Iris Publishers-Open access Journal of Biomedical Engineering & Biotechnology | Gene Associated and Risk Factor of HPV Wharts : A Review Article

 

Authored by Nanda Rachmad Putra Gofur*,

Abstract

Introduction : HPV can infect basal epithelial cells of the skin or deep tissue and are categorized as either skin type or mucosal type. This skin type is epidermotropic and infects the surface of the keratinized skin, targeting the skin of the hands and feet. The type of mucosa that is infected is the lining of the mouth, throat, respiratory, or anogenital tract epithelium. The direct correlation between the number of sexual partners and the presence of HPV was shown to be independent of other risk factors such as age, race or use of oral contraceptives as well. Several genes and risk factors have been associated with genital HPV infection. The purpose of this review is to determine the genes and risk factors for Wharts. Discussion : Detection of various genital HPV as many as 28 types that have been identified so far can use various methods. Identification of viral DNA or RNA by various hybridization techniques. Time to analyze the results is also very important to know the validity of the different HPV techniques, the sensitivity, specificity, and the spectrum of HPV types detected. Southern Blot hybridization is still used as the standard for DNA identification of various types of HPV. However, between 5000 and 50 000 copies of HPV DNA must be present in a clinical sample to be detected. Conclusion : The seroprevalence of other types, including 18, 31, 33, 39, 58, and 59, ranging from 9% to 23%. In addition to VLP, HPV DNA is also most common in women under 25 years of age, prevalence tends to peak in women over 25 years of age using HPV antibodies. Number of sexual partners was recognized as an independent risk factor for genital HPV infection in patients with immunosuppression will also be a risk factor for HPV infection, for example in patients with autoimmune, HIV infection and organ transplantation.

Keywords: Gene; Risk Factor; HPV infection; Wharts disease

Introduction

HPV can infect basal epithelial cells of the skin or deep tissue and are categorized as either skin type or mucosal type. This skin type is epidermotropic and infects the surface of the keratinized skin, targeting the skin of the hands and feet. The type of mucosa that is infected is the lining of the mouth, throat, respiratory, or anogenital tract epithelium.

Some HPVs are associated with transient warts whereas other manifestations may be risk factors for invasive cervical cancer and precancerous lesions. Currently, more than 150 types of HPV have been identified and about 40 can infect the epithelial lining of the anogenital tract and other mucosal areas of the human body. The incidence rate of genital warts in Canada also increased significantly, 43,586 EGW events from 1999 to 2006, finding that the overall incidence slightly increased from 1.07 per 1,000 population in 1999 to 1.26 per 1,000 population in 2006. Overall incidence between years 1999 and 2006 were always higher in men than women, being 1.31 per 1,000 population in men and 1.21 in women. Both decline gradually with age. However, several studies have noted an increase in HPV infection in women after age 50.

Transmission of HPV infection can be through two events, through direct sexual contact or without sexual contact. For condylomata acuminata the interval between exposure and clinical appearance of disease ranged from 3 weeks to 8 months. Incubation period data for subclinical and latent infection are unknown. The direct correlation between the number of sexual partners and the presence of HPV was shown to be independent of other risk factors such as age, race or use of oral contraceptives as well. Several genes and risk factors have been associated with genital HPV infection. The purpose of this review is to determine the genes and risk factors for Wharts.

Discussion

Detection of various genital HPV as many as 28 types that have been identified so far can use various methods. Identification of viral DNA or RNA by various hybridization techniques. Time to analyze the results is also very important to know the validity of the different HPV techniques, the sensitivity, specificity, and the spectrum of HPV types detected. Southern Blot hybridization is still used as the standard for DNA identification of various types of HPV. However, between 5000 and 50 000 copies of HPV DNA must be present in a clinical sample to be detected.

Gene Associated HPV

Recently, a more sensitive technique on HPV DNA amplification uses polymerase chain reaction (PCR) followed by a simple hybridization method. This method has been widely applied, especially in large epidemiological studies. This allows between 10 and 100 copies of the HPV DNA to be found. In addition, combined with phylogenetic classification, new HPV types can be created. With PCR, HPV type-specific primers allow detection of a single HPV type whereas consensus or generalized primers strengthen the entire panel of different HPV types, shown in table 3. Standardization of PCR methods will be required to allow comparison of valid results produced by various laboratories. In estimates using one point, assays using dot-blot hybridization varied between 1% and 20%, 8% and 11% using in situ hybridization filters, 3% and 29% using Southern blot, 5% to 53% using general-type PCR and HPV specific. This prevalence estimate consists of subclinical and latent disease (Table 1).

Table 1: Genes Associated HPV.

Research shows that HPV infection is more common in women than men, with the highest cohort occurring among sexually active women under the age of 25. Other data suggest that at least 80% of women have had an HPV infection by the time they reach age 50. Data A recent study from another study in British Columbia showed that the prevalence of genital warts was highest among women aged 20 and 24 (3.38 per 1,000 population), whereas in men, the incidence peaked between ages 25 and 29 (3.03 per 1,000 population). Another study by Jiang and colleagues noted a high prevalence of HPV infection in Canada relative to other parts of the country and an almost 50% higher prevalence (27.6% vs 18.5%) among Aboriginal women compared to non-Aboriginal women in the region. HPV-16 was the most common strain found in 14,598 Pap smear cytology samples. As with women, HPV infection is associated with cancer and non-malignant disease in men as well, although data for the male population are sparse. One international study estimated that asymptomatic genital HPV infection affects 65.2% of men aged 18-25 years.

Genital HPV infection is also common in men, with the prevalence using the PCR method ranging from 3.5% to 46.4%. In a case-control study of the role of men in the epidemiology of cervical cancer in Colombia and Spain, detectable HPV DNA was collected from the distal urethra and the outer surface of the glans penis and the penile coronal sulcus. In Colombia, 26% of husbands of 210 women with cervical cancer and 19% of husbands of 262 women without cervical cancer were positive for HPV DNA by PCR, whereas in Spain, 18% of husbands of 183 women with and 4% of husbands of 171 women without cervical cancer who were positive for HPV DNA.

Serological tests for certain types of HPV have been used to detect antibodies to viral particles such as (VLP), which is a viral capsid synthesized from the viral L1 protein. The prevalence of HPV infection using VLP as antigen showed that, among women clinically absent of HPV, 2-43% had antibodies to HPV 16, and 9-25% had antibodies to HPV 6 or 11. The seroprevalence of other types, including 18, 31, 33, 39, 58, and 59, ranging from 9% to 23%. In addition to VLP, HPV DNA is also most common in women under 25 years of age, prevalence tends to peak in women over 25 years of age using HPV antibodies.

The study showed 21% of women (n = 90) reported having only one male sexual partner positive for HPV via the PCR method compared with 69% of women (n = 102). Frequently changing partners 10 or more (OR = 11-2, 95% CI 4.9-24.4). Previous studies have not shown an association between HPV detection and sexual activity, this is due to the possibility of misclassifying HPV and its manifestations and the small sample size of subjects which may distort the results. Subclinical HPV infection and HPV-associated disease are common (64% to 70%) in male and female partners with cervical HPV infection and intraepithelial neoplasia.

The study reported 24 women affected by genital warts, after 2-4 weeks of sexual intercourse with a husband who had warts on his penis. Transmission of genital HPV infection does not have to be intercourse into the vagina but can be done through skin-to-skin contact in the genitals. The presence of abrasions on the genital skin is a place where the virus enters, the virus enters the stratified epithelial cells. Transmission of HPV infection is not only with sexual activity, transmission through the fingers can also be. In a recent study of men and women with genital warts, the same types of HPV were found in genital and finger samples.

Transmission of HPV 6 or 11 to the baby by an infected mother can cause recurrent respiratory papillomatosis (RRP), although it is still rare. It remains unclear whether vertical transmission through the amnion is intact or during birth. Peripartal transmission was demonstrated by a study showing HPV DNA in 33% of 45 nasopharyngeal aspirates from neonates, using Southern blot, and HPV DNA in only two amniotic fluid samples. Only 2-8% (2 of 72) oropharynx in newborns are positive for HPV by dot-blot hybridization in other countries. Peripartal transmission to the genital area (n = 4) and oral cavity (n = 2) was demonstrated in newborns from ten HPV-positive mothers based on specific PCR analysis.

Studies in preschool children (n = 21) in oral and genital HPV infections were positive for HPV 6 in 24% and for HPV 16 in 19% according to type-specific PCR compared with 17% and 23%, in adult men (n = 35) . Thus, the oral cavity can act as a reservoir for genital HPV. In addition, the presence of “high-risk” HPV types such as HPV 16 and HPV 33 can lead to malignant lesions as indicated for tonsillar carcinoma. Genital HPV types such as HPV 16 and HPV 35 can also be found in skin lesions of the periungual area and are potentially infective for the genital area. Fomites may play a role in transmitting the virus since HPV DNA can be demonstrated on a small number of gynecological instruments after sterilization. Transmission from mother to fetus during pregnancy can occur and cause laryngeal papillomatosis or condylomata can occur in the first week since the baby is born.

Risk factor Associated HPV

A number of risk factors have been associated with genital HPV infection. So far only some of these factors have been examined in relation to its progression to cancer. The risk factors associated with HPV infection are shown in (Figure 1).

Number of sexual partners was recognized as an independent risk factor for genital HPV infection with an odds ratio (OR) of 4.3 (95% CI 21.9.0) for <16 years to 24 years in studies in Colombia and Spain measured by consensus-PCR. In patients with immunosuppression will also be a risk factor for HPV infection, for example in patients with autoimmune, HIV infection and organ transplantation. Renal allograft recipients are at increased risk for genital warts. This was confirmed for latent and subclinical HPV infection when 27% of women (n = 49) with renal allografts were positive for HPV-16 or 18, compared with only 6% of controls (n = 69).

Individuals who are HIV positive have high rates of HPV infection and HPV-associated neoplasia. This phenomenon is currently explained by changes in the immune system of HIV-infected persons increasing the risk for the acquisition of a new one. HPV infection or reactivation of latent HPV infection. Transactivation of viral replication may be another interaction pathway between these viruses. Cytological markers of HPV infection were found in HIV-positive women at significantly higher levels compared with women at risk of HIV infection or HIV-negative women. Symptoms of HIV infection in women (n = 33) indicated a significantly higher 70% HPV prevalence than in asymptomatic HIV-positive women (22%) or in HIV-negative high-risk women (22%).

The peak prevalence rate of HPV infection spans the age range of 20 to 24 years, with a steady decline with age. The PCR method applied to patients under 25 years of age (n = 872) showed that 43% were HPV-positive, compared with 32% in the 26- and 35-years age groups (n = 617) and 21% in women older than 35 years. (n = 21%). Other studies on HPV have shown a similar distribution pattern across age groups. The effect of pregnancy on HPV detection is controversial although studies are needed to find higher rates of HPV detection during pregnancy: 8% to 20% in nonpregnant women and 9% to 35% in pregnant women. Four of the six studies found an increase in prevalence during pregnancy and three of the four studies described a decrease in HPV detection postpartum. Early age at first birth was a risk factor for <16 years vs 24 years in the PCR method.

