Edward Mezones-Holguín

Impaired quality of life among middle aged women: a multicentre Latin American study.

BACKGROUND Several studies indicate that quality of life (QoL) is impaired in middle aged women. Assessment of QoL using a single validated tool in Latin American climacteric women has not been reported to date at large scale. OBJECTIVE The Menopause Rating Scale (MRS) was used to assess QoL among middle aged Latin American women and determine factors associated with severe menopausal symptoms (QoL impairment). METHODS In this cross-sectional study, 8373 healthy women aged 40-59 years, accompanying patients to healthcare centres in 18 cities of 12 Latin American countries, were asked to fill out the MRS and a questionnaire containing socio-demographic, female and partner data. RESULTS Mean age of the entire sample was 49.1+/-5.7 years (median 49), a 62.5% had 12 or less years of schooling, 48.8% were postmenopausal and 14.7% were on hormonal therapy (HT). Mean total MRS score (n=8373) was 11.3+/-8.5 (median 10); for the somatic subscale, 4.1+/-3.4; the psychological subscale, 4.6+/-3.8 and the urogenital subscale, 2.5+/-2.7. The prevalence of women presenting moderate to severe total MRS scorings was high (>50%) in all countries, Chile and Uruguay being the ones with the highest percentages (80.8% and 67.4%, respectively). Logistic regression determined that impaired QoL (severe total MRS score > or =17) was associated with the use of alternatives therapies for menopause (OR: 1.47, 95% CI [1.22-1.76], p=0.0001), the use of psychiatric drugs (OR: 1.57, 95% CI [1.29-1.90], p=0.0001), attending a psychiatrist (OR: 1.66, 95% CI [1.41-1.96], p=0.0001), being postmenopausal (OR: 1.48, 95% CI [1.29-1.69, p=0.0001]), having 49 years or more (OR: 1.24, 95% CI [1.08-1.42], p=0.001), living at high altitude (OR: 1.43, 95% CI [1.25-1.62, p=0.0001]) and having a partner with erectile dysfunction (OR: 1.69, 95% CI [1.47-1.94, p=0.0001]) or premature ejaculation (OR: 1.34, 95% CI [1.16-1.55, p=0.0001]). Lower risk for impaired QoL was related to living in a country with a lower income (OR: 0.77, 95% CI [0.68-0.88], p=0.0002), using HT (OR: 0.65, 95% CI [0.56-0.76], p=0.0001) and engaging in healthy habits (OR: 0.59, 95% CI [0.50-0.69], p=0.0001). CONCLUSION To the best of our knowledge this is the first and largest study assessing QoL in a Latin American climacteric series with a high prevalence of impairment related to individual female and male characteristics and the demography of the studied population.

Sexual dysfunction in middle-aged women: a multicenter Latin American study using the Female Sexual Function Index

Objective: The purpose of this study was to assess the prevalence of sexual dysfunction (SD) and associated risk factors among middle-aged Latin American women using one validated instrument. Methods: The Female Sexual Function Index (FSFI) was applied to 7,243 healthy women aged 40 to 59 years who were users of 19 healthcare systems from 11 Latin American countries. An itemized questionnaire containing personal and partner sociodemographic data was also filled out. Results: Mean ± SD age of surveyed women was 49.0 ± 5.7 years, with 11.6 years of schooling on average. There were 55.1% of women who were married, 46.8% who were postmenopausal, 14.1% who used hormonal therapy (HT), and 25.6% who were sexually inactive. Among those who were active (n = 5,391), the mean ± SD total FSFI score was 25.2 ± 5.9 and 56.8% of them presented SD (FSFI total score ≤26.55), with a prevalence varying from 21.0% to 98.5% depending on the center. Centers were grouped in terciles (according to mean ± SD prevalence). The tercile with higher SD prevalence (86.4%) compared with that with lower SD prevalence (32.2%) had significantly older women (49.5 ± 5.3 vs 48.0 ± 5.6 y) with a higher rate of vaginal dryness (60.4% vs 40.8%) and older partners (53.0 ± 6.9 vs 50.2 ± 7.5 y). Similarly, there was a significantly higher rate of married (68.5% vs 63.1%), postmenopausal (49.7% vs 39.3%), and HT-using women (23% vs 9.2%). There were no differences in regard to their health perception, history of oophorectomy, rape, and partner SD rate (27% vs 26.2%). The total FSFI score was significantly lower in the tercile with higher SD prevalence (22.0 ± 5.0 vs 27.5 ± 5.4). Logistic regression analysis was used to determine the odds ratios (95% CIs) for the main risk factors associated with SD among those who were sexually active: bad lubrication, 3.86 (3.37-4.43); use of alternative menopausal therapies, 2.13 (1.60-2.84); partner SD, 1.89 (1.63-2.20); older women (>48 y), 1.84 (1.61-2.09); bladder problems, 1.47 (1.28-1.69); HT use, 1.39 (1.15-1.68); negative perception of female health status, 1.31 (1.05-1.64); and being married, 1.22 (1.07-1.40). Protective factors were higher educational level (women), partner faithfulness, and access to private healthcare. Conclusions: The prevalence of SD in this middle-aged Latin American series was found to be high, varying widely in different populations. A decrease in vaginal lubrication was the most important associated risk factor. Differences in the prevalence of risk factors among the studied groups, several of which are modifiable, could explain the variation of SD prevalence observed in this study.

A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women

Objective: The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool. Methods: The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries. Results: Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years). Conclusions: In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.

Impact of diabetes mellitus on the sexuality of Peruvian postmenopausal

Aim. To evaluate sexual function among postmenopausal diabetic women. Patients and methods. A total of 72 postmenopausal women, 36 diabetic, with a stable partner were included in this study. Sexual functioning was assessed using the Female Sexual Functioning Index (FSFI) and depression using the Beck Depression Inventory scale. Results. There was no difference between diabetic and control women regarding age, years of schooling, number of children, age at menarche, age at first sexual experience, years postmenopausal or body mass index. Diabetics had a worse score for depression (11.5 ± 5.6 vs. 8.9 ± 4.7, p < 0.03), a lower frequency of sexual intercourse per month (2.7 ± 2.8 vs. 4.4 ± 2.9, p < 0.01) and a more deteriorated marital relationship (scale of 0–20: 13.4 ± 2.9 vs. 15.1 ± 1.9, p < 0.009). Diabetics demonstrated worse scores globally (19.3 ± 8.1 vs. 26.8 ± 4.5, p < 0.0001) and in all domains of the FSFI: desire (2.6 ± 1.4 vs. 3.8 ± 1.1, p < 0.0001), arousal (3.5 ± 1.9 vs. 4.7 ± 0.8, p < 0.002), lubrication (3.2 ± 1.9 vs. 4.5 ± 1.3, p < 0.003), orgasm (3.2 ± 1.8 vs. 4.5 ± 1.1, p < 0.002), satisfaction (3.8 ± 1.3 vs. 4.8 ± 0.9, p < 0.0005) and pain (3.1 ± 1.7 vs. 4.6 ± 1.3, p < 0.0001) (values all mean ± standard deviation). Considering sexual dysfunction as a score higher than 26.55, the prevalence of sexual dysfunction among diabetics was 75.0% vs. 30.6% in the control group (p < 0.001). After adjusting for depression, years of schooling, hysterectomy, marital relationship and age, diabetes mellitus remained an important risk factor for sexual dysfunction (odds ratio 6.2, 95% confidence interval 2.0–19.6, p < 0.02). Conclusion. Diabetes mellitus affects all areas of female sexuality and this condition is independent of depression.

Assessing predictors of sexual function in mid-aged sexually active women

OBJECTIVE To assess predictors of sexual function in mid-aged women. METHODS We analyzed data of 262 healthy sexually active women (40-59 years) who filled out the Female Sexual Functioning Index (FSFI), the Menopause Rating Scale (MRS) and a general questionnaire containing female/partner data. Correlations between these two measures were also analyzed. RESULTS Significant inverse correlations were found between all FSFI and MRS scores. This was most evident for the MRS urogenital score in relation to FSFI total, pain and lubrication scores. Multiple linear regression analysis determined best model predicting total FSFI index scores that explained a 66% of the variance. In this model, MRS urogenital score was an important predictor of female sexual function (total FSFI scores) with a significant inverse relation. Additionally total FSFI scores displayed a significant positive correlation with female educational level and HT use and an inverse relation with partner age and female parity. CONCLUSION Several female/partner factors predicted female sexual function in this mid-aged series. MRS urogenital scores significantly correlated with total FSFI scores.

Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

OBJECTIVE To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age. METHODS The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organizations ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed. FINDINGS For the 20 cohorts, net costs with PCV10 and PCV13 were US

Type II diabetes mellitus and menopause: a multinational study.

363.26 million and US

Menopausal symptoms appear before the menopause and persist 5 years beyond: a detailed analysis of a multinational study

408.26 million, respectively. PCV10 prevented 570,273 AOM; 79,937 PP; 2217 PM; 3049 PS; 282 NS; 173 AS; and 7512 deaths. PCV13 prevented 419,815 AOM; 112,331 PN; 3116 PM; 4285 PS; 404 NS; 248 AS; and 10,386 deaths. Avoided DALYs were 226,370 with PCV10 and 313,119 with PCV13. Saved treatment costs were US

Association between sexual function and depression in sexually active, mid-aged, Peruvian women

37.39 million with PCV10 and US

Sexual Dysfunction Risk and Associated Factors in Young Peruvian University Women

47.22 million with PCV13. Costs per DALY averted were US