Menopause in adult women with human papillomavirus: health-related quality of life and determinants.

OBJECTIVE: Human papillomavirus (HPV) infection and menopause entail a considerable impairment in health-related quality of life (HRQoL). The objective of the present study was to analyze the impact of the menopause status on HRQoL in women with HPV infection. METHODS: A cross-sectional, nationwide, multicenter sample of women with HPV infection was conducted throughout clinics of gynecology representative of the Spanish population with regard to age, geographic density, and autonomous regions. Demographic and clinical characteristics and the specific HPV-QoL questionnaire score with its domains were compared according to reproductive status: premenopausal and peri-/postmenopausal. Correlation with other validated patient-reported outcomes measurements was also tested, including General Health Questionnaire-12 (GHQ-12), Female Sexual Function Index (FSFI), and Hospital Anxiety and Depression Scale (HADS). RESULTS: A sample of 1,016 noninstitutionalized women, aged 18-80 y, was recorded, 191 (18.8%) peri-/postmenopausal and 825 (81.2%) premenopausal. Total HPV-QoL scoring was significantly lower in peri-/postmenopausal (38.8, 95% CI [35.2-42.4]) compared to premenopausal (46.4, 95% CI [45.0-47.8]) women, and also in every domain of the scale (P < 0.05), except in social well-being and health domains, with a small effect size of 0.39. In women with sexual dysfunction according to FSFI, adjusted total scoring and domains sexuality, general well-being, and psychological well-being scored significantly higher in premenopause women (P < 0.01), although the magnitude of differences were of small to moderate size. CONCLUSIONS: HRQoL was impaired during menopause in women with HPV infection according to HPV-QoL questionnaire. The sexuality domain was the most differentiating dimension between these populations.

Population-based norms for the human papillomavirus-quality of life (HPV-QoL) questionnaire: A cross-sectional multicenter study.

INTRODUCTION: Human papillomavirus (HPV) diagnosis has a considerable emotional and psychological impact on women. To evaluate the impairment this infection leads to regarding quality of life (QoL), several scales have been suggested, such as the human-papillomavirus-quality-of-life (HPV-QoL) questionnaire. This has been validated for the Spanish population and measures the impact of HPV on health-related-quality-of-life (HR-QoL). However, normative values are yet to be developed. Thus, the objective was to describe the population-based norms of the HPV-QoL for Spanish women aged 25-65 years and to test the questionnaire's construct validity. MATERIAL AND METHODS: This was a cross-sectional nationwide multicenter study. Women from outpatient clinics in Spain aged 25-65 years, with a diagnosis of past or active HPV infection were recruited. The central tendency, dispersion, and percentiles were calculated for the total score and its dimensions for each age group. Construct validity was tested by analyzing age groups and their correlations with other related scales (12-Item General Health Questionnaire [GHQ-12], Female Sexual Function Index [FSFI], and Hospital Anxiety and Depression Scale [HADS]). RESULTS: A total of 1352 women were included in the study. The norms showed moderate and significant coefficients of correlation with other related scales. Significant differences between age strata groups were found according to educational level, sexual dysfunction, sexual activity, mental deterioration, and severity of anxiety and depression symptoms (p < 0.001 in all cases). The total score differed significantly between the groups (p = 0.006). Significant differences in the contagiousness, health, and sexuality dimensions (p < 0.05) were found among the groups. It was seen that HPV infection impaired women's QoL. Dimensions within all test age groups (p < 0.001 in all cases) were significantly different, with the health dimension being the highest contributor to women's QoL impairment, whereas social well-being was the main determinant of QoL. CONCLUSIONS: Population-based norms for the novel HPV-QoL questionnaire showed adequate validity and could be a useful tool for assessing the impact of QoL among women with HPV in Spain.

Development and psychometric properties of the human papillomavirus-quality of life (HPV-QoL) questionnaire to assess the impact of HPV on women health-related-quality-of-life.

PURPOSE: The HPV-Quality-of-Life (HPV-QoL) questionnaire was developed to determine the impact of Human-Papillomavirus (HPV) infection and related interventions on women health-related quality-of-life. This study provides the development and preliminary psychometric properties of a novel HPV-QoL questionnaire for adult women with HPV. METHODS: After reviewing literature and cognitive debriefing interviews in women who had experienced HPV-related conditions, instrument items and domains were developed. A draft questionnaire was pilot tested for comprehension and ease of completion. Psychometric evaluation of the final HPV-QoL scale was conducted in a psychometric study including 252 adult women derived to our centre by a positive HPV test in the cervical cancer screening program and/or presenting genital warts. RESULTS: The present study reveals that the HPV-QoL questionnaire, structured in four domains: general well-being [including psychological well-being and social well-being subdomains], health, contagiousness and sexuality, showed good metric properties of feasibility irrespective of age or educational level, and time to administer was less than 5 min. Internal consistency and temporal stability (reliability) showed values above the acceptable standards. The instrument showed its concurrent validity by means of a significant correlation with mental and sexual existing instruments; GHQ-12 and FSFI questionnaires, respectively, and also known groups validity showing significant differences among the subgroups regarding either sexual dysfunction or mental deterioration. CONCLUSION: This study provides an HPV-QoL questionnaire with an innovative patient-reported outcomes specific measurement tool to assess HRQoL in women with HPV infection. The present study suggests this questionnaire has satisfactory psychometric properties, including validity and reliability. Results support the use of the HPV-QoL questionnaire as a HRQoL measurement instrument for daily medical practice and clinical research.

Diagnóstico diferencial entre lupus eritematoso sistémico y preeclampsia en una gestante / Differential diagnosis between systemic lupus erythematosus and preeclampsia in a pregnant woman

Presentamos el caso de una mujer de 18 años que durante el tercer trimestre de su embarazo comenzó con hipertensión arterial (HTA) y proteinuria y fue diagnosticada de preeclampsia. La gestación finalizó con éxito, habiéndose controlado satisfactoriamente con tratamiento antihipertensivo. En el plazo de una semana tras el parto desarrolló un síndrome de HELLP y una insuficiencia renal y respiratoria aguda, y fue diagnosticada entonces de lupus eritematoso sistémico y se inició tratamiento con esteroides, plasmaféresis, hemodiálisis y ciclofosfamida. La situación clínica se complicó al sufrir una neumonía por Acynetobacter. Creemos que se trató de una preeclampsia superimpuesta a una nefropatía lúpica hasta entonces silente (AU)

We report the case of an 18 year-old woman that during the third trimester of her pregnancy developed high blood pressure and proteinuria, being diagnosed of preeclampsia. The pregnancy ended successfully having being the hypertension satisfactorialy controlled with treatment. One week after delivery she developed a HELLP syndrome, an acute renal failure and respiratory insufficiency, being diagnosed then of systemic lupus erithematosus and starting a treatment with steroids, plasmapheresis, hemodyalisis and cyclophosphamide. The clinical situation got more complicated due to a pneumony by acynetobacter. We believe that it was a preeclampsia superimposed to an underlying lupus nephritis (AU)

Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales / Preterm premature rupture of membranes and neonatal outcome prior to 28 weeks of gestation

Objetivo: Describir las características y el pronóstico del manejo conservador en gestantes con rotura prematura de membranas pretérmino (RPMP). Material y métodos: Estudio observacional descriptivo de 65 casos de RPMP < 28 semanas, entre 1995 y 2005. Resultados: Características principales: gestación múltiple (29,3%), exudado positivo para Estreptococcus agalactiae (Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de días de bolsa rota (BR), cuando el índice de Bishop es < 7 es de 14 para gestantes con RPMP < 24 semanas y de 5 para gestantes con RPMP ≥ 24 semanas (p = 0,01). El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo: el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios. Conclusiones: Las gestantes con RPMP < 24 semanas e índice de Bishop < 7 presentan mayores períodos de latencia, pero la morbimortalidad maternofetal no aumenta si el índice de líquido amniótico es normal (AU)

Objective: To describe the characteristics and outcomes after conservative management of pregnancies with preterm premature rupture of membranes (PPROM). Material and methods: We performed a descriptive, observational study of 65 cases of PPROM at less than 28 weeks of pregnancy between 1995 and 2005. Results: The main characteristics were twin pregnancies, positive culture for group B Streptococcus agalactiae (14,85%) and previous PPROM (16%). The median number of days with broken membranes, when the Bishop score was < 7, was 14 for pregnancies with PROM < 24 weeks and 5 for pregnancies with PPROM ≥ 24 weeks (P=.01). Conservative management does not increase morbidity or mortality, unless there is moderatesevere oligohydramnios: 100% of chorioamnionitis and 69% of perinatal mortality occurred in pregnancies with oligohydramnios. Conclusions: Pregnancies with RPMP < 24 weeks and a Bishop¿s score of < 7 have a longer latency period and maternal-fetal morbidity and mortality are not increased if the amniotic fluid index is normal (AU)