1
|
Abstract
Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.
Collapse
Affiliation(s)
- Erin R Duralde
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Talia H Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Bień A, Korżyńska-Piętas M, Zarajczyk M, Wysokiński M, Niewiadomska I, Jurek K, Rzońca E. Factors Determining the Quality of Life of Polish Women during Menopause Based on the Menopause-Specific Quality of Life Questionnaire. Healthcare (Basel) 2023; 11:healthcare11081173. [PMID: 37108007 PMCID: PMC10138136 DOI: 10.3390/healthcare11081173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The aim of the study was to present the process of cultural adaptation to Polish conditions and the validation of a scale assessing the quality of life of Polish women during the menopause and to identify the factors determining this quality of life. METHODS The research tools were the menopause-specific quality of life (MENQOL) questionnaire and a standardized interview questionnaire comprising questions on the participants' characteristics. The study involved 516 women using health care services who had symptoms caused by the menopause. RESULTS The value of the Cronbach's alpha coefficient was 0.923. The discriminative power coefficients of all the questionnaire items were higher than 0.3. The study confirmed the validity and internal consistency of the Polish version of the MENQOL questionnaire for measuring the quality of life of postmenopausal women, suggesting that the tool can be used for screening menopausal symptoms in women. There was a relationship between general quality of life and age (p = 0.002), marital status (p < 0.001), education (p = 0.021), the impact of professional work (p < 0.001), the impact of physical activity (p < 0.001) and the impact of social life (p < 0.001). CONCLUSION In the group of women who took part in the study, the authors observed a lower quality of life during menopause reported by older women who were married/in a stable relationship, with no formal education (no formal education) and who, according to their subjective assessment, negatively evaluated the impact of the accompanying menopause-related symptoms on their work, physical activity and social life.
Collapse
Affiliation(s)
- Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland
| | - Magdalena Korżyńska-Piętas
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland
| | - Marta Zarajczyk
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland
| | - Mariusz Wysokiński
- Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland
| | - Iwona Niewiadomska
- Department of Social Psychoprevention, John Paul II Catholic University of Lublin, 20-950 Lublin, Poland
| | - Krzysztof Jurek
- Institute of Sociological Sciences, John Paul II Catholic University of Lublin, 20-950 Lublin, Poland
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland
| |
Collapse
|
3
|
Sundell M, Spetz Holm AC, Fredrikson M, Hammar M, Hoffmann M, Brynhildsen J. Pulmonary embolism in menopausal hormone therapy: a population-based register study. Climacteric 2022; 25:615-621. [PMID: 36218141 DOI: 10.1080/13697137.2022.2127352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Oral but not transdermal menopausal hormone therapy (MHT) increases the risk of venous thromboembolism. There is no evidence regarding the risk of the serious complication pulmonary embolism (PE). The aim was to investigate the risk of PE in women using MHT depending on administration route, type of progestin and treatment duration. METHOD The population-based case-control study covered 1,771,253 women aged 40-69 years, during 2006-2015. Diagnoses of PE (n = 13,974) and drug dispensations were received from national validated registers. RESULTS Current MHT users had a higher risk of PE than non-users (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.05-1.26). First ever users had the highest risk (OR 2.07, 95% CI 1.23-3.50). Transdermal administration was not associated with increased risk of PE. The OR was slightly but non-significantly higher with estrogen combined with medroxyprogesterone acetate than with norethisterone acetate. DISCUSSION The risk of PE was significantly increased in users of oral but not transdermal MHT, with the highest risk in first ever users of oral estrogen combined with medroxyprogesterone acetate. The risk was considerably lower in women with recurrent treatment, probably because of the healthy user effect. CONCLUSION PE was most common close to initiation of oral treatment. Transdermal MHT did not increase the risk of PE.
