RESUMO
OBJECTIVE: A previous survey investigated postmenopausal vaginal atrophy in a sample of women across Latin America. To help implement a tailored approach to improve postmenopausal care and outcomes in Brazil, we consider results from the survey for this country. METHODS: A total of 2509 postmenopausal women resident in Argentina, Brazil, Chile, Colombia, or Mexico completed an online questionnaire. The Brazilian cohort comprised 504 women. RESULTS: Over half of the Brazilian cohort (56%) reported experiencing symptoms of vaginal atrophy; most described them as moderate or severe (76%), and almost half (48%) experienced symptoms for at least 1 year. Three-quarters of the Brazilian cohort (75%) were unaware of the chronic nature of the condition. Upon experiencing symptoms of vaginal atrophy, 92% had visited a health-care provider to discuss treatment options. Overall, 56% were aware of some form of local hormone therapy and 40% of those affected by vaginal atrophy had used such treatment. CONCLUSION: Postmenopausal women in Brazil are likely to benefit from increased awareness of the symptoms of vaginal atrophy. Health-care providers can potentially improve outcomes by helping women to understand the chronic nature of the condition and available treatment options. Women may be open to education pre menopause, before symptoms occur.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pós-Menopausa/psicologia , Vagina/patologia , Doenças Vaginais/psicologia , Saúde da Mulher/estatística & dados numéricos , Atrofia , Brasil/epidemiologia , Brasil/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , América Latina/epidemiologia , América Latina/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pós-Menopausa/etnologia , Inquéritos e Questionários , Doenças Vaginais/epidemiologia , Doenças Vaginais/etnologia , Saúde da Mulher/etnologiaRESUMO
PURPOSE: Vitamin D deficiency (VDD) and polymorphisms in the group-specific component (GC) gene are known to be associated in different populations. However, the effects of such genetic variants may vary across different populations. Thus, the objective of this study was to estimate the association between Vitamin D-Binding Protein (VDBP) haplotypes and VDD in mestizo postmenopausal women and Mexican Amerindian ethnic groups. METHODS: This was a cross-sectional study of 726 postmenopausal Mexican women from the Health Workers Cohort Study (HWCS) and 166 postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort in Mexico. GC polymorphisms (rs7045 and rs4588) were analyzed by TaqMan probes. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by Chemiluminescent Microparticle Immuno Assay. RESULTS: The prevalence of VDD serum 25(OH)D < 20 ng/mL was 43.7% in mestizo women and 44.6% in indigenous women. In HWCS, the single nucleotide polymorphisms (SNPs) rs7041 and rs4588 were associated with VDD. In addition, women from the HWCS, carrying the haplotypes GC2/2 and GC1f/2 had higher odds of VDD (OR = 2.83, 95% CI 1.14, 7.02; and OR = 2.30, 95% CI 1.40, 3.78, respectively) compared to women with haplotype 1f/1 s. These associations were not statistically significant in the MAIS cohort. CONCLUSIONS: Our results show genetic association of the analyzed SNPs and related haplotypes, on the GC gene, with VDD in mestizo Mexican postmenopausal women. Moreover, a high prevalence of VDD with high genetic variability within the country was observed. Our results support the need for national policies for preventing VDD.
Assuntos
Pós-Menopausa , Deficiência de Vitamina D/etnologia , Deficiência de Vitamina D/genética , Proteína de Ligação a Vitamina D/genética , Idoso , Alelos , Estudos de Coortes , Estudos Transversais , Etnicidade/genética , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença/etnologia , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Grupos Populacionais/etnologia , Grupos Populacionais/genética , Pós-Menopausa/sangue , Pós-Menopausa/etnologia , Pós-Menopausa/genética , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangueRESUMO
STUDY OBJECTIVES: To describe racial/ethnic differences in sleep duration, continuity, and perceived sleep quality in postmenopausal women and to identify statistical mediators of differences in sleep characteristics. METHODS: Recruited from the observational Study of Women's Health Across the Nation (SWAN), 1,203 (548 white, 303 black, 147 Chinese, 132 Japanese, and 73 Hispanic; mean age 65 years, 97% postmenopausal) women participated in a week-long actigraphy and daily diary study in 2013-2015. Actigraphic measures of sleep duration and wake after sleep onset (WASO), and diary-rated sleep quality were averaged across the week. Candidate mediators included health-related variables; stress; and emotional well-being assessed up to 13 times across 18 years from baseline to sleep study. RESULTS: Whites slept longer than other groups; the significant mediators were concurrent financial hardship and increasing number of stressors for Hispanics or Japanese versus whites. Whites had less WASO than blacks and Hispanics; significant mediators were concurrent number of health problems, physical inactivity, waist circumference, vasomotor symptoms, number of life stressors, and financial hardship, and increasing number of health problems from baseline to sleep study. Whites reported better sleep quality than blacks, Chinese, and Japanese; significant mediators were concurrent physical inactivity, vasomotor symptoms, positive affect, and depressive symptoms. CONCLUSIONS: Sleep differences between blacks or Hispanics versus whites were mediated by health problems, number of stressors, and financial hardship, whereas sleep differences between Chinese or Japanese versus whites were mediated by emotional well-being. This is the first study using formal mediational approaches.
