the menopausal transition
stages and 37% of postmenopausal women reporting that
hot flashes occurred several times per day.14
In the Penn
Ovarian Aging Study, 26% of women reported their hot
flashes were moderate to severe, with 15% experiencing hot
flashes on ⬎15 days per month and 9% reporting having hot
flashes daily.10
Studies with trajectory data indicate that symptoms such
as hot flashes peak in severity during the later part of the
menopausal transition, when women are skipping menstrual
periods.14,45–47
It is unclear whether and when symptoms
abate after menopause owing to limited follow-up. To date
the longest reported follow-up of a cohort has been the
MWMHP, which has reports based on 8 years of follow-up
data.14
Women’s attributions about
symptoms and correlates in
community-based population studies
Although there are only a few reports about women’s attri-
butions of their symptoms, the women’s view of factors asso-
ciated with their symptoms (ranging from hot flashes and
sweats to aches and stiffness) correspond closely to findings
from epidemiologic studies of community-based populations.
Women attribute their symptoms to factors such as aging,
menopausal hormone changes, family history, role overload,
stress, health changes, emotional changes, attitudes and expec-
tations, lack of information, and uncertainty about meno-
pause.7
Epidemiologic studies link similar symptoms to factors
including age; endocrine changes (estradiol, FSH, DHEAS,
testosterone, androstenedione); stressors such as economic
strain and parenting strain; stressful life circumstances such as
abuse; health behaviors such as smoking, alcohol intake, ex-
ercise, and nutrient intake; personal characteristics such as
optimism; concurrent and past health conditions, including
prior episodes of depression or premenstrual symptoms; and
physical indicators such as body mass index.14,15,40,46
Despite
the wide range of factors associated with a wide array of
symptoms, focus has remained on the role of endogenous
endocrine factors such as estrogen.14,22
Significance of symptoms in women’s lives
Data from the MWMHP indicate little relation between
symptoms (hot flashes, night sweats, vaginal dryness) and
well-being.48
Instead, well-being during the perimenopause
was influenced by past well-being, changes in marital status,
work satisfaction, daily hassles, and stressful life events.
Moreover, in the MWMHP cohort, well-being improved as
women entered the late menopausal transition stage. Data
from studies of negative mood do indicate, however, that
severe vasomotor symptoms affect sleep and mood and
imply that these symptoms may interfere with women’s
well-being.22
The appraisal of the consequences of peri-
menopausal symptoms by women from different ethnic
groups will be enhanced significantly as a result of the
SWAN findings.49–53
State of the science, clinical implications,
and future directions for research
The STRAW recommendations for staging the menopausal
transition have prompted investigators to differentiate wom-
en’s experiences across the reproductive aging stages. The
20S The American Journal of Medicine, Vol 118 (12B), December 19, 2005
8. late menopausal transition and early postmenopausal stages
appear to be intervals of vulnerability in which the preva-
lence of symptoms is higher than during other reproductive
aging stages. This pattern has been observed in ⬎1 study for
hot flashes and sweats, vaginal dryness, and sleep distur-
bances. Depressed mood may increase in prevalence during
the menopausal transition stages for a subset of women, but
data about its persistence are limited.23–27
Difficulty sleep-
ing seems to increase in a linear fashion over the meno-
pausal transition and postmenopause, suggesting an associ-
ation with increasing age as well as with prevalence of hot
flashes and social factors.14
To date there is no evidence of
cognitive symptoms, urinary incontinence, somatic/pain
symptoms, or depressed mood peaking in any of the stages.
