Validation of the Menopause Rating Scale in Serbian language

Effect of Electroacupuncture Versus Cognitive Behavioral Therapy for Perimenopausal Insomnia: Protocol for a Noninferiority Randomized Controlled Trial

BACKGROUND

Perimenopausal insomnia (PMI) has a high global incidence, which is common in middle-aged women and is more severe than nonmenopausal insomnia. Effective treatments with fewer side effects and more consistent repeatable results are needed. Acupuncture, a therapy based on traditional Chinese medicine, is safe and may be effective for PMI. It is widely accepted in Western countries, and evidence supports the use of acupuncture as a main or supplementary therapy. Cognitive behavioral therapy is also used to improve sleep quality. It has structured sessions and has been recommended as a first-line treatment for insomnia (cognitive behavioral therapy for insomnia [CBT-I]) by the American Association of Physicians. However, few randomized controlled trials have been conducted to compare the effectiveness of these 2 therapies. This study will be performed in perimenopausal women with insomnia to determine the efficacy of electroacupuncture (EA) versus CBT-I.

OBJECTIVE

This study aimed to compare the preliminary effectiveness and safety of EA and CBT-I for PMI through a randomized controlled noninferiority study design.

METHODS

This study is designed as an assessor-blinded, noninferiority, randomized controlled trial. A total of 160 eligible participants with PMI will be randomly divided into 2 groups to receive either EA or CBT-I. Participants in the EA group will receive electroacupuncture for 8 weeks. The intervention will be delivered 3 times weekly for a total of 12 sessions and 2 times weekly for the next 4 weeks. Meanwhile, participants in the control group will undergo CBT-I (once a week) for 8 weeks. Treatment will use 7 main acupoints (GV20, DU24, EX-HN3, EX-HN18, EX-CA1, RN6, and RN4) and an extra 4 acupoints based on syndrome differentiation. The primary outcome is the Insomnia Severity Index. The secondary outcome measures are the Pittsburgh Sleep Quality Index; Menopause-Specific Quality of Life; Menopause Rating Scale; Hamilton Depression Scale; Hamilton Anxiety Scale; hot flash score; and the level of estradiol, follicle-stimulating hormone, and luteinizing hormone in serum. Sleep architecture will be assessed using polysomnograms.

RESULTS

Participants are currently being recruited. The first participant was enrolled in January 2023, marking the initiation of the recruitment phase. The recruitment process is expected to continue until January 2025, at which point data collection will commence.

CONCLUSIONS

This trial represents a pioneering effort to investigate the efficacy and safety of EA and CBT-I as interventions for PMI. It is noteworthy that this study is conducted solely within a single center and involves Chinese participants, which is a limitation. Nonetheless, the findings of this study are expected to contribute valuable insights for clinicians engaged in the management of PMI.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300070981; https://www.chictr.org.cn/showprojEN.html?proj=194561.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51767.

Unveiling the Role of the Work Environment in the Quality of Life of Menopausal Physicians and Nurses

BACKGROUND

There is a lack of scientific evidence regarding the specific challenges faced by menopausal medical professionals in different work settings. This study aims to investigate the relationship between work environment and the menopausal quality of life (QoL) in physicians and nurses.

METHODS

This survey was conducted using the Menopausal Quality of Life Questionnaire (MENQOL) with a sample of 35 menopausal physicians and 95 nurses employed in health facilities in Astana and Kyzylorda cities, Kazakhstan.

RESULTS

Physicians reported a higher frequency of menopausal symptoms compared to nurses. The difference was statistically significant (p < 0.05) for symptoms such as decreased productivity (60.00% vs. 38.20%), flatulence or gas pains (71.43% vs. 48.39%), weight gain (79.41% vs. 61.80%), changes in skin appearance (79.59% vs. 50.00%), and changes in sexual desire (58.82% vs. 33.70%). Physicians with managerial duties had a significantly higher occurrence of vasomotor symptoms compared to non-managerial physicians (mean 3.35 ± 2.14 vs. 1.69 ± 0.89) and also had a higher mean psychological score (mean 3.26 ± 1.28 vs. 2.29 ± 1.19).

CONCLUSIONS

These findings reflect differences between the menopause effects related to work environment for doctors and nurses, and shed light on the specific challenges faced by them during menopause. In addition, it is important to consider socio-demographic and workplace-related factors in investigating their impact on the QoL.

The mothers' breastfeeding behaviour within six weeks postpartum: new scale development and psychometric validation study

BACKGROUND

The evaluation of mothers' breastfeeding behaviour within 6 weeks postpartum could help health workers comprehensively identify maternal breastfeeding shortcomings, clarify nursing problems, and provide targeted interventions. However, no prior study was found, therefore this study aimed to develop and validate the reliability and validity of the mothers' breastfeeding behaviour scale within 6 weeks postpartum.

METHODS

A main two-step approach was used: (1) a qualitative pilot study using the purposive sampling method was adopted to test the fitness, simplicity, and clarity of items with 30 mothers; (2) a cross-sectional survey using the convenient sampling method was conducted for item analysis and psychometric validation with 600 mothers.

RESULTS

The final version of the scale consisted of 36 items with seven dimensions, explaining 68.852% of the total variance. The Cronbach's α, split-half, and retest coefficients were 0.958, 0.843, and 0.753, respectively. The validity of the scale: (1) Content validity: content validity index (CVI) range of items was between 0.882 and 1.000. The scale-level-CVI was 0.990. (2) Structure validity: The fitting indices were as follows: χ²/ⅆf =2.239, RMR = 0.049, RMSEA = 0.069, TLI = 0.893, CFI = 0.903, IFI = 0.904, PGFI = 0.674, and PNFI = 0.763. (3) Convergent validity: The composite reliability and average variance extracted (AVE) of the seven dimensions were between 0.876 and 0.920 and between 0.594 and 0.696. (4) Distinguish validity: The correlation coefficients were less than the square root of the AVE, except for self-decision behaviour, self-coping behaviour, and self-control behaviour. However, the fit index of the original three-factor model was better than that of the other new models, with significant differences (P < 0.001). (5) Calibration validity: The area under the curve was 0.860 or 0.898 when the scale was used to predict exclusive or any breastfeeding at 42 days. The correlation coefficients of the maternal breasting feeding evaluation scale, breastfeeding self-efficacy short-form scale, and the scale were 0.569 and 0.674, respectively.

CONCLUSION

The newly developed mothers' breastfeeding behaviour scale within 6 weeks postpartum consists of 36 items belonging to seven dimensions with good reliability and validity and is a reliable and valid instrument to be used in future maternal breastfeeding behaviour assessments and interventions.

Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial

PURPOSE

This study aimed to determine the efficacy of non-hormonal therapy with citalopram vs fluoxetine for treating vasomotor syndrome (VMS) and urogenital syndrome of menopause (GSM) in Mexican women.

METHODS

A parallel prospective randomized clinical trial was conducted in 91 postmenopausal women with a total score on the Menopause Rating Scale (MRS) ≥ 17 and with the clinical diagnosis of VSM and GSM. Patients were randomly assigned to receive citalopram (n = 49) or fluoxetine (n = 42). Follow-up was carried out at 3 and 6 months.

RESULTS

The citalopram group experienced a significant improvement compared to the fluoxetine group in the MRS total score (p < 0.01), as well as in the psychological (p < 0.001) and somatic (p < 0.0001) domains at 3 and 6 months of follow-up. After 6 months of follow-up, the group that received citalopram decreased the relative risk (RR) to present VMS symptoms (RR = 0.30, CI 0.19-0.5, p = 0.0001), depressed mood (RR = 0.31, CI 0.15-0.6, p = 0.0002), irritability (RR = 0.40, CI 0.22-0.73, p = 0.002), anxiety (RR = 0.30, CI 0.13-0.69, p = 0.003), physical and mental exhaustion (RR = 0.35, CI 0.18-0.67, p = 0.001), sexual problems (RR = 0.18, CI 0.06-0.48, p = 0.0001), vaginal dryness (RR = 0.34, CI 0.14-0.80, p = 0.01), and urinary problems (RR = 0.36, CI 0.14-0.92, p = 0.043).

CONCLUSION

We conclude that citalopram tends to improve VSM and GSM symptoms in postmenopausal Mexican women. Thus, we recommend the daily use of citalopram 20 mg. However, further studies will be required to support the results of the present work. These should include a larger number of patients and a placebo group.

CLINICAL TRIAL REGISTRATION

This clinical trial was retrospectively registered by the United States National Library of Medicine in the www.

CLINICALTRIALS

gov database on 04/20/2022. The given test Registration Number is NCT05346445.

Review of menopausal palpitations measures

Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.

The psychometric properties of the Persian menopause rating scale

Background

To measure the severity of menopausal complaints and determine the pattern of menopausal symptoms, a valid and reliable instrument is needed in women’s healthcare. The Menopause Rating Scale (MRS) is one of the best-known tools in response to the lack of standardized scales. The purpose of this study was to examine the psychometric properties of the MRS in an Iranian example.