Assuntos
Etnicidade/psicologia , Grupos Raciais/etnologia , Grupos Raciais/psicologia , Sono/fisiologia , Saúde da Mulher/etnologia , Actigrafia/tendências , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Polissonografia/tendências , Pós-Menopausa/etnologia , Pós-Menopausa/fisiologia , Pós-Menopausa/psicologia , Estados Unidos/etnologia , Saúde da Mulher/tendênciasRESUMO
Resumo: O pensamento científico sobre o corpo da mulher sofreu várias modificações no decorrer do tempo. Isto ocorre porque a biologia interage com a história e a cultura para produzir uma experiência única sobre a saúde. No caso específico da menopausa, ela deixou de ser entendida como uma ocorrência natural do processo de envelhecimento da mulher e passou a ser vista como uma doença que requer intervenção médica e farmacêutica. Este artigo analisa como esta nova perspectiva sobre a menopausa aparece no contexto de atendimento do Ambulatório de Menopausa do Centro de Atenção Integral à Saúde da Mulher - CAISM. Buscou-se em particular conhecer as narrativas das mulheres atendidas em função da menopausa e identificar a influência do modelo médico-científico vigente em tais narrativas. A análise se baseia em material coletado no hospital-escola durante o período de setembro de 2009 a outubro de 2010, abrangendo observações no Ambulatório de Menopausa e dos materiais informativos que lá são distribuídos, entrevistas com mulheres e profissionais de saúde, além do acompanhamento do grupo de apoio psicológico oferecido no local. São apresentadas evidências da construção do conhecimento médico-científico sobre a menopausa a partir de um padrão "masculino" de normalidade, que representa o corpo feminino como doente e inferior.
Resumen: El pensamiento científico sobre el cuerpo de la mujer sufrió varias modificaciones a lo largo del tiempo. Esto ocurre porque la biología interactúa con la historia y la cultura para producir una experiencia única sobre la salud. En el caso específico de la menopausia, la misma dejó de ser entendida como un evento natural del proceso de envejecimiento de la mujer y pasó a ser vista como una enfermedad que requiere intervención médica y farmacéutica. Este artículo analiza cómo esta nueva perspectiva sobre la menopausia aparece en el contexto de atención de la Clínica de Menopausia del Centro de Atención Integral a la Salude de la Mujer - CAISM. Se buscó conocer en particular las narrativas de las mujeres atendidas en función de la menopausia e identificar la influencia del modelo médico-científico vigente en tales narrativas. El análisis se basa en material recolectado en el hospital-escuela entre septiembre de 2009 y octubre de 2010 a partir de observaciones en la Clínica, materiales informativos allí distribuidos, entrevistas con mujeres y profesionales de la salud, y acompañamiento del grupo de apoyo psicológico allí ofrecido. Se presentan evidencias de la construcción del conocimiento médico-científico sobre la menopausia a partir de un patrón "masculino" de normalidad, que representa el cuerpo femenino como enfermo e inferior.
Abstract: Scientific thinking about the woman body has changed over time, as a result of the strong link between biology, history, and culture. In the specific case of menopause, its definition has moved from a natural occurrence of the aging process to a disease that needs medical and pharmaceutical intervention. This paper analyzes how this new perspective on menopause appears in the context of the Menopause Outpatient Facility at the Center for Women's Integral Care - CAISM. In particular, it explores the narratives of the women about menopause, and attempts to identify the role of the medical-scientific discourse on such narratives. The analysis is based on material collected at the university hospital between September 2009 and October 2010, including field observations, informative materials, interviews with women and health professionals, and participation in a psychologic support group. Evidence is provided that current medical knowledge constructs menopause from a standard of 'masculine' normalcy, and represents the female body as sick and in need of control.