Understanding the various trajectories of symptoms in
women (intraindividual analyses), coupled with between-
groups analysis to reveal the joint effects of population and
individual factors, remains to be accomplished. Most studies
initiated in the 1990s have measured symptoms prospectively
using standardized symptom checklists.1–12
Many have incor-
porated severity ratings, providing verbal descriptors that
women can choose to indicate whether their symptoms are
barely noticeable or extremely bothersome.7,9
Few have mea-
sured the frequency of symptoms. Little is known about
whether and when each of the symptoms considered in this
review will cease. Attempts to relate symptoms to hypothe-
sized causal factors have included measures precisely timed to
allow understanding of antecedent-consequent relationships:
measures of endocrine levels have been timed to a specific day
of the menstrual cycle and related to symptoms measured at
the same time or shortly thereafter.7,12
Conceptual framework for studying
perimenopausal symptoms
Research on symptoms during the perimenopause can be
strengthened by use of a conceptual framework that bridges
emphasis on the genetic, molecular, and physiologic factors
hypothesized to cause symptoms as well as the social and
cultural context in which women experience them. A pro-
posed conceptual framework builds on earlier work address-
ing symptom perception, evaluation, and response (Figure
1). Symptoms such as hot flashes are sensations that people
perceive that differ from the ordinary. Perception and eval-
uation of symptoms precede response to symptoms. Symp-
tom perception refers to noticing symptoms, their fre-
quency, and their intensity, whereas symptom evaluation
refers to judgments individuals make about symptoms, such
as the degree of seriousness, treatability, causes, and con-
sequences in their lives.54
People use culturally based ex-
planatory models—a set of professional, lay, or idiosyn-
cratic categories—to ascribe meaning to their symptoms.55
Responses to symptoms may include feelings, thoughts, or
behaviors, such as self-care efforts (e.g., changing dietary
intake, using herbal or over-the-counter preparations), seek-
ing help or advice from one’s social network, seeking help
from a health professional that may include a prescribed
medication, or choosing to do nothing about the symptoms.
The processes of symptom perception, evaluation, and re-
sponse occur within a social context that shapes the mean-
ings individuals ascribe to their symptoms as well as to their
responses.54,55
Such a framework will enhance the efforts of
clinicians and researchers to understand the experiences of
women from various ethnic groups, such as those reflected
in SWAN, and will contribute important insights on symp-
tom management for women in the menopausal transi-
tion.49–53
Summary: perimenopausal symptoms
The prevalence of hot flashes, night sweats, vaginal dry-
ness, and sleep disruption increases beginning with the
late menopausal transition stage and persists postmeno-
pause. Nearly 40% of women are bothered by hot flashes
during the late menopausal transition and postmeno-
pausal stages. Sleep problems seem to increase in a linear
fashion across the menopausal transition and postmeno-
pausal stages. Vaginal dryness becomes more prevalent
during the postmenopause than during the late reproduc-
tive and early and late menopausal transition stages, as do
other sexual symptoms. It is unclear whether problems
with depressed mood, urinary control, cognitive function-
ing, and joint and muscle aches and pains vary across the
menopausal transition stages. Severity of symptoms (hot
flashes, night sweats, vaginal dryness, and sleep prob-
lems) increases during the late menopausal transition
stage and postmenopause, but owing to the availability of
limited follow-up data, it is unclear how long symptoms
persist postmenopause. Women attribute their symptoms
to a variety of factors, including hormone changes, aging,
role overload, stress, health changes, and emotional
changes; epidemiologic studies link symptoms to aging,
endocrine, genetic, psychosocial, cultural, behavioral,
and health history factors.
Clinical implications
Although there is growing evidence about the relation of
symptoms to endocrine levels, factors other than endocrine
changes should be considered in diagnostic workups and
symptom management plans. Not everything that women
experience during the menopausal transition can be attrib-
uted to menopause. Menopause-related health consultations
provide an opportunity to promote healthy aging.
Future research directions
Greater attention needs to be focused on the longitudinal
analyses of the data from the cohorts studied to identify
21S
Woods and Mitchell Symptoms during perimenopause: prevalence, severity, trajectory, and significance
9. within-woman patterns of symptoms over time, from the
late reproductive stage through the postmenopause. In par-
ticular, longitudinal analyses of individual symptom clus-
ters (e.g., vasomotor, sleep disturbances, depressed
mood, sexuality), their trajectories, and their interrelation
over time are needed. These analyses should be corre-
lated to endocrine measures where available. Identifica-
tion of women who have high levels of many symptom
clusters should be pursued to determine whether there are
important clinical correlates. Symptom clusters that are
associated with high human and financial cost (e.g., de-
pressed mood, incontinence, and somatic pain) should
receive special attention.
