Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis.

BACKGROUND: During menopause women experience vasomotor and psychosexual symptoms that cannot entirely be alleviated with hormone replacement therapy (HRT). Besides, HRT is contraindicated after breast cancer. OBJECTIVES: To review the evidence on the effectiveness of psychological interventions in reducing symptoms associated with menopause in natural or treatment-induced menopausal women. SEARCH STRATEGY: Medline/Pubmed, PsycINFO, EMBASE and AMED were searched until June 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) concerning natural or treatment-induced menopause, investigating mindfulness or (cognitive-)behaviour-based therapy were selected. Main outcomes were frequency of hot flushes, hot flush bother experienced, other menopausal symptoms and sexual functioning. DATA COLLECTION AND ANALYSIS: Study selection and data extraction were performed by two independent researchers. A meta-analysis was performed to calculate the standardised mean difference (SMD). MAIN RESULTS: Twelve RCTs were included. Short-term (<20 weeks) effects of psychological interventions in comparison to no treatment or control were observed for hot flush bother (SMD -0.54, 95% CI -0.74 to -0.35, P < 0.001, I2  = 18%) and menopausal symptoms (SMD -0.34, 95% CI -0.52 to -0.15, P < 0.001, I2  = 0%). Medium-term (≥20 weeks) effects were observed for hot flush bother (SMD -0.38, 95% CI -0.58 to -0.18, P < 0.001, I2  = 16%). [Correction added on 9 July 2018, after first online publication: there were miscalculations of the mean end point scores for hot flush bother and these have been corrected in the preceding two sentences.] In the subgroup treatment-induced menopause, consisting of exclusively breast cancer populations, as well as in the subgroup natural menopause, hot flush bother was reduced by psychological interventions. Too few studies reported on sexual functioning to perform a meta-analysis. CONCLUSIONS: Psychological interventions reduced hot flush bother in the short and medium-term and menopausal symptoms in the short-term. These results are especially relevant for breast cancer survivors in whom HRT is contraindicated. There was a lack of studies reporting on the influence on sexual functioning. TWEETABLE ABSTRACT: Systematic review: psychological interventions reduce bother by hot flushes in the short- and medium-term.

Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy.

OBJECTIVES: To reduce the risk of ovarian cancer, women with BRCA1/2 mutations are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) at a premenopausal age. Premenopausal RRSO results in acute menopause and is associated with various menopausal symptoms. This study investigates the severity and duration of subjective menopausal symptoms after premenopausal RRSO and associated factors. METHODS: We included 199 women who had undergone RRSO before age 52 in this cross-sectional study. The Menopause Rating Scale (MRS) was used to measure the level of psychological, somato-vegetative and urogenital symptoms (no/little, mild, moderate, or severe). Uni- and multivariate logistic regressions were performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for having moderate or severe symptoms as compared to having no or mild symptoms. Duration of symptoms was investigated by calculating the time since RRSO. RESULTS: Sixty-nine percent (137/199) of the included women reported moderate or severe symptoms on the MRS, a mean of 7.9 years after RRSO. Fifty-seven percent (94/137) of these women reported severe urogenital symptoms, and about one-quarter reported severe psychological and/or somato-vegetative symptoms. Only psychological symptoms tended to improve over time (>=10 years). A personal history of breast cancer was independently associated with having moderate or severe menopausal symptoms (OR = 3.4; 95%CI = 1.6-7.1). CONCLUSIONS: The majority of women report moderate or severe menopausal symptoms, even 10 years after surgical menopause, and breast cancer survivors especially. To improve quality of life, follow-up care after RRSO should focus on these symptoms and be accessible for many years after RRSO.

Anemia in young children living in the Surinamese interior: the influence of age, nutritional status and ethnicity.

PURPOSE: This study investigates the prevalence of anemia in young children living in the interior of Suriname and the influence of the associated factors age, nutritional status and ethnicity. RESULTS: In this cross-sectional observational study, 606 children aged 1-5 years from three different regions of Suriname's interior were included, and hemoglobin levels and anthropometric measurements were collected. Logistic regression models were computed to examine independent associations between anemic and nonanemic groups and to measure the influence of age, nutritional status and ethnicity. RESULTS: A total of 606 children were included, of whom 330 (55%) were aged 1-3 years and 276 were aged 4-5 years. The overall prevalence of anemia was 63%. Younger age was associated with anemia (odds ratio [OR]=1.78; 95% confidence interval [CI]: 1.27-2.51). Anemia was less prevalent in Amerindian than in Maroon children (OR=0.51; 95% CI: 0.34-0.76). Hemoglobin level was not influenced by nutritional status nor by sex. CONCLUSION: The prevalence of anemia in children aged 1-5 years living in Suriname's interior is high (63%) compared to that in similar aged children in Latin America and the Caribbean (4-45%). Children aged 1-3 years were more affected than those aged 4-5 years as were Maroon children compared to Amerindian children. Nutritional status and sex were not of influence.

Anaemia in young children living in the Surinamese interior: the influence of age, nutritional status and ethnicity

OBJECTIVE: Anaemia may lead to poor motor development and impaired neurocognitive function and affects 43% of children 1–5 years worldwide. Currently, there is little information on the prevalence of anaemia in young children living in the interior of Suriname. This study investigates the prevalence of anaemia in these children and the influence of the associated factors of age, nutritional status and ethnicity. SUBJECTS AND METHODS: Haemoglobin levels and anthropometric measurements of children aged 1–5 years were collected, after informed consent was provided, in three different interior regions of Suriname in the period September–October 2015. World Health Organization(WHO) standards for anaemia and underweight assessment were applied. Logistic regression models were computed to examine independent associations between the anaemic and non-anaemic groups and were expressed as odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: Six hundred and six children were included: 330(55%) very young (1–3 years) and 276 older (4–5 years). Younger age was associated with anaemia (OR = 2.45;95% CI 1.75, 3.45). Anaemia was less prevalent in Amerindian than in Maroon children (OR = 0.51; 95% CI0.34, 0.76). Haemoglobin level was not influenced by nutritional status. CONCLUSIONS: The prevalence of anaemia in children 1–5years old living in Suriname’s interior is high (55%) compared to similar aged children in Latin America and the Caribbean (4–45%). Children 1–3 years of age were more affected than 4–5-year old children, as were Maroon children compared to Amerindian children. Nutritional status was not of influence. These findings call for further studies and may support adaptation of anaemia prevention and control programmes in young children in Suriname.