Suling Li

Relationship between soft tissue body composition and bone mass in perimenopausal women.

OBJECTIVES Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women. MATERIAL AND METHODS The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained. RESULTS Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site. CONCLUSIONS These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.

THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND PERIMENOPAUSE

Our purpose in conducting this study was to examine the relationship between physical activity and symptoms associated with perimenopause. A group of 214 perimenopausal women aged 40-55 years (mean = 47 years) completed the Womens Health Assessment Scale (assesses symptoms associated with perimenopause: vasomotor, psychosomatic, menstrual, and sexual symptoms) and the physical activity questionnaire. These women were categorized into three groups based on their levels of physical activity: inactive, relatively active, and active. Analyses of covariance (ANCOVA) revealed significant differences between groups in frequency and distress of overall symptoms associated with perimenopause (F = 8.86, p = .00, F = 6.25, p = .00, respectively). Further analyses indicated that relatively active and active women had significantly fewer and less distressful psychosomatic symptoms (F = 8.05, p = .00, F = 5.80, p = .00, respectively), such as irritability, forgetfulness, and headache as well as fewer and less distressful sexual symptoms (F = 3.42, p = .03, F = 3.73, p = .03, respectively), such as vaginal dryness and decreased sexual desire than inactive women. No significant differences were found among groups on vasomotor and menstrual symptoms. In conclusion, physical activity may be an important alternative/adjunct to hormone therapy particularly for psychosomatic and sexual symptom management at perimenopause.

Perimenopause and the Quality of Life

The purposes of this study are to describe the frequency and distress of symptoms associated with perimenopause, to examine the changes in the quality of life (QOL) related to perimenopause, and to examine the relationships between symptoms associated with perimenopause and the QOL. A cross-sectional, correlational design was employed. Two hundred fourteen perimenopausal women completed the Women’s Health Assessment Scale (WHAS) and the Quality of Life Scale. It was found that vasomotor symptoms were not central to the list of symptoms associated with perimenopause. More women reported psychosomatic complaints as opposed to vasomotor complaints. Compared to the premenopausal period, women during perimenopause experienced slightly, yet significantly decreased, levels of QOL. Multiple regression analysis demonstrated that the psychosomatic symptom category was the sole predictor of the QOL during perimenopause. In summary, psychosomatic symptoms occur most frequently and are most distressful for perimenopausal women in this study. It may be important to manage psychosomatic symptoms to improve the QOL for perimenopausal women.

VALIDATION OF A SINGLE-ITEM MEASURE OF USUAL PHYSICAL ACTIVITY

The purpose of this study was to assess the reliability and validity of a single-item measure of Usual Physical Activity and to assess its usefulness as a physical activity tool for perimenopausal women. 188 perimenopausal women participated (age: M = 47 yr., SD = 3; range = 40–55). Data were collected using the Womens Health Assessment Scale, the Physical Activity Questionnaire, the Perimenopause-related Quality of Life Scale, a health history and demographic questionnaire, and the rater. Scores were stable over a 2-wk. interval. Convergent validity was supported by a correlation of .66 between ratings on Usual Physical Activity and the Physical Activity Questionnaire. Concurrent validity was supported by the association of the rating of Usual Physical Activity with three parameters of Body Mass Index, psychosomatic symptoms, and perimenopause-related quality of life, known to be associated with physical activity. Highly active women had a lower Body Mass Index than less active and inactive women. Active women tended to report fewer and less distressing psychosomatic symptoms and better quality of life. These findings support the use of rating of Usual Physical Activity to classify perimenopausal women into categories of physical activity.

Physical activity alone and in combination with hormone replacement therapy on vasomotor symptoms in postmenopausal women.

The purposes of this study were (a) to examine the influence of physical activity alone, and in combination with, hormone replacement therapy (HRT) on vasomotor symptoms and (b) to identify factors that are predictive of vasomotor symptoms at menopause. A total of 239 postmenopausal women completed a modified Women’s Health Assessment scale, a Usual Physical Activity questionnaire, and a Health History and Demographic questionnaire. It was found the inactive women without HRT experienced more vasomotor symptoms than women with HRT, regardless of their levels of physical activity. Physical activity, however, may be synergistic to HRT, as a trend was noted that within the same HRT–non-HRT groups, active women tended to report fewer vasomotor symptoms than inactive women, although the difference did not reach statistical significance. In addition, sociodemographic and health-related variables had limited predictive power for vasomotor symptoms.