Increased emphasis on understanding the ethnic popula-
tions that have been studied and the meaning of symptoms
within their cultures is needed as a basis for symptom
management. Data are missing from menopause research
about American Indian women, many Hispanic groups, Fili-
pina American women, and Southeast Asian American
women. Little attention has been focused on the early post-
menopause, particularly the 5 years immediately after the
FMP. SWAN will have the largest database of postmeno-
Figure 1 Conceptual model for understanding perimenopausal symptoms. (A) Symptom perception, symptom evaluation, and symptom
responses are components of the process by which symptoms influence responses and are, in turn, influenced by explanatory models. (B)
Symptom perception, evaluation, and responses are influenced by sociocultural context and personal characteristics.
22S The American Journal of Medicine, Vol 118 (12B), December 19, 2005
10. pausal symptoms and biomarkers and, along with other
cohort studies, it will provide a rich resource for understand-
ing persistence of hot flashes, sleep disturbances, depressed
mood, sexual symptoms, and the link between the meno-
pausal transition and healthy aging. Models that include
social as well as biologic and behavioral correlates of peri-
menopausal symptoms are essential to achieve a full under-
standing of the mechanisms responsible for symptoms and
to guide symptom management efforts. Longitudinal studies
of women’s experiences of symptoms, symptom evaluation,
and responses to symptoms are needed to fully understand
women’s symptom management strategies. Evaluation of
effects of symptoms (e.g., vasomotor and sleep distur-
bances, dysphoric mood) on well-being, role performance,
and adaptation to demands of daily living are essential to
fully understand the impact of perimenopausal symptoms in
women’s lives. These effects should be weighed against the
effects of midlife events. It is not yet possible to depict the
sequence of occurrence of these symptoms, but efforts to do
so may help discern the time course of symptoms (e.g.,
whether hot flashes precede sleep disruption or vice versa).
References
1. McKinlay SM, Brambilla DJ, Posner J. The normal menopause tran-
sition. Maturitas. 1992;14:103–115.
2. North American Menopause Society. Recommendations for estrogen
and progestogen use in peri- and postmenopausal women: October
2004 position statement of The North American Menopause Society.
Menopause. 2004;11(pt 1):589–600.
3. Bair YA, Gold EB, Greendale GA, et al. Ethnic differences in use of
complementary and alternative medicine at midlife: longitudinal results
from SWAN participants. Am J Public Health. 2002;92:1832–1840.
4. Matthews KA, Wing RR, Kuller LH, et al. Influences of natural
menopause on psychological characteristics and symptoms of middle-
aged healthy women. J Consult Clin Psychol. 1990;58:345–351.
5. Kaufert PA, Gilbert P, Tate R. The Manitoba Project: a re-examination of
the link between menopause and depression. Maturitas. 1992;14:143–
155.
6. Holte A. Influences of natural menopause on health complaints: a
prospective study of healthy Norwegian women. Maturitas. 1992:14:
127–141.
7. Woods NF, Mitchell ES. Anticipating menopause: observations from the
Seattle Midlife Women’s Health Study. Menopause. 1999;6:167–173.
8. Hunter M. The South-East England longitudinal study of the climac-
teric and postmenopause. Maturitas. 1992;14:117–126.
9. Dennerstein L, Smith AM, Morse CA, et al. Menopausal symptoms in
Australian women. Med J Aust. 1993;159:232–236.
10. Freeman EW, Grisso JA, Berlin J, et al. Symptom reports from a
cohort of African American and white women in the late reproductive
years. Menopause. 2001:8:33–42.
11. Harlow BL, Cohen LS, Otto MW, et al. Prevalence and predictors of
depressive symptoms in older premenopausal women: the Harvard
Study of Moods and Cycles. Arch Gen Psychiatry. 1999;56:418–424.
12. Sowers M, Crawford S, Sternfeld B, et al. SWAN: A multicenter,
multiethnic community-based cohort study of women and the MT. In:
Lobo R, Kelsey J, Marcus R, eds. Menopause: Biology and Pathobi-
ology. San Diego, CA: Academic Press; 2000:175–188.
