Metintas Selma, Arýkan Inci, Kalyoncu Cemalettin, Ozalp Sinan
Eskisehir Osmangazi University Medical Faculty, Public Health Department, Turkey.
Rural Remote Health. 2010 Jan-Mar;10(1):1230. Epub 2010 Mar 31.
Women living in rural areas of Turkey experience difficulties in accessing healthcare services, and this is attributed to distance from urban healthcare centers, financial barriers and poverty, a low education level, and gender discrimination. The purpose of this study was to test the applicability of the menopause rating scale (MRS) as a screening tool by primary healthcare professionals for identifying women with severe menopausal symptoms. The objectives of the study were to test the validity and reliability of the MRS in rural areas of Turkey, to determine estimation values for referral to the secondary level of healthcare, and to assess the prevalence of severe menopausal symptoms among rural Turkish women.
The sample size was 600 women. The Turkish version of the MRS and the Kupperman index were used to evaluate the severity of symptoms. The internal consistency coefficient (Cronbach's alpha) of the MRS was computed using the test-retest method. The influence of the MRS with regard to the decision to seek medical advice due to menopausal symptoms was considered the validity criterion, and the sensitivity and specificity of the test were established according to this criterion. Estimation values of the test were determined by ROC analysis. Independent variables for the severity of menopausal symptoms were determined using a logistic regression model.
A positive correlation between the MRS and the Kupperman index was revealed (r=0.86, p=0.000). The estimation value or the MRS score that would predict whether a woman had visited a gynecologist at least once due to the severity of menopause symptoms was found to be 16, its sensitivity and specificity were both 60%. The MRS score was higher among participants who evaluated their general health as 'unfit' or who had advanced age, chronic disease, a history of dysmenorrhea, or who had had two or more miscarriages.
This evaluation of the MRS indicates that the instrument is a comprehensible, useable, reliable screening test for the identification of women with severe menopausal symptoms. By screening using the MRS it is possible for primary healthcare workers in rural areas to identify women in need of referral to an upper-level healthcare institution.
生活在土耳其农村地区的女性在获得医疗服务方面面临困难，这归因于与城市医疗中心距离远、经济障碍和贫困、教育水平低以及性别歧视。本研究的目的是测试更年期评分量表（MRS）作为基层医疗专业人员识别有严重更年期症状女性的筛查工具的适用性。该研究的目标是测试MRS在土耳其农村地区的有效性和可靠性，确定转诊至二级医疗保健机构的估计值，并评估土耳其农村女性中严重更年期症状的患病率。
样本量为600名女性。使用MRS的土耳其语版本和库珀曼指数来评估症状的严重程度。采用重测法计算MRS的内部一致性系数（克朗巴哈系数）。将MRS对因更年期症状寻求医疗建议决策的影响视为有效性标准，并据此确定测试的敏感性和特异性。通过ROC分析确定测试的估计值。使用逻辑回归模型确定更年期症状严重程度的自变量。
MRS与库珀曼指数之间呈正相关（r = 0.86，p = 0.000）。发现预测女性是否因更年期症状严重程度至少就诊过一次妇科医生的MRS估计值或分数为16，其敏感性和特异性均为60%。在将自身总体健康评估为“不健康”或年龄较大、患有慢性病、有痛经病史或有两次或更多次流产史的参与者中，MRS分数更高。
对MRS的这项评估表明，该工具是一种可理解、可用、可靠的筛查测试，用于识别有严重更年期症状的女性。通过使用MRS进行筛查，农村地区的基层医疗工作者有可能识别出需要转诊至上级医疗机构的女性。