Assuntos
Humanos , Feminino , Imagem Corporal , Menopausa , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Saúde da Mulher , Medicalização , Envelhecimento , Pós-Menopausa/etnologia , Pós-Menopausa/psicologia , Assistência Integral à Saúde , Fatores Culturais , Narrativa Pessoal , Acontecimentos que Mudam a Vida , Antropologia CulturalRESUMO
BACKGROUND: Osteoporosis, a disease characterized by low bone mineral density (BMD), is an important health problem in Mexico. BMD is a highly heritable trait, with heritability estimates of 50-85%. Several candidate genes have been evaluated to identify those involved in BMD variation and the etiology of osteoporosis. This study investigated the possible association of single-nucleotide polymorphisms (SNPs) in the MEF2C, SOST and JAG1genes with bone mineral density (BMD) variation in postmenopausal Mexican-Mestizo women. METHODS: Four hundred unrelated postmenopausal women were included in the study. Risk factors were recorded and BMD was measured in total hip, femoral neck and lumbar spine using dual-energy X-ray absorptiometry. In an initial stage, a total of twenty-five SNPs within or near SOST gene and seven SNPs in the JAG1 gene were genotyped using a GoldenGate assay. In a second stage, three MEF2C gene SNPs were also genotyped and SOST and JAG1 gene variants were validated. Real time PCR and TaqMan probes were used for genotyping. RESULTS: Linear regression analyses adjusted by age, body mass index and ancestry estimates, showed that five SNPs in the SOST gene were significantly associated with BMD in total hip and femoral neck but not lumbar spine. The lowest p value was 0.0012, well below the multiple-test significance threshold (p=0.009), with mean effect size of -0.027 SD per risk allele. We did not find significant associations between BMD and MEF2C/JAG1 gene variants [rs1366594 "A" allele: ß=0.001 (95% CI -0.016; 0.017), P=0.938; rs2273061 "G" allele: ß=0.007 (95% CI -0.007; 0.023), p=0.409]. CONCLUSIONS: SOST polymorphisms may contribute to total hip and femoral neck BMD variation in Mexican postmenopausal women. Together, these and prior findings suggest that this gene may contribute to BMD variation across populations of diverse ancestry.
Assuntos
Densidade Óssea/genética , Proteínas Morfogenéticas Ósseas/genética , Proteínas de Ligação ao Cálcio/genética , Estudos de Associação Genética , Marcadores Genéticos/genética , Peptídeos e Proteínas de Sinalização Intercelular/genética , Proteínas de Membrana/genética , Pós-Menopausa/genética , Proteínas Adaptadoras de Transdução de Sinal , Idoso , Estudos de Coortes , Feminino , Estudos de Associação Genética/métodos , Humanos , Proteína Jagged-1 , Fatores de Transcrição MEF2/genética , México/etnologia , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/etnologia , Osteoporose Pós-Menopausa/genética , Polimorfismo de Nucleotídeo Único/genética , Pós-Menopausa/etnologia , Proteínas Serrate-JaggedRESUMO
OBJECTIVE: to compare the climacteric symptoms between women from Mexico City and those from a Mayan community of the state of Yucatan. METHODS: In two groups of women, Group I) Spanish-speaking women from Mexico City and Group II) Maya speaking women from the state of Yucatan, 22 climacteric symptoms were evaluated using an analog visual scale (AVS) and the SUMEVA index. For statistical analysis t student test was used as well as Chi squared. RESULTS: 105 women, 50 of Mexico City and 55 of Maxcanu, Yucatan were studied. When comparing the groups no difference was found in age (52.5 +/- 6.5 vs 53.7 +/- 6.2, for group I and II respectively), the body mass index was significantly smaller in group I (29.7 +/- 5.0 vs 34.0 +/- 6.0, p < 0.001). In group 1, 15 of the 22 evaluated symptoms were significantly more intense in Group I, as well as the SUMEVA (Sum of Analog Visual Scale) index (71.4 +/- 44.5 vs 45.8 +/- 24.8, p < 0.001). The proportion of symptomatic women for each one of the symptoms was similar in both groups except for hair fall that was significantly greater in group I (74% vs 52%). CONCLUSION: climacteric symptoms were perceived with more intensity by Mexico City women, which allows suppose that western culture influence can be the responsible.
Assuntos
Etnicidade , Indígenas Norte-Americanos , Menopausa/etnologia , População Urbana , Afeto , Alopecia/etnologia , Altitude , Índice de Massa Corporal , Estudos Transversais , Características Culturais , Dispareunia/etnologia , Dispareunia/psicologia , Etnicidade/psicologia , Feminino , Fogachos/etnologia , Humanos , Indígenas Norte-Americanos/psicologia , Menopausa/psicologia , Dor/etnologia , Dor/psicologia , Perimenopausa/etnologia , Perimenopausa/psicologia , Pós-Menopausa/etnologia , Pós-Menopausa/psicologia , Fatores Socioeconômicos , Espanha/etnologia , Avaliação de SintomasRESUMO
OBJECTIVE: To test the association between polymorphisms rs9939609 T>A and rs8050136 A>C of the fat mass and obesity-associated (FTO) gene and metabolic and cardiovascular variables in postmenopause. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENT(S): A total of 135 postmenopausal women (mean age 52 ± 4 years). INTERVENTION(S): Anthropometric measurements and collection of blood samples. MAIN OUTCOME MEASURE(S): Blood pressure, metabolic variables, and FTO genotype. RESULT(S): The frequency of polymorphism rs9939609 was 43.7% for the wild TT genotype, 43.0% for TA, and 13.3% for AA. The frequency of the rs8050136 polymorphism was 12.6% for the wild AA genotype, 39.3% for AC, and 48.1% for CC. The polymorphic AA genotype of the SNP rs9939609 was associated with higher glucose levels and lipid accumulation product (LAP) index, whereas the wild AA genotype of the SNP rs8050136 was associated with higher LAP. CONCLUSION(S): The rs9939609 polymorphism in the FTO gene is related to abnormal glucose levels and with LAP, a surrogate marker of diabetes and cardiovascular risk in postmenopause. Further studies are needed in different ethnic backgrounds to confirm the clinical relevance of these associations.
Assuntos
Glicemia/genética , Glicemia/metabolismo , Distribuição da Gordura Corporal , Variação Genética/genética , Pós-Menopausa/sangue , Pós-Menopausa/genética , Proteínas/genética , Dioxigenase FTO Dependente de alfa-Cetoglutarato , Antropometria/métodos , Distribuição da Gordura Corporal/métodos , Brasil/etnologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade , Polimorfismo de Nucleotídeo Único/genética , Pós-Menopausa/etnologiaRESUMO
BACKGROUND: Latin American women present more severe menopausal symptoms when compared to those from other regions of the world. Since this population is an ethnic blend of Caucasian and indigenous people, we sought to test the hypothesis that severe menopausal symptoms in Latin American women are associated with an indigenous origin. OBJECTIVE: To assess menopausal symptoms among two specific indigenous Latin American populations. METHOD: A total of 573 natural postmenopausal indigenous women aged 45-59 years (288 Quechua (Peru) and 285 Zenú (Colombia)) living in isolated communities were surveyed with a general questionnaire and the Menopause Rating Scale (MRS). RESULTS: The total MRS score was significantly higher among Quechua women as compared to Zenú ones (22.7 ± 5.7 vs. 14.7 ± 2.5, p < 0.0001); both figures were higher than those described for Hispanic or European populations. Quechua women presented more intense somatic and psychological symptoms as compared to Zenú (8.8 ± 2.3 vs. 5.3 ± 1.8; and 7.8 ± 2.4 vs. 3.2 ± 1.7, p < 0.0001); however, both indigenous groups presented similar intense urogenital symptoms (6.1 ± 1.6 vs. 6.2 ± 1.4, not significant). These differences persisted after adjusting for age, years since menopause onset and parity. The percentage of women presenting severe somatic and psychological symptoms significantly increased with aging among Quechua. This was not the case for Zenú women. More than 90% of indigenous women (Quechua and Zenú) at all age intervals presented severe urogenital scores, a percentage that is much higher than that described in the world literature. CONCLUSION: Severe menopausal symptoms found among Latin American women could be the result of their indigenous ethnic origin; the urogenital domain is the most affected.
Assuntos
Etnicidade , Pós-Menopausa/etnologia , Pós-Menopausa/psicologia , Índice de Gravidade de Doença , Fatores Etários , Ansiedade/etnologia , Artralgia/etnologia , Colômbia/epidemiologia , Estudos Transversais , Depressão/etnologia , Fadiga/etnologia , Feminino , Fogachos/etnologia , Humanos , Humor Irritável , Pessoa de Meia-Idade , Peru/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/etnologia , Inquéritos e QuestionáriosRESUMO
To determine the prevalence of dyslipoproteinemias and their related factors in a Brazilian systemic lupus erythematosus (SLE) population, fasting lipids were measured in 185 female SLE outpatients. Age, BMI, smoking, post-menopausal status, presence of diabetes and hypertension, SLE duration, number of ARA criteria, drug treatment and disease activity (by SLEDAI) were registered. Statistics included uni and multivariate logistic regression. Eighty-nine patients (48.1%) had hypercholesterolemia, 55 (29.7%) had hypertriglyceridemia and 109 (58.9%) had either. On multivariate analysis, 24-h proteinuria (OR = 2.08, 95% CI: 1.11-3.88), BMI (OR = 1.08, 95% CI: 1.01-1.16) and post-menopausal status (OR = 2.48, 95% CI: 1.25-4.92) were associated with hypercholesterolemia. Disease activity was related to low HDL-cholesterol (OR = 2.59, 95% CI: 1.20-5.58) and, in pre-menopausal patients, also to hypertriglyceridemia (OR = 1.16, 95% CI: 1.03-1.30). Antimalarial use was protective for hypertriglyceridemia (OR = 0.44, 95% CI: 0.22-0.90). In conclusion, the increased prevalence of dyslipoproteinemias is due to proteinuria, obesity and SLE activity. Antimalarials have beneficial effect on lipid profile that may be due to reduction in disease activity.
Assuntos
Hipercolesterolemia/etnologia , Hipercolesterolemia/etiologia , Hipertrigliceridemia/etnologia , Hipertrigliceridemia/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/etnologia , Adulto , Antimaláricos/uso terapêutico , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipercolesterolemia/prevenção & controle , Hipertrigliceridemia/prevenção & controle , Modelos Logísticos , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Razão de Chances , Pós-Menopausa/etnologia , Prevalência , Proteinúria/complicações , Proteinúria/etnologia , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Quality of life decreases after the menopause as it has been assessed by several designed tools. Despite this, few studies have reported correlations between quality of life and the metabolic syndrome and its determinants. OBJECTIVE: Evaluate quality of life and determine factors related to its impairment among postmenopausal Ecuadorian women. METHODS: Postmenopausal women that participated in a metabolic syndrome screening and educational program at the Institute of Biomedicine of the Universidad Católica of Guayaquil, Ecuador were interviewed using the Menopause-Specific Quality of Life Questionnaire (MENQOL). Mean domain scores as well as factors associated to higher scores within each of the domains of the questionnaire (vasomotor, psycho-social, physical and sexual) were determined. RESULTS: Three hundred twenty-five postmenopausal women (n=325) were surveyed. Mean age of participants was 55.9+/-8.1 years (median: 54 years). Women presented metabolic syndrome, hypertension, hyperglycemia, hypertriglyceridemia and abdominal obesity in 41.5%, 38.8%, 16.6%, 56.9% and 54.2% respectively. Mean scores obtained for each domain were: vasomotor: 3.5+/-2.5 (median 3); psycho-social: 3.7+/-1.5 (median 3.6); physical: 3.8+/-1.2 (median 3.8); sexual: 4.9+/-2.3 (median 5.3). More than 50% of women had scores above the median for each domain of the questionnaire. Logistic regression determined that vasomotor score decreased with age. Abdominal obesity increased the risk of having vasomotor, psycho-social and physical scores above the median. Hypertension and hyperglycemia increased the risk for higher scores within the psycho-social and sexual domain respectively. CONCLUSION: In this postmenopausal Ecuadorian population, impairment of quality of life was found to be associated to age and related conditions such as abdominal obesity, hypertension and hyperglycemia.