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Prevalence and impact of vasomotor symptoms associated with menopause among women in Brazil: Subgroup analysis from an international cross-sectional survey 巴西妇女与更年期相关的血管运动症状的发生率和影响:一项国际横断面调查的分组分析
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1016/j.maturitas.2024.108114
Rogério Bonassi Machado , Roberto Soler , Marcos Freire , Maria Celeste Osorio Wender , Luciano Melo Pompei

Objective

This study assessed the prevalence and impact of moderate and/or severe vasomotor symptoms and related treatment patterns in midlife women in Brazil.

Study design

Brazilian women aged 40 to 65 years completed an online survey. The prevalence of moderate to severe vasomotor symptoms was assessed in postmenopausal women who completed a series of questionnaires to elicit responses regarding their treatment patterns and attitudes to treatments.

Main outcome measures

Perimenopausal and postmenopausal women with moderate to severe vasomotor symptoms completed three standardized questionnaires (Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbances Short Form 8b) and answered open-ended questions.

Results

Of 1244 postmenopausal women who accessed the survey, 36.2 % had experienced moderate to severe vasomotor symptoms in the previous month. Moderate to severe vasomotor symptoms among 501 perimenopausal and postmenopausal women negatively affected overall quality of life (mean total score on the Menopause-Specific Quality of Life questionnaire was 3.6/8). On the Work Productivity and Activity Impairment questionnaire, women's scores for impairments in overall work and daily activities due to vasomotor symptoms were 50.3 % and 60.0 %, respectively. Overall mean (standard deviation) score on the Patient-Reported Outcomes Measurement Information System Sleep Disturbances Short Form 8b was 25.5 (5.8) on a scale of 8 to 40. Most women sought medical advice (65.5 %), but over half were not receiving treatment. Those who received treatment reported moderately favorable attitudes to hormone and nonhormone prescription medicines, but safety concerns remained.

Conclusion

Brazilian women experienced a relatively high prevalence and burden of moderate to severe vasomotor symptoms.
研究设计40至65岁的巴西妇女完成了一项在线调查。对绝经后妇女中度至重度血管运动症状的患病率进行了评估,并填写了一系列调查问卷,以了解她们对治疗模式和治疗态度的反应。主要结果测量有中度至重度血管运动症状的绝经期和绝经后妇女填写了三份标准化问卷(绝经期生活质量问卷、工作生产率和活动障碍问卷以及患者报告结果测量信息系统睡眠障碍简表8b),并回答了开放式问题。结果在1244名参与调查的绝经后妇女中,36.2%的人在上个月有中度至重度血管运动症状。501名围绝经期和绝经后妇女的中度至重度血管运动症状对整体生活质量产生了负面影响(绝经期生活质量问卷的平均总分为3.6/8)。在 "工作效率和活动障碍 "问卷中,妇女因血管运动症状而导致的整体工作和日常活动障碍得分分别为 50.3% 和 60.0%。患者报告结果测量信息系统睡眠障碍简表 8b 的总平均分(标准差)为 25.5(5.8)分(8-40 分)。大多数妇女寻求医疗建议(65.5%),但超过一半的妇女没有接受治疗。接受治疗的妇女对激素和非激素处方药的态度一般,但对其安全性仍存在担忧。
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引用次数: 0
Validation of the efficacy of a personalized information-provision and exercise-coaching app on the quality of life of menopausal women 验证个性化信息提供和运动指导应用程序对更年期妇女生活质量的影响
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1016/j.maturitas.2024.108113
Na Yeon Kim , Da Seul Kim , Doug Hyun Han , Ji Sun Hong , Yoojin Shim , Youn Jung Yoon , Hee Jun Kim , Sun Mi Kim

Objectives

Menopausal symptoms severely impact women's quality of life (QoL). Digital health interventions provide an accessible, personalized alternative for managing menopausal symptoms. In this study, we validated the Menopause Assistant Manager (MAMA®; Hudit, Seoul, S. Korea) app developed to provide personalized information, exercise coaching, and management of appointments and medications to menopausal women, and evaluated its efficacy on their QoL.

Study design

This nonrandomized interventional trial enrolled 48 peri- and postmenopausal women into experimental (MAMA) and control (Waitlist) groups (n = 24 each). Participants in the MAMA group used the app for 8 weeks, whereas the Waitlist group received no intervention. Both groups continued their usual treatments.

Main outcome measures

Clinical assessments at baseline and study completion included the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Menopause Rating Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 (PHQ-15), Menopause Emotional Symptom Questionnaire, and Subjective Memory Complaints Questionnaire.

