Factors associated with reporting classic menopausal symptoms differ.

OBJECTIVES: To investigate how symptoms experienced in midlife cluster and to identify factors independently associated with hot flushes, night sweats, and vaginal dryness. METHODS: A questionnaire was sent to 8206 women aged 45-54 years, recruited from family practices in north-east Scotland, UK. Using data collected about 23 symptoms, we conducted factor analysis for premenopausal, perimenopausal, postmenopausal and surgically menopausal women. Forward stepwise logistic regression was used to identify sociodemographic, lifestyle and psychological variables independently associated with the classic menopausal symptoms. RESULTS: Overall, 4407 women responded. Hot flushes were experienced by 46.7% (95% confidence interval (CI) 45.2-48.2) of women, night sweats by 46.4% (95% CI 44.9-47.9) and vaginal dryness by 28.2% (95% CI 26.9-29.6). Seven factors including 20 symptoms emerged from factor analysis. Hot flushes were associated with: being perimenopausal or postmenopausal; low education; obesity; low social support; reporting night sweats, musculoskeletal, bloating, menstrual and sexual symptoms; using complementary alternative medicines, lifestyle (e.g. exercising) or psychological management strategies (e.g. talking to family or friends) for menopausal symptoms. Night sweats were associated with: lower body weight; smoking; possible depression; reporting sleep difficulties, hot flushes and sexual symptoms; using lifestyle strategies for menopausal symptoms. Vaginal dryness was associated with: being postmenopausal; high education; high social support; below average physical health, reporting hot flushes, somatic symptoms and decreased sexual interest; using psychological or lifestyle strategies for menopausal symptoms. CONCLUSION: It is important to investigate each classic menopausal symptom separately. Combining menopausal symptoms into categories such as vasomotor symptoms may lead to inaccurate conclusions about variables associated with these symptoms.

The impact and management of symptoms experienced at midlife: a community-based study of women in northeast Scotland.

OBJECTIVES: To determine the frequency and management of menopausal symptoms among community-dwelling women. DESIGN: Cross-sectional study. SETTING: Northeast Scotland. POPULATION: Women aged 45-54 years registered with 16 general practices. METHODS: In 2009, a self-completed questionnaire enquiring about the frequency, associated level of bothersomeness and management of 23 symptoms experienced during the previous month was sent to 8206 women. MAIN OUTCOME MEASURES: The proportion (95% CI) of women reporting each symptom and management strategy. RESULTS: Hot flushes, night sweats and vaginal dryness were reported by 46.7% (95% CI 45.2-48.2), 46.4% (95% CI 44.9-47.9) and 28.2% (95% CI 26.9-29.6) of women, respectively. Two-fifths of women rated these symptoms as quite bothersome or extremely bothersome. More than 60% managed menopausal symptoms using social support by talking to friends and family. Avoidance or alleviating options were common. Herbal remedies were more commonly used than prescription drugs. Current hormone replacement therapy use was highest among surgically menopausal women (21%); 8% of postmenopausal and <2% of perimenopausal women with symptoms were using hormone replacement therapy. Many women had sought information about symptom management. More than one-third of women wanted more support about menopausal symptoms from their general practitioner or practice nurse. CONCLUSION: Following the publication of the Women's Health Initiative trial results, menopausal symptoms remain common and are often bothersome. Many women seek information about menopausal symptoms from healthcare professionals. Future studies should look beyond frequently researched management strategies, to consider other commonly used options, such as social support, strategies to reduce core body temperature and information about managing menopausal symptoms.

The menopause 'It's somewhere between a taboo and a joke'. A focus group study.

OBJECTIVES: To explore the menopause from the perspective of women in the community, with specific emphasis on their experience of menopausal symptoms, management strategies and support post the Women's Health Initiative trial. METHODS: Four focus groups were conducted with 14 middle-aged women living in the Grampian region of Scotland. The groups lasted up to 2 hours and were analyzed using the framework approach. RESULTS: Symptom experience was multifaceted and varied, depending on factors such as embarrassment from symptoms, loss of identity, expectations, social support and effectiveness of management strategies. Lack of support was highlighted as a reason why some participants felt confused about the symptoms that they could attribute to the menopause and the management strategies available to them. A variety of management strategies had been used including hormone replacement therapy, herbal remedies and lifestyle changes, with varying levels of success. Some women who chose not to use hormone replacement therapy (HRT) preferred to use lifestyle changes or felt that their symptoms did not warrant hormonal therapy. Some women felt that they had to persuade their family doctor to prescribe HRT and felt that their doctors were too restrictive in prescribing this treatment. CONCLUSIONS: Although having good social support in general, some respondents felt less supported about the menopause and felt that improved support networks would diminish some of the confusion about symptoms experienced and management strategies available. In spite of the negative publicity surrounding HRT in recent years, a number of women perceived their family doctor as too restrictive when prescribing HRT.

Review of the impact of voice training on the vocal quality of professional voice users: implications for vocal health and recommendations for further research.

OBJECTIVE: To review the current published available research into the impact of voice training on the vocal quality of professional voice users, to provide implications for vocal health and recommendations for further research. DESIGN: Literature review with a systematic approach. METHODS: A systematic search of the literature was conducted using electronic databases and the following defined search terms: occupational voice or occupational dysphonia or voice and occupational safety and health. To obtain the comprehensive relevant literature, no studies were excluded on the basis of study design. In total, 10 studies that investigated the impact of a voice training intervention on the vocal quality of professional voice users as a potential prevention strategy for voice disorders were selected for this review. RESULTS: The 10 studies ranged in design from observational to randomized controlled trials with mainly small sample sizes (N = 11-60). Nine studies showed that voice training significantly (P < 0.05) improved at least one voice-related measurement from the several investigated from baseline. Five studies reported that voice training significantly (P < 0.05) improved at least one measurement compared with no training. CONCLUSIONS: Findings indicate that there is no conclusive evidence that voice training improves the vocal effectiveness of professional voice users, as a result of a range of methodological limitations of the included studies. However, some studies did show that voice training significantly improved the knowledge, awareness, and quality of voice. Therefore, there is a need for robust research to empirically confirm this, with implications for vocal health, and occupational safety and health policies.

Occupational voice demands and their impact on the call-centre industry.

BACKGROUND: Within the last decade there has been a growth in the call-centre industry in the UK, with a growing awareness of the voice as an important tool for successful communication. Occupational voice problems such as occupational dysphonia, in a business which relies on healthy, effective voice as the primary professional communication tool, may threaten working ability and occupational health and safety of workers. While previous studies of telephone call-agents have reported a range of voice symptoms and functional vocal health problems, there have been no studies investigating the use and impact of vocal performance in the communication industry within the UK. This study aims to address a significant gap in the evidence-base of occupational health and safety research. The objectives of the study are: 1. to investigate the work context and vocal communication demands for call-agents; 2. to evaluate call-agents' vocal health, awareness and performance; and 3. to identify key risks and training needs for employees and employers within call-centres. METHODS AND DESIGN: This is an occupational epidemiological study, which plans to recruit call-centres throughout the UK and Ireland. Data collection will consist of three components: 1. interviews with managers from each participating call-centre to assess their communication and training needs; 2. an online biopsychosocial questionnaire will be administered to investigate the work environment and vocal demands of call-agents; and 3. voice acoustic measurements of a random sample of participants using the Multi-dimensional Voice Program (MDVP). Qualitative content analysis from the interviews will identify underlying themes and issues. A multivariate analysis approach will be adopted using Structural Equation Modelling (SEM), to develop voice measurement models in determining the construct validity of potential factors contributing to occupational dysphonia. Quantitative data will be analysed using SPSS version 15. Ethical approval is granted for this study from the School of Communication, University of Ulster. DISCUSSION: The results from this study will provide the missing element of voice-based evidence, by appraising the interactional dimensions of vocal health and communicative performance. This information will be used to inform training for call-agents and to contribute to health policies within the workplace, in order to enhance vocal health.

Effects of various cytochrome P-450 inducers on testosterone metabolism and several monooxygenase activities in Sprague-Dawley (SpD), high alcohol sensitivity (HAS) and low alcohol sensitivity (LAS) rats.

Hydroxylation of testosterone (TST) has been shown to be regio- and stereo-specific for a number of cytochrome P-450 isoenzymes. Three rat lines [Sprague-Dawley (SpD), high alcohol sensitivity (HAS) and low alcohol sensitivity (LAS)] were tested for this enzymatic specificity after treatment with phenobarbital, clofibrate, 3-methylcholanthrene and pregnenolone-16 alpha-carbonitrile. These compounds are known to induce cytochrome P-450 2B, 4A, 1A and 3A1, respectively, in the rat. Induction efficiency was established by using the usual enzyme activities specific for these P-450s (pentoxyresorufin, lauric acid, ethoxyresorufin and nifedipine oxidase). Five mono hydroxylated TST metabolites were separated using a sensitive HPLC procedure. The hydroxylation of TST was found to be significantly different between the lines even in the uninduced state. The formation of the metabolites of TST, hydroxylated on 2 alpha or 7 alpha or 16 alpha positions and oxidated on carbon 17 (delta 4), was found to be significantly increased in SpD rats when compared with the HAS-LAS lines (P < 0.0001 in each case). When the HAS-LAS lines were compared, the quantity of 2 alpha and 16 alpha hydroxylated metabolites was found to be significantly lower in LAS rats (P < 0.05). These differences persisted, although in the opposite direction, after 3-methylcholanthrene (P < 0.01 for both 2 alpha and 16 alpha) and phenobarbital induction (P < 0.01 for 2 alpha).(ABSTRACT TRUNCATED AT 250 WORDS)

Tolerance and dependence in high alcohol sensitivity (HAS) and low alcohol sensitivity (LAS) rats after chronic alcohol intoxication by inhalation.

In rats selected for their differences in sleep time following acute administration of ethanol (high or low alcohol sensitivity: HAS or LAS), alcohol chronic tolerance and behavioural dependence were determined. Tolerance was assessed by calculating the interval between the loss and regain of the righting reflex following an acute administration of ethanol (4 g/kg body wt), after intoxication by inhalation of ethanol vapour for 3 weeks. The importance of behavioural dependence was estimated by measuring the ethanol intake in a free-choice situation water/ethanol (10% v/v), after intoxication by inhalation for 4 weeks. The two HAS and LAS lines did not show any behavioural dependence, while they developed a significant tolerance to the hypnotic effect of ethanol, which was more marked for the LAS line.

Attenuation of the effects of chronic ethanol administration in the brain lipid content of the developing rat by an oil enriched in gamma linolenic acid.

Chronic ethanol administration to adult rats results in an increase in the linolenic (18:2) to arachidonic (20:4) acid ratios in brain phospholipids. Administration of a diet rich in essential fatty acids can reverse some of the effects of chronic ethanol administration on neuronal membranes. In this study we investigated the effect of ethanol on the neuronal membranes of rat pups and also the effect of the concomitant administration of gamma linolenic acid (18:3) as a component of Evening Primrose Oil (EPO). We found an increase in the concentration of several saturated fatty acids that are components of the phospholipids and a decrease in the mono- and polyunsaturated fatty acid content. EPO was found to attenuate the effect of ethanol in inhibiting the synthesis of polyunsaturated fatty acids. These effects of EPO are probably a direct consequence of the essential fatty acids in the oil circumventing the inhibitory effects of ethanol on polyunsaturated fatty acid synthesis.

Effects of an oil enriched in gamma linolenic acid on locomotor activity and behaviour in the Morris Maze, following in utero ethanol exposure in rats.

Ethanol is known to decrease the quantity of polyunsaturated fatty acids in brain membranes possibly as the repercussion of an inhibition of delta-5- and delta-6-desaturases. Consequently behavioural changes may occur. Evening Primrose Oil (EPO) which is rich in gamma linolenic acid (10% 8:3 (n-6)) was proposed to try to circumvent these deleterious effects of ethanol. An animal model of the foetal alcohol syndrome was used in which ethanol was administered throughout gestation and into the weaning period, in a milk diet. EPO was administered concurrently with ethanol to establish the effect of this essential fatty acid and ethanol on the animal's behaviour. Animals were tested at approximately 60 days of age for their responses in two different behavioural paradigms, i.e. the stressful memory task of the Morris Maze and the non-stressful activity monitor. In this study we report an increase in learning ability in male (Control-EPO and alcohol-EPO versus their control: P less than 0.00001 and P less than 0.01, respectively) and female rats (Control-EPO and alcohol-EPO versus control: P less than 0.0001 and P less than 0.00001, respectively) after administration of EPO. It was also found that ethanol plus EPO administration consistently raised the activity scores of the rats in the activity monitor (daytime activity scores for male and female rats were P less than 0.00001 and P less than 0.0001, respectively), while ethanol alone decreased the scores (male and female rats P less than 0.00001 and P less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in whole brain membranes of rats following pre- and post-natal exposure to ethanol.

The chronic effects of ethanol on the fatty acid composition of rats that have been exposed to ethanol in utero were examined. Ten female Wistar rats were fed a nutritionally adequate liquid diet for 3 weeks before mating, throughout gestation and until the offspring reached the 10th or 20th post-natal day. Whole brain lipid changes were examined at these 2 time points. On day 10, a decrease in 18:1 lipid content was found, indicating tolerance development. However, by day 20 an increase in polyunsaturated fatty acid content (20:4) was detected, indicating that ethanol may be causing an increase in membrane fluidity. Although these results are contrary to those found in adult rats following chronic ethanol administration, it seems likely that, in the immature animal, the brain is still undergoing rapid development and therefore may be affected differentially by ethanol.

N-methyl-D-aspartate receptor complex modulation by neuropeptide Y and peptide YY in rat hippocampus in vitro.

Neuropeptide Y (NPY) and peptide YY (PYY) are known to bind with high affinity to sigma (sigma) and phencyclidine (PCP) binding sites in rat brain. The functional significance of these results was assessed by testing both peptides in an in vitro bioassay system used for studying the N-methyl-D-aspartate (NMDA) receptor and consisting of rat hippocampal slices preloaded with [3H]noradrenaline (NA) and maintained under superfusion. The addition of NMDA in the superfusion medium induced an efflux of [3H]NA from the slices and the presence of NPY and PYY produced an enhancement of the stimulating effect. These results suggest that NPY and PYY could have a modulatory role at the NMDA receptor complex through an interaction with the sigma and/or PCP receptor.

Pasteurella multocida bacteremia associated with peritonitis and cirrhosis.

Pasteurella multocida has been the etiologic agent in at least three cases of "spontaneous" bacterial peritonitis (SBP). We report another patient with P. multocida bacteremia and SBP and suggest that there may be more than a chance association between cirrhotic liver disease and this unusual organism which rarely causes sepsis in man.