Journal of Mid-life Health最新文献

Falls among the elderly pose a significant public health concern globally. In India, the prevalence of falls ranges from 14% to 53%. Falls can have a significant financial impact on families, particularly in the middle socioeconomic strata, where preventive tools may be more cost-effective. The objective is to assess the awareness and practice of home modification interventions for fall prevention among the elderly population in urban Pune. A cross-sectional questionnaire-based survey was conducted among elderly individuals aged 60 and above, living in four cooperative housing societies in urban Pune. The questionnaire included 35 questions on attitudes, knowledge, and practices related to fall prevention. Statistical analyses included Kruskal-Wallis tests, ANOVA, independent t-tests, and correlation and regression analyses. The knowledge subscale had adequate reliability (Cronbach's alpha = 0.741), while the attitude (0.529) and practice (0.200) subscales showed lower reliability. The study included 132 participants, with 59.09% males and 40.91% females. Majority were from the lower middle socioeconomic status (SES) (51.52%). The mean score for knowledge was 3.90 ± 0.47. Correlation analyses, including Pearson's correlation, linear regression, and point-biserial correlation, revealed a very low and nonsignificant relationship between knowledge and practice (r = 0.019, P = 0.832). Age and SES did not significantly influence practices (P > 0.05). Despite high awareness, significant gaps remain in the practice of fall prevention measures among the elderly in urban Pune. Multifactorial interventions and an Indian-specific assessment tool are necessary for effective fall prevention.

Introduction: The primary objective of evaluating abnormal uterine bleeding is to exclude intrauterine abnormalities, particularly endometrial hyperplasia and carcinoma. Therefore, all individuals over the age of 40 need to undergo endometrial sampling for histopathological evaluation before any definitive management strategies. Endometrial sampling may be conducted using various techniques, including dilatation and curettage (D and C) with metal curettes, such as Novak and Kevorkian, or through endometrial aspiration utilizing flexible instruments like the Pipelle aspirator. Despite the availability of the Pipelle, numerous medical centers continue to prefer D and C under anesthesia. A study at a tertiary medical center compared the adequacy of samples and the detection of malignancies between the Pipelle aspirator and D and C. This study further evaluated pain scores and the overall acceptability of both procedures among participants, providing valuable insights into their effectiveness and patient experience.

Methodology: A comparative study was undertaken to evaluate the adequacy of samples for microscopic examination. This study compared outpatient endometrial sampling conducted with a Pipelle device to D and C performed under anesthesia. Furthermore, the assessment included the evaluation of postprocedure pain and patient satisfaction.

Results: The analysis concluded no significant differences in sample adequacy between the two techniques examined. Women who underwent endometrial biopsies with anesthesia reported experiencing reduced levels of pain and expressed greater satisfaction with the procedure.

Conclusion: While outpatient endometrial sampling utilizing the Pipelle aspirator is a feasible option in low-resource settings, it is essential to consider postoperative pain and patient satisfaction when evaluating practices in high-resource environments.

Adenofibroma of the cervix is an extremely rare benign Mullerian mixed tumor, which contains both benign epithelial and mesenchymal tissue. The WHO 2020 classification of the female genital tract does not even include adenofibroma as a separate entity. A postmenopausal lady in her mid-50s presented with bleeding per vagina. On examination, there were multiple cervical polyps. Histopathology of cervical polyps suggested adenofibroma of the cervix due to the absence of mitotic figures and cellular atypia. Sometimes even well-differentiated adenosarcomas can be misdiagnosed as adenofibroma. Immunohistochemistry markers help in differentiating adenosarcoma from adenofibroma. There are no typical clinical or imaging characteristics that strongly suggest the diagnosis. Although adenofibroma is a benign tumor; still it has been found to invade the myometrium and pelvic veins, relapse, and metastasize. It is crucial to perform a detailed histopathological examination of all the cervical tumors not only to exclude malignant lesions but also to exclude adenofibroma regardless of clinical symptoms.

In the current century, climate change has been regarded as one of the most serious public health threats, which has drastic health, environmental, and social aftereffects. The purpose of the current article is to identify the direct and indirect impacts of climate change on reproductive health and to propose specific public health recommendations to reduce these identified impacts. Climate change has been linked with multiple reproductive concerns, such as pregnancy complications, sexually transmitted infections, and infertility, which can cumulatively pose to be a major concern. Climate change significantly contributes to the deterioration of the air quality, while exposure to fine particulate matter and heavy metals can result in infertility in both men and women by altering hormone levels, impairment of sperm, and the quality of eggs. There arises the need to adopt a proactive and interdisciplinary approach to minimize the impact of climate change on reproductive health. In conclusion, a wide range of direct and indirect consequences of climate change have been reported on reproductive health. This calls for the need to develop climate-adaptive healthcare systems and policies to reduce the existing risks, including promoting easy access to family planning.

Estrogen is a key hormone that influences metabolism, health, and overall well-being throughout a woman's life. Its levels fluctuate across different reproductive stages: perimenopause, menopause, and postmenopause - each bringing unique physiological changes. During perimenopause, estrogen helps regulate insulin production, glucose metabolism, and fat distribution. However, as levels become unstable in this phase, women may experience increased insulin resistance, shifts in fat storage, and a greater risk of metabolic disorders such as diabetes. Given its widespread effects, proactive lifestyle interventions are essential. A balanced diet rich in phytoestrogens, regular physical activity, and maintaining a healthy body weight can help manage hormonal shifts. Advancing research in molecular endocrinology and personalized medicine offers the potential for targeted strategies that deepen our understanding of estrogen's tissue-specific effects. By personalizing interventions to individual hormonal transitions, we can improve women's health outcomes and quality of life.

Orthostatic hypotension (OH) refers to a clinically significant quick drop in blood pressure upon standing. This is due to hypovolemia, autonomic dysfunction, or adverse drug effects. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor which has been typically associated with hypertension. However, several cases of OH have been reported predominantly in elderly people at higher doses. This case highlights a unique presentation of symptoms at the therauptic dose that too in a patient without conventional risk factors. A 55-year-old postmenopausal female with bipolar disorder presented with generalized weakness, dizziness, and lightheadedness a week after initiating venlafaxine for depressive symptoms. Clinical evaluation revealed significant hypotension with normal systemic, neurological, and cardiological examinations. Laboratory investigations didn't reveal anything either. The temporal association between the initiation of venlafaxine and symptom onset led to discontinuation of the drug coupled with supportive management. Symptoms resolved within 48 h, with blood pressure returning to baseline as well. Thus, this case highlights the need for clinicians to be vigilant about potential OH even at standard doses of venlafaxine in patients without typical risk factors. Hence, proving that early identification of such symptoms and prompt dose adjustment/change in therapy can mitigate complications and optimize patient outcomes.

Background: Perimenopause is a transitional phase before menopause, characterized by hormonal fluctuations and irregular menstrual cycles, which can impact overall well-being and relationship. This study examines the prevalence of menopausal symptoms in perimenopausal women and their association with marital relationship.

Materials and methods: A cross-sectional study from November 2023 to February 2024 recruited 979 perimenopausal women aged 40-60 from 7 rural and 3 urban sectors of Khordha district, Odisha. On screening, 768 participants who fulfilled the inclusion criteria were assessed for the severity of menopausal symptoms using the Menopause Rating Scale and the Marital Relationship Questionnaire assessed marital relationship. A semi-structured interview was conducted to explore the partner's support from a woman's point of view. Chi-square and Bonferroni's post hoc analysis were used to associate the severity of menopausal symptoms with marital relationship.

Result: The prevalence of menopausal symptoms was 81.19% among the women whose mean age was 47.8 ± 5.2 years. On assessment, severe symptoms were more prevalent among 52.73% of women, whereas only 1.40% reported mild symptoms. There was a significant association between the severity of menopausal symptoms and marital relationship. On Bonferroni's post hoc analysis, a significant association existed between mild symptoms with good marital relationship and severe menopausal symptoms with a poor relationship. The age and previous medical history were also associated with severe menopausal symptoms, whereas marital relationship was associated with previous medical history.

Conclusion: In perimenopausal women, the symptoms significantly impact marital relationship. Effectively addressing the needs and challenges of menopause can facilitate a smoother transition, promoting better health outcomes and overall well-being for women during this phase.

Primary squamous cell carcinoma (SCC) of the breast is classified by the World Health Organization as a metaplastic carcinoma, meaning that it is made up solely of squamous cells that have undergone metaplasia and frequently show variable degrees of keratinization. Less than 0.1% of all invasive breast carcinomas are primary SCCs, making them incredibly uncommon. The exact cause and development of SCC in the breast remain uncertain. Some suggest it could represent an extreme form of squamous cell metaplasia progressing into adenocarcinoma, potentially explaining its mixed forms. Existing literature reveals only a handful of documented cases to date. This malignancy is notably aggressive, typically lacking hormone receptor expression (triple negative), resistant to standard treatments, and associated with a bad prognosis.

Osseous metaplasia of nonteratomous ovarian cyst is extremely rare, with 33 cases having been reported in the literature till 2020. Research is needed to fully understand the pathogenesis and clinical implications of this condition. Hence, we report this case of a 43-year-old woman with left-sided ovarian endometrioma and osseous metaplasia of both ovaries. A 43-year-old primipara presented with heavy menstrual bleeding and dysmenorrhea of 4 years duration. An ultrasound performed 5 months back showed bilateral ovarian endometriomas, and she had been treated medically. Upon presentation to us, an ultrasound revealed an adenomyotic uterus, with right ovary measuring 3.3 cm × 3.8 cm and left ovary measuring 2.5 cm × 2.8 cm. She was started on tablet dienogest once a day. A repeat ultrasound 3 months later revealed enlarged and calcified right ovary measuring 6 cm × 5 cm and left ovary measuring 5 cm × 4 cm. Her cancer antigen 125 was 21.8 U/mL She denied for an MRI pelvis. Total abdominal hysterectomy and bilateral adnexectomy were performed. Histopathology of the right ovary showed ovarian parenchyma along with areas of extensive osseous metaplasia with calcifications. Sections from the left ovary showed ovarian parenchyma with an endometriotic cyst and moderate to dense inflammation with multiple foci of osseous metaplasia with calcifications. To conclude, osseous metaplasia of the ovary is rare. Our case was associated with benign ovarian endometrioma. The exact etiology of osseous metaplasia of the ovary is not known. We report this case to shed more light on the subject.