Results

Compared with the Waitlist group, the MAMA group showed postintervention improvements in WHOQOL-BREF physical health (F = 4.84, P = .03) and environmental (F = 5.01, P = .03) domains and GAD-7 (F = 5.53, P = .02) and PHQ-15 (F = 4.14, P = .048) scores. Changes in WHOQOL-BREF physical health scores negatively correlated with PHQ-15 scores (ρ = −0.53, P = .004).

Conclusion

By increasing treatment accessibility, the app improved physical and environmental QoL and reduced anxiety and somatic symptoms. App-based exercise coaching alleviated somatic symptoms, and the in-app psychological content reduced anxiety by normalizing menopausal symptoms, providing accurate information, decreasing uncertainty, and improving symptom perception.

Trial registration

Clinical Research Information Service KCT 0008603; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25078&status=5&seq_group=25078&search_page=M.

更年期症状严重影响妇女的生活质量(QoL)。数字健康干预为控制更年期症状提供了一种便捷、个性化的选择。在这项研究中,我们验证了更年期助理管理器(MAMA®;Hudit,韩国首尔)应用程序的有效性,该应用程序旨在为更年期妇女提供个性化信息、运动指导以及预约和用药管理,并评估了其对更年期妇女生活质量的影响。MAMA 组的参与者使用该应用程序 8 周,而 Waitlist 组不接受任何干预。主要结果测量基线和研究完成时的临床评估包括世界卫生组织生活质量简易版(WHOQOL-BREF)、更年期评分量表、患者健康问卷-9、广泛性焦虑症-7(GAD-7)、患者健康问卷-15(PHQ-15)、更年期情绪症状问卷和主观记忆投诉问卷。结果与候补名单组相比,干预后 MAMA 组的 WHOQOL-BREF 身体健康(F = 4.84,P = .03)和环境(F = 5.01,P = .03)领域以及 GAD-7 (F = 5.53,P = .02)和 PHQ-15 (F = 4.14,P = .048)得分均有所改善。WHOQOL-BREF 身体健康评分的变化与 PHQ-15 评分呈负相关(ρ = -0.53,P = .004)。基于应用程序的运动指导减轻了躯体症状,而应用程序内的心理内容通过使更年期症状正常化、提供准确信息、减少不确定性和改善症状感知,减轻了焦虑。试验注册临床研究信息服务 KCT 0008603; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25078&status=5&seq_group=25078&search_page=M.
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引用次数: 0
Prior pre-eclampsia does not diminish the vascular protective effect of menopausal hormone therapy 先兆子痫不会削弱绝经激素疗法对血管的保护作用
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-04 DOI: 10.1016/j.maturitas.2024.108112
Minttu Venetkoski , Hanna Savolainen-Peltonen , Johanna M. Joensuu , Mika Gissler , Olavi Ylikorkala , Tomi S. Mikkola

Objective

Women with prior pre-eclampsia are at increased risk of cardiovascular disease (CVD). Menopausal hormone therapy (MHT) may affect this risk. We evaluated the impact of MHT use on cardiovascular risk between women with and without prior pre-eclampsia.

Study design and main outcome measures

We assessed the occurrence of any CVD, myocardial infarction (MI) and stroke in MHT users (n = 9700) and non-users (n = 19,914) with prior pre-eclampsia, and likewise in MHT users (n = 27,764) and non-users (n = 58,248) without prior pre-eclampsia over the period 1994–2019. Follow-up started at MHT initiation (mean age 50.4 in pre-eclamptic women and 50.3 in non-pre-eclamptic women) and lasted for a mean of 13.3 years.

Results

The use of MHT in prior pre-eclamptic women was associated with significant risk reductions for any CVD (HR 0.85, 95 % CI 0.78–0.91), MI (HR 0.66, 95 % CI 0.55–0.78) and stroke events (HR 0.71, 95 % CI 0.63–0.81) in comparison with non-users with prior pre-eclampsia. The risk reductions for cardiovascular deaths were even more pronounced (HR 0.43, 95 % CI 0.31–0.59 for any CVD death; HR 0.49, 95 % CI 0.30–0.80 for MI death; HR 0.25, 95 % CI 0.10–0.64 for stroke death). However, none of these risk reductions differed from those seen in MHT users without prior pre-eclampsia. The risk of any CVD decreased already within five years of MHT use in women with prior pre-eclampsia but not in those without prior pre-eclampsia.