Collapse
Affiliation(s)
- Micaela Sundell
- Department of Obstetrics and Gynecology, Kalmar County Hospital, Kalmar, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna-Clara Spetz Holm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Linköping University Hospital, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael Hoffmann
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Brynhildsen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
4
|
Yerra AK, Bala S, Yalamanchili RK, Bandaru RK, Mavoori A. Menopause-Related Quality of Life among Urban Women of Hyderabad, India. J Midlife Health 2021; 12:161-167. [PMID: 34526752 PMCID: PMC8409714 DOI: 10.4103/jmh.jmh_272_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/10/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Menopause is regarded as the marker for various symptoms such as physical, psychological, vasomotor, and sexual impairing the quality of life (QOL). Objectives: To assess the menopause-related QOL and determine associated factors among postmenopausal women. Materials and Methods: A cross-sectional study was conducted among 378 postmenopausal women attending the obstetrics and gynecology department of a tertiary care hospital using a standardized menopause-specific QOL (MENQOL) questionnaire consisting of physical, vasomotor, psychosocial, and sexual domains. Results: The study included 378 women aged above 40 years, with majority belonging to the age group of 46–50 years. The total MENQOL mean score was found to be 19.35 ± 16.20, with physical domain score the highest 14.89 ± 11.85, followed by vasomotor 1.98 ± 3.83, psychosocial 1.82 ± 3.29, and the least as sexual domain with score of 0.624 ± 2.21. Post menopausal women with age less than 50 years, No formal education, High socio-economic status, Home makers and duration of menopause less than 5 years was found to have statistical significant association with higher vasomotor domain score; No formal education, higher socio economic status and duration of menopause with greater than 5 years was found to be significant with higher sexual domain scores. Conclusions: Menopause may be associated with a decrease in QOL. Certain sociodemographic variables showed a statistically significant association with the vasomotor and sexual domains. Awareness and interventions that affect the modifiable factors may help in increasing the QOL at menopause.
Collapse
Affiliation(s)
- Aruna Kumari Yerra
- Department of Obstetrics and Gynaecology, ESIC Medical College, Hyderabad, Telangana, India
| | - Sudha Bala
- Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India
| | | | - Rajiv Kumar Bandaru
- Department of General Medicine, ESIC Medical College, Hyderabad, Telangana, India
| | - Archana Mavoori
- Department of Dermatology, ESIC Medical College, Hyderabad, Telangana, India
| |
Collapse
|
5
|
Costanian C, Zangiabadi S, Bahous SA, Deonandan R, Tamim H. Reviewing the evidence on vasomotor symptoms: the role of traditional and non-traditional factors. Climacteric 2020; 23:213-223. [DOI: 10.1080/13697137.2019.1711051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- C. Costanian
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - S. Zangiabadi
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - S. A. Bahous
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - R. Deonandan
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - H. Tamim
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| |
Collapse
|
6
|
Jaff NG, Rubin LH, Crowther NJ, Norris SA, Maki PM. Menopausal symptoms, menopausal stage and cognitive functioning in black urban African women. Climacteric 2019; 23:38-45. [DOI: 10.1080/13697137.2019.1646719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- N. G. Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - L. H. Rubin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - N. J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - S. A. Norris
- SAMRC/Developmental Pathways for Health Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - P. M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Cengiz H, Kaya C, Suzen Caypinar S, Alay I. The relationship between menopausal symptoms and metabolic syndrome in postmenopausal women. J OBSTET GYNAECOL 2019; 39:529-533. [DOI: 10.1080/01443615.2018.1534812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Huseyin Cengiz
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Sema Suzen Caypinar
- Department of Obstetrics and Gynecology, Bahcelievler State Hospital, Istanbul, Turkey
| | - Ismail Alay
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Avis NE, Crawford SL, Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am 2018; 45:629-640. [PMID: 30401547 DOI: 10.1016/j.ogc.2018.07.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Vasomotor symptoms (VMS) are the primary menopausal symptoms, occurring in up 80% of women and peaking around the final menstrual period. The average duration is 10 years, longer in women with an earlier onset. Compared with non-Hispanic white women, black and Hispanic women are more likely and Asian women are less likely to report VMS. Risk factors include greater body composition (in the early stage of menopausal transition), smoking, anxiety, depression, sensitivity to symptoms, premenstrual syndrome, lower education, and medical treatments, such as hysterectomy, oophorectomy, and breast cancer-related therapies. VMS patterns over time and within higher-risk subgroups are heterogeneous across women.
Collapse
Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, 55 Lake Avenue, S1-853, Worcester, MA 01655, USA
| | - Robin Green
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue Block, Room 316, Bronx, NY 10461, USA
| |
Collapse
|
9
|
Fooladi E, Bell RJ, Masoumi M, Azizi M, Atarod Z, Davis SR. Bothersome menopausal symptoms amongst postmenopausal Iranian women. Climacteric 2018; 21:586-593. [PMID: 30145921 DOI: 10.1080/13697137.2018.1493452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study was undertaken to determine the impact of menopause on middle-eastern women. METHODS This was a cross-sectional study of 1520 women, aged 40-64 years, living in Sari, Northern Iran, recruited by multistage cluster sampling between October 2016 and April 2017. All women completed the Menopause Quality of Life Questionnaire (MENQOL) and Beck Depression Inventory-II (BDI-II). RESULTS Of all the women, 54.5% were perimenopausal or postmenopausal. The prevalences of any vasomotor symptom (VMS) and moderate-severely bothersome VMS were greatest for postmenopausal women aged <55 years (66.4%, 95% confidence interval (CI) 59.9-72.3% and 13.5%, 95% CI 9.6-18.6%, respectively). Having moderate-severe VMS was associated with moderate-severe depressive symptoms (adjusted odds ratio (AOR) 2.9; 95% CI 1.6-5.2; p < 0.001). Symptoms of vulvovaginal atrophy (VVA) were reported by 41.1% (95% CI 37.4-45.0%) of perimenopausal and postmenopausal women, with 22.9% (95% CI 19.8-26.3%) reporting their symptoms as moderate-severely bothersome. In women with moderate-severe VMS, the proportion with both moderate-severe depressive symptoms and moderate-severe VVA symptoms (12.1%) was four times that in women with no or mild VMS (3.3%) (p < 0.001). CONCLUSION One in seven perimenopausal and postmenopausal women has moderate-severely bothersome VMS and few women receive appropriate therapy. The reporting of moderate-severe VMS should alert clinicians to the likelihood of significant concurrent VVA and depressive symptoms.
Collapse
Affiliation(s)
- E Fooladi
- a Women's Health Research Program , School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia.,b Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery , Mazandaran University of Medical Sciences , Sari , Mazandaran , Iran
| | - R J Bell
- a Women's Health Research Program , School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - M Masoumi
- b Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery , Mazandaran University of Medical Sciences , Sari , Mazandaran , Iran
| | - M Azizi
- b Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery , Mazandaran University of Medical Sciences , Sari , Mazandaran , Iran
| | - Z Atarod
- c Department of Obstetrics and Gynecology, School of Medicine , Mazandaran University of Medical Sciences , Sari , Mazandaran , Iran
| | - S R Davis
- a Women's Health Research Program , School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| |
Collapse
|
10
|
The time has come for a safe, effective way to relieve menopausal symptoms. Menopause 2017; 24:1113-1115. [DOI: 10.1097/gme.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
An investigation of life circumstances associated with the experience of hot flashes in Campeche, Mexico. Menopause 2017; 24:52-63. [DOI: 10.1097/gme.0000000000000725] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
12
|
|
13
|
|
14
|
Menopausal symptoms among British Pakistani women: a critique of the standard checklist approach. Menopause 2015; 22:79-87. [PMID: 24824643 DOI: 10.1097/gme.0000000000000256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to identify problems with the standard menopause symptom checklist method previously used to study variations in menopause symptoms and to explore data collected using an alternative approach. METHODS As part of a biosocial study of menopause, 257 British Pakistani women aged 39 to 61 years and living in West Yorkshire, UK, were interviewed. Participants reported and rated any menopause-associated changes (positive or negative) they had experienced. Participants also reported whether they associated with menopause each of the 34 symptoms on a standard checklist. Responses were analyzed using factor analysis, and factor scores from five factors were used to assess predictors of the attribution of symptoms to menopause. RESULTS Women reported a wide range of symptoms, most of which are not on symptom checklists. Attribution of symptoms to menopause was associated with menopause status, age, and migration status. Women's beliefs about which experiences were attributable to menopause did not correspond to those of the checklist developers. Women interpreted some items on the standard checklist in ways other than originally intended based on local ideas; however, because of the use of a more open approach, this produced useful data. CONCLUSIONS Symptom checklists have serious limitations as a tool for understanding symptom experience, and prior justifications for their use leave much to be desired. The use of a more open approach generates useful data; moreover, research participants' understanding of changes attributable to menopause may accurately reflect biological changes and may have a relationship with population-specific disease risk.
Collapse
|
15
|
Staging reproductive aging using Stages of Reproductive Aging Workshop + 10 in black urban African women in the Study of Women Entering and in Endocrine Transition. Menopause 2014; 21:1225-33. [DOI: 10.1097/gme.0000000000000235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Sgan-Cohen H, Livny A, Listl S. Dental health among older Israeli adults: is this a reflection of a medical care model inadequately addressing oral health? Int Dent J 2014; 65:49-56. [PMID: 25345406 DOI: 10.1111/idj.12135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Israel's health-care system is considered as one of the most efficient worldwide. The purpose of the present study was to assess oral health outcomes, dental care use and respective social inequalities among the older segment of the Israeli population. METHODS Secondary analyses were conducted of recently available data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Israel, wave 2), which specifically includes information on chewing ability, denture wearing and dental care use obtained from more than 2,400 Israeli people, 50+ years of age. Multivariate logistic regressions and concentration indices were used to analyse determinants of oral health and dental care use. RESULTS Seventy per cent of respondents reported being able to bite/chew on hard foods and 49% of respondents reported wearing dentures. Forty-three per cent of respondents had visited a dentist within the past 12 months, with about half of all dental visits being made for solely nonpreventive reasons. Significant income-related inequalities were identified, with higher income being associated with greater dental care use (particularly preventive dental visits), better chewing ability and less denture wearing. CONCLUSIONS For the older segment of the Israeli population and compared with other countries, the findings of the present study suggest a relatively low level of chewing ability, a high extent of nonpreventive dental visiting, as well as considerable inequalities in oral health and care. It seems that the Israeli health-care system may be improved even further by more comprehensive inclusion of dental care into universal health coverage.
Collapse
Affiliation(s)
- Harold Sgan-Cohen
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | | | | |
Collapse
|
17
|
|
18
|
Abstract
Vasomotor and vaginal symptoms are cardinal symptoms of menopause. Vasomotor symptoms can be particularly troubling to women and are the most commonly reported menopausal symptoms, with a reported prevalence of 50-82% among U.S. women who experience natural menopause (1, 2). The occurrence of vasomotor symptoms increases during the transition to menopause and peaks approximately 1 year after the final menstrual period (3-5). The purpose of this document is to provide evidence-based guidelines for the treatment of vasomotor and vaginal symptoms related to natural and surgical menopause. (Treatment of menopausal symptoms in cancer survivors is discussed in the American College of Obstetricians and Gynecologists' Practice Bulletin Number 126, Management of Gynecologic Issues in Women With Breast Cancer.).
Collapse
|
19
|
Sievert LL. Subjective and objective measures of hot flashes. Am J Hum Biol 2013; 25:573-80. [DOI: 10.1002/ajhb.22415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 12/11/2022] Open
|
20
|
Effects of physical activity on vasomotor symptoms: examination using objective and subjective measures. Menopause 2013; 19:1095-103. [PMID: 22735162 DOI: 10.1097/gme.0b013e31824f8fb8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Physical activity (PA) is essential for successful aging and for the prevention and management of common chronic diseases. The empirical support for the beneficial effects of PA on vasomotor symptoms has, however, been mixed. The purpose of this study was to assess the effects of acute aerobic exercise and daily PA on menopausal vasomotor symptoms. METHODS Community-dwelling midlife women (N = 121; age range, 40-60 y) not using hormone therapy were recruited for a 15-day daily diary study. Women completed psychological, cardiorespiratory fitness, body composition, and hormonal status screening followed by a 15-day prospective assessment in a "real-life" setting using a personal digital assistant. Participants also completed a 30-minute moderate-intensity aerobic exercise bout on a treadmill between days 5 and 8. Daily PA was assessed objectively through accelerometry, and all symptomatic women (n = 92) completed two 24-hour Biolog sternal skin conductance recordings of hot flashes (HFs)-one at baseline and one immediately after treadmill exercise. RESULTS Both total objective (P = 0.054) and total subjective (P < 0.05) HFs decreased after the acute exercise bout. At the between-person level, daily PA was not associated with self-reported HFs. However, at the within-person level, performing more moderate physical activity than usual was associated with more self-reported HFs in women with lower fitness levels. CONCLUSIONS Moderate aerobic exercise decreases objective and subjective HFs 24 hours after exercise; however, in women with lower fitness levels, more daily moderate PA leads to more self-reported symptoms.
