Journal of Mid-life Health最新文献

Background: Menopause brings about significant hormonal changes that can affect various aspects of women's health, including nasal function. However, the specific impact of menopause on nasal health in Indian women remains underexplored. This study aims to compare nasal function using the Nasal Obstruction Symptom Evaluation (NOSE) score between premenopausal and postmenopausal Indian women.

Materials and methods: A comparative cross-sectional study was conducted involving 107 premenopausal and 111 postmenopausal women recruited from a tertiary care hospital in India. Demographic data, medical history, and NOSE scores were collected. Statistical analyses including Wilcoxon rank-sum test, Chi-squared test, logistic regression, and receiver operating characteristic curve analysis were performed.

Results: Postmenopausal women were significantly older with higher body mass index (BMI) compared to premenopausal women. Postmenopausal women consistently had higher NOSE scores indicating worse nasal function across various time points. Logistic regression revealed menopausal status as a significant predictor of severe nasal obstruction (odds ratio: 1.45, 95% confidence interval: 1.10-1.90, P = 0.015), independent of age, BMI, and other factors.

Conclusion: Menopause is associated with a significant decline in nasal function in Indian women, as evidenced by higher NOSE scores in postmenopausal women. Addressing nasal symptoms in postmenopausal women may improve their quality of life. Further research is needed to develop targeted interventions for managing nasal obstruction in this population.

Background: The hormonal shifts and physiological changes during menopause, including perimenopause and postmenopause, significantly affect women's mental health, often causing depression and sleep disruptions. The objectives of this study are to estimate the prevalence of depression and sleep disturbances among perimenopausal and postmenopausal women and to find the associated risk factors.

Materials and methods: In a community setting, 462 women aged 45-60 years were chosen from 23 clusters using probability proportional to size sampling. Sociodemographic information was collected through standardized surveys, whereas depression levels were measured with Beck's Depression Inventory-II and sleep quality with the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS version 21.

Results: The prevalence of depression among the study participants was 33.3% (95% confidence interval [CI]: 29%, 37%), whereas poor sleep quality was found in 37% (95% CI: 36%, 39%). Factors such as low socioeconomic status (adjusted odds ratios [aOR] =1.64), recent negative life events (aOR =2.27), lack of social media usage (aOR =2.77), and being unmarried/widowed (aOR =2.1) were identified as independent predictors of depression. Living in urban areas (aOR =1.69), low socioeconomic status (aOR =1.96), and inadequate intake of fruits and vegetables (aOR =0.43) were identified as independent predictors for sleep disturbances.

Conclusions: This study highlights a notable burden of depression and sleep disruptions among menopausal women. Tackling these challenges necessitates accessible mental healthcare, educational workshops on stress management and sleep habits, nutritional guidance, and peer support networks. Incorporating these measures into health initiatives and policies holds promise for mitigating these concerns and enhancing overall well-being.

Cystic adenomyosis, a rare variant of adenomyosis, poses diagnostic challenges due to its resemblance to other uterine pathologies. We present the case of a 37-year-old multiparous woman with a history of cesarean sections, who presented with heavy menstrual bleeding and progressive pelvic pain. Despite initial medical management, symptoms persisted, prompting further investigation. Ultrasonography initially suggested fibroid degeneration or a neoplastic change, later confirmed by magnetic resonance imaging which showed degenerative changes in fibroid. However, worsening symptoms and failed medical management led to surgical intervention. The patient underwent a total abdominal hysterectomy, revealing cystic spaces filled with altered blood within the myometrium. Histopathological analysis postsurgery confirmed the diagnosis of cystic adenomyosis. This case highlights the diagnostic challenges and therapeutic considerations in managing cystic adenomyosis in multiparous women.

Uterine arteriovenous malformation (UAVM) is an infrequent occurrence among postmenopausal women. Our review of the literature revealed only a few documented cases of UAVM in this demographic. Treatment options for these patients encompass uterine artery embolization (UAE), medical management, and hysterectomy. We encountered a case involving a 54-year-old woman, postmenopausal for 9 years, who presented with a history of postmenopausal bleeding over the preceding 3 months. Imaging studies confirmed the presence of UAVM. Despite an attempted UAE, the procedure proved unsuccessful, leading to the decision to perform a hysterectomy with meticulous attention to minimizing blood loss. Notably, UAE may not consistently achieve favorable outcomes in addressing UAVM in postmenopausal women, thereby underscoring the consideration of hysterectomy as a safe alternative - treatment option without any excessive intraoperative bleeding.

Background: The elderly are disproportionately affected by depression, a devastating mental health illness that is common and causes significant impairment and a poor quality of life. In a community setting in India, this study sought to evaluate the prevalence of depression, degrees of associated disability, healthcare use patterns, health-seeking behavior, and awareness of government initiatives of mental health and care for the elderly.

Objectives: This study was aimed to determine the prevalence of depression and to assess the health-seeking behavior among the geriatric population aged ≥60 years in the study area during the study period.

Methodology: A cross-sectional community study including 450 senior citizens aged ≥60 years living in urban slums was carried out. Data were collected through structured interviews, utilizing the Geriatric Depression Scale using 30 items for assessing depression, the Sheehan Disability Scale for evaluating disability levels, and questionnaires on healthcare utilization, health-seeking behavior, and knowledge of government programs.

Results: The prevalence of depression was high, with 129 (28.67%) participants suffering from mild depression and 33 (7.33%) from severe depression. Moderate to marked disruptions in their work (17, 51.52%), social life/leisure pursuits (24, 72.73%), and social responsibilities (family life) (27, 51.52%) were reported in a significant proportion of those with severe depression. Additionally, a substantial percentage reported feeling impaired and unproductive for most days of the week (P < 0.001). While the majority (358, 79.56%) visited healthcare providers, with 333 (93.02%) visiting government providers and 330 (92.18%) visiting community-level providers, the utilization of mental health services (10, 2.79%) and treatment for depression with antidepressants (7, 4.32%) was minimal. In addition, just 26 people (5.78%) and 3 people (0.67%) knew about the National Programme for Health Care of the Elderly and the Mental Healthcare Act of 2017, respectively, indicating a lack of knowledge regarding government initiatives pertaining to mental health and geriatric care.

Conclusion: The study highlights the significant burden of depression, associated disabilities, and inadequate health-seeking behavior among the elderly population in the study setting. Efforts should focus on strengthening community-based mental health services, improving awareness and access to existing health services and government programs and addressing the various risk factors responsible for the emergence and persistence of depression, and poor health-seeking behavior in the aforementioned vulnerable group.

Superficial myofibroblastoma of the lower female genital tract is a rare and recently identified benign mesenchymal tumor with only 57 cases reported till now. Majority of the cases are described in the vagina and few cases in the cervix and vulva. It may present as a polypoid or cystic mass, and few cases are detected incidentally. It has a unique morphology and immunohistochemical features. The entity may mimic other benign and malignant conditions of the female genital tract and hence pose a diagnostic challenge. Here, we describe a patient with cervical superficial myofibroblastoma who presented with bleeding per vaginum and polyp in the cervix. Morphology and immunohistochemical findings helped in the final diagnosis. Awareness of this rare benign entity can help us to differentiate superficial myofibroblastoma from many aggressive entities and thus prevent radical surgeries.

Diet plays an important role in the complete management of type 1 and type 2 diabetes. The aim of nutritional management of diabetes is to optimize glycemic control, help in achieving ideal body weight, and correct any lipid abnormalities to reduce the risk of long-term complications. However, there are varied and many unscientific beliefs about diet among patients with diabetes as well as in physicians, which very often makes nutritional management challenging. The most common misconception is that patients with diabetes should not consume sugar at all. The taste of food plays an important role in food choices, eating behaviors, food intake, and associated satisfaction. The more distant a recommended change is from the person's actual eating habits, the more difficult it will be to achieve long-term compliance to the recommended change. It is important to provide therefore achievable and sustainable dietary modifications that will encourage people to adopt healthier food choices without compromising their taste preferences. Special attention needs to be given to the nutrition intake in gestational diabetes mellitus. Consensus guidelines have recommended a low glycemic index, high fiber, and protein diet in gestational diabetes mellitus. Alcohol intake in nonpregnant women and supplements rich in micronutrients are both key considerations. There is clearly a need for conducting educational programs for physicians as well as patients to dispel misconceptions regarding the consumption of carbohydrates, especially added sugar, in patients with diabetes. The focus should be on balancing the calorie intake rather than placing unnecessary and inappropriate restrictions.

Primary ovarian leiomyoma is a very rare benign tumor accounting for 0.5%-1% of all the benign ovarian neoplasms. The most common presentation is unilateral, small masses discovered incidentally on radiology, predominantly occurring in premenopausal women of age group 20-65 years. A 49-year-old woman presented with pain in the abdomen and abnormal uterine bleeding. Ultrasonography showed a heterogeneous, hypoechoic solid mass of size 10.4 cm × 6.4 cm × 7.7 cm arising from fundus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histological examination revealed a leiomyoma arising primarily in the right ovary. The diagnosis was confirmed immunohistochemically. Ovarian leiomyoma, a rare tumor of the ovary, should be considered in the differential diagnosis of solid ovarian masses, which display gross anatomical and histological similarities. An immunohistochemical analysis is essential for definitive diagnosis. Herein, we report a case of unilateral ovarian leiomyoma in a premenopausal woman.

Cellular angiofibroma (CA) is a relatively recently described, rare, benign soft tissue tumor that predominantly occurs in the vulvoperineal region. It was first described in 1997 as a mesenchymal-origin tumor composed of connective (fibrous) tissue and blood vessels. We report a case of vaginal CA in a 40-year-old woman who presented with pressure symptoms, incidentally diagnosed with a vaginal mass and clinically suspected as vaginal myoma. This case was diagnosed based on histomorphology and immunohistochemistry and underwent surgical treatment. This tumor was a diagnostic dilemma for other benign and aggressive spindle cell tumors in the same area, such as endometrial stromal nodule, spindle cell lipoma, solitary fibrous tumors, and mixed tumors of the vagina.