Does AMH relate to timing of menopause? Results of an Individual Patient Data meta- analysis.

CONTEXT: Anti-Müllerian hormone based (AMH) age at menopause predictions remain cumbersome due to predictive inaccuracy. OBJECTIVE: To perform an Individual Patient Data (IPD) meta-analysis, regarding AMH based menopause prediction. DATA SOURCES: A systematic literature search was performed using PubMed, Embase and Cochrane databases. STUDY SELECTION: Prospective cohort studies regarding menopause prediction using serum AMH levels were selected by consensus discussion. DATA SELECTION: Individual cases were included if experiencing a regular cycle at baseline. Exclusion criteria were hormone use and gynecological surgery. DATA SYNTHESIS: 2596 women were included, 1077 experienced menopause. A multivariable Cox regression analysis assessed time to menopause (TTM) using age and AMH. AMH predicted TTM, however, added value on top of age was poor (age alone C-statistic 84%; age + AMH HR 0.66 95% CI 0.61-0.71, C-statistic 86%). Moreover, the capacity of AMH to predict early (≤45 years) and late menopause (≥55 years) was assessed. An added effect of AMH was demonstrated for early menopause (age alone C-statistic 52%; age + AMH HR 0.33, 95% CI 0.24-0.45, C-statistic 80%). A Weibull regression model calculating individual age at menopause revealed that predictive inaccuracy remained present and increased with decreasing age at menopause. Lastly, a check of non-proportionality of the predictive effect of AMH demonstrated a reduced predictive effect with increasing age. CONCLUSION: AMH was a significant predictor of TTM and especially of time to early menopause. However, individual predictions of age at menopause demonstrated a limited precision, particularly when concerning early age at menopause, making clinical application troublesome.

Is the association between insulin resistance and diabetogenic haematopoietically expressed homeobox (HHEX) polymorphism (rs1111875) affected by polycystic ovary syndrome status?

Polycystic ovary syndrome (PCOS) is frequently accompanied by insulin resistance (IR). The aim of the present study was to investigate whether the genetic association between insulin resistance and two single nucleotide polymorphisms (SNPs), namely rs7903146 (C/T) in transcription factor 7-like 2 (TCF7L2) and rs1111875 (A/G) in haematopoietically expressed homeobox (HHEX), is affected by PCOS status in Iranian women. The study participants consisted of 582 women with PCOS (cases) referred to the Reproductive Endocrinology Research Center and 504 subjects without PCOS (controls), randomly selected from the Tehran Lipid and Glucose Study. Cases and controls were further subdivided to two groups according to IR status: those with and without IR. IR was identified on the basis of homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.63. The SNPs in TCF7L2 and HHEX were genotyped by polymerase chain reaction-restriction fragment length polymorphism. There were no significant differences in the distribution of genotypes and alleles between cases and controls (P<0.05). Among cases, the prevalence of the CC, CT and TT genotypes was 37.8%, 46.3% and 15.9%, respectively, whereas the prevalence of the AA, AG and GG genotypes was 13.5%, 46.1% and 40.4%, respectively. In the control group, the prevalence of the CC, CT and TT genotypes was 32.2%, 53.9% and 13.9%, respectively, whereas the prevalence of the AA, AG and GG genotypes was 11.3%, 48.6% and 40.0%, respectively. After adjustment for age and body mass index, the probability of IR was decreased by 49% among carriers of the A allele in the control group (95% confidence interval 0.33-0.78; P=0.002). The findings of the present study suggest that the association between IR and diabetogenic polymorphisms may be affected by PCOS status.

Sexual function and hormonal profiles in women with and without polycystic ovary syndrome: a population-based study.

There is no consensus regarding the impact of polycystic ovary syndrome (PCOS) and its hormonal profile on sexual function of affected women; majority of data documented are not population based and there is a lack of studies investigating the association between hormonal profiles with sexual function in women with PCOS. We aimed to compare the sexual function of PCOS women with controls in a population-based study based on their hormonal profiles. In this cross-sectional study, sexual function (using the Female Sexual Function Index (FSFI) questionnaire) and hormonal profiles were determined in 63 PCOS subjects and 216 healthy women (controls); aged 18-45 years. A comparison of PCOS women and controls showed no statistically significant difference in total FSFI and each of its specific domain scores. There were significant positive correlations between dehydroepiandrosterone sulfate and total FSFI, orgasm and satisfaction domains in controls (r=0.156, r=0.206, r=0.275, respectively). No significant correlations between hormonal profiles and FSFI scores were found in the PCOS group, except for prolactin and orgasm (r=-0.250). In conclusion, sexual function did not differ between PCOS women and controls. High levels of androgens in women with PCOS were not associated with an improvement in sexual function.

Community mobilization for youth health promotion: a lesson learned from iran.

BACKGROUND: More than 36 % of the total population of Iran consists of young people aged 15 to 25 yr. Recent studies show that this age group has the highest rate of serious health problems. Youth participatory studies on youth health priority have shown that mental health is one of the most important priorities in youth health. Aim to assessing the mental health needs of youth we conducted a peer group based multidisciplinary study. METHODS: To conduct a multi disciplinary approach through involving youth for finding their mental health needs and their suggestion for solving them, we designed a qualitative approach based on grounded theory. To data collection, we used a semi-structured guide questionnaire. Sixteen focus group discussions were conducted by trained peers with youth aged 15-25 years. RESULT: According to FGDs results, most of youth health needs concern with their interpersonal communications skills particularly with their parents'; they had some problems with their parental expectations meet; life skills; self-expression and problem solving process. They were extremely interested in participatory approach in which they involved in assessment and determination of their health problems also in designing health programs. CONCLUSION: Success of program shows empowering the community through capacity building and notice to peer group-based interventions to critical enhancing in various aspects of youth health is the most effective method to needs assessment and community mobilization for better health.

An Experience of Peer Education Model among Medical Science University Students in Iran.

BACKGROUND: The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers' experiences. METHODS: This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness. RESULTS: In our experience Stakeholders' partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators' role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness. CONCLUSION: Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth.