***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES ( 1 ) To assess the prevalence of risk factors for osteoporosis and cardiovascular disease and the prevalence and severity of the appearance of menopausal symptoms among Spanish menopausal women . ( 2 ) To identify the main factors responsible for this severity . ( 3 ) To detect symptom differences between perimenopausal and postmenopausal women . METHODS Cross-sectional descriptive study encompassing women aged 45 - 65 years in the whole Spanish territory . The study population sample was collected through r and om sampling . A total of 10,514 women were included . The sociodemographic , medical history and lifestyle data were assessed by means of a survey . The Kupperman scale was used to assess the severity of menopausal symptoms . RESULTS The prevalence of risk factors for osteoporosis and cardiovascular disease were 67.6 % and 74.8 % , respectively . The most common risk factors were physical inactivity ( 53.6 % ) , obesity ( 44.3 % ) , arterial hypertension ( 36.6 % ) , hypercholesterolemia ( 31.4 % ) , low calcium intake ( 30.1 % ) and smoking ( 28.7 % ) . The predominant symptoms experienced by menopausal women were hot flushes ( 51.4 % ) , insomnia ( 45.7 % ) and irritability ( 42.2 % ) . These were severe in 3.3 % of the sample , moderate in 27.3 % , mild in 24.6 % while 44.8 % had no symptoms . The prevalence of joint pain ( 40.1 % ) and depressive mood ( 40 % ) was higher in perimenopausal than in postmenopausal women . Logistic regression analysis showed that there were differences for age , BMI , smoking , social class and poor consumption of dairy products in the severity of menopausal symptoms . CONCLUSIONS A high prevalence of risk factors for osteoporosis and cardiovascular disease was observed in our study . The main factors contributing to more severe menopausal symptoms were age , BMI , smoking social class and poor consumption of dairy products . In general , postmenopausal women presented significantly higher rates of menopausal symptoms when compared to perimenopausal women The purpose of this study was to determine whether psychological support associated with  hormone replacement therapy ( HRT )  was more beneficial than replacement therapy alone . Our findings showed that HRT alone was more effective against vasomotor symptoms than HRT with psychological treatment ( PT ) . While the combination of both treatment modalities ( HRT + PT ) was more effective against insomnia , nervousness , melancholy , fatigue , palpitations , and vertigo .  Hormonal treatment alone and HRT with psychological treatment had little effect against paresthesia or tingling . Neither HRT alone nor HRT with psychological treatment was effective against joint and muscle pain or headache Cardiovascular disease is a leading cause of death and disability and remains so in the future . The aim of this study was to detect the impact of a 6-month diet intervention on cardiovascular risk factors in postmenopausal Iranian women . It was a r and omized controlled trial that carried out in the East Health Clinic in Ahvaz-Iran . This study started on June 2007 and was completed on May 2008 . A total 64 healthy postmenopausal women recruited and r and omly assigned to the intervention group ( 35 ) and control ( 29 ) . Over the six months follow-up , the intervention group received five educational sessions ( two face to face and three lecture discussion classes with slide demonstration ) at the first month . These sessions were about menopause , cardiovascular disease and healthy diet . Every participant in the intervention group received one face to face education session at the 3rd month , and also received a telephone call at the end of each month starting with the second month to remain on the diet . Pre-intervention and post-intervention anthropometric measurements , blood pressure , blood lipids and dietary intake were assessed . Data analyzed using the SPSS version 15 . Descriptive ( means and SD ) , univariate ( Paired-t test , Chi-Square and Independent T-test ) and multivariate ( GLM Repeated Measure ) statistics were used . Participants in the diet group had significantly lower weight ( -0.9 kg ) , body mass index ( -0.4 kg/m2 ) , and fasting blood sugar ( -4.5 mg/dl ) . The diet group significantly increased their daily intake of fiber ( + 2.3 g , P = 0.05 ) , decreased their intake of sodium ( -28 mg , P = 0.04 ) , and consumption of fruit and vegetable ≥ 5 serving a day ( 80 % , P = 0.03 ) compared to the control group . Post menopausal women are at a greater risk for cardiovascular disease . Healthy diet using educational intervention can be an effective means of reducing cardiovascular risk in postmenopausal women The purpose of this study was to develop and test a decision support intervention ( DSI ) to assist women to make and act on informed decisions that are consistent with their values in the area of menopause and hormone replacement therapy ( HRT ) . Mode and intensity of intervention were tested in midlife women ( N = 248 ) , r and omly assigned to one of three intervention formats : written information only , guided discussion , or personalized decision exercise . Data were collected over 12 months . Knowledge , decisional conflict , satisfaction with health care provider , and self-efficacy improved following intervention and were maintained for 12 months for all groups . Women 's adherence to their own plans over 12 months was 59 % ( exercise ) , 76 % ( calcium intake ) , and 89 % ( HRT ) . Carefully written information is effective in promoting knowledge , adherence , and satisfaction among well-educated , interested women . It was concluded that women can underst and complex information , including tradeoffs regarding treatment options . Women will adhere to their own plans , suggesting that consumer rather than provider plans may be the more appropriate gold st and ard for measuring adherence OBJECTIVE Knowledge relevant to women 's peri- and postmenopausal health decisions has been evolving rapidly . Web-based decision supports can be rapidly up date d and have the potential to improve the quality of patients ' decisions . We developed and tested a web-based decision support for peri- and postmenopausal health decisionmaking . METHODS We recruited 409 women aged 45 - 75 for one r and omized , controlled trial and 54 women with an upcoming clinic appointment for a subsequent trial . Women were r and omized to use the web-based decision support versus a printed brochure ( first trial ) and usual care ( second trial ) . Outcomes were changes in decisional satisfaction , decisional conflict , and knowledge , both within each trial and compared across the trials . RESULTS Intervention subjects had greater increases in decisional satisfaction in the second trial and knowledge in both trials . A high dropout rate among women r and omized to the website in the first trial effectively negated benefits in that trial , but not in the second . CONCLUSIONS The utility of this web-based decision support in two trials depended on a number of factors that appear related to the urgency of making a decision . PRACTICE IMPLICATION S Decision aids should be targeted to patients actively trying to make a decision Background : During peri- and postmenopause there is a high prevalence of psychological symptoms such as emotional instability , depressive moods , anxiety , sleep disorders , and sexual dysfunction . Aetiologically relevant factors for discomfort are decline of sex hormones and psychosocial factors such as lifestyle , attitude towards menopause , pre-menopausal mental health and sociocultural factors . In contrast to the relevance of psychosocial factors , there are few studies on psychological interventions . The present study evaluates an open trial of cognitive-behavioural group intervention consisting of psychoeducation , group discussion and coping skills training for women suffering from climacteric symptoms . Methods : Thirty women were enrolled in this first trial . St and ardised ( MRS , HADS-D , Partnership Question naire , McCoy Female Sexuality Question naire ) and especially developed ( ‘ Attitudes Towards the Menopause ’ ) instruments were administered 3 times , twice before ( T1 and T2 ) and once after the group intervention ( T3 ) . General linear model repeated measures were used to analyse changes in question naire measures . Results : Taking the average of the two pre-intervention scores , significant improvements were observed in anxiety ( p < 0.01 ) , depression ( p < 0.02 ) , partnership relations ( p < 0.02 ) , overall score of sexuality ( p < 0.02 ) , hot flashes ( p < 0.01 ) and cardiac complaints ( p < 0.01 ) from pre- to post-intervention . No changes were found for sexual satisfaction and stressfulness of menopausal symptoms . Conclusions : This pilot study points at a possible effectiveness of cognitive-behavioural interventions for the treatment of climacteric syndrome . Further studies will have to use r and omised trials , comparing different treatments ( HRT , phyto-oestrogens , relaxation training , discussion groups ) for their effectiveness Many women approach menopause with uncertainty about what will happen and how to deal with changes that occur . The current study aim ed to evaluate the short-term outcome of a health education intervention devised to prepare 45-year old women in general practice s. One hundred and seventy-eight 45-year old women registered at five general practice s in south London were targeted for the research ; 106 of the women responded and 86 of these women formed a usable pre-menopausal sample which was r and omly allocated to the preparation intervention and control conditions . Preparation involved two health education sessions carried out in small groups and covering information and discussion of the normal menopause transition in the context of mid-life . The women completed pre- and post-intervention ( 3 and 15 months ) question naires which assessed knowledge and beliefs about menopause and a number of health-related behaviours . Knowledge improved significantly at the follow-up assessment s for the preparation group but not for the control group . On the whole , the prepared women 's beliefs about menopause became less negative following the intervention , although there were also some changes reported by the control group . The proportion of smokers decreased from 25 to 20 % for the prepared women although this did not reach statistical significance . There was no change in the prevalence of regular exercise . There was also a decrease in the intention to take hormonal treatments following the intervention . Suggestions for further development of health promotion services for mid-aged women and more holistic health care practice s are proposed The purpose of this quasi-experimental research was to assess the effectiveness of a perimenopausal health education intervention for mid-life women in northern Taiwan . The health education intervention included a health education brochure , one-on-one teaching .  One hundred seventy-nine women were in the intervention group and 174 women were in the control group . Education effectiveness was assessed by participants ' scores on four question naires at the beginning of the study and 3 months after initial recruitment . Both groups of women were compared on changes in their scores on health knowledge , level of perceived uncertainty , health behaviors and perceived perimenopausal disturbances . The intervention group had significantly reduced scores on perimenopausal disturbances ( P < 0.005 ) and reported increase practice of healthy behaviors ( P < 0.001 ) compared to the control group . However , a significant decrease of perceived uncertainty was only found in the subgroup of women recruited from the Chinese medicine clinic of the control group ( t = 2.22 ; d.f . = 58 ; P < 0.05 ) . Chinese medicine physicians assess patients based on a philosophical approach that treats all symptoms holistically . This may have helped reduce patient uncertainty Aim To identify aspects of health in postmenopausal Brazilian women using a health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late postmenopausal symptoms . Design A prospect i ve cohort was formed with 69 postmenopausal women ; they were divided into groups corresponding to early ( n = 32 ) and late postmenopause ( n = 37 ) through gynecological and clinical evaluations . We administered the Kuppermann – Blatt Menopausal Index and the Women 's Health Question naire before and after health education instructions . Results The average age for the onset of menopause was 47.9 years ( n = 69 ) . Fifty women ( 72.5 % ) in this study had completed their primary education , 78.3 % ( n = 54 ) performed manual labor , and 60.9 % ( n = 42 ) showed concomitant chronic illnesses . After attending a series of health-related presentations , the mean weight of the women was reduced by 3.54 % in early postmenopausal women ( p < 0.001 ) and by 2.06 % in the late postmenopausal group ( p < 0.001 ) . The mean abdominal circumference was reduced by 1.75 % ( p < 0.001 ) in the early postmenopausal group . In addition , the total score in the Kuppermann – Blatt Menopausal Index decreased by 34.38 % in the early and by 33.33 % in the late postmenopausal groups . According to the Women 's Health Question naire , there was a decrease in the domain Depressive mood by 0.839 to 0.700 ( p < 0.001 ) in the early and by 0.814 to 0.648 ( p < 0.001 ) in the late postmenopausal groups . Conclusion Regardless of improving menopausal symptoms and anthropometric parameters , the effects of the multidisciplinary team activities in early postmenopausal women may be similar to those in late postmenopausal women OBJECTIVE To assess the effect of an Internet 
    Output:
    
Psychosocial options are promising intervention options for self-management and self-care , as they provide multiple benefits with no side effects .
Moreover , these options are recommended for women in clinical , sub clinical and asymptomatic groups , as they offer women the agency and skills necessary to manage and relieve menopausal symptoms , as well as provide information and alternatives to prevent menopausal symptoms and to have a more positive experience during these life stages .
These options do more than reduce distress and complaints , as they allow women in any condition to enjoy enhanced health , well-being and quality of life .
Moreover , these options are accompanied by important cost reductions in pharmaceutical investment and healthcare .