Conclusions

The use of MHT is associated with reduced CVD risk in women with prior pre-eclampsia. This is important to clinicians considering the initiation of MHT for recently menopausal women with prior pre-eclampsia.

目标曾患先兆子痫的妇女罹患心血管疾病(CVD)的风险增加。绝经期激素疗法(MHT)可能会影响这一风险。研究设计和主要结果指标我们评估了1994-2019年期间使用MHT(9700人)和未使用MHT(19914人)的先兆子痫妇女以及未使用MHT(27764人)和未使用MHT(58248人)的先兆子痫妇女的心血管疾病、心肌梗死(MI)和中风发生率。随访从开始使用MHT时开始(先兆子痫妇女的平均年龄为50.4岁,非先兆子痫妇女的平均年龄为50.3岁),平均持续13.3年。结果先兆子痫妇女使用MHT可显著降低任何心血管疾病的风险(HR 0.85,95 % CI 0.78-0.91)、心肌梗死(HR 0.66,95 % CI 0.55-0.78)和中风事件(HR 0.71,95 % CI 0.63-0.81)。心血管死亡的风险降低更为明显(任何心血管疾病死亡的 HR 为 0.43,95 % CI 为 0.31-0.59;心肌梗死死亡的 HR 为 0.49,95 % CI 为 0.30-0.80;中风死亡的 HR 为 0.25,95 % CI 为 0.10-0.64)。然而,这些风险的降低均与未患过先兆子痫的MHT使用者的风险降低情况不同。结论使用MHT可降低先兆子痫妇女的心血管疾病风险。这对临床医生在考虑对有先兆子痫的绝经期妇女开始使用MHT具有重要意义。
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引用次数: 0
Sexual health and wellbeing and the menopause: An EMAS clinical guide 性健康与更年期:EMAS 临床指南
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-02 DOI: 10.1016/j.maturitas.2024.108055
Stavroula A. Paschou , Kleoniki I. Athanasiadou , Trish Hafford-Letchfield , Sharron Hinchliff , Melissa Mauskar , Margaret Rees , James A. Simon , Eleni Armeni , C. Tamer Erel , Ivan Fistonic , Timothy Hillard , Angelica Lindén Hirschberg , Blazej Meczekalski , Nicolás Mendoza , Alfred O. Mueck , Tommaso Simoncini , Petra Stute , Dorenda van Dijken , Irene Lambrinoudaki

Introduction

Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care.

Aim

To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond.

Materials and methods

Review of the literature and consensus of expert opinion.

Results and conclusion

The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

导言性健康和性幸福是生活质量的重要方面。然而,在医疗实践中,人们往往避免询问性史,从而在管理和认识方面留下了空白。材料与方法文献综述和专家共识。结果与结论性问题的评估包括病史采集、检查和实验室调查(如有必要),有时也会使用特定的有效问卷。性问题的治疗需要采用生物-心理-社会多维方法。医疗管理和性心理咨询包括药物和非药物干预、性治疗和心理教育。此外,如果围绝经期妇女希望避免怀孕,应告知她们避孕的必要性。此外,性传播疾病在任何年龄都有可能感染。总之,应将性生活史纳入医疗实践,并对医疗服务提供者进行适当的培训,以评估和处理更年期及以后的性问题。
{"title":"Sexual health and wellbeing and the menopause: An EMAS clinical guide","authors":"Stavroula A. Paschou ,&nbsp;Kleoniki I. Athanasiadou ,&nbsp;Trish Hafford-Letchfield ,&nbsp;Sharron Hinchliff ,&nbsp;Melissa Mauskar ,&nbsp;Margaret Rees ,&nbsp;James A. Simon ,&nbsp;Eleni Armeni ,&nbsp;C. Tamer Erel ,&nbsp;Ivan Fistonic ,&nbsp;Timothy Hillard ,&nbsp;Angelica Lindén Hirschberg ,&nbsp;Blazej Meczekalski ,&nbsp;Nicolás Mendoza ,&nbsp;Alfred O. Mueck ,&nbsp;Tommaso Simoncini ,&nbsp;Petra Stute ,&nbsp;Dorenda van Dijken ,&nbsp;Irene Lambrinoudaki","doi":"10.1016/j.maturitas.2024.108055","DOIUrl":"10.1016/j.maturitas.2024.108055","url":null,"abstract":"<div><h3>Introduction</h3><p>Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care.</p></div><div><h3>Aim</h3><p>To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond.</p></div><div><h3>Materials and methods</h3><p>Review of the literature and consensus of expert opinion.</p></div><div><h3>Results and conclusion</h3><p>The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.</p></div>","PeriodicalId":51120,"journal":{"name":"Maturitas","volume":"189 ","pages":"Article 108055"},"PeriodicalIF":3.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Menopause and sexual health: The elephant in the room 更年期与性健康:房间里的大象
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-02 DOI: 10.1016/j.maturitas.2024.108067
Kleoniki I. Athanasiadou , Stavroula A. Paschou , Irene Lambrinoudaki , Margaret Rees
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引用次数: 0
Biopsychosocial factors intersecting with weekly sleep difficulties in the menopause transition 生物心理社会因素与更年期过渡期每周睡眠困难的交叉影响
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.maturitas.2024.108111
Sneha Chenji, Bethany Sander, Julia A. Grummisch, Jennifer L. Gordon