Methods

Participants were randomly selected from women referred to healthcare centers in Miandoab, West Azerbaijan, Iran. A total of 330 questionnaires were completed (response rate of 96.9%). Two samples were considered for analysis in the validation process. An exploratory factor analysis (EFA) was conducted on the first sample (n₁ = 165), and a confirmatory factor analysis (CFA) was done using a second study sample (n₂ = 165). The psychometric properties process was concluded with assessment of internal consistency and test-retest reliability.

Results

The EFA with Principal Component Analysis extracted three factors explaining 75.47% cumulative variance. The CFA confirmed a three-factor structure of the 11-items MRS. All fit indices proved to be satisfactory. The relative chi-square (χ2/df) was 3.686 (p < .001). The Root Mean Square Error of Approximation (RMSEA) of the model was .04 (90% CI = .105–.150). All comparative indices of the model, including the Comparative Fit Index, Normed Fit Index, and Relative Fit Index, were more than .80 (.90, .87, and .80, respectively). For the overall scale, Cronbach’s alpha was .931, whereas the alpha for the subscales ranged from 0.705–0.950. The intraclass correlation was .91 (95% CI = .89–.93), p < 0.001.

Conclusion

The results of the study indicate that the Persian model of the MRS is a valid and reliable scale. As a screening tool, the Persian MRS could be used to identify the pattern of symptoms among menopausal, premenopausal, and postmenopausal women to care for and educate them on how to identify and treat the symptoms.

The Persian Version of Menopause Rating Scale (MRS): A Psychometric Study

Objective

Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).

Study Design

The study was conducted on a random sample of 270 middle-aged women (age range 40-60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.

Results

Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.91) indicated good internal consistency.

Conclusion

The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

Hormonal therapy in menopausal transition: implications for improvement of health-related quality of life

The study aim was to assess scores of the Menopause Rating Scale (MRS) among women who use and desire to use hormonal therapy (HT), as well as to evaluate factors contributing to HT use and desire to use HT among women in menopausal transition. A total of 513 mid-aged women participated in the study. Data were collected using socio-demographic questionnaire, MRS and Beck Depression Inventory. The prevalence of current HT use was 9.7%, while 4.5% of women who did not use HT expressed a desire to start using HT. The MRS cutoff score for HT use was 10.5 and 11.5 among those who desire to use HT. Living in the central city districts, having lower body mass index, younger age at menopause, more gynecological illnesses, and worse MRS were associated with HT use. Living in the central city districts, having fewer births, more gynecological and chronic illnesses and having more depressive symptoms were associated with the desire to use HT. Mid-aged women who perceive their quality of life as poor due to climacteric symptoms should be advised to consider HT to improve their health status and everyday functioning.

The relationship between management strategies for menopausal symptoms and women's decision making styles during menopausal transition

Introduction

Considering the importance of identifying the factors affecting women’s decision making process about the management of menopausal symptoms, this study was conducted with the aim of investigating the relation between decision making styles and women’s chosen options for management of menopausal symptoms.

Material and methods

This cross-sectional study was conducted from May 2016 to July 2018 in Gonabad, north east of Iran.Using the cluster sampling method 473 women between 45 and 60 years old were recruited to the study. Data were collected using a demographic questionnaire, a menopause symptom treatment options questionnaire, the Menopause Rating Scale and the Decision Making Styles Questionnaire. The data analysis was conducted using SPSS software version 16 as well as descriptive and analytical statistics; a p-value of< 0.05 was considered as statistically significant.

Results

The mean age of participants was 51.6 ±4.6 years old and the majority of them (85.5%) were housewives. The most popular menopause symptom treatment option was hormone replacement therapy. The majority of participants (45.4%, 228 people) used an avoidant decision making style. There was no statistically significant difference between menopausal symptom treatment options and decision making styles type(p = 0.525). There was a statistically significant difference between severity of menopausal symptoms and type of decision making style (p = 0.003).

Conclusions

The findings showed that there was no significant relation between the selected method to manage menopausal symptoms and women’s decision making styles. It is recommended that this study be conducted on a population that has greater access to all menopausal symptom treatment options.

Menopausal symptoms and associated factors in women living with HIV in Cambodia

This study investigated the prevalence and severity of menopausal symptoms and associated factors among women living with HIV in Cambodia. Menopause Rating Scale (MRS) assessed the menopausal symptoms, and SPSS Version 20.0 analyzed the data. The three most dominant symptoms, which were also rated the top three "severe" symptoms, were psychological: physical and mental exhaustion (91.5%), irritability (84.1%), and depressive mood (83.6%). The highest incidence was among the perimenopausal women. Severity of symptoms was associated with personal income, abortion, and intake of calcium supplements. Health-care professionals need to provide appropriate individualized interventions to maintain the social, emotional, and overall well-being of menopausal women living with HIV.

Construct validity of the Menopause Rating Scale in Indonesia

Objective: This study assessed the construct validity of the Menopause Rating Scale (MRS) in Indonesia. Methods: The study included 240 women aged over 45 years in Indonesia. The MRS measures psychological, somatic-vegetative, and urogenital symptoms using 11 items obtained from participants' daily symptom records. The intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient were measured to examine the test-retest reliability and internal consistency reliability. The test-retest reliability was evaluated by an extra 30 participants twice at 2-week intervals. For construct validity, exploratory factor analysis (EFA) was employed to assess factor structure and confirmatory factor analysis (CFA) was used to evaluate the structural model fit of the MRS. Results: The ICC for the test-retest reliability ranged between 0.90 and 0.95. The Cronbach alpha coefficients in the somatic-vegetative, psychological, and urogenital dimensions were 0.92, 0.93, and 0.95, respectively. The Kaiser-Meyer-Olkin value was 0.96, and the Bartlett's test of sphericity was statistically significant and adequate for EFA. CFA was tested using the second-order model with three first-order factors and yielded an excellent model fit. Conclusion: Results indicated that the brief questionnaire of the MRS possesses acceptable construct validity for evaluating menopause symptoms in Indonesian women.

Cross cultural adaptation and analysis of psychometric properties of Sinhala version of Menopause Rating Scale

BACKGROUND

Menopause Rating Scale (MRS) evaluates eleven menopausal symptoms and health related quality of life (HRQOL) of postmenopausal women under three subscales. In this study we attempted cross cultural adaptation and evaluation of psychometric properties of a Sinhala translation of MRS.

METHODS

Sinhala version of MRS was adapted following standard methodology; forward and backward translations, review by an expert group, focus group discussion (FGD) and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling 166 postmenopausal women (aged; median = 56.5, IQR, 53.0-59.0 years) along with the Short Form 36 (SF-36) survey questionnaire. MRS was re-administered among a subsample (n = 80) after two weeks of first administration. Psychometric properties; reliability and validity were evaluated.

RESULTS

In Sinhala version of MRS, both internal consistency (Cronbach's alpha coefficient = 0.79) and test retest reliability (intra class correlation / ICC = 0.86, 95%CI = 0.82-0.91, p < 0.001 and Pearson correlation / r = 0.93) were high. Factor analysis (FA) with Principal Component Analysis (PCA) extracted three factors explaining 59.82% cumulative variance with few exceptions from the original version. In the item-subscale correlation analysis items showed stronger correlations within their own subscale score (r range between 0.56-0.84) than with other subscales scores and subscales' scores showed strong correlations with the overall MRS score (r range between 0.70-0.86) indicating strong convergent validity. Mean (SD) symptom severities of each item were significantly different between symptomatic and asymptomatic women (p < 0.05) emphasizing good discriminant validity. The overall MRS and SF-36 scores correlated significantly (Pearson correlation: - 0.52, p < 0.01 and Kendall's tau-b: - 0.39, p < 0.01) ensuring strong criterion validity.

CONCLUSIONS

The Sinhala version of MRS we adapted is an informative tool with high reliability and validity and this tool can be used to evaluate the menopausal symptoms and HRQOL in postmenopausal women conversant in Sinhala.

Factors associated with general and health-related quality of life in menopausal transition among women from Serbia

This study assessed factors associated with quality of life (QOL) among Serbian peri- and postmenopausal women using two menopause-specific scales. This cross-sectional study included 500 women aged 40-65 years who had a gynecologic check-up in one of two Community Health Centers in Belgrade during February 2014 to January 2015. Women completed: a questionnaire about socio-demographics, habits, and health status; a menopause-specific questionnaire, Utian's Quality of Life Scale (UQOL); and a Women's Health Questionnaire (WHQ) and Beck's Depression Inventory (BDI). Higher education was associated with better occupational UQOL and memory/concentration, but with lower emotional UQOL and more anxiety/fears. City center residency was associated with better occupational and sexual UQOL. Being employed was associated with better occupational UQOL and lower anxiety/fears. Higher income was associated with better emotional UQOL. Not having uterine prolapse, insomnia, or tachycardia was associated with better occupational UQOL and fewer sleep problems. Higher parity was associated with better sexual UQOL. Having regular recreation was associated with better health and sexual UQOL but with more frequent vasomotor symptoms. Leaner women felt more attractive. QOL during the menopausal transition does not entail only somatic symptoms and therefore requires a more comprehensive approach that includes psychosocial underpinnings.