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QUALITY OF LIFE - A FEW DEFINITIONS

QUALITY OF LIFE - A FEW DEFINITIONS. “.….gap between expectations and achievement: the smaller the gap, the higher the quality of life” Calman …..ability to function cognitively, physically, socially and sexually, to perform usual daily activities” Stewart & King

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QUALITY OF LIFE - A FEW DEFINITIONS

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  1. QUALITY OF LIFE - A FEW DEFINITIONS “.….gap between expectations and achievement: the smaller the gap, the higher the quality of life” Calman …..ability to function cognitively, physically, socially and sexually, to perform usual daily activities” Stewart & King “…..overall satisfaction with life and sense of personal well-being” Shumaker

  2. QUALITA’ DI VITA Salvaguardare la salute di un individuo significa non solo assicurare il suo benessere fisico ma anche quello psicologico

  3. Menopause: factors that can affect QoL • vasomotor and sleep disturbances • psychological and emotional stress • genitourinary and sexual complaints • changes in body image • op: backache, fractures • CVD: angina • Alzheimer disease

  4. QUALITA’ DI VITA • Uno dei principali sforzi del ginecologo dovrebbe essere quello di eliminare o migliorare questi sintomi • HRT può essere utilizzata per mantenere l’efficienza fisica e psicologica quotidiana della donna in menopausa

  5. Women’s Health Questionnaire (WHQ) scores according to menopausal status in 928 women

  6. CONSEGUENZE DELLA MENOPAUSA A breve termine A medio termine A lungo termine Artralgie Ansia Sudorazioni VampateAtrofia Parestesiegenito-urinaria Palpitazioni Astenia Depressione Cefalea Insonnia Vertigini Precordialgie Osteoporosi Malattie cardiovascolari Peggioramento funzioni cognitive Danni cutanei e oculari

  7. Progetto Menopausa Italiasotto il patrocinio ed il coordinamento dell’AOGOI Obiettivi 1) descrivere l’epidemiologia dell’approccio diagnostico- terapeutico alla menopausa nei centri specialistici in Italia 2) descrivere le conseguenze della menopausa stessa sulla salute della donna. Eleggibili per lo studio tutte le donne osservate per la prima volta nel periodo di reclutamento presso i centri collaboranti

  8. Progetto Menopausa Italiasotto il patrocinio ed il coordinamento dell’AOGOI 99.363 donne arruolate al 02/02/02 1 CED 240 SPAC 185 U.O.

  9. PROGETTO DONNA QUALITÀ DI VITA 74 Centri Universitari e Ospedalieri sul territorio Nazionale Presidente Prof. A. R. Genazzani (Pisa) Comitato ScientificoSegreteria Scientifica Prof. C. Campagnoli (Torino) Prof .C. Nappi (Napoli) Dr. M. Gambacciani (Pisa) Prof. GiovanBatttista Serra(RM) Comitato di Coordinamento Prof. D. de Aloysio (Bologna) Prof. C. Donati Sarti (Perugia) Prof. S. Guaschino (Trieste) Prof. A. Cianci (Catania) Prof. F. Petraglia (Udine) Prof. S.. Schonauer (Bari) Prof. A. Volpe (Modena) Prof . G. Palumbo (Catania) Dr. A. Genazzani (Modena) Prof. F. Bottiglioni (Bologna)

  10. The WOMEN’S HEALTH QUESTIONNAIRE WHQ (by Myra Hunter) • 36 items combined into nine factors describing: • somatic symptoms • depressed mood • cognitive difficulties • anxiety/fear • sexual function • vasomotor symptoms • sleeps problems • menstrual symptoms • attraction • All the questions are rated on four-point scale.

  11. The MOS 36-Item Short-Form Health Survey (SF- 36) • 36 items combined into eight factors • physical function • physical role • bodily pain • general health • vitality • social function • mental health • and two summarizing measures • physical health • mental health

  12. The European Quality of Life Questionnaire EQ-5D • Simple, generic measure • Minimum number of questions • It produces an overall single number, “an index” of health status • Includes 5 dimensions: • mobility • personal care • usual activities • pain/discomfort • anxiety/depression) • (with 5 questions, 3 levels of response for each dimension)

  13. QUALITY OF LIFE EVALUATION IN ITALIAN MENOPAUSAL WOMEN • Multicentric study on the quality of life (QoL ) in women aged between 45 and 65 years, attending menopause centres in Italy. • Each of 64 menopause centres involved recruited up to 50 women, using random lists stratified by HRT (yes – no).

  14. QoL variables • Age • marital status • employment, partners’ employment • Employment was considered as a proxy for socio-economic status. To this purpose, a socio-economic score (SES) was created, ranging from 1 to 6. The score was assigned as follows: unemployed, housewife=1; retired=2; unskilled worker=3; skilled worker, artisan=4; technical, clerical=5; professional, managerial=6. For married women, the profession scoring higher between wife and husband was considered. • geographic area • menopause duration • presence of chronic diseases • presence of HRT

  15. Percent distribution of the 2760 PMW according to HRT( on HRT, n=1342, 49%). Women on HRT were significantly more likely to have a menopause duration >3 years and significantly less likely to suffer from chronic diseases. 0.00002 0.0003

  16. 0.000001 0.00007 0.00006 0.00001 Percent distribution of the 2760 PMW according to geographic area. PMW attending menopause centres in northern Italy are older, with lower education, lower socio-economic score and longer menopause duration.

  17. QUALITY OF LIFE EVALUATION IN ITALIAN MENOPAUSAL WOMEN • Correlates of QoL were first investigated with a series of bivariate analyses • To adjust for the possible confounding effects, multiple logistic regression analyses were applied to evaluate the independent role of variables investigated in predicting QoL

  18. Results of the stepwise logistic regression analyses with SF-36 scores as dependent variables. • school education(the higher the education, the better the QoL), • socio-economic score(the higher the SES, the better the QoL), • geographic area(women in southern Italy showing worse QoL), • presence of chronic conditions(associated with poorer QoL) • marital status and menopause durationare not related with any of the SF-36 areas

  19. Independent predictors of SF-36 domains HRT associated with better QoL in all of the areas investigated * * * * * * * * * * *p< 0.05

  20. Dolore corp. Salute generale Salute mentale Attività fisica Role emotional Role physical Social function Vitality MCS PCS HRT Yes No NS NS NS NS 0.005 1.0 1.3 NS NS NS NS NS Stepwise logistic regression analyses with SF-36 scores as dependent variables. the use of HRT represents an independent predictor for limitations due to emotional problems

  21. WHQ scores according to HRT use • A high score (lower QoL) is associated with: • low school education • low SES • living in Southern Italy • presence of chronic diseases * * * * * * *

  22. Anxiety/ fears Odds Ratio Attractiveness Depression Memory/ concentr. Menstrual symptoms Sexual problems Odds Ratio Sleep problems Somatic sympt. Vasomotor sympt. Odds Ratio HRT Yes No p 1.0 1.4 .0001 NS NS NS NS 1.0 1.5 .003 NS NS 1.0 2.6 .000 Results of the stepwise logistic regression analyses with WHQ scores as dependent variablesaccording to HRT Untreated women showed a 40% increased risk of reporting anxiety/fears, a 50% increased risk of sexual problems and a more than two-fold increased risk of vasomotor symptoms

  23. EQ-5D: Percentages of respondents referring absence of problems * * * * p< 0.05

  24. EQ-5D Results of the stepwise logistic regression analyses The presence of chronic conditions and the geographic area represent the most important predictors. After adjusting for the other variables investigated, women not treated with HRT show an increased risk of reporting problems in the areas of usual activities and pain/discomfort

  25. Progetto Menopausa Italia in Lombardia Coordinatore: Massimo Luerti

  26. Situazione delle 18 SPAC della Lombardia al 24/02/2000

  27. Età: media e deviazione standard Media: 54,31 Deviazione standard: 7,72 Numero soggetti: 5820

  28. Età Menopausa spontanea Media: 49,15 Deviazione standard: 4,30 Numero soggetti: 3247

  29. Età media d’insorgenza della menopausa in Europa

  30. DETERMINANTI DELL’ETA’ DELLA MENOPAUSA • FUMO • non fumatrici 50,8 anni • < 10 50,7 anni • 10 - 20 50,5 anni • > 20 50,0 anni • ETA’ AL MENARCA • <11 50,4 anni • 12-13 50,7 anni •  14 51,2 anni

  31. FREQUENZA ALL’AMBULATORIO

  32. FREQUENZA ALL’AMBULATORIO

  33. SITUAZIONE NELLE DONNE CHE HANNO EFFETTUATO SOLO 1° VISITA

  34. RELAZIONE FRA USO DI HRT PRIMA DELLA VISITA E FATTORI SELEZIONATI Odds Ratio (IC 95%) • ISTRUZIONE • Nessuna/elementare 1+ • Media 1,33 (1,22 - 1,46) • Superiore/università 1,39 (1,27 - 1,53) • IMC (kg/m2) • <23,8 1+ • 23,8 - 27,2 0,76 (0,70 - 0,83) •  27,2 0,60 (0,55 - 0,65)

  35. RELAZIONE FRA USO DI HRT PRESCRITTO ALLA VISITA E FATTORI SELEZIONATI Odds Ratio (IC 95%) • OSTEOPOROSI • No 1+ • Sì 1,42 (1,26 -1,61) • CVD • No 1+ • Sì 1,02 (0,95 - 1,10)

  36. SOSPENSIONE TERAPIA NELLE DONNE CHE HANNO EFFETTUATO PIU’ CONTROLLI

  37. MOTIVI DI SOSPENSIONE DELLA TERAPIA

  38. IDENTIKIT DELLE UTILIZZATRICI DI HRT • reddito familiare e livelli di scolarità superiore • più magre, praticano più esercizio fisico, hanno un assetto lipidico più favorevole • fumano di più e assumono più alcoolici • sono più spesso isterectomizzate • lamentano più spesso una sintomatologia climaterica (specie artralgie)

  39. CONCLUSIONI “Perceptions of well-being in healthy, post-menopausal women depend less upon biology than on socio-economic circumstances, individual experiences, resources and cultural morals” Hunt SM. Quality of Life Res 2000;9:709-719

  40. Cross-sectional Evaluation of QoL, Menopause and HRT • different factors play an important role • low education is associated with a higher risk of reporting somatic and vasomotor symptoms, • low Social Economic Scores exerts a negative effect on attractiveness, depression and sleep problems • HRT is a factor that can modify at least some aspects of QoL in symptomatic PMW

  41. CONCLUSIONI HRT users • have a shorter duration of menopause • have less chronic diseases • tend to be slightly more educated and to belong to higher socio-economic classes, but these differences were marginal

  42. CONCLUSIONI • At univariate analyses, HRT users showed a significantly better QoL in all the areas investigated by the SF-36, in three of the six items of the EQ-5D and in all the symptoms scores of the WHQ, with the only exceptions of menstrual symptoms and memory/concentration. • After adjusting the analyses for a large array of different socio-economic and clinical variables, several associations between HRT use and QoL became not significant, suggesting that they were mediated by the other factors considered in this study. • Nevertheless, HRT users showed a lower probability of reporting role limitations due to emotional problems (SF-36) and anxiety/fears (WHQ). • HRT was also associated with a lower probability of reporting problems in the usual activities and pain/discomfort items of the EQ-5D

  43. CONCLUSIONI • When looking at menopause symptoms, HRT users showed highly significant better outcomes in vasomotor symptoms and sexual problems (particularly vaginal dryness). • HRT can be of benefit for many of the postmenopausal mood changes, pain perception and social functioning, sexual problems and vasomotor symptoms • untreated women have a 40-50% increase in the risk of suffering from anxiety and sexual problems, with an almost 3- fold increase in the incidence of hot flushes and sweats

  44. Progetto Menopausa Italia Statistiche per la regione Lombardia Situazione al 24/02/2000

  45. Situazione SPAC Lombardia al 24/02/2000

  46. HRT HRT free Duration of menopause < 3 years > 3 years 627 (55%) 510 (45%) 782 (64%) 444 (36%) 0.00002 Chronic diseases 306 (23%) 409 (29%) 0.0003 HRT AND QoL • Women on HRT were significantly more likely to have a menopause duration >3 years and significantly less likely to suffer from chronic diseases. “Healthy user effect” should be considered when we evaluate the HRT effects in Italy

  47. Progetto Menopausa Italiasotto il patrocinio ed il coordinamento dell’AOGOI Obiettivo migliorare la qualità di assistenza alle donne in menopausa favorendo la diffusione culturale tra medici, istituzione e diverse componenti del tessuto sociale, organizzando relazioni e programmi interdisciplinari. Si propone inoltre di istituire un laboratorio di epidemiologia al fine di valutare l'adeguatezza e la compliance delle strategie mediche, promuovere, partecipare e monitorare trials sperimentali

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