Objectives

Sleep difficulties are common in the menopause transition and increase risk for a variety of physical and psychological problems. The current study investigated potential interactions between psychosocial variables and within-person changes in ovarian hormones in predicting perimenopausal sleep problems as well as the potential interactions between poor sleep and psychosocial factors in predicting worsened mood, affect, and attention.

Study design

The sample included 101 perimenopausal individuals. Participants completed 12 weekly assessments of self-reported sleep outcomes, depressive mood and affect, and attention function, and of estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) levels (urinary metabolites of estradiol and progesterone, respectively); they also had 24-h tracking of vasomotor symptoms. Other psychosocial variables such as trauma history and stressful life events were assessed at baseline.

Results

A history of depression, baseline depressive symptoms, trait anxiety, and more severe and bothersome vasomotor symptoms predicted worsened sleep outcomes. Recent stressful life events, trauma history, and person-centred E1G and PdG changes did not predict sleep outcomes. However, there was an interaction whereby person-centred E1G decreases predicted lower sleep efficiency in those with higher baseline depressive symptoms. Higher baseline depression and trauma history also amplified the effect of vasomotor symptoms on sleep outcomes. In evaluating the effect of poor sleep on psychological and cognitive outcomes, stressful life events emerged as a moderating factor. Finally, trauma history and poor sleep interacted to predict worsened attention function.

Conclusions

The current study suggests that certain individuals may be at greater risk of perimenopausal sleep problems and the resulting negative effects on mood and cognition.

目的:睡眠困难是绝经过渡期的常见问题,会增加出现各种生理和心理问题的风险。本研究调查了心理社会变量和卵巢激素在人体内的变化在预测围绝经期睡眠问题方面的潜在相互作用,以及睡眠不佳和心理社会因素在预测情绪、情感和注意力恶化方面的潜在相互作用:样本包括 101 名围绝经期人士。参与者每周完成 12 次自我报告睡眠结果、抑郁情绪和情感、注意力功能以及雌酮葡糖醛酸(E1G)和孕二醇葡糖醛酸(PdG)水平(分别为雌二醇和孕酮的尿液代谢物)的评估;他们还对血管运动症状进行了 24 小时跟踪。基线评估还包括其他社会心理变量,如创伤史和生活压力事件:结果:抑郁症病史、基线抑郁症状、特质焦虑以及更严重、更烦人的血管运动症状预示着睡眠结果会恶化。近期的生活压力事件、创伤史以及以人为本的E1G和PdG变化并不能预测睡眠结果。然而,在基线抑郁症状较重的人群中,以人为中心的E1G下降会导致睡眠效率降低,这两者之间存在相互作用。较高的基线抑郁和创伤史也会放大血管运动症状对睡眠结果的影响。在评估睡眠质量差对心理和认知结果的影响时,生活压力事件成为一个调节因素。最后,精神创伤史和睡眠质量差相互作用,导致注意力功能恶化:目前的研究表明,某些人可能更容易出现围绝经期睡眠问题,从而对情绪和认知产生负面影响。
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引用次数: 0
The ability of decline in intrinsic capacity to indicate the risk of mortality in older adults: A meta-analysis 内在能力下降对老年人死亡风险的指示能力:荟萃分析
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.maturitas.2024.108109
Yidan Li , Tingting Yang , Xuedan Wang , Xiang He , Jianhui Dong , Qiuxia Qian , Xingxia Zhang , Jie Zheng , Xiangping Fan , Yuxia Ma

Objective

To evaluate the ability of decline in intrinsic capacity to indicate the risk of mortality in older adults.

Design

Meta-analysis.

Methods

PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, CNKI, VIP, and CBM were searched for relevant studies published from inception to October 31, 2023. Stata17.0 software was used to perform the meta-analysis. A random effects model was used to pool the results of the risk of mortality (as hazard ratios, HRs) in older adults and decline in intrinsic capacity. The Newcastle Ottawa Scale was used to evaluate the quality of studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to determine the confidence in the estimated effect of pooled outcomes.

Results

Twelve studies, with a total of 38,531 participants, were included in this meta-analysis. The findings show that older adults with intrinsic capacity decline have a higher risk of mortality (HR = 1.11, 95 % CI 1.08–1.14, I2 = 95.9 %, P<0.001) than older adults with normal intrinsic capacity. The pooled HR estimates for the locomotion, vitality, and cognitive dimensions of intrinsic capacity in the prediction of mortality were 0.89 (HR = 0.89, 95%CI 0.83–0.96, I2 = 41.3 %, P = 0.146), 0.76 (HR = 0.98, 95 % CI 0.59–0.97, I2 = 60.8 %, P = 0.078), and 0.99 (HR = 0.99, 95 % CI 0.98–1.00, I2 = 0.0 %, P = 0.664), respectively. The pooled HR estimates of the psychological dimension to predict mortality were not statistically significant (P > 0.05). GRADE evaluations of outcome indicators were of moderate confidence.

Conclusions

Decline in intrinsic capacity is a significant predictor of mortality. Locomotion, vitality, and cognition dimensions can all predict mortality. Clinical personnel should early assess the intrinsic capacity of older adults, focusing on changes in the dimensions of locomotion and vitality, to identify the risk of mortality, avoid adverse health outcomes, and improve the quality of life of older adults.

Review protocol registered in PROSPERO: CRD42023481246

方法在PubMed、EMBASE、Web of Science、Cochrane Library、万方数据库、CNKI、VIP和CBM中检索从开始到2023年10月31日发表的相关研究。使用Stata17.0软件进行荟萃分析。采用随机效应模型对老年人的死亡风险(以危险比表示,HRs)和内在能力下降的结果进行汇总。采用纽卡斯尔-渥太华量表评估研究质量。采用建议、评估、发展和评价分级(GRADE)系统确定汇总结果估计效应的置信度。结果本荟萃分析纳入了 12 项研究,共有 38,531 人参与。结果显示,与内在能力正常的老年人相比,内在能力下降的老年人的死亡风险更高(HR = 1.11,95 % CI 1.08-1.14,I2 = 95.9 %,P<0.001)。运动、活力和认知方面的内在能力在预测死亡率方面的综合 HR 估计值为 0.89(HR = 0.89,95%CI 0.83-0.96,I2 = 41.3 %,P = 0.146)、0.76(HR = 0.98,95 % CI 0.59-0.97,I2 = 60.8 %,P = 0.078)和 0.99(HR = 0.99,95 % CI 0.98-1.00,I2 = 0.0 %,P = 0.664)。心理维度预测死亡率的汇总 HR 估计值无统计学意义(P > 0.05)。结论内在能力下降是预测死亡率的重要指标。运动、活力和认知能力均可预测死亡率。临床人员应及早评估老年人的内在能力,重点关注运动和活力方面的变化,以识别死亡风险、避免不良健康后果并提高老年人的生活质量。
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引用次数: 0
Association between type of menopause and mild cognitive impairment: The REDLINC XII study 更年期类型与轻度认知障碍之间的关系:REDLINC XII 研究
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-28 DOI: 10.1016/j.maturitas.2024.108110
María T. Espinoza , Juan E. Blümel , Peter Chedraui , María S. Vallejo , Mónica Ñañez , Eliana Ojeda , Claudia Rey , Doris Rodríguez , Marcio A. Rodrigues , Carlos Salinas , Konstantinos Tserotas , Andrés Calle , Maribel Dextre , Alejandra Elizalde , Carlos Escalante , Gustavo Gómez-Tabares , Álvaro Monterrosa-Castro

Objective

To evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI).

Study design

This study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries.

Method

We assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool.

Results

The study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14–0.30).

Conclusion

When comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.

目标评估绝经类型(自然绝经或手术绝经)与轻度认知障碍(MCI)之间的关系。研究设计本研究是一项横断面观察性子分析调查,在九个拉美国家的妇科门诊中进行。方法我们使用蒙特利尔认知评估(MoCA)工具对社会人口学、临床和人体测量数据、痴呆症家族史以及是否患有 MCI 进行了评估。结果这项研究涉及 1185 名绝经后妇女,她们的平均年龄为 55.3 岁,体重指数为 26.4 kg/m2。她们平均受教育年限为 13.3 年,37% 是家庭主妇。399 名妇女在 40 岁之前绝经,其中 136 名妇女通过手术绝经(双侧输卵管切除术)。在 786 名 40 岁或 40 岁以上绝经的妇女中,有 110 人是由于双侧输卵管切除术而绝经的。在 40 岁之前或之后绝经的女性中,MoCA 得分没有差异。然而,与自然绝经的妇女相比,手术绝经的妇女的MoCA评分较低(分别为23.8 ± 4.9分和25.0 ± 4.3分,p <0.001)。我们的逻辑回归模型对国家内的患者进行了聚类,发现 MCI 与手术绝经(OR 1.47,95 % CI:1.01-2.16)、使用(曾经)绝经激素治疗(OR 0.33,95 % CI:0.21-0.50)和受过>12 年教育(OR 0.21,95 % CI:0.14-0.30)。结论将 40 岁以上自然绝经的女性与在此年龄之前绝经的女性进行比较,没有观察到患 MCI 的风险增加,而与年龄无关,手术绝经的女性更容易出现认知能力下降。曾经使用过更年期激素疗法的女性患 MCI 的风险较低。要深入研究这一课题,还需要进一步的研究。
{"title":"Association between type of menopause and mild cognitive impairment: The REDLINC XII study","authors":"María T. Espinoza ,&nbsp;Juan E. Blümel ,&nbsp;Peter Chedraui ,&nbsp;María S. Vallejo ,&nbsp;Mónica Ñañez ,&nbsp;Eliana Ojeda ,&nbsp;Claudia Rey ,&nbsp;Doris Rodríguez ,&nbsp;Marcio A. Rodrigues ,&nbsp;Carlos Salinas ,&nbsp;Konstantinos Tserotas ,&nbsp;Andrés Calle ,&nbsp;Maribel Dextre ,&nbsp;Alejandra Elizalde ,&nbsp;Carlos Escalante ,&nbsp;Gustavo Gómez-Tabares ,&nbsp;Álvaro Monterrosa-Castro","doi":"10.1016/j.maturitas.2024.108110","DOIUrl":"10.1016/j.maturitas.2024.108110","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI).</p></div><div><h3>Study design</h3><p>This study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries.</p></div><div><h3>Method</h3><p>We assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool.</p></div><div><h3>Results</h3><p>The study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m<sup>2</sup>. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, <em>p</em> &lt; 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having &gt;12 years of education (OR 0.21, 95 % CI: 0.14–0.30).</p></div><div><h3>Conclusion</h3><p>When comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.</p></div>","PeriodicalId":51120,"journal":{"name":"Maturitas","volume":"189 ","pages":"Article 108110"},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative plasma fibrinogen level is a risk factor for the long-term survival of postmenopausal women after surgery for breast cancer 术前血浆纤维蛋白原水平是绝经后妇女乳腺癌术后长期生存的一个风险因素。
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-28 DOI: 10.1016/j.maturitas.2024.108108
Jinxi Hu , Dong Xu , Hanqian Zeng , Yijun Chen , Xiaoli Zhu

Background

Studies have indicated an association between fibrinogen levels and the prognosis of breast cancer patients. However, fibrinogen levels are notably susceptible to fluctuations due to the menstrual cycle. This study explored the relationship between preoperative plasma fibrinogen levels and the prognosis of postmenopausal breast cancer women after surgery.

Method

855 patients with postmenopausal breast cancer were monitored for 10 years. Cox proportional hazards regression models were used to perform univariate and multivariate analyses to identify factors that are of substantial prognostic value.

Results

The median follow-up was 77 months (51–105 months), and the maximum 142 months. Over the follow-up period, 65 deaths (7.6 %) were recorded. Multivariate Cox regression results show that preoperative plasma fibrinogen level (hazard ratio [HR] =1.615, 95 % confidence interval [CI]: 1.233–2.115) and age (HR = 1.626, 95%CI: 1.250–2.116) were independent risk factors for 10-year overall survival after surgery in postmenopausal breast cancer patients, while endocrine therapy (HR = 0.414, 95%CI: 0.202–0.846) was an independent protective factor. Multivariate Cox regression results also show preoperative plasma fibrinogen level was an independent risk factor for 10-year disease-free survival (HR = 1.398, 95 % CI: 1.137–1.719) and 10-year distant metastasis-free survival (HR = 1.436, 95%CI: 1.153–1.787).

