Patterns of medication use for the treatment of menopausal symptoms before and after the women’s health initiative;implications for decision-making practices of women and women’s health professionals

Background: The Women’s Health Initiative (WHI) published findings in 2002 that changed the perception of the use of hormone replacement therapy (HRT) for the reduction of cardiovascular risks. Menopausal women using HRT for the relief of vasomotor symptoms were advised to use the lowest possible dose of HRT over the shortest possible duration. Objective: This study sought to examine patterns of HRT use for the treatment of menopausal symptoms before and after the WHI among women at least 40 years of age. Methods: A retrospective analysis was performed on a total of 1367 women in the pre-WHI group and 6467 women in the post-WHI group using the U.S. General Electric (GE) Centricity electronic medical record database. Menopause diagnosis was assessed using ICD-9 codes. Clinical characteristics and medication use were assessed for women with at least 3 years of enrollment (1 year baseline, 2 years follow-up). Results: The proportion of women in the post-WHI group that initiated HRT was significantly less than that of women in the pre-WHI group (31.3% vs. 56.9%, respectively;p < 0.001). Combination HRT use declined significantly (21.9% pre-WHI cohort vs. 7.2% post- WHI cohort, p < 0.001) among increases in non-HRT use, namely SSRIs (15.2% pre-WHI cohort v. 22.3% post-WHI cohort, p < 0.001) and tranquilizers (9.5% pre-WHI cohort v. 15.8% post-WHI cohort, p < 0.001). Conclusion: The results of the WHI 2002 publication made an impression on the perception of HRT’s role in the relief of menopausal symptoms. Decision-making on the part of women seeking treatment for vasomotor symptoms and women’s health professionals demonstrates that despite HRT precautions, women continue to exhibit a need for HRT use. This study’s findings suggest that women seeking treatment for menopausal symptom relief and women’s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.

Impact of the Changes in Women’s Characteristics over Time on Antenatal Health Care Utilization in Egypt (2000-2008)

Objectives: This study empirically assesses the impact of the changes in women’s characteristics, empowerment, availability and quality of health services on woman’s decision to use antenatal care (ANC) and the frequency of that use during the period 2000-2008. Study Design: The study is a cross-sectional analytical study using 2000 and 2008 Egypt Demographic and Health Surveys. Methods: The assessment of the studied impact is conducted using the Zero-inflated Negative Binomial Regression. In addition, Factor Analysis technique is used to construct some of the explanatory variables such as women’s empowerment, the availability and quality of health services indicators. Results: Utilization of antenatal health care services is greatly improved from 2000 to 2008. Availability of health services is one of the main determinants that affect the number of antenatal care visits in 2008. Wealth index and quality of health services play an important role in raising the level of antenatal care utilization in 2000 and 2008. However, the impact of the terminated pregnancy on receiving ANC increased over time. Conclusions: Further research of the determinants of antenatal health care utilization is needed, using more updated measures of women’s empowerment, availability and quality of health services. In order to improve the provision of antenatal health care services, it is important to understand barriers to antenatal health care utilization. Therefore, it is advisable to collect information from women about the reasons for not receiving antenatal care.

Limitations and possibilities on health assessment to women in violence situation

The aim was to know how health assessment to women in violence situation is developed. Literature review on LILACS and MEDLINE databases was conducted in April 2013 with the descriptors: “domestic violence” and “women’s health”, on a 1994-2012 timeframe. Statistics characterization and content theme analysis of the scientific production were developed. Results showed that the assessment is permeated by institutional limitation and an approach strictly clinical that makes identification and diagnosis of violence difficult, reinforcing invisibility in health care. Professional assessment is influenced by socio-cultural and the naturalization of the phenomena, which is not considered a public health issue. Technical knowledge is insufficient, making the possibility of promoting violence cycle rupture difficult. However, we envisage reception as a possibility to assess female demands. We conclude the need to include the theme in health undergraduate courses and also the urgency of this learning experience to support a multidisciplinary and intersectoral work web. Thus, rethinking assessment as a way of (re)organizing how health care is structured in order to compose an assessment web to women and guarantee reception of their demands is needed. Else, constructing competence allied to coping public policy to the problem and guaranteeing a human and full assistance will stay only on the academic field, constituting itself as a limit on protecting life of these women and their families.

Examining the relationship between sport and health among USA women:An analysis of the Behavioral Risk Factor Surveillance System

Background：Research has been conducted linking sports participation and health in childhood and adolescence;however,little is known about the contribution of sport to women＇s health.The purpose of this study was to examine the relationship between sport and women＇s health in the USA by analyzing data from the Behavioral Risk Factor Surveillance System（BRFSS）.Methods：This study was a secondary data analysis of the 2013 national BRFSS survey.Unlike the BRFSS core component from previous years,in2013,participants were questioned extensively about their physical activity behaviors.Seventy-six different activities were identifie by the participants.Two researchers categorized the 76 activities as sport,conditioning exercise,recreation,or household tasks based on previously identifie categories.Logistic regression was utilized to calculate odds ratios and adjusted odds ratios for chronic diseases based on physical activity category.Results：Women who participated in sport had better health outcomes with significant y lower odds for all chronic diseases except asthma and better general health than women who participated in conditioning exercise,household tasks,or recreation,and many of the significan differences remained after controlling for demographic characteristics.Conclusion：Sport participation was associated with more positive health outcomes among women in the USA compared with the other categories.As a means to improve health of women,the USA could focus on efforts to increase sport participation among women.

Iodine deficiency and women’s health: Colonialism’s malign effect on health in Oromia region, in Ethiopia

Objectives: Iodine is an essential nutrient needed for the synthesis of hormone thyroxin. Hormone thyroxin is involved in the metabolism of several nutrients, the regulation of enzymes and differentiation of cells, tissues and organs. Iodine deficiency (ID) impairs the development of the brain and nervous system. It affects cognitive capacity, educability, productivity and child mortality. ID hinders physical strength and causes reproductive failure. The objective of this paper is to explore if the health impacts of ID are more common and severe among women. Design: Using primary data (notes from a visit) and secondary data, this paper examines if the effects of ID are more common and severe among Oromo women inEthiopia. Findings: The health impacts of ID are more common and severe among women. Conclusions: ID is an easily preventable nutritional problem. In Oromia, the persistence of ID is explained by the Ethiopian government’s colonial social policies. Preventing ID should be seen as part of the efforts we make to enhance capacity building, promote health, gender equity and social justice. Implications: Iodine deficiency has a wide range of biological, social, economic and cultural impacts. Preventing ID can be instrumental in bringing about gender equity and building the capacity of people.

Self-Medication of Senegalese Women through Social Networks

Self-medication is a form of self-care which has evolved considerably with the development of digital technology. It particularly challenges public health actors given the risks to which it may be exposed if it is not properly supervised. The aim of this work was to study the knowledge, attitudes and practices of Senegalese women on self-medication through social networks. A transversal descriptive study was conducted from June 10 to 30, 2019. It concerned all Senegalese women registered in at least one of the following women’s Facebook groups: Femme chic, Femme leader, Ladies club or Entre yaays. A study information sheet was posted on the wall of these different groups, and enabled consenting women to find a questionnaire deployed online directly through a link. Consenting women were able to complete the data collection tool directly online. The proportions were compared by setting the alpha risk at 5%. A total of 508 women were surveyed. The results thus showed a high prevalence (68.9%) of self-medication. A proportion of 46.3% of those self-medicated used Facebook or the Internet as a source of information to find the drugs to use. The advice received from these groups related to hygiene and dietary measures (96.1%), consultation with health personnel (54.6%), consultation with a traditional healer (50.4%) and taking medication (41.8%). The health problems most treated with these self-medications were headaches ((84.6%) and painful periods (45.1%). Simple analgesics (84.6%) and vitamins (66.9%) were the most recommended drugs, but it was also found antibiotics (40.0%), centrally acting analgesics (20.0%), anti-diabetics (6.9%) and antihypertensive (5.4%). Oral tablets (92.3%) remained the most widely used dosage forms, but eye drops (5.4%) and injectables (5.4%) were also found. Although searching for information on Facebook/internet, women obtained the drugs from pharmacies (72.4%) or the family medicine box (19%). Regarding self-medication on Facebook, its easy accessibility (67.8%) was the main motivation for which women chose it, as well as saving time (33.9%). Advice on health through the Facebook network is important for Senegalese women but taking medication on advice from these forums remains low. A better presence for health actors in social networks is becoming urgent in order to promote responsible self-medication.

Report on the Educational Process for the Promotion of Health of Women Attended in a Reference Center of Social Assistance

This article discusses one experienced by students and preceptors of Programs Pro-Pet-Health and Health of the Federal University of Rio Grande do Norte/Faculty of Health Sciences of Trairí in the Reference Center for Social Assistance (CRAS) in the municipality of experience Santa Cruz/RN, with a view to the relationship between preventive health activities and social assistance. The proposed work of Pro-Pet in the assistance unit sought to unravel the lifestyle of the target audience in order to know the risk factors and suggest the adoption of health measures for disease prevention. Work to guide the educational process for health promotion with socioeconomic and cultural contextualization built on scientific papers surveyed in Lilacs and Scielo data was used. On average, 12 women aged between 35 and 60 years participated in the group. Eight group sessions occurred in the period from March to May 2014. Regarding work methodologies, we used dynamic integration and self-knowledge;dialogued lectures;lectures;reports of experiences;thematic workshops;educational videos;wheels conversation complemented by the use of texts and poems;as well as application of the checklist in conducting health and anthropometry. The experience helped identify the characteristics of the group and plan understandable and meaningful guidance for women, facilitating the understanding of the importance of self-care in preventing disease.

A New Page for Women's Reproductive Health in Integrated Traditional Chinese and Western Medicine

The integrated traditional Chinese and western medicine (ICWM) of obstetrics and gynecology (OBS/GYN) emerged eventually with more than 40 years’ hard struggle, and one of the most promising articles is the integration of the masterpieces of menstrual disorder and infertility in TCM and the virtual explosion of new knowledge and methods in

Therapeutic termination of pregnancy and women’s mental health:Determinants and consequences

The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

The Way Food, Diet, and Exercise Are Communicated in Women’s Health Magazine: From a Critical Perspective

Women’s Health Magazine creates a fantasy world for many women,in which they can attach themselves to the ideal beauty standards,and work towards reaching those ideals by engaging in diet and exercise.The advertisements in this magazine mostly give value to the Western ideal of white beauty,which is about the slenderness of the feminine physical body.However,the white beauty ideal makes women in different cultures such as the Turkish and Latin women to resemble this ideal by changing their darker hair colors to blonde,changing their darker eye colors to blue,and changing their curvy body types to slim;even though,their curviness represents sexual desire in their specific culture,and thus it leads these women to lose their cultural characteristics that make them more feminine(Mendible,2007,pp.3-8).In other words,the white ideal beauty causes many women in other cultures to have some kind of cultural assimilation in terms of their own beauty standards,and instead cause them to embrace an international standard of beauty that is Western,and many women such as the Turkish and Hispanic,as well as,the Korean,Chinese,and Japanese,undergo some kind of a process of cultural assimilation related to their cultural body characteristics,as a result(Yan&Bissell,2014,p.197).In other words,these women lose their indigenous body characteristics and they instead try to resemble the slender ideal body of the West with the spread of globalization,which has a major influence on that(Hoskins,2014,p.110).The aim of this paper is to show how the Women’s Health Magazine,a popular contemporary magazine,crates a discourse on food,diet,and exercise,which have a major influence in shaping and assimilating the body type of Turkish women from a critical perspective.

Women’s Perception Concerning Health Care in the Post-Partum Period: A Meta-Synthesis

This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.

Diplomatic Implications of Women＇s Work in American Consumer Society

American foreign policies have observed guiding principles of democracy, yet an overemphasis on political values leads to more conflicts than mutual understandings in today＇s world. Therefore, this paper proposes that exploring diplomatic implications of ＂women＇s work＂ provides new insights into cultural values of the Four Freedomsmmajor pillars supporting modern American liberalism. This paper foregrounds the domestic and diplomatic significance of ＂women＇s work＂ by analyzing women＇s contributions as laborers at home, in the labor force, and in American consumer society. As American women participated in the paid labor force and took up most consumptive activities, women outside America also worked hard to provide food and care for families. This paper argues that a more comprehensive definition of＂women＇s work＂ is not only indispensable for the development of American industry, consumer society, and the expansion of marketplace, but integrates a system of dualisms separating wage labor and housework, or divisions between spheres of men and women. Moreover, investigations into hidden values of women＇s work alleviate worries arising from information revolution and economic globalization. Moreover, placing women＇s work in perspective enables diplomats to see through factors leading to international hostilities, to reduce conflicts arising from information revolution and economic globalization, and to understand America＇s soft power pertinently.

Magnesium in Women’s Health and Gynecology

Magnesium is well known in the world of obstetrics for many important uses. It has been utilized in treating pre-eclampsia, eclampsia, and preventing preterm labor, though it has been found recently that prolonged magnesium administration in pregnant women may result in adverse outcomes to fetal bone metabolism, resulting in a new FDA warning [1]. Outside of obstetrics, magnesium is recommended for treating the arrhythmias torsades de pointes and rapid atrial fibrillation, treating severe acute asthma, improving migraine symptoms, and for treating dyspepsia and constipation [2]. Many women in our modern society are magnesium deficient due to low dietary intake, and low dietary magnesium intake resulting in hypomagnesaemia has recently been shown to have many deleterious effects. Magnesium’s uses are wide-reaching, touching many areas of women’s health and gynecology from pre-menstrual syndrome to menopause, PCOS to endometriosis, and beyond.

Rural Women's Aspirations through Art Work

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Obstacles to advancing women’s health in Mozambique:a qualitative investigation into the perspectives of policy makers

Background: Despite substantial investment in women’s health over the past two decades, and enthusiasticgovernment support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest inthe world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408;the estimated HIV prevalencefor women of 15-24 years is over twice that for men;and only 12.1% of women are estimated to be using moderncontraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates onthe challenges that are preventing Mozambique from achieving greater gains in women’s health.Methods: We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health andaffiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic randomsampling and snowball sampling. Participants were asked about their experiences formulating and implementinghealth policies and programs, what is needed to improve women’s health in Mozambique, and the barriers andopportunities to achieving such improvement.Results: Participants unanimously argued that women’s health is already sufficiently prioritized in national healthpolicies and strategies in Mozambique;the problem, rather, is the implementation and execution of existing women’shealth policies and programs. Participants raised challenges related to the policy making process itself, including anever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignmentof programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership,rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported adisconnect between policy makers at the national level and realities on the ground, with poor dissemination ofstrategies, limited district resources, and poor consideration of local cultural contexts.Conclusions: To achieve meaningful gains in women’s health in Mozambique, more focus must be placed onresolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiplehealth systems components, therefore, solutions to address them must also reach across these multiple components.A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.

What does women’s empowerment have to do with malnutrition in Sub-Saharan Africa?Evidence from demographic and health surveys from 30 countries

Background:The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries.The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development,labour supply,productivity,economic growth and development.This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries.Methods:The study utilized secondary datasets of women in their child bearing age(15-49 years)from the latest Demographic and Health Survey(DHS)conducted in 2011-2017 across 30 sub Saharan Africa countries.The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence.Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status.Results:Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status(stunted and underweight)at p<0.001.These characteristics were also statistically significantly associated with empowerment status of women(Decision-making,Violence attitudes and Experience of violence)at p<0.001 except for child age and sex.The association between childhood nutritional statuses and women’s empowerment(all three empowerment measures)was significant after controlling for other covariates that could also influence childhood nutrition statuses at p<001.Two of the empowerment measures(attitudes towards violence and experience of violence)showed positive association with childhood nutritional statuses while the third(decision-making)showed negative association.Conclusion:There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries.Women’s empowerment was found to be related to childhood nutritional status.Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.

Shifts in endocrine homeostasis and preventive hormone replacement therapy:extending the Women’s Health Initiative globally

Background:Reducing disease risk for women after menopause is global health issue.A major portion of the Women’s Health Initiative(WHI)consisted of two clinical trials involving 161,809 post-menopausal women aged 50–79 that tested the effect of hormone replacement therapy(HRT)on reducing cardiovascular disease and other secondary outcomes.Previous analyses of the data reveal that HRT should not be recommended for postmenopausal women,but show potential benefits for younger women.Thus,there may be a critical period just prior to or during the early stages of menopause where HRT could be both safe and beneficial.Main body:Menopause marks the beginning of a process of non-reversible reduction in estrogen by which estrogen levels decline progressively,followed by a reduction in estrogen receptors.This results in periods of hormone-receptor imbalances,exacerbating the effects of lower serum estrogen and is considered the primarily endocrinal source of menopause symptoms.Eventually a hormone-receptor balance is achieved at a lower level.Here,we purport that the negative outcomes from WHI trials were primarily due to the fact preventive HRT was initiated in women who had already achieved hormone-receptor equilibrium at lower hormonal levels.Conclusion:We argue for further HRT clinical trials in women at varying stages of menopause,including premenopause and early menopause,and in women from different countries.Variation across countries and subgroups in how women experience menopause and perceive menopause symptoms suggest that biocultural differences should be considered in both study design and measurement approaches to test the effectiveness of HRT.Particularly,we recommend longitudinal studies to assess changes in hormonal level over time,and to detect the“most effective period”for HRT to reduce health risk for women going through the whole menopause period.

Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work disability.METHODS For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

Women with overweight, mixed hyperlipidemia, intolerance to glucose and diastolic hypertension

Primarily healthy women who attended a practice of General Medicine were examined and coded data were evaluated using two statistical methods (n = 248, aged 36 ± 14 years). It was found that participants with LDL-related (mixed) hyperlipidemia showed higher blood pressure, a higher proportion of alcohol problems and/or smoking compared to normolipidemic women (p ≤ 0.05). These hyperlipidemic women who reported alcohol problems and/or smoking more often showed proteinuria and/or hematuria, rise of LDL/HDL, critical fasting blood glucose and lower HDL-cholesterol compared to hyperlipidemic women reporting healthy lifestyle (p ≤ 0.05). Likewise, high triglycerides were associated with rise of blood pressure and intolerance to glucose (p ≤ 0.05) and also with elevated total cholesterol. Alcohol-related hypertriglyceridemia overlapped with diastolic hypertension, rise of body weight and urine pathology, lowering of HDL-cholesterol and critical fasting blood glucose. The motivating message was that women with mixed hyperlipidemia and healthy lifestyle had functionally renal endothelium and healthy HDL-related baseline measures. Altogether, LDL-related hyperlipidemia and/or high triglycerides were correlated with diastolic hypertension whereby critical alcohol consumption declined renal endothelium and lowered HDL-cholesterol implicating baseline strategies to neutralize early risk factors.