Collapse
|
21
|
InterLACE: A new International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events. Maturitas 2013; 74:235-40. [DOI: 10.1016/j.maturitas.2012.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022]
|
22
|
|
23
|
Abstract
OBJECTIVE The aim of the present study was to determine age at menopause and the prevalence of menopausal symptoms among women in a community in Babol, Iran, and then identify the factors associated with these symptoms and age. METHODS A retrospective, descriptive, epidemiological study was conducted on the characteristics of perimenopausal and postmenopausal women. A total of 1,397 individuals aged 45 to 63 years were selected using a standard cluster sampling technique. The questionnaire used included menopausal symptoms, menopause status, causes of menopause, use of hormones, reproductive history, and sociodemographic factors. A standard questionnaire named Symptom ScoreCard was used to assess the frequency and severity of menopausal symptoms. The data were analyzed by χ2 analysis, t test, analysis of variance, and adjusted odds ratios with their 95% CIs. RESULTS Recalled mean ± SD age at natural menopause was 47.7 ± 4.9 years. No significant difference by age at menopause was observed in sociodemographic data, smoking status, reproductive history, and oral contraceptive use. The most prevalent symptoms were irritability (72.1%), joint pain (70.6%), and depression (59.7%) during the previous 2 weeks. An increase in the percentage of occurrence and severity of some symptoms with transition to menopause was observed. The total score for menopausal symptoms was 13.0 ± 7.7. High economic situation (odds ratio, 1.89; 95% CI, 1.37-2.58) was a factor significantly associated with a total menopausal score of higher than 15. CONCLUSIONS This study shows a high prevalence of menopausal symptoms and an earlier mean age at menopause (47.7 y) for women in a community in Babol, Iran. It would be beneficial to establish a menopausal clinic in primary healthcare centers for the clinical staff to monitor postmenopausal women.
Collapse
|
24
|
Lerner-Geva L, Boyko V, Blumstein T, Benyamini Y. The impact of education, cultural background, and lifestyle on symptoms of the menopausal transition: the Women's Health at Midlife Study. J Womens Health (Larchmt) 2012; 19:975-85. [PMID: 20380577 DOI: 10.1089/jwh.2009.1381] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aimed to examine differences in symptom clusters among women in midlife from different cultural origins and to identify sociodemographic, lifestyle, and health characteristics that could account for the differences between the cultural groups in symptom reporting. METHODS Israeli women aged 45-64 were randomly selected according to age and population strata of three groups: long-term Jewish residents (LTR), Jewish immigrants from the former Soviet Union, and Arab women (mostly Israeli-born). Interviews were conducted with 540 LTR, 151 immigrants, and 123 Arab women. The survey instrument included the occurrence and rating of how bothersome to everyday function were 16 symptoms. Three outcome variables included hot flashes and two scales for mental and somatic symptoms extracted from exploratory factor analysis. RESULTS Multivariate logistic regressions showed that immigrants and Arab women (compared to LTR) had a significantly lower risk of reporting hot flashes and mental and somatic symptoms. Menopausal status was related only to hot flashes. Low education and depression were associated with the three symptom scales, whereas nonhealthy lifestyle was related only to somatic symptoms. CONCLUSIONS Our main finding is that cultural group is an independent predictor of each of the three menopausal symptom scales. A possible explanation for the lower reporting of symptoms among Arab and immigrant groups is that they differ from the LTR in level of acculturation and attitudes toward menopause. These findings support the proposition of a cultural factor in menopausal symptomatology that needs to be addressed by clinicians caring for women at midlife.
Collapse
Affiliation(s)
- Liat Lerner-Geva
- Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | | | | | | |
Collapse
|
25
|
Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation. Obstet Gynecol Clin North Am 2012; 38:489-501. [PMID: 21961716 DOI: 10.1016/j.ogc.2011.05.006] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.
Collapse
Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
26
|
A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause 2011; 18:778-85. [PMID: 21407137 DOI: 10.1097/gme.0b013e318207851d] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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.
Collapse
|
27
|
Abstract
Each menopausal body is the product of decades of physiological responses to an environment composed of cultural and biological factors. Anthropologists have documented population differences in reproductive endocrinology and developmental trajectories, and ethnic differences in hormones and symptoms at menopause demonstrate that this stage of life history is not exempt from this pattern. Antagonistic pleiotropy, in the form of constraints on the reproductive system, may explain the phenomenon of menopause in humans, optimizing the hormonal environment for reproduction earlier in the life course. Some menopausal symptoms may be side effects of modernizing lifestyle changes, representing discordance between our current lifestyles and genetic heritage. Further exploration of women's experience of menopause, as opposed to researcher-imposed definitions; macro- and microenvironmental factors, including diet and intestinal ecology; and folk etiologies involving the autonomic nervous system may lead to a deeper understanding of the complex biocultural mechanisms of menopause.
Collapse
Affiliation(s)
- Melissa K. Melby
- Department of Anthropology, University of Delaware, Newark, Delaware 19716
- National Institute of Health and Nutrition, Tokyo, 162-8363, Japan
| | - Michelle Lampl
- Predictive Health Institute and Department of Anthropology, Emory University, Atlanta, Georgia 30322
| |
Collapse
|
28
|
Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants. Maturitas 2011; 70:110-9. [DOI: 10.1016/j.maturitas.2011.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/23/2022]
|
29
|
Thurston RC, Santoro N, Matthews KA. Adiposity and hot flashes in midlife women: a modifying role of age. J Clin Endocrinol Metab 2011; 96:E1588-95. [PMID: 21778220 PMCID: PMC3200246 DOI: 10.1210/jc.2011-1082] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The nature of the relationship between adiposity and hot flashes has been debated, but it has not been examined using physiological measures of hot flashes. We examined associations between body size/composition and physiologically assessed hot flashes among women with hot flashes. METHODS A subcohort of women in the Study of Women's Health Across the Nation (n = 52; 25 African-American and 27 non-Hispanic Caucasian; ages, 54 to 63 yr) who reported hot flashes, had their uterus and ovaries, and were not taking medications impacting hot flashes were recruited in 2008-2009. Women completed anthropometric measures [bioimpedance analysis of total percentage of body fat, body mass index (BMI), waist circumference], a blood draw (estradiol, SHBG, FSH, dehydroepiandrosterone sulfate), and 4 d of ambulatory sternal skin conductance monitoring with diary (physiological and reported hot flashes, respectively). Associations between anthropometrics and hot flashes were estimated with generalized estimating equations with covariates age, race, and anxiety. RESULTS Higher BMI (odds ratio, 0.97; 95% confidence interval, 0.94-0.99; P < 0.05) and waist circumference (odds ratio, 0.98; 95% confidence interval, 0.97-0.99; P < 0.01) were associated with fewer physiological hot flashes. Interactions by age (P < 0.05) indicated that inverse associations of body fat, BMI, and waist circumference with hot flashes were most apparent among the oldest women in the sample. Estradiol and SHBG reduced but did not eliminate age-related variations in relations between body size/composition and hot flashes. CONCLUSION Higher adiposity was associated with fewer physiological hot flashes among older women with hot flashes. A modifying role of age must be considered in understanding the role of adiposity in hot flashes.
Collapse
Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213, USA.
| | | | | |
Collapse
|
30
|
Melby MK, Sievert LL, Anderson D, Obermeyer CM. Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants: Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies. Maturitas 2011; 70:99-109. [DOI: 10.1016/j.maturitas.2011.07.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/27/2022]
|
31
|
Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population. Menopause 2010; 17:351-8. [DOI: 10.1097/gme.0b013e3181bcd6f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Im EO, Lim HJ, Lee SH, Dormire S, Chee W, Kresta K. Menopausal symptom experience of Hispanic midlife women in the United States. Health Care Women Int 2009; 30:919-34. [PMID: 19742365 DOI: 10.1080/07399330902887582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the United States This was a qualitative online forum study among 27 Hispanic midlife women in the United States. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) "Cambio de vida (change of life)," (b) "being silent about menopause," (c) "trying to be optimistic," and (d) "getting support." More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.
Collapse
Affiliation(s)
- Eun-Ok Im
- The University of Texas at Austin, Austin, Texas 78701, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Thurston RC, Matthews KA, Hernandez J, De La Torre F. Improving the performance of physiologic hot flash measures with support vector machines. Psychophysiology 2009; 46:285-92. [PMID: 19170952 DOI: 10.1111/j.1469-8986.2008.00770.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hot flashes are experienced by over 70% of menopausal women. Criteria to classify hot flashes from physiologic signals show variable performance. The primary aim was to compare conventional criteria to Support Vector Machines (SVMs), an advanced machine learning method, to classify hot flashes from sternal skin conductance. Thirty women with > or =4 hot flashes/day underwent laboratory hot flash testing with skin conductance measurement. Hot flashes were quantified with conventional (> or =2 micromho, 30 s) and SVM methods. Conventional methods had poor sensitivity (sensitivity=0.41, specificity=1, positive predictive value (PPV)=0.94, negative predictive value (NPV)=0.85) in classifying hot flashes, with poorest performance among women with high body mass index or anxiety. SVM models showed improved performance (sensitivity=0.89, specificity=0.96, PPV=0.85, NPV=0.96). SVM may improve the performance of skin conductance measures of hot flashes.
Collapse
Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | | | | | | |
Collapse
|
34
|
Crawford SL, Avis NE, Gold E, Johnston J, Kelsey J, Santoro N, Sowers M, Sternfeld B. Sensitivity and specificity of recalled vasomotor symptoms in a multiethnic cohort. Am J Epidemiol 2008; 168:1452-9. [PMID: 18953064 PMCID: PMC2727191 DOI: 10.1093/aje/kwn279] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/11/2008] [Indexed: 11/15/2022] Open
Abstract
Many epidemiologic studies include symptom checklists assessing recall of symptoms over a specified time period. Little research exists regarding the congruence of short-term symptom recall with daily self-reporting. The authors assessed the sensitivity and specificity of retrospective reporting of vasomotor symptoms using data from 567 participants in the Study of Women's Health Across the Nation (1997-2002). Daily assessments were considered the "gold standard" for comparison with retrospective vasomotor symptom reporting. Logistic regression was used to identify predictors of sensitivity and specificity for retrospective reporting of any vasomotor symptoms versus none in the past 2 weeks. Sensitivity and specificity were relatively constant over a 3-year period. Sensitivity ranged from 78% to 84% and specificity from 85% to 89%. Sensitivity was lower among women with fewer symptomatic days in the daily assessments and higher among women reporting vasomotor symptoms in the daily assessment on the day of retrospective reporting. Specificity was negatively associated with general symptom awareness and past smoking and was positively associated with routine physical activity and Japanese ethnicity. Because many investigators rely on symptom recall, it is important to evaluate reporting accuracy, which was relatively high for vasomotor symptoms in this study. The approach presented here would be useful for examining other symptoms or behaviors.