Conclusion

Elevated pretreatment plasma fibrinogen levels are associated with a poorer long-term prognosis in postmenopausal breast cancer patients following surgical treatment.

背景:研究表明,纤维蛋白原水平与乳腺癌患者的预后有关。然而,纤维蛋白原水平明显易受月经周期的影响而波动。本研究探讨了绝经后乳腺癌妇女术前血浆纤维蛋白原水平与术后预后之间的关系。采用 Cox 比例危险度回归模型进行单变量和多变量分析,以确定哪些因素对预后具有重要价值:中位随访时间为 77 个月(51-105 个月),最长随访时间为 142 个月。在随访期间,共记录到 65 例死亡病例(7.6%)。多变量Cox回归结果显示,术前血浆纤维蛋白原水平(危险比[HR] =1.615,95%置信区间[CI]:1.233-2.115)和年龄(HR =1.626,95%CI:1.250-2.116)是绝经后乳腺癌患者术后10年总生存率的独立危险因素,而内分泌治疗(HR =0.414,95%CI:0.202-0.846)是独立的保护因素。多变量Cox回归结果还显示,术前血浆纤维蛋白原水平是10年无病生存率(HR = 1.398,95%CI:1.137-1.719)和10年无远处转移生存率(HR = 1.436,95%CI:1.153-1.787)的独立危险因素:结论:手术治疗前血浆纤维蛋白原水平升高与绝经后乳腺癌患者较差的长期预后有关。
{"title":"Preoperative plasma fibrinogen level is a risk factor for the long-term survival of postmenopausal women after surgery for breast cancer","authors":"Jinxi Hu ,&nbsp;Dong Xu ,&nbsp;Hanqian Zeng ,&nbsp;Yijun Chen ,&nbsp;Xiaoli Zhu","doi":"10.1016/j.maturitas.2024.108108","DOIUrl":"10.1016/j.maturitas.2024.108108","url":null,"abstract":"<div><h3>Background</h3><p>Studies have indicated an association between fibrinogen levels and the prognosis of breast cancer patients. However, fibrinogen levels are notably susceptible to fluctuations due to the menstrual cycle. This study explored the relationship between preoperative plasma fibrinogen levels and the prognosis of postmenopausal breast cancer women after surgery.</p></div><div><h3>Method</h3><p>855 patients with postmenopausal breast cancer were monitored for 10 years. Cox proportional hazards regression models were used to perform univariate and multivariate analyses to identify factors that are of substantial prognostic value.</p></div><div><h3>Results</h3><p>The median follow-up was 77 months (51–105 months), and the maximum 142 months. Over the follow-up period, 65 deaths (7.6 %) were recorded. Multivariate Cox regression results show that preoperative plasma fibrinogen level (hazard ratio [HR] =1.615, 95 % confidence interval [CI]: 1.233–2.115) and age (HR = 1.626, 95%CI: 1.250–2.116) were independent risk factors for 10-year overall survival after surgery in postmenopausal breast cancer patients, while endocrine therapy (HR = 0.414, 95%CI: 0.202–0.846) was an independent protective factor. Multivariate Cox regression results also show preoperative plasma fibrinogen level was an independent risk factor for 10-year disease-free survival (HR = 1.398, 95 % CI: 1.137–1.719) and 10-year distant metastasis-free survival (HR = 1.436, 95%CI: 1.153–1.787).</p></div><div><h3>Conclusion</h3><p>Elevated pretreatment plasma fibrinogen levels are associated with a poorer long-term prognosis in postmenopausal breast cancer patients following surgical treatment.</p></div>","PeriodicalId":51120,"journal":{"name":"Maturitas","volume":"189 ","pages":"Article 108108"},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0378512224002032/pdfft?md5=810f4098e9d53c6536f1b43caa0d6cde&pid=1-s2.0-S0378512224002032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic review and meta-analysis of the effects of progestins on depression in post-menopausal women: An evaluation of randomized clinical studies that used validated questionnaires 孕激素对绝经后妇女抑郁症影响的系统回顾和荟萃分析:对使用有效问卷的随机临床研究进行评估
IF 3.9 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-28 DOI: 10.1016/j.maturitas.2024.108105
Ambrogio P. Londero , Veronica Gallina , Francesca Cremonini , Anjeza Xholli , Angelo Cagnacci

Objective

Hormone therapy (HT) can relieve symptoms of menopause and treat chronic diseases. Its effectiveness in treating psychological symptoms is still debated. Several progestins can be used in HT, but their effects on mood, in particular depressive symptoms, is still unclear. This systematic review evaluates the evidence from randomized clinical trials with postmenopausal women on the effect of adjunctive progestins on symptoms of depression assessed by validated questionnaires. The primary aim was to evaluate scores on the Center for Epidemiologic Studies Depression Scale (CESD). The secondary aim was to assess scores on the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAMD), and the Zung Self-Rating Depression Scale (SDS).

Methods

A systematic review and meta-analysis were conducted to identify the most reliable evidence of the effects of progestin on depression to inform decision-making. A PICO- and PRISMA-based framework was established to formulate explicit and reasoned recommendations. The pre-/post-treatment effect was evaluated using standardized mean change (SMC).

Results

We selected and analyzed 16 randomized clinical trials qualitatively and 12 studies quantitatively out of 9320 items identified. Most of the studies used medroxyprogesterone acetate as progestin. The results indicate that depressive symptoms do not increase with the addition of a progestin to estrogen HT. Depressive symptoms improved over time in the progestins-estrogen HT group, independent of progestin type (SMC CES-D −0.08 CI.95–0.10/−0.06, BDI −0.19 CI.95–0.32/−0.06, HAM-D −1.13 CI.95–1.47/−0.78, and SDS −0.11 CI.95–0.82/0.60). Yet similar effects were observed with estrogens alone and did not significantly differ from control groups on placebo. In one study, the addition of fluoxetine greatly increased the reduction of depressive symptoms observed with estrogen-progestin HT.

Conclusions

In summary, in randomized clinical trials using validated questionnaires adjunctive progestin with estrogens did not increase depressive symptoms of postmenopausal women. Overall, depressive symptoms decreased with estrogen-progestin HT but also with estrogen alone. The decrease was not so pronounced to differ from controls on placebo. HT does not hamper the clinical efficacy of fluoxetine. The scarcity of randomized studies makes it difficult to determine the exact effect on depressive symptoms of different types of progestins.

Project protocol registered in PROSPERO, registration number CRD42023454099.

目的 激素疗法(HT)可以缓解更年期症状,治疗慢性疾病。但它对心理症状的治疗效果仍存在争议。有几种孕激素可用于激素治疗,但它们对情绪,尤其是抑郁症状的影响仍不明确。本系统性综述评估了以绝经后妇女为研究对象的随机临床试验的证据,这些试验通过有效问卷评估了辅助性孕激素对抑郁症状的影响。主要目的是评估流行病学研究中心抑郁量表(CESD)的得分。次要目的是评估贝克抑郁量表 (BDI)、汉密尔顿抑郁评定量表 (HAMD) 和 Zung 抑郁自评量表 (SDS) 的得分。方法进行了系统综述和荟萃分析,以确定孕激素对抑郁症影响的最可靠证据,为决策提供依据。建立了基于 PICO 和 PRISMA 的框架,以提出明确合理的建议。结果我们从已确定的 9320 个项目中筛选并定性分析了 16 项随机临床试验,定量分析了 12 项研究。大多数研究使用醋酸甲羟孕酮作为孕激素。结果表明,在雌激素 HT 中添加孕激素不会增加抑郁症状。随着时间的推移,孕激素-雌激素 HT 组的抑郁症状有所改善,这与孕激素类型无关(SMC CES-D -0.08 CI.95-0.10/-0.06、BDI -0.19 CI.95-0.32/-0.06、HAM-D -1.13 CI.95-1.47/-0.78、SDS -0.11 CI.95-0.82/0.60)。然而,单独使用雌激素也能观察到类似的效果,而且与使用安慰剂的对照组没有明显差异。结论综上所述,在使用有效问卷的随机临床试验中,孕激素与雌激素的辅助治疗并未增加绝经后妇女的抑郁症状。总体而言,使用雌激素-孕激素 HT 和单独使用雌激素时,抑郁症状都有所减轻。与服用安慰剂的对照组相比,抑郁症状的减少并不明显。孕激素抑制剂不会妨碍氟西汀的临床疗效。由于缺乏随机研究,因此很难确定不同类型的孕激素对抑郁症状的确切影响。项目方案已在 PROSPERO 注册,注册号为 CRD42023454099。
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引用次数: 0
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