Evaluation of the Menopause-Specific Quality of Life Questionnaire: a factor-analytic approach.

OBJECTIVE: Despite being used in multiple studies, the Menopause-Specific Quality of Life Questionnaire (MENQOL) has not been assessed with factor analysis, a common method of item reduction in quality of life tools. METHODS: The Menopause Epidemiology Study is a cross-sectional population-based study of women 40 to 65 years old in the United States chosen from a source population selected by random digit dialing and probability sampling. We focused on 2,703 postmenopausal women for our analyses. Before analysis and to prevent model overfitting, we split our sample into two equal groups using a uniform random sample. Using parallel analysis for factor extraction, we performed confirmatory factor analysis on the MENQOL to examine the current factor structure and to evaluate the efficiency of the items in the existing tool. Reliability coefficients (Cronbach α) were calculated for each of the domains. RESULTS: With few exceptions, the items from the original MENQOL factored into the domains under which they were originally placed. Using this method, five items did not add significant statistical value to the scoring of the domains: difficulty sleeping; poor memory; accomplishing less than I used to; changes in appearance, texture, or tone of my skin; and feeling tired. Reliability coefficients for the four original domains were acceptable: vasomotor, 0.87; psychosocial, 0.85; physical, 0.88; and sexual, 0.77. CONCLUSIONS: Results from factor analysis indicate that although the MENQOL was developed more than 15 years ago, the strength of the items is still highly valuable today in the assessment of women's menopause-related quality of life.

Longitudinal association of vasomotor symptoms and psychosocial outcomes among postmenopausal women in the United States: a population-based study.

OBJECTIVE: Vasomotor and psychosocial symptoms persist as common manifestations of menopause; their explicit association is unclear. We investigated this association among postmenopausal women over a 2-year period. METHODS: The Menopause Epidemiology Study is a cross-sectional population-based study of women 40 to 65 years old in the United States. We followed participants who were postmenopausal at baseline and at 2-year follow-up (n = 1,506) in the analyses. The vasomotor and psychosocial domains of the Menopause-Specific Quality of Life Questionnaire were used to assess exposure and outcome. Change in symptoms was defined as the difference in the Menopause-Specific Quality of Life Questionnaire domain score from baseline to follow-up 2 years later. Demographic information, behavioral activities, reproductive history, and medication use were evaluated for effect modification and confounding. Covariate-adjusted linear regression was used to assess the relationship between the change in vasomotor symptoms and change in psychosocial symptoms. RESULTS: One quarter (n = 375) of the women reported an increase in vasomotor symptoms over the 2-year study period. Twenty-two percent of the women reported an increase in both vasomotor and psychosocial symptoms. Current smoking status was found to be an effect modifier: a one-unit increase in the vasomotor domain was associated with a 0.21-unit (95% CI, 0.12-0.29) increase in the psychosocial domain among smokers; this was stronger (0.29, 95% CI, 0.20-0.39) among past or never smokers. CONCLUSIONS: This study provides further evidence of an association between vasomotor symptoms and psychosocial symptoms using a validated instrument in a population-based study. There is a small increase in psychosocial symptoms with increasing vasomotor symptoms. Clinicians may want to note this association when treating postmenopausal women with either condition.

Seasonal patterns in health care use and pharmaceutical claims for asthma prescriptions for preschool- and school-aged children.

BACKGROUND: In children, hospitalization for asthma is reported to have a distinct seasonal pattern with peaks coincident with the start of school. Although guidelines indicate that asthma controller medications should be used daily, there is limited information on actual seasonal patterns of medication use. OBJECTIVE: To describe seasonal patterns of asthma-related health care use and asthma controller and reliever medication claims in children. METHODS: An ecological analysis was conducted of data collected from records for children aged 2 to 12 years from 2002 through 2004 from an automated research database of insurance claims from a large US health care plan. Seasonal patterns for health care use and estimates of prescription asthma controller and reliever use were determined for preschool-aged children (aged 2-5 years) and school-aged children (aged 6-12 years). Rates were constructed by week; deviations from annual mean rates were used to determine peaks in use. Results were confirmed using Poisson regression models, modeling for rates within age group, with factors for week, year, and regions. RESULTS: Emergency department and outpatient visits and hospitalizations were lowest during summer; rates increased beginning in September, peaking in October or November. Asthma controller and reliever medication claims increased beginning in September, peaking in December. Rates also were elevated in February. CONCLUSIONS: The data suggest that children who reduce their asthma medications during the summer do not resume taking medications until signs or symptoms of asthma worsen. The summer hiatus and other factors may contribute to seasonal increases in health care use and in asthma medication prescriptions, particularly in the fall.