Patients using oral contraceptives (OC) had an increased risk factor of 1.5 for condylomata acuminata which increased to 9-8 after long-term use. Using Southern blot analysis, current OC use was associated with HPV positivity. A linear relationship between OC use and HPV was detected by consensus primer PCR was evident in female students with an OR of 2.8 after one year of OC use and an OR of 4.6 after 4 to 5 years of OC use. The use of OCs may have a synergistic effect with HPV. Hormonal factors also influence the transcription of the HPV genome also in vitro. Eightfold transcriptional expression of HPV E6 and E7. A history of smoking was associated with an increased risk for condylomata acuminata (RR = 3.7; 95% CI 1.8-7.6). Increased concentrations of nicotine and cotinin are found in vaginal mucus. Smoking also causes immunosuppression by reducing the Langerhans cell population and can trigger HPV infection. Nutritional factors were also found in patients with vitamin A, B-carotene, vitamin C, and folic acid deficiencies. Using the Southern blot for HPV 6, low folate levels were an independent risk factor for HPV compared with women with folate above nutritional intake.

Conclusion

The seroprevalence of other types, including 18, 31, 33, 39, 58, and 59, ranging from 9% to 23%. In addition to VLP, HPV DNA is also most common in women under 25 years of age, prevalence tends to peak in women over 25 years of age using HPV antibodies. Number of sexual partners was recognized as an independent risk factor for genital HPV infection in patients with immunosuppression will also be a risk factor for HPV infection, for example in patients with autoimmune, HIV infection and organ transplantation.

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Iris Publishers-Open access Journal of Civil & Structural Engineering | Operational Modal Analysis and Structure Health Monitoring

 

Authored by Roberta Lima*,

Abstract

Modal parameters are able to characterize any structure uniquely. All the structural elements and the respective boundary conditions have a direct impact in all of the modal parameters (natural frequencies, damping ratios and mode shapes), making them suitable to detect damage along the structure. To this end, experimental identification of the modal parameters is necessary and must be conducted periodically. In the last decade, operational modal analysis has been developed to this purpose. It allows the identification of the modal parameter with the structures in operational conditions and using ambient excitation. Several improvements in the field were recently made with the computation of modal parameters uncertainties and with the automation in the identification process. Therefore, vibration-base structural health monitoring system is getting popular for critical civil structures such as bridges, high buildings and old constructions.

Keywords:Operational modal analysis; Structure health monitoring; Uncertainty quantification; Stochastic modeling; Linear time-invariant systems; Identification

Introduction

Operational Modal Analysis (OMA) consists in finding the dynamic characteristics of a structure through its modal parameters using output-only measurements and ambient excitation. Differently from the classical approach of Experimental Modal Analysis (EMA), where the excitation in the structure is controlled and measured, OMA only uses hypothesis of the stochastic nature of the inputs. This fact allows the identification of systems under circumstances where EMA is limited. Large and heavy structures, commonly found in civil engineering, are good examples where OMA is more suitable than EMA. A controlled input in those structures is in general hard to apply or expensive. Also, to bring them into laboratory conditions, where the perturbations from the ambient are minimized, is usually impossible. One cannot avoid the action of ambient excitations, like the wind, nearby traffic, seismic activities, etc., on those structures. Another example where OMA becomes necessary is when a structure is too small and has a high flexibility. The small size of the structure restricts the use of an electromagnetic shaker since it adds significant mass to the system. On the other hand, the high flexibility restricts the use of a modal hammer since a clean single impact becomes hard to apply [1]. In those cases, it is better to use the ambient excitation as the only excitation for the identification process. This opens a good opportunity to periodically identify the modal parameter of the structure and assess its integrity

Discussion

From the linear theory for time-invariant systems, the relationship between the excitation and the response of any structure is given by the impulse response function (IRF) or the frequency response function (FRF), depending on which domain (time or frequency) has been considered. Such functions characterize the structure uniquely and can be easily decomposed in terms of the modal parameter [2]. Therefore, the identification procedure in EMA corresponds first in estimating the IFR or FRF using the input and output signals and latter applying a dedicated curve fitting method to extract the values of modal parameters [3,4]. Since the input signal is no longer available in OMA, neither the IRF nor the FRF can be estimated from the experimental data. Nevertheless, under the special and idealistic consideration of white noise excitation, it is possible to show that the correlation functions and power spectral densities (PSD) of the systems responses can also be decomposed in terms of modal parameters [5]. This modal decomposition maintains a similar mathematical structure found in the IRF and FRF decomposition. Therefore, it is possible to apply most of the identification methods developed for EMA in OMA. The only difference is that IRFs are replaced by correlation functions and FRFs by PSDs. Although a white noise excitation is not realizable, such model is still valid because one can always consider a loading filter that transform the hypothetical white noise excitation into the actual one. The identification of the system un- der this white noise excitation hypothesis is then the identification of the loading force filter together with the actual structure. A discernment between the modal parameters related to the structure from those related to the loading filter is usually possible by examining the identified modal parameters and stabilization diagrams. In summary, to be able to perform OMA, the ambient forces must be at least random, stationary, and have a broadband spectrum to excite all the modes in the frequency band of study.

Most of the modal identification methods were developed for EMA in the second half of the twentieth century and were motivated by the aerospace and automotive industry [4]. During the 1990s, new output-only identification techniques helped in the popularization of OMA [6,7], especially in the civil engineering community. In particular, the stochastic subspace identification method became the standard identification method in the beginning of this millennium thanks to an extensive literature and its user-friendly implementation in commercially software. When compared to EMA, the main drawback of OMA is the fact that the excitation quality signal can no longer be guaranteed. The excitation level at some frequencies can become particularly low, reducing the signal-to- noise ratio significantly. The understanding of how such measurement noise affects some statistical functions were done recently to improving the robustness of identification methods [8]. The measurement error also motivated the scientific community to develop identification methods that allow the uncertainty quantification of the modal parameters [9]. The developed methods can be divided in two groups depending on the definition of uncertainty: from a frequentist point of view or from a Bayesian one. In the former, the uncertainty is the reflection of the variability of the modal parameters identified from different data sets of equal events. Perturbation techniques were implemented to evaluate the first order sensitivity of the modal parameters due to the variability of the data [10]. In a Bayesian point of view, the modal parameters are considered random variables with probability distributions that depends on the available information. The uncertainty is then related to the spread of the probability distribution nearby its maximum value, usually quantified with a Gaussian approximation. The Bayesian methods were already formulated using time domain data, power spectral density and the Fast Fourier Transform of the data [11]. Computational algorithms were latter developed [12] and field examples are currently emerging [13].

Perhaps the vibration-based structure health monitoring (SHM) is the engineer field that has been benefit- ing the most with the developments of OMA. This statement is reinforced by the large number of publications on the subject in the past few years. A quick examination on the latest proceedings of the International Operational Modal Analysis Conference (IOMAC) will prove just that [14]. Many new extremely tall buildings and long bridges have been constructed with integrated sensor for a SHM system [15]. Some of those systems have also been used to guarantee the structure quality during the construction [16]. Beside civil structure, offshore oil rigs and wind turbine farms have also been widely instrumented with SHM systems. In essence, the vibrationbased SHM evaluates the integrity of a structure by analyzing the trends on the modal parameters along the time. Such variations on the modal parameters can happen slowly (from the degradation of the structure) or suddenly (cause by damage after a cataclysmic event). A good SHM system should be able to analyze the slow trends compensating and influence of the ambient (temperature, humidity etc.) on the modal parameters [17]. Also, the SHM system should be able to assess if the structure still safe after been exposed to sever conditions. A great challenge in the field of vibration based SHM is how to perform a fully automatic OMA that enables the modal characterization of a structure in an online, unassisted and robust way. Also, it must deal with transmission, storage, and analysis of this large amount of data. A recent field where OMA is now been applied is in the characterization of nonlinear systems through lin- ear approximations. OMA is a technique that is restricted to linear time-invariant systems, so any attempt to describe nonlinear systems with this technique leads, at best, to good approximation. Nevertheless, it is still a convenient task to perform since linear model are well understood and can be interesting for structure control, model reduction and also to obtain physical insights. Nonlinear systems are energy dependent, so the linearization is not unique and should be conducted at different energy levels. Researches have already been made in the identification of orthogonal modes with the usage of the properorthogonal (Karhunen-Loève) decomposition. This technique leads to optimized representation of the system in terms of energy and is excellent for model reduction. To extract also information regarding fundamental oscillations of the modes, an extension of the properorthogonal decomposition was also proposed and is known as smooth orthogonal decomposition [18,19].

Conclusion

After almost 30 years of its popularization, OMA can be considered a mature research field. Nevertheless, it is still an active one. Identification’s techniques can be considered well established but improvements have still been published. From the knowledge provided by OMA about a structure, new applications are emerging every day and considerable enhancements are still needed on those areas.

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Iris Publishers-Open access Journal of Biology & Life Sciences | Securing Funding: Non-traditional Funding Opportunities Available for Small Undergraduate Teaching Institutions

 

Authored by Leanne Petry*,

Introduction

Department of Defense (DoD) grants are offered regularly for public, private and military academic institutions to serve the military mission in society [1,2] as well as enhancing the research efforts of faculty and the training of all students registered for any academically accredited institution [1,2]. The nature of these grants differs in some aspects from other national, state and other federal sources which fund basic and applied research within the scientific community. Securing these prestigious grants, however, requires a clear vision and a solid plan of work, in addition to needs and goals to connect the DoD mission with that of the warfighter and the university requesting the funds. These grants usually require long term plans and acceptable assessment methods.

Many faculty members in undergraduate teaching institutions are usually hired without a research start up package that will enhance their ability to grow their research in spite of the fact that they are required to secure grants and publish scholarly work to advance through the ranks for promotion and tenure. With heavy teaching loads and the lack of research support personnel and facilities, many faculty members are not aware of unconventional funding opportunities that may be available to them, thinking they are out of reach and depend only on the scarce funding opportunities that the university provides to them irregularly at best. This was the authors’ opinion as researchers in a small institution and that from observing colleagues and the rate of DoD grants awarded to the institution as well.

The authors’ research and experience notes that DoD will support solid applications regardless of the size and rank of the institution [2,3]. Knowing this fallacy, the authors took on the preparation of such a large undertaking well in advance of the due date for the response for proposal (RFP) to a recent DoD solicitation. From their combined experiences in applying and securing national grants, the authors advise that faculty applicants should start reading and preparing as soon as the RFP is released carefully examining the guidelines for funding including whether or not military personnel involvement or other clearly specified criteria is required for submission. The authors advise the strict adherence to a timeline to ensure on time submission of the proposal. Applicants must seek assistance and advice from their Office of Sponsored Programs with trained personnel if they exist in their institutes to assist with grant writing. If this service is not available, the authors advise collaboration with other colleagues from other institutions which may have this type of support.

Historically DoD grants were established and offered to support small institutions in their research efforts by supplying funding as a means to enhance research capacity at qualifying universities [1] and created the Basic Research Office (BRO) to oversee and manage implementation of its basic research programs and initiatives [4]. This Office aims to ensure new and innovative cutting-edge technologies for inquiry and investigation are at the forefront of basic and applied research at the nation’s universities. BRO manages programs including: the Vannevar Bush Faculty Fellowship, the Minerva Research Initiative, Historically Black Colleges & Universities/Minority Institutions (HBCU/MI) Program, as well as a number of pilot programs and workshops including the multidisciplinary university research initiative, future directions workshops, and laboratory university research initiative - all created to support, invest and manage basic research initiatives [4]. These funding streams are important to small teaching institutions as well as HBCUs and play a significant role in how these universities are able to connect their institutional priorities for teaching and learning as governed by their institutional accrediting agencies with that of the DoD mission and current Biden Administration who has strategically earmarked a percentage of money directly targeting HBCUs.

In the authors’ case, the relevance and purpose of the HBCU/MI Program to their work is to increase the research and educational capacity of HBCUs/MIs, and to increase the entry of underrepresented minorities into science, technology, engineering, and mathematics (STEM) disciplines which are of great importance to diversifying the workforce in national defense and security. In this last 5 years, the authors’ institution reported receiving eight (8) grants across the board from the National Science Foundation (NSF) compared to three (3) for this type of DoD grant (one of which was awarded to the authors). These facts suggested to the authors of this grant that there was greater than a 20% chance of award and necessitating the urgency to establish a robust plan of work. In earnest, the authors’ planned, prepared, and collaborated with necessary organizational units in order to execute the proposal response on time.

The authors pride themselves on the annual achievements of their chemistry program, specifically the placement of students and their acceptance into graduate and other professional programs. They were fortunate their institution houses a Reserves Officers’ Training Corps (ROTC) program with several students coenrolled/ co-graduates as majors in the academic department as well as military science. As a result, the authors successfully built a relationship with the institutional ROTC and DoD institutional offices of higher education in the areas that both PIs have previous interaction and collaboration with to solicit their support, which is an important component in securing the grant and sustaining future efforts [5]. Those providing letters of support are in branches of military fortifying the authors’ research and workforce development of highly trained officers graduating with degrees in STEM areas. Collectively, the author’s leveraged existing research initiatives with collaborating institutions and DoD programs to support the DoD mission with their instructional mission, vision and goals thereby enhancing their research and teaching and the learning of the students enrolled in their programs.

The authors advise strongly the need to read the pertinent DoD RFT to connect the its objectives with the proposed plan of work. Faculty need to tailor their proposal objectives to fit perfectly within the requirements and guidelines as stipulated in the RFT. The authors tackled this process by strategically bulletizing the preparatory stage of the writing process. In the budget section, the allocation of the funding thoroughly and adequately was defined to justify the work proposed. Allowable expenses according to the RFT were justified by presenting recent quotes, plus or minus 10% to accommodate changes in cost between the proposal submission and award dates. In case of limited space or internal physical spaces needing renovation the budget included facilities costs and/or any institutional support provided. Overall, the authors pose that strong proposals benefit the faculty, the student and the university, and these mutual benefits must be highlighted throughout the proposal.

Additionally, from the authors’ perspective, the award of a DoD instrumentation grant was considered capacity building for securing additional grants in the future to impact subsequent sustainable research to be reported and provided to the DoD as achievable outcomes. The PIs are continually looking for additional grants related to faculty development and advancement/sabbatical and in support of the research and teaching and learning curriculum initiatives for which they are passionate. Even small grants that support the same mission give a clearer vision and demonstrate the pathway toward next steps in the plan of work.

Conclusion

These types of grants are attainable, even for small institutions, if the initiators prepare well for them. These authors advise not to shy away from this funding source as a viable option. These types of awards provide faculty freedom to pursue interests without constraints from various internal sources that change abruptly. And at a greater than 20% odds, there is a significant chance that submitters may be rewarded for their diligent efforts.

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Iris Publishers-Open access Journal of Complementary & Alternative Medicine | Use of Complementary and Alternative Medicine for Menopause Symptoms and Its Effect on Quality of Life Among Turkish Women

 

Authored by Pinar G*,

Abstract

Introduction: The research was conducted to determine complementary and alternative medicine (CAM) applications that women resorted for menopause symptoms and the effect of this on life quality.

Methods: The descriptive and cross-sectional study was performed on 270 women in 2014. Data were collected using The Survey Form and The Menopause-Specific Quality of Life Scale.

Results: Average age of women in the study was 54.2±5.0. It was determined that women in menopause stage experienced frequent hot flushes (86.9%), vaginal dryness/dyspareunia (81.7%), muscle-joint ache (70.4%) and decrease in sexual desire (65.7%). CAM use ratio was found to be 62.2%. It was determined that 10% of women applied these methods by consulting a health team. It was found that the biologically based of therapies (90.5%), with the use of herbal medicine, is the main practice used during menopause, then the mind-body interventions (83.3%) as the prayer of healing and the manipulation body-based methods (34.5%), exercises and acupuncture are also cited with common practices. It was determined that life qualities of women using CAM were better in vasomotor, psychosocial, physical and sexual areas (p<0.05).

Conclusion: More than half the women had used a CAM therapy in the study. CAM methods used by women are beneficial considerably (53%- 90%) for menopause symptoms. It is suggested that women in this stage, when menopause symptoms are controlled better by CAM use, should receive training and consultancy about safe CAM use and further studies are conducted.

Keywords:Menopause; Menopause Symptoms; CAM Methods; Quality of life

Introduction

The term menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. The World Health Organization (WHO) defines menopause after 12 consecutive months of amenorrhea for which there is no other obvious pathological or physiological cause [1]. Along with the decrease of estrogen level during menopause stage; in the early phase, hot flush, sweating, and attention and memory problems are experienced, and in the late phase, problems are experienced such as sexual dysfunction, urogenital atrophy, vulva itching, dyspareunia, uterine bleeding, urinary incontinence, fertility loss, defect in body image, cardiovascular system disorders, and osteoporosis [2]. These are combined with social and symbolical meanings, and thus quality of life can be affected negatively [3]. It is estimated that 1.2 billion women will be in the menopause and post-menopause stages by 2030 [1]. Thus, a great number of women will be enduring the problems of menopause and the resulting lower quality of life.

The WHO defines quality of life as individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns [4]. Various studies showed that women in the menopause stage experienced hot flashes and sweats (41.6%- 71.2%) considerably. However, joint and muscle disorders (80.1%), physical and mental exhaustion (67.1%), insomnia (%65), vaginal dryness and pain with intercourse (37.9% - 57%) are included among other problems in the studies [5-9]. Augmentation of the time spent in menopausal stage and life quality of women affected unfavorably by menopause-dependent health problems make the treatment inevitable [7]. In the conducted studies, it is reported that medical treatments used in the management of menopause symptoms have an important clinical role however due to their complex biological effects and their limited benefits against risks, they are not preferred by many women [10,11]. Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practice, and products that are not presently considered to be part of conventional medicine. Although their reliability is not revealed completely, during the recent years, women prefer CAM methods which they believe that they are safer and natural in order to relieve menopause symptoms [10,12,13].

According to 2014-2023 “Traditional Medical Strategy” report of the WHO, it is reported that interest in CAM use increased in many developed countries and its use became widespread (%40-%80) [13]. The conducted studies show that CAM use frequency during menopause stage changes between 37.4% and 55.0% [14-16]. Women resort to CAM methods that they think are effective in the management of vasomotor symptoms especially [5]. The conducted studies reported that phytoestrogens and physical-mental methods were preferred by women most frequently [4,17,18]. Nevertheless, it was determined that the studies evaluating the relationship of CAM use during menopause stage and life quality are limited. Some of these studies reported that traditional acupuncture is effective on vasomotor symptoms, yoga caused positive changes in life quality of women and Mediterranean diet and physical exercise had positive effects on haemostatic balance and life quality [2,7,13,19- 21]. Silva et al reported in their study that women who experienced low sleep quality due to fibromyalgia during menopausal stage improved their sleep quality by passive body warming method [22].

According to the literature, although there are various studies in Turkey about the methods to cope with menopausal symptoms and CAM use in menopause, there are limited numbers of researches to determine the effect of CAM use on life quality.

Aim: Purpose of this study was determining CAM applications used by women for menopausal symptoms and the effect of this on life quality.

Research Questions: 1) What is the CAM use rate during menopausal stage? 2) What are CAM-methods used during menopausal stage? 3) Is there a relationship between CAM use and the score averages of Menopause-Specific Quality of Life Scale (MENQOL)?

Methods

Study design, setting, period, population, and sample size

This descriptive and cross-sectional study was conducted during February 15-September 25 2014 in a private university hospital, menopause polyclinic in Turkey. 800 women who applied to the menopause polyclinic of this hospital during one year made up the universe of the study. 270 women made up the research sample with 95% confidence interval and ± 5% deviation according to the formula to estimate the sampling number in cases when the universe is known by considering Ozdamar’s study [23]. The women were included in the study by selection with simple random sampling method. 168 women out of 270 women in the sampling indicated that they used CAM and 102 women indicated that they did not use any CAM method. Until this number is reached, the women fitting the research criteria among those who applied to the clinic were included in the study group in a randomized fashion. Only 6 women did not wish to participate in the study among the determined ones.

Exclusion and inclusion criteria

Inclusion criteria: in the framework of menopause definition of the WHO, women who 1) did not have menstruation for at least 12 months, 2) entered menopause by surgical intervention by having total abdominal hysterectomy with bilateral salpingooophorectomy, 3) did not pass 65 years of age which is accepted as the old age limit by the WHO, 4) did not have auditory or mental disability, 5) are open to communication and collaboration, 6) are volunteers to participate in the study were included.

Exclusion criteria: 1) receiving hormone replacement therapy, 2) women with a diagnosed psychiatric disease and serious chronic diseases (malignancies, neurological conditions, immediate deterioration of chronic illness, etc.) were excluded.

Variables

Independent variables: socio-demographic, obstetric and menopausal characteristics.

Dependent variables: MENQOL score.

Instruments

The researcher completed the data collection forms by face-toface interview method and each interview lasted 15 minutes. The instruments used include:

The Survey Form: It consists of 33 questions enabling determination of individual characteristics of women (9 questions), obstetric and general health story (7 questions), menopausal characteristics (8 questions), CAM use (past 6 months),used CAM methods, CAM using reasons and the symptoms they affect, knowledge on CAM use information source, the effectiveness of the methods (9 questions) and their side effects and sharing with health team[3,12,14,15,20]. Pre-application of the survey was carried out on 27 women in order to determine the clarity of the data collection form. It was determined after the pre-application that there was no difficulty in the understanding of the questions in the data collection form.

CAM methods were defined as follows in the survey form: CAM is a group of diverse medical and health care systems, practice, and products that are not presently considered to be part of conventional medicine. The National Center for Complementary and Alternative Medicine (NCCAM, 2015) and WHO classifies were used to determine CAM therapies categories in the study [13,24];

1. Alternative medical systems (include homeopathic medicine and naturopathic medicine, ayurveda)

2. Mind-body interventions (include meditation, yoga, prayer, mental healing, acupuncture, and therapies that use creative outlets such as art, music, or dance).

3. Biologically based therapies (include natural herbs, foods, and vitamins)

4. Manipulative and body-based methods (include chiropractic or osteopathic manipulation, reflexology and massage).

5. Energy therapies (include qi gong, reiki, cupping and therapeutic touch)

4.4.2. The MENQOL Scale: It is a life quality scale related to the health state unique to menopause and developed by Hilditch, Lewis, and Peter A et al [25] in 1996. It was adapted to Turkish society in 2007 by Kharbouch and Sahin, and the validity and reliability study was conducted [26]. The scale is a Liker type consisting of 29 questions. It is made of four sub areas as vasomotor (1-3), psychosocial (4-10), physical (11-26) and sexual (27-29). Each sub areas are listed from scale 1 to 6 in scale scoring. As the score increases, the severity of the complaint increases and life quality drops. Total scale scoring is not estimated [26]. Cranach’s alpha value of the scale is 0.73-0.88’dir.In this study, the Cranach’s Alpha reliability coefficient was found to be 0.96.

The Ethics Committee of Private University Hospital approved this study. Legal permission was also obtained from the hospital management. All participants signed a written informed-consent form before enrolling in the study. Rules specified in the Helsinki Declaration were observed in the data collection phase.

Statistical Analysis

The data were evaluated with the Statistical Package for the Social Sciences (SPSS) 20 package program. The statistical analysis was carried out using descriptive analyses (percentage distribution, mean and standard deviation), chi-square and Mann-Whitney U test. The statistical level of significance was adopted to be p<0.05.

Results

The average age of the women who participated in the research was 54.2±5.0. It was determined that 95.9% of the women were married, 45.2% of them were high school graduates and had higher education, 27.8% worked in an income bringing job, and 72.6% of them had good economic status. Average menopause age of the women was 46.9±1.9. It was determined that 95.2% of them entered menopause naturally. It was determined that health problems of the women experienced during menopause stage were in turn; sudden hot flushes (86.9%), vaginal dryness/dyspareunia (81.7%), muscle-joint ache (70.4%), reduced sexual desire (65.7%) and sleep problems (64.8%) (Table1).

Table 1: Distribution of individual characteristics of women (n=270).

It was determined that 62.2% of the women resorted to CAM methods to alleviate their menopause complaints and 72.6% used these methods for 3 years and longer. It was determined that 42.3% of the women obtained information on CAM method from women who applied CAM, 31.6% from mass communication devices, 16.1% from friends and relatives, and 10% from health providers (Table 2).

Table 2: Distribution of characteristics use of CAM for menopausal symptoms women’s.

It was found that the biologically based of therapy (90.5%), with the use of herbal medicine, is the main practice used during menopause, then the mind-body interventions (83.3%) as the prayer of healing and the manipulation body-based methods (34.5%), exercises and acupuncture are also cited with common practices (Table 3).

Table 3: Distribution of effectiveness and CAM methods (N=168).

When the reasons for CAM use were examined, in turn, it was stated by the women that; it decreased hot flush and sweating complaints (28.6%), it was natural and safe (27.4%), it reduced aches (22.6%), and it helped physical and mental fatigue (8.8%).

CAM methods used by women are beneficial considerably (biologically based methods; 90%, mind-body based 80%, and manipulation-based therapy 53%) for menopause symptoms.

CAM use by the women who worked in an income-earning job was 38.7%, and this ratio was 71.6% for the women who did not work. Higher level of CAM use in the unemployed group was found to be statistically significant (x2= 24.1, p=0.0001). Although CAM use was greater in the advanced age group (ײ=0.08, p=0.956) and in the group who had low educational level (ײ=5.26, p= 0.071), the difference between them was not significant statistically (p<0.05).

Table 4: Distribution of mean scores of MENQOL.

Table 5: Distribution of mean scores of MENQOL according to use of CAM.

When the score averages of the subgroups of the participants’ MENQOL were scrutinized; vasomotor area was 3.3±1.3 (0-6), psychosocial area was 1.4±1.1 (0-4.1), physical area was 2.2±1.1 (0- 4.6), and sexual area average was 3.2±1.5 (0-6) (Table 4). As a result of the analysis, it was determined that the women who entered menopause by surgical means experienced more physical (z=-4.10, p=0.0001) and sexual problems (z=-2.12, p=0.034) and their life quality was affected unfavorably. Menopausal symptoms in the study group among CAM using women were observed less. Accordingly, it was determined that vasomotor (z=-6.9, p=0.0001), psychosocial (z=-5.4, p=0.0001), physical (z=-5.6, p=0.0001) and sexual life (z=- 3.1, p=0.0001) qualities were higher (Table 5). According to CAM methods, in the comparison of MENQOL subscales score averages, it was found that life quality was higher in the women who used biological method the most (z=-3,15; p=0.002) (p=0.002).

Discussion

The conducted studies showed that women in menopause stage experienced significant level of hot flushes and sweating problems (%41.6-%71.2) [9,27]. Hot flashes and sweating problems (66.5% and 65.2%, respectively) were determined to be the most frequently experienced health problems by women in menopausal stage in Turkey as well [28]. It was also determined in our study similarly that the women had hot flashes-sweats (86.9%). In the researches, the ratio of women who experience vaginal dryness changes between 37.9% and 57% [9,29,30]. In our study, dyspareunia/ vaginal dryness complaint was higher than that in other studies (81.7%) (Table 1).

During the recent years, women who wish to fix their acute health problems and improve their life quality resort to CAM because of its easy access and being an alternative to medical treatment [31,32]. In the study of Gartoulla et al [5], it was reported that the interest of Australian women in menopause stage to CAM use increased. In the study of Sluijs et al [33], CAM use rate in menopause stage was 53.8%. This ratio changed between 31% to 82.5% in the literature search to determine CAM use rates [6,7]. In the studies performed in the national level, CAM use rate of women in menopause stage changed between 29.9% to 37.4% [14,34]. In our study, it was determined that 62.2% of the women resorted to CAM methods. CAM use rate was found to be higher in our study to be different than other research results.

In a literature search conducted to evaluate the variation of the used methods in different countries; it was seen that the first method resorted by women was biological-based methods generally [5,32,33]. The studies conducted in Turkey reported that women in menopausal stage preferred herbal treatments especially to cope with their problems [14,34] Nevertheless, in a study making an evaluation based on race/ethnic groups, it was reported that ginseng as biologically based therapy was used frequently in all groups, Chinese tea, vegetarian diets, and soybean fortifications were used by Chinese and Japanese women and white women and Afro-American women resorted to praying more frequently than other groups did. Also, manipulative-body based methods (massage, acupressure, and reflexology) and mindbody methods (meditation, yoga, acupuncture, mental imagery or progressive relaxation) were used by Chinese women [35]. Some of these results are similar to the literature in terms of especially herbal use and adaptation of praying in our study. Various herbal supplements and spiritual therapies as religious healing which can allow positive influences on health are well known among the community in Turkey, generally used by adult female. Cultural beliefs and practices often lead to home remedies or consultation with religious healers in our country. On the other hand, one might argue this is a true reflection of the patients’ culture where prayer and spiritual believes are part of people’s everyday life and may not be included in CAM. The use of other methods (such as acupuncture, yoga, homeopathy, meditation or hypnotherapy) did not find adequate support for its use in menopausal symptoms. We suggest that there is a cultural background underlying these findings. Successful programs in dealing with menopausal symptoms need to include the establishment of a community-based intervention strategy including health providers to educate people about use of CAM methods. It is indicated in the literature that CAM-using women resorted to this method by media, the internet, and with the suggestion of friends and family, and most of CAM users did not collaborate with health providers [16,36]. Our study results are compatible with the literature in this aspect and only 10% of CAM using women collaborated with health providers (Table 2).

Cardin et al reported in their study that women sought advice of herbalists, dieticians and homeopaths for preference of CAM use. In the same study, it was emphasized that the difficulties experienced by women to receive information about CAM should be overcome by education in health institutions [32]. In Turkey, the Regulation of Traditional, CAM Applications regulated the procedures and principles about the application of these methods and the involvement of the persons and organizations that are not health professionals in CAM applications is attempted to be prevented [37].

Women generally prefer treatment methods consorting with their cultural values in the selection of a CAM method during menopause stage. Natural estrogen resources, meditation, acupuncture and exercise is preferred by women to alleviate menopausal complaints. Soya products and black snakeroot is reported to be beneficial in vasomotor symptoms, and ginseng tea, evening primrose oil, licorice root and polemonium is useful for physical and psychological problems [24,38,39]. In other studies, biology-based plant therapy preferences of women in menopausal stage ranged between 5% to 29.9% [5,14,27,34]. In our research, the widely preferred CAM method was biological treatments (90.5%) and it was determined that soya products were used the most (45.8%) (Table 3). Similarly, it was reported in the other researches that women preferred soya products to alleviate menopause complaints [7,14]. Nevertheless, phytoestrogen-based products can be beneficial in easing the menopause symptoms however there are not adequate studies reporting their complications [40]. Based on all these findings, it is observed that interest in phyto therapy among women is intense. In this sense, it is crucial that CAM methods are supported by evidence-based researches.

Body-mind treatments have a crucial place in the management of menopause symptoms. The second most preferred CAM method in our research was determined to be body-mind treatments (83.3%) (Table 3). Brett et al determined in their study that 25% of women used body-mind methods to deal with the menopause problems [17]. Lunny and Fraser [18] reported in their research that there were relaxation techniques (57%), yoga/meditation (37.6%) and praying (35.7%) among body-mind methods preferred by women. It is remarkable that in our study, majority of the women (80.9%) preferred “praying method” among the bodymind treatments (Table 3). It is natural that resorting to religious applications intensely for dealing with health problems complies with the socio-cultural structure of Turkey.

Although energy treatments among CAM methods were used in a limited level in our research (3.0%), the women evaluated it as having the highest effectiveness. Body and mind treatments and biology-based treatments followed this (Table 3). Whereas there are limited numbers of studies evaluating the effectiveness level based on CAM methods in the literature, it was determined in a research conducted on German women that the used CAM methods were perceived as effective in the rate of 45.5% to 84.5%.5Lunny and Fraser [18] determined in their study that the methods benefited the most by women in menopause stage were praying/ spiritual healing, relaxation techniques, consultancy/therapy and treatment, touching/Reiki.

The conducted studies manifest that menopause-based physical, psychological and social changes affect life quality of women unfavorably [3,12,16,20]. It can be concluded that when the results of our study were compared with those of the other studies, the life quality score averages that we gathered were lower (Table 4). In our study, it is thought that especially alleviation of life quality in sexual area is because women in menopause stage in Turkey see the problems about their sexual life as a natural outcome of the process and don’t search solution.

It was found in our study that life quality of the CAM using women was higher in comparison to the women who don’t use it in the areas of vasomotor, psychosocial, physical and sexual (p<0.05) (Table 4). Reed et al observed in their study that regularly performed “yoga” improved sleep quality and physical area life quality of women in menopause stage by regular exercise [20]. It is reported in the literature that women with postmenopausal symptoms can improve their life quality with exercise [25]. In Thompson’s study [41], it was determined that homeopathy treatment improved life quality of women who were in menopausal stage and had breast cancer in especially vasomotor area. Taovani et al [42] determined that therapeutic massage and aromatherapy controlled psychological indications of menopause and regulated women’s life. Caputo and Costa reported in their literature review that physical activity was essential for improving life quality of postmenopausal women with osteoporosis [43]. Although the results of the studies support our research finding, they illustrated that CAM methods influenced life qualities of the women in menopause stage favorably.

Conclusion

In the study, it was determined that women in menopausal stage especially experienced hot flushes and sweating intensely. It is thought that CAM methods used by women are beneficial considerably (53% - 90%) for menopause symptoms. Life quality of women who use CAM methods was determined to be better in comparison to women who do not use them. CAM may contribute positively to menopausal period by helping to relieve some of symptoms. It is suggested that CAM methods are supported by evidence-based researches.

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