Collapse
Affiliation(s)
- Sybil L Crawford
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Shaw Building Room 228, Worcester, MA 01655, USA.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Sievert LL, Begum K, Sharmeen T, Chowdhury O, Muttukrishna S, Bentley G. Patterns of occurrence and concordance between subjective and objective hot flashes among Muslim and Hindu women in Sylhet, Bangladesh. Am J Hum Biol 2008; 20:598-604. [PMID: 18461600 DOI: 10.1002/ajhb.20785] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study examined the pattern of occurrence and the rate of concordance between objective hot flashes measured by sternal skin conductance and the subjective experience of "gorom vap laga" (feeling steaming hot) among Muslim and Hindu women living in Sylhet, Bangladesh. Participants were aged 40-55, not pregnant or lactating, not using hormone therapy, and with no history of hysterectomy. Thirty women wore an ambulatory hot flash monitor for 8 h on average, from mid-morning to early evening. True positive, false negative, and false positive measures of hot flashes were examined in relation to demographic, reproductive, and lifestyle variables. On body diagrams, women were most likely to indicate hot flashes on the top of their head (64%) and upper chest (68%). The greatest number of objective hot flashes occurred during the hour of 17:00, perhaps due to the heat of the day, and the clothing and activity associated with prayer. Muslim participants demonstrated more objective hot flashes per woman than Hindu participants (1.5 vs. 0.1, P < 0.05), and Muslims had more false positive measures (86%) compared with Hindu participants (0%, P = 0.06). Among all women who reported subjective hot flashes (n = 19), the proportion of true positive scores was 19%. Overall, the frequency of objective hot flashes was low compared with reports from studies in the United States. The pattern of sweating assessed by body diagrams was not associated with variation in hot flash experience.
Collapse
|
36
|
Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy. Menopause 2008; 15:862-70. [DOI: 10.1097/gme.0b013e318167b902] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Voss U, Tuin I. Relationship of Sleep Quality with Coping and Life Styles in Female Moroccan Immigrants in Germany. Womens Health Issues 2008; 18:210-6. [DOI: 10.1016/j.whi.2007.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 11/27/2007] [Accepted: 12/15/2007] [Indexed: 10/22/2022]
|
38
|
Fujita T, Hayashi K, Katanoda K, Matsumura Y, Lee JS, Takagi H, Suzuki S, Mizunuma H, Aso T. Prevalence of diseases and statistical power of the Japan Nurses' Health Study. INDUSTRIAL HEALTH 2007; 45:687-694. [PMID: 18057812 DOI: 10.2486/indhealth.45.687] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Japan Nurses' Health Study (JNHS) is a long-term, large-scale cohort study investigating the effects of various lifestyle factors and healthcare habits on the health of Japanese women. Based on currently limited statistical data regarding the incidence of disease among Japanese women, our initial sample size was tentatively set at 50,000 during the design phase. The actual number of women who agreed to participate in follow-up surveys was approximately 18,000. Taking into account the actual sample size and new information on disease frequency obtained during the baseline component, we established the prevalence of past diagnoses of target diseases, predicted their incidence, and calculated the statistical power for JNHS follow-up surveys. For all diseases except ovarian cancer, the prevalence of a past diagnosis increased markedly with age, and incidence rates could be predicted based on the degree of increase in prevalence between two adjacent 5-yr age groups. The predicted incidence rate for uterine myoma, hypercholesterolemia, and hypertension was > or =3.0 (per 1,000 women, per year), while the rate of thyroid disease, hepatitis, gallstone disease, and benign breast tumor was predicted to be > or =1.0. For these diseases, the statistical power to detect risk factors with a relative risk of 1.5 or more within ten years, was 70% or higher.
Collapse
Affiliation(s)
- Toshiharu Fujita
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
This summary of the 3-day "Cross-Cultural Comparisons, Midlife, and Aging" workshop introduces 15 papers that examine menopause from biological, cultural, and health perspectives. The workshop was designed to critically examine the conceptual and methodological bases of cross-cultural studies and to make recommendations regarding future research on midlife and aging. This summary first reviews the comparative method with an emphasis on cross-cultural studies of menopause. Then the difference between etic and emic data is introduced. Etic data are collected by standardized instruments according to the interests of the investigator, whereas emic data reflect the concerns of individuals in the community studied. A brief review of cross-country studies concludes that there is a set of "core" menopausal symptoms but that the nuances of those symptoms seem to be culture-specific. The workshop concluded with a unanimous plea for the collection of similar information, both emic and etic data, to improve cross-cultural comparisons. This multidisciplinary collection of papers is an impressive commentary on what has been done in cross-cultural research and a compendium of suggestions for the future.
Collapse
|