An analysis of menopause in the popular press

With the increased interest in menopause, it is imperative that midlife women be given reliable information. An analysis of the lay literature on menopause over the past ten years in the United States was conducted in order to determine the content of the articles, their source, and their credibility. Most articles were found to blend opinion with fact, and many of the authors of these articles did not have any stated qualifications in midlife womens health. Physicians, particularly those espousing the medicalization of menopause, were the most often quoted experts, and few nurses or other health care workers were cited as experts. It is suggested that nurses become more involved in health education for midlife women.

A longitudinal study of bone density in midlife women.

A longitudinal study of 386 healthy Black and White women aged 35-60 years was conducted to determine the effects of physical activity and other related factors on lumbar bone mineral density over 24 months. Bone mineral density of the lumbar spine, L2-L4, was measured using dual energy x-ray (Hologic 1000). Physical activity levels in three dimensions (leisure, household, and occupational) from both a lifelong and current perspective were obtained by questionnaire. Body mass index was calculated from measured weight in kilograms divided by measured height in meters squared. Calcium, caffeine, and alcohol intake was estimated using a food frequency questionnaire. Age, race, and smoking were determined by self-report. Radioimmunoassays of follicle stimulating hormone (FSH) and estradiol were used to validate self-reports of menopausal status. Multiple regression analysis revealed that race, age, weight, FSH, calcium, and years of tobacco intake formed the best model at baseline ( r 2 = 0.32) and at 24 months ( r 2 = 0.303). Physical activity was not a significant predictor for bone mineral density at either time point. There were cross-sectional changes of bone mineral density with race, age, and menopausal status. Black women had significantly higher bone mineral density than White women. However, an age-related decline in bone mineral density was exhibited in both Black and White women. Perimenopausal women had significantly lower bone mineral density as compared with premenopausal women. Furthermore 37 (9.6%) women at baseline and 34 (11%) at 24 months were designated at risk for fracture.

A Regulatory Model on Transitioning Nurses From Education to Practice

he National Council ofState Boards of Nursing’s(NCSBN) Board of Direc-tors charged their Practice, Regu-lation, and Education Committeewith developing a regulatorymodel for transitioning newnurses from education to practice.Because the mission of the boardsof nursing is to protect the public,they are responsible for ensuringthat safe and competent nursesare entering the workforce. There-fore, the Board requested an evi-dence-based transition model thatboards of nursing could use as aresource for the transition issuesthat many states are facing.

Evidence-based Nursing Education for Regulation

he National Council of State Boards of Nursing (NCSBN) is responsible for assisting its 60 member boards in meeting their mission of protecting the public through the regulation of safe nursing practice. Related to this mission of public protection, 58 of the 60 boards of nursing approve nursing programs in their states or territories to ensure that nursing is practiced by minimally competent, licensed nurses within their authorized scope of practice. The Institute of Medicine’s 1999 widely publicized report on the problem of medical errors in healthcare and 2003 report on the need to improve healthcare education suggest the importance of regulatory oversight of nursing education programs. Boards of nursing are governmental agencies that approve nursing programs, promulgating rules and regulations that address entry-into-practice standards that nursing programs must meet. If the programs fail to meet the boards’ regulations, the boards have the authority to sanction them after allowing for a reasonable opportunity to comply with the standards. This differs from national nursing accreditation, which is accomplished through either the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education. Nursing accreditation is a voluntary process (in most states) that addresses quality through a nongovernmental peer review process. If nursing programs do not meet national accreditation standards, the accreditors do not have the authority to sanction or close the programs. Therefore, national accreditation and state or territory approval processes have different objectives and methods. In many states, the national nursing accreditors and the boards of nursing work together closely to prevent duplication of efforts. Because the boards of nursing are mandated to approve nursing programs, the boards are interested in knowing the evidence-based elements of nursing education that are essential for preparing new nurses for safe entry-level practice. Although