13. Soules MR, Sherman S, Parrott E, et al. Executive summary: Stages of
Reproductive Aging Workshop (STRAW). Fertil Steril. 2001;76:874–
878.
14. Dennerstein L, Dudley E, Hopper J, et al. A prospective population-based
study of menopausal symptoms. Obstet Gynecol. 2000;96:351–358.
15. Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and
lifestyle factors to symptoms in a multi-racial/ethnic population of
women 40–55 years of age. Am J Epidemiol. 2000;152:463–473.
16. Kaufert P, Syrotuik J. Symptom reporting at the menopause. Soc Sci
Med. 1981;151:173–184.
17. Gold E, Block G, Crawford S, et al. Lifestyle and demographic factors in
relation to vasomotor symptoms: baseline results from the Study of Wom-
en’s Health Across the Nation. Am J Epidemiol. 2004;159:1189–1199.
18. Freeman E, Sammel M, Lin H, Gracia CR, Kapoor S, Ferdusi T. The
role of anxiety and hormonal changes in menopausal hot flashes.
Menopause. 2005;12:258–266.
19. Lock M. Culture and the menopause. In: Aso T, Yanaihara T, Fujimoto
S, eds. The Menopause at the Millennium: The Proceedings of the 9th
International Menopause Society World Congress on the Menopause:
Yokohama, Japan, October 17–21, 1999. New York: Parthenon; 2000:
29–35.
20. Guthrie J, Dennerstein L, Hopper J, et al. Hot flushes, menstrual status,
and hormone levels in a population-based sample of midlife women.
Obstet Gynecol. 1996;88:437–442.
21. Dennerstein L, Guthrie JR, Clark M, et al. A population-based study of
depressed mood in middle-aged, Australian-born women. Menopause.
2004;11:563–568.
22. Avis NE, Crawford S, Stellato R, et al. Longitudinal study of hormone
levels and depression among women transitioning through menopause.
Climacteric. 2001;4:243–249.
23. Avis NE, Brambilla D, McKinlay SM, Vass K. A longitudinal analysis
of the association between menopause and depression: results from the
Massachusetts Women’s Health Study. Ann Epidemiol. 1994;4:214–
220.
24. McKinlay JB, McKinlay SM, Brambilla D. The relative contributions
of endocrine changes and social circumstances to depression in mid-
aged women. J Health Social Behav. 1987;28:345–363.
25. Woods NF, Mariella A, Mitchell E. Patterns of depressed mood across
the MT: approaches to studying patterns in longitudinal data. Acta
Obstet Gynecol Scand. 2002;81:623–632.
26. Woods NF, Mitchell ES. Patterns of depressed mood in midlife wom-
en: observations from the Seattle Midlife Women’s Health Study. Res
Nurs Health. 1996;19:111–123.
27. Bromberger JT, Assmann SF, Avis NE, et al. Persistent mood symp-
toms in multiethnic community cohort of pre- and perimenopausal
women. Am J Epidemiol. 2003;158:347–356.
28. Busch C, Zonderman A, Costa P. MT and psychological distress in a
nationally representative sample: is menopause associated with psy-
chological distress? J Aging Health. 1994;6209–6228.
29. Lock M, Kaufert P, Gilbert P. Cultural construction of the menopausal
syndrome: the Japanese case. Maturitas. 1988;10:317–332.
30. Bromberger J, Harlow S, Avis N, et al. Racial/ethnic differences in the
prevalence of depressive symptoms among middle-aged women: the
Study of Women’s Health Across the Nation (SWAN). Am J Public
Health. 2004;94:1378–1385.
31. Bromberger J, Meyer P, Kravitz H, et al. Psychologic distress and
natural menopause: a multiethnic community study. Am J Public
Health. 2001;92:1435–1442.
32. Freeman EW, Sammel MD, Liu L, et al. Hormones and menopausal
status as predictors of depression in women in transition to menopause.
Arch Gen Psychiatry. 2004;61:62–70.
33. Schmidt P, Haq N, Rubinow D. A longitudinal evaluation of the
relationship between reproductive status and mood in perimenopausal
women. Am J Psychiatry. 2004;161;2238–2244.
34. Bromberger JT, Kravitz HM, Wei HL, et al. History of depression and
women’s current health and functioning during midlife. Gen Hosp
Psychiatry. 2005;27:200–208.
35. Kravitz J, Ganz P, Bromberger J, et al. Sleep difficulty in women at
midlife: a community survey of sleep and the MT. Menopause. 2003;
10:19–28.
23S
Woods and Mitchell Symptoms during perimenopause: prevalence, severity, trajectory, and significance
11. 36. Avis NE, Stellato R, Crawford S, Johannes C, Longcope C. Is there an
association between menopause status and sexual functioning? Meno-
pause. 2000;7:297–309.
37. Dennerstein L, Lehert P. Modeling mid-aged women’s sexual functioning: a
prospective, population-based study. J Sex Marital Ther. 2004;30:173–183.
38. Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones,
mood, sexuality, and the menopausal transition. Fertil Steril. 2002;
779(suppl 4):S42–S48.
39. Gracia C, Sammel M, Freeman E, et al. Predictors of decreased libido in
women during the late reproductive years. Menopause. 2004;11:144–150.
40. Mitchell ES, Woods NF. Midlife women’s attributions about perceived
memory changes: observations from the Seattle Midlife Women’s
Health Study. J Womens Health Gend Based Med. 2001;10:351–362.
41. Woods NF, Mitchell ES, Adams C. Memory functioning among
midlife women: observations from the Seattle Midlife Women’s
Health Study. Menopause. 2000;7:257–265.
42. Henderson VW, Guthrie JR, Dudley EC, et al. Estrogen exposures and
memory at midlife: a population-based study of women. Neurology.
2003;60:1369–1371.
43. Meyer PM, Powell LH, Wilson RS, et al. A population-based longitudinal
study of cognitive functioning in the MT. Neurology. 2003;61:801–806.
44. Sampselle CM, Harlow DS, Skurnick J, et al. Urinary incontinence
predictors and life impact in ethnically diverse perimenopausal
women. Obstet Gynecol. 2002;100:1230–1238.
45. Avis NE, McKinlay SM. Health care utilization among mid-aged
women. Ann N Y Acad Sci. 1990;592:228–238.
46. Avis NE, Crawford SL, McKinlay SM. Psychosocial, behavioral, and
health factors related to menopause symptomatology. Womens Health.
1997;3:103–120.
47. Woods NF, Mitchell E, Percival D, et al. Patterns of hot flash severity
across the perimenopause: observations from the Seattle Midlife
Women’s Health Study. Presented at: meeting of the Society of Men-
strual Cycle Research; June 6, 2005; Boulder, CO.
48. Dennerstein L, Lehert P, Guthrie J. The effects of the menopausal
transition and biopsychosocial factors on well-being. Arch Women
Ment Health. 2002;5:15–22.
49. Sampselle CM, Harris V, Harlow SD, et al. Midlife development and
menopause in African American and Caucasian women. Health Care
Women Int. 2003;23:351–363.
50. Villaruel AM, Harlow SD, Lopez M, Sowers M. El cambio de vida:
conceptualizations of menopause and midlife among urban Latina
women. Res Theory Nurs Pract. 2002;16:91–102.
51. Kagawa-Singer M, Kim S, Wu K, et al. Comparison of menopause and
midlife transition between Japanese American and European American
women. Med Anthropol Q. 2002;16:64–91.
52. Adler SR, Fosket JR, Kagawa-Singer M, et al. Conceptualizing meno-
pause and midlife: Chinese American and Chinese women in the US.
Maturitas. 2000;35:11–23.
53. Avis NE, McKinlay SM. A longitudinal analysis of women’s attitudes
toward the menopause: results from the Massachusetts Women’s
Health Study. Maturitas. 1991;13:65–79.
54. Mechanic D. The concept of illness behavior. J Chron Dis. 1962;15:
189–194.
55. Chrisman N, Kleinman A. Popular health care, social networks, and
cultural meanings: the orientation of medical anthropology. In: Me-
chanic D, ed. Handbook of Health Care and Health Professions. New
York: Free Press; 1983:569–590.
24S The American Journal of Medicine, Vol 118 (12B), December 19, 2005