Mayo Clinic proceedings最新文献

Objective: To evaluate the accuracy of patient self-reported menopause stage among midlife US women.

Patients and methods: This cross-sectional analysis included women 40 to 65 years of age who presented to women's health clinics at one of three Mayo Clinic sites from December 2016 to September 2019. Patients self-reported their menopause stage (pre-, peri-, postmenopausal, or unsure) while clinician-determined stage (pre-, peri-, postmenopausal, or unknown) was assessed by menopause-trained specialists using a standardized form. Only women with both self- and clinician-reported menopause stages were included.

Results: A total of 3411 women (mean age 53.5±6.2 years) were included with the majority being White (91.1%), educated (67.2%, at least some college education) and married/partnered (84.1%). Overall, 323 (9.5%), 640 (18.8%), 1182 (34.7%), and 1266 (37.1%) women self-reported being pre-, peri, postmenopausal, or unsure, respectively. Patient-reported and clinician-determined menopause stages aligned in only 56.6% of cases (n=1930, kappa=0.38). Notably, more than one-third of women (n=1266, 37.1%) reported being unsure of their menopause stage, whereas just 389 (11.4%) were classified as unknown by their clinicians. Of those who self-reported being unsure of their stage, 958 (75.7%) were classified as postmenopausal by clinicians. In a subset of women from 45 to 55 years of age (n=1786), the agreement was 56.8% (n=1015, kappa=0.40), with the highest concordance observed in the postmenopausal stage (41.0%).

Conclusion: These findings highlight significant discrepancies between patient-reported and clinician-determined menopause stages, underscoring a lack of awareness among women regarding their menopause stage. This gap may result in missed opportunities for timely and appropriate interventions for care.

Objectives: To evaluate the association between the dietary digestible carbohydrate intake level and the incidence of cardiovascular disease (CVD) and type 2 diabetes (T2D).

Methods: We searched Embase, MEDLINE, and Cochrane Central from January 1, 2000, to July 19, 2024, to find randomized controlled trials and prospective cohort studies evaluating healthy individuals over 2 years of age, isolating for the effect of the digestible carbohydrate intake level from other macronutrients.

Results: Thirty prospective cohort studies with more than 1.7 million participants were included. Most of the studies reported inadequate confounding adjustment and were deemed to have serious risks of bias. No eligible studies evaluated children under 18 years. The association between the digestible carbohydrate intake level and CVD and T2D was nonlinear, which was supported by a low strength of evidence. The risk of CVD was the lowest at a carbohydrate intake level of 50% of total energy intake. The risk of CVD significantly increased when the carbohydrate intake level exceeded 65% of total energy intake. The risk of incident T2D gradually reduced with increasing carbohydrate intake levels up to 45% of total energy intake, then plateaued between 45% and 55% of total energy intake, before rising with higher carbohydrate intake levels. The nonlinear relationships were overall similar based on sex or geographic location but with variable intake range associated with the lowest risk.

Conclusion: A U-shaped relationship was observed between the intake level of digestible carbohydrates and CVD and T2D. The findings have important implications on the incidence and morbidity of chronic conditions and public health.

Registration: clinicaltrials.gov: PROSPERO #CRD42024494567 and CRD42024496101.

Cardiothoracic surgery can be a physically and emotionally challenging experience for patients, often involving significant pain, anxiety, and a reliance on opioid-based analgesia. As health care moves toward more holistic and patient-centered approaches, there is growing interest in complementary therapies like music. Music interventions represent a safe, noninvasive, and cost-effective strategy to support recovery in cardiothoracic surgery patients. This review explores how music interventions can support recovery in patients undergoing cardiothoracic procedures, focusing on pain reduction, anxiety alleviation, and physiological responses. A search of PubMed, CINAHL, and PsychInfo identified 19 studies, primarily randomized controlled trials, investigating music interventions during the perioperative period in adult cardiothoracic surgery patients. Across the studies reviewed, music interventions significantly reduced postoperative pain and anxiety compared with control groups. Several trials also reported reductions in analgesic use, heart rate, and blood pressure, although findings on physiological measures were mixed. Although further research is still warranted to optimize implementation and assess long-term benefits, the current evidence suggests that music can positively impact surgical recovery. Incorporating music into multimodal recovery protocols may improve patient experiences and reduce reliance on pharmacological interventions.