Maturitas最新文献

Breast cancer affects the lives of many women and their loved ones. Women's health practitioners have an important role in identifying women at increased risk for breast cancer and guiding them toward appropriate counseling, imaging surveillance, and preventive care. Familial cancer syndromes account for a substantial proportion of breast cancer diagnoses. When family history or other clinical features suggest a hereditary predisposition, practitioners should consider recommending genetic testing and genetic counseling to help mitigate risk. The U.S. National Comprehensive Cancer Network offers evidence-based guidelines for identifying candidates for genetic testing and provides tools for surveillance and screening. Genetic counselors can help patients select appropriate tests and interpret results, facilitating informed decision-making. Additional risk factors for breast cancer include increasing age, lifestyle factors, prolonged exposure to endogenous or exogenous hormones, prior radiotherapy, high breast-tissue density, and a personal history of high-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ. Several validated risk-assessment tools for breast cancer are available for clinical use and incorporate patient-specific data to guide management. For individuals at increased risk of developing breast cancer, preventive and risk-reducing strategies include early-detection enhanced surveillance protocols, risk-reducing surgery, pharmacologic interventions, and lifestyle modifications.

Background: Testosterone constitutes an indispensable determinant of male corporeal integrity, psychological resilience, and overall vitality across the life course. Testosterone deficiency (male hypogonadism) represents an endocrine disorder capable of engendering a broad spectrum of somatic derangements and psychosocial sequelae. Its origins may lie in testicular insufficiency, hypothalamic-pituitary dysfunction, or, more subtly, in functional hypogonadism arising from comorbid states such as obesity and type 2 diabetes mellitus.

Methods: This review distills contemporary evidence on the pathophysiology, clinical expression, diagnostic algorithms, and therapeutic armamentarium of male hypogonadism, with particular attention to functional hypogonadism and its repercussions for quality of life. Data from recent randomized trials and large-scale observational studies delineate both the efficacy and the safety of therapeutic strategies.

Results: Hypogonadism-whether primary, secondary, or functional - commonly manifests through disturbances of mood and cognition (including depression, fatigue, and mental decline), sexual dysfunction (diminished libido and impaired erectile capacity), disproportionate visceral adiposity, sarcopenia, osteopenia or osteoporosis, and anemia. These cumulative impairments markedly degrade quality of life. Crucially, aging per se does not precipitate hypogonadism; rather, age-associated comorbidities catalyze the emergence of functional hypogonadism. Epidemiological data corroborate a bidirectional nexus between functional hypogonadism and the metabolic syndrome, both being harbingers of increased cardiovascular mortality. Guideline-directed testosterone therapy, when judiciously prescribed, can reverse many of these perturbations-ameliorating sexual function, mood, vitality, muscle mass, bone density, and anemia-while simultaneously mitigating metabolic derangement.

Conclusions: Converging evidence, including from recent large-scale randomized controlled trials, demonstrates that modern testosterone therapy does not augment cardiovascular risk or mortality. On the contrary, it confers tangible metabolic and quality-of-life advantages, even in advanced age, provided coexistent conditions are addressed concomitantly. Optimal outcomes hinge upon meticulous patient selection, exclusion of contraindications (e.g., active prostate carcinoma or current fertility intention), and vigilant monitoring of prostate health and hematocrit. When applied with discernment, testosterone therapy offers a safe and efficacious means of restoring androgen sufficiency, thereby enhancing male health and well-being in its fullest sense.

Breast cancer is the most common malignancy among women of reproductive age, with increasing incidence influenced by delayed childbearing, genetic predisposition, and lifestyle factors. Younger patients often present with more aggressive tumor biology, including hormone receptor negativity and HER2 positivity. Pregnancy exerts a complex effect on breast cancer risk: the risk initially increases postpartum, particularly in older first-time mothers and those with a family history, but pregnancy has a long-term protective effect, mainly for estrogen receptor positive cancers. Pregnancy-associated breast cancer often presents at later stages and with aggressive features as physiologic changes in pregnancy and lactation increase breast density and ductal and lobular proliferation, which can complicate clinical and radiologic evaluation. Because of this, early risk assessment and tailored imaging are crucial for timely diagnosis. This review defines high-risk factors for breast cancer, and the management of these individuals during pregnancy and lactation.

Objectives: To investigate the independent associations between dietary live-microbe intake, as well as circulating levels of folate metabolites, and fatigue, and to examine their interaction as a potential biological pathway underlying fatigue in aging adults.

Study design: Cross-sectional analysis of adults aged ≥40 years participating in the National Health and Nutrition Examination Survey 2011-2023.

Main outcome measures: Fatigue was assessed using the Patient Health Questionnaire fatigue item and categorized as none/low versus moderate/severe. Dietary intake of live-microbe foods was derived from two 24-h recalls and classified as low, medium, or high. Total serum concentrations folate and its metabolites, including 5-methyltetrahydrofolate, were quantified. Survey-weighted logistic regression, adjusted for sociodemographic, dietary, and clinical covariates, estimated main effects and interactions between the effects of 5-methyltetrahydrofolate and of live-microbe intake; sensitivity analyses additionally adjusted for depressive symptoms and sleep disturbance.

Results: Moderate/severe fatigue was reported by 16.3% of 14,376 participants and 15.0% reported no intake of live-microbe foods. High versus low live-microbe intake was associated with lower odds of moderate/severe fatigue (odds ratio [OR] 0.60; 95% confidence interval [CI] 0.46-0.79). Higher serum 5-methyltetrahydrofolate levels were also associated with lower odds of moderate/severe fatigