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Biomedical subjects

N E Avis

Publications and source records attributed to N E Avis.

At least 19 recordsLinked to original sources
PubMed2004

Quality of life in diverse groups of midlife women: assessing the influence of menopause, health status and psychosocial and demographic factors.

This paper examines whether menopausal status is associated with global quality of life (QOL) among women aged 40-55 and whether this association varies by race/ethnicity. We further examine the contributions of other health-related and psychosocial factors to QOL and whether these associations vary by racial/ethnic group. Analyses are based on 13,874 women who participated in the multi-ethnic, multi-race study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include global QOL, menstrual history (to assess menopausal status), sociodemographics, health status, lifestyle, and psychosocial variables. Results showed that in unadjusted analyses, early perimenopausal women reported lower QOL compared with premenopausal women, but menopausal status was no longer associated with QOL when analyses were adjusted for other variables. In multivariable models, being married and having low levels of perceived stress were associated with better QOL across all racial/ethnic groups. While there were many consistencies across racial/ethnic groups, we also found that the nature of the associations between QOL and education, marital status, perceived stress and social support varied across racial/ethnic groups.

Adult↗
PubMed2001

Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups.

In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40-55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups? Analyses are based on 14,906 women who participated in the multi-ethnic, multi-race, multi-site study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include symptoms, menstrual history (to assess menopausal status), health status, and sociodemographics. Factor analysis results showed that across all five racial/ethnic groups, two consistent factors emerged; one consisting of clearly menopausal symptoms -- hot flashes and night sweats -- and the other consisting of psychological and psychosomatic symptoms. Results of regression analyses showed racial/ethnic differences in symptom reporting, as well as differences by menopausal status. Controlling for age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African-American women reported significantly more vasomotor symptoms. Perimenopausal women, hormone users, and women who had a surgical menopause reported significantly more vasomotor symptoms. All of these groups, plus postmenopausal women, reported significantly more vasomotor symptoms than premenopausal women. The pattern of results argues against a universal menopausal syndrome consisting of a variety of vasomotor and psychological symptoms.

Black or African American↗
PubMed2001

Longitudinal study of hormone levels and depression among women transitioning through menopause.

OBJECTIVE: To address the association between depression and absolute levels of estradiol, and change in estradiol, among women during the menopausal transition. METHODS: This was a prospective, observational study conducted in Massachusetts, USA. Analyses reported here are based on the first three interviews following baseline (T1-T3). The participants were 309 women aged initially 43-53 years, who contributed a total of 728 observations (mean number of observations per subject 2.36). The main outcome measure was depression as measured by the Center for Epidemiologic Studies-Depression (CES-D) scale. RESULTS: CES-D score was not significantly associated with menopause status categories, nor was it associated with annual change in estradiol level (E2) (p = 0.19). The unadjusted association between log E2 and CES-D was negative (odds ratio 0.69) and statistically significant (p = 0.03). Upon adjustment for symptoms, however, the association remained negative but was no longer statistically significant (p = 0.26). Hot flushes/night sweats were positively associated with CES-D (p = 0.04), and trouble sleeping was strongly positively related to CES-D (p < 0.001). CONCLUSIONS: Results provide strong support for the domino or symptom hypothesis, which posits that depressed mood is caused by vasomotor symptoms associated with changing estrogen levels. Estradiol did not have a direct effect, independent of symptoms. This study adds to the body of literature suggesting that any association found between menopause and depression is most likely to be explained by other factors, such as symptoms and sleep problems. Findings also highlight the importance of studying the complex relationship between hormone levels, sleep problems and vasomotor symptoms during the menopausal transition.

Adult↗
PubMed1999

Distinguishing between quality of life and health status in quality of life research: a meta-analysis.

Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.

Health Status↗
PubMed1999

Quality of life in advanced ovarian cancer: identifying specific concerns.

PURPOSE: To identify issues affecting the quality of life (QoL) in women receiving palliative therapy for ovarian cancer. METHODS: Twenty women with advanced recurrent ovarian cancer were interviewed to establish what issues affect QoL. All patients were receiving palliative chemotherapy or other palliative therapy in the department of Gynecologic Oncology at the Massachusetts General Hospital, and were felt to have a life expectancy of 1 year or less by best clinical estimate. RESULTS: Twenty patients with an average age of 56.7 years participated. Psychosocial issues were more common than physical ones, and patients were more likely to mention issues that positively impact on QoL rather than those with a negative effect. Most patients noted that a sense of hope, enhanced appreciation for day to day life, and a strong support system had a significantly positive effect on QoL. Issues negatively impacting QoL included fear of their disease (90%) and concern for family and friends (100%), particularly children. Most common physical symptoms impacting QoL included fatigue (100%) and anorexia (55%). CONCLUSIONS: Little research has been done into QoL issues for ovarian cancer patients receiving palliative care. Available QoL studies tend to focus on the physical aspects of a disease or its treatment. This pilot study suggests that women with advanced, recurrent ovarian cancer feel that psychosocial issues play a greater role in determining QoL than do physical issues. Further QoL studies for these patients should include assessment of psychosocial realms. This information can then be used to design interventions to improve QoL.

Journal Article↗
PubMed1999

The importance of AIDS-related knowledge for mid-life and older women.

Although the AIDS epidemic has had a major impact on the lives of women throughout the world, there is little knowledge regarding risk factors, transmission factors, prevention methods, and results of prevention efforts for older women, even though almost 10% of all AIDS cases in the United States are among those 50 years and older. This article reports results on AIDS knowledge and risks from the Massachusetts Women's Health Study, a longitudinal community-based study of middle-aged women. AIDS-related questions were asked of this sample at their last study interview, which occurred in 1995 when the women were aged 58-67. Results indicate that this sample of older, predominantly Caucasian women are quite knowledgeable about transmission factors but are less knowledgeable about early interventions and their own risk status. Many are also likely to know someone with HIV or AIDS. Even though these women are generally at low risk, they may be at higher risk than they perceive. They may also be significant disseminators of knowledge to friends and relatives who may be at risk, and thus could represent an important target group for AIDS educational programs.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Gender differences in sexual activity among mid-aged adults in Massachusetts.

OBJECTIVES: The purpose of this study was to determine if self-reported measures of sexual activity differ between aging men and women. METHODS: Responses to 12 questions concerning various aspects of sexual activity were compared between 349 women and 589 men aged 51-61, who were participants in two larger community surveys in Massachusetts conducted in 1987 and 1988. Comparisons were made by least squares means adjusted for age, socio-demographic and health-related variables. Analyses were stratified by the presence or absence of one or more current sexual partners. RESULTS: Regardless of partner status, overall satisfaction with sex life did not differ between men and women. For those with partners, the mean frequency of intercourse was somewhat higher for women than men, while mean frequency of sexual desire and fantasies was significantly higher for men. Similar results were seen for those without partners, although frequency was lower and did not differ by gender. CONCLUSIONS: We found no gender difference in sexual satisfaction and little difference in frequency in mid-aged adults, but sexual desire and fantasies were more common for men.

Aging↗
PubMed1997

Use of the MQoL-HIV with asymptomatic HIV-positive patients.

The purpose of this study was to determine the appropriateness of the recently developed Multidimensional Quality of Life Questionnaire for HIV/AIDS (MQoL-HIV) as a measure of quality of life (QoL) in cases of asymptomatic human immunodeficiency virus (HIV) infection. The MQoL-HIV is a 40-item instrument measuring ten domains (mental health, physical health, physical functioning, social functioning, social support, cognitive functioning, financial status, partner intimacy, sexual functioning and medical care) relevant to HIV infection. An overall QoL score, the MQoL-HIV Index, is a weighted composite of two domain scores. In a sample of 216 HIV-infected men and women, the MQoL-HIV distinguished acquired immune deficiency syndrome (AIDS), symptomatic and asymptomatic cases in overall QoL and in seven individual QoL domains. The index was responsive to perceived QoL changes over 5.5 months (r = 0.52). We also found the MQoL-HIV was less susceptible to ceiling effects in asymptomatic cases than was the Medical Outcomes Study (MOS) SF-20. These results suggest that the MQoL-HIV is a valid and reliable measure of QoL for both asymptomatic and symptomatic HIV infection.

Adult↗
PubMed1997

Psychosocial, behavioral, and health factors related to menopause symptomatology.

Despite wide variation in the reporting of hot flashes and night sweats among menopausal women, what differentiates symptomatic from asymptomatic women is not well understood. In this article, we use longitudinal data from a large cohort of initially premenopausal women to address premenopausal factors predictive of length of the perimenopause, frequency of hot flash/night sweat (HF/NS) reporting, bothersomeness of HF/NS, and treatment seeking during menopause. The sample for analysis consists of 454 women from the Massachusetts Women's Health Study who were premenopausal at baseline and postmenopausal by the sixth and last study follow-up. Each of the four study outcomes was modeled as a function of premenopausal characteristics using logistic regression. Results confirm a wide range of symptom reporting, with 23% of women not reporting HF/NS at any of the six interviews. Variables related to greater frequency of HF/NS reporting included a longer perimenopause, more psychological and physical symptoms prior to menopause, lower education, and more negative attitudes toward menopause prior to menopause. Symptom bothersomeness was related to greater frequency of HF/NS reporting, smoking, and being divorced. Variables that predicted medical doctor consultation were greater frequency and bothersomeness of symptoms, higher education, and greater health care utilization. We conclude that general symptom reporting, attitudes toward menopause, and lifestyle factors can explain some of the individual variation in symptom reporting.

Attitude to Health↗
PubMed1996

Development of the multidimensional index of life quality. A quality of life measure for cardiovascular disease.

OBJECTIVES: The purpose of this study was to design a multidimensional measure of health-related quality of life appropriate for patients with cardiovascular disease that was psychometrically sound, brief, and easy to administer. METHODS: Qualitative interviews conducted with healthy subjects and patients with cardiovascular diseases identified nine major quality of life domains. Based on the responses of 129 cardiovascular disease patients recruited from hospitals and clinics, a criterion-based approach was used to select 35 questionnaire items that best tapped these domains. Psychometric properties of the Multidimensional Index of Life Quality (MILQ) were tested with a sample of 348 patients with various cardiovascular diseases. RESULTS: Cronbach's alpha was 0.76 or higher for eight of the nine MILQ domains. Test-retest reliability coefficients were 0.73 or greater in all but two domains. Individual domain scores as well as a weighted overall quality of life index were correlated highly with self-assessed health and the number of heart-related symptoms. CONCLUSIONS: The Multidimensional Index of Life Quality is a psychometrically reliable and valid instrument for measuring quality of life in patients with cardiovascular diseases. The MILQ also may be a suitable measure for other types of chronic diseases.

Adult↗
PubMed1994

A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study.

The present article prospectively examines the effect of change in menopause status on depression, while controlling for prior depression. This is a longitudinal follow-up of previous cross-sectional analyses reported by McKinlay, McKinlay, and Brambilla who examined the relative contribution of menopause to depression. The data derive from the Massachusetts Women's Health Study, a 5-year longitudinal study of a cohort of 2565 women aged 45 to 55 years at baseline (1981 to 1982). Results show that prior depression is the variable most predictive of subsequent depression, as measured by the Center for Epidemiologic Studies-Depression (CES-D) scale. Onset of natural menopause was not associated with increased risk of depression. Experiencing a long perimenopausal period (at least 27 months), however, was associated with increased risk of depression. The association between a long perimenopause and depression appeared to be explained by increased menopausal symptoms rather than by the menopause status itself. The observed increase in depression during a lengthy perimenopause appears to be transitory.

Climacteric↗
PubMed1991

The effect of widowhood on health: a prospective analysis from the Massachusetts Women's Health Study.

Previous research has consistently demonstrated adverse physical and psychological effects following the death of a spouse. Conclusions regarding the effects of widowhood have been hampered, however, by such methodological limitations as lack of adequate comparison groups, non-random samples of the widowed, and lack of data on pre-widowhood status. This paper examined the physical and psychological effects of widowhood in a randomly sampled cohort of women, aged 45-55 years at baseline, who were followed prospectively for five years. Analyses employed a design in which women whose spouses died during the course of the study (N = 76) were compared to age-matched married controls (N = 1625). The following two questions were addressed: (1) What are the physical and psychological effects of widowhood? and (2) What is the effect of widowhood on socioeconomic factors, social support and health behavior? Following the death of a spouse, the percentage of widows reporting psychological symptoms increased. The widows did not report higher rates of physical symptoms or a decrease in health. Widows had higher rates of health care utilization, in particular, taking prescribed medication, which were in part for mental health reasons. There was no evidence of changes in health behaviors among the widows, but social support increased following widowhood and more widows reported a decrease in income. The results highlight the importance of controlling for pre-widowhood status when studying the consequences of widowhood and provide additional evidence that widowhood may not adversely affect physical health for women.

Female↗
PubMed1991

A longitudinal analysis of women's attitudes toward the menopause: results from the Massachusetts Women's Health Study.

This paper examines women's attitudes towards menopause in a large representative sample of middle-aged women. Data were derived from the Massachusetts Women's Health Study (MWHS) which is a prospective study of 2565 women aged 45-55, randomly sampled throughout Massachusetts. The paper addressed the following questions: (1) What are women's attitudes towards the menopause and how do attitudes change as a function of menopause? (2) What variables are related to attitudes towards menopause? and (3) Do attitudes towards menopause predict subsequent symptom reporting during menopause? Results showed that the majority of women reported relief or neutral feelings about the cessation of menses and that feelings became more positive as women experienced menopause. Negative attitudes towards menopause were related to general symptom reporting and depression. Additionally, negative attitudes prior to menopause were related to subsequent symptom reporting during menopause. These results suggest that the so-called menopause syndrome may be more related to personal characteristics than to menopause per se.

Attitude to Health↗
PubMed1989

Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed?

Using perceived risk of a heart attack, we examined the relative importance of perceived risk factors and sociodemographic variables on subjects' perception of heart attack risk, the relationship between perceived and objectively measured heart attack risk, and the effect of health risk appraisal (HRA) feedback on risk perceptions. Data derive from a random sample of 732 Greater Boston, Massachusetts area men and women ages 25-65 years, who participated in a field trial of health risk appraisal instruments. At baseline and approximately two months later, all respondents completed a questionnaire assessing their own health-related behavior, risk factors, and perception of heart attack risk. At baseline, respondents also completed one of four HRA instruments. Physiologic measures of cholesterol, blood pressure, and weight were taken at either baseline or follow-up visit. Results showed that respondents used established risk factors in estimating overall risk; that compared to objective measures of risk, a high percentage of respondents displayed an optimistic bias; and that HRA feedback had some effect on perception of heart attack risk for those at high risk. Implications of these results for health promotion are discussed.

Adult↗
PubMed1983

Stability of overt Type A behaviors in children: results from a one-year longitudinal study.

This paper describes the degree of similarity between repeated ratings (taken 1 year apart) of overt Type A behaviors in 2 samples totaling 633 children. The measure of overt Type A behaviors was the Matthews Youth Test for Health (MYTH), which was completed by the children's classroom teacher. Results showed that correlations between repeated MYTH ratings approximated .55 and in general increased somewhat with the children's school grade, although correlations between repeated ratings of competitive achievement behaviors of boys residing in an affluent eastern suburb were somewhat lower than above. The degree of similarity across 1 year in children's Type A behaviors is comparable to that found for adult Type A behaviors and for other cardiovascular risk factors in children. The discussion includes a consideration of assumptions underlying research on the origins of Type A behavior and suggests that etiological factors in the development of Type A might profitably be studied in primary school-aged children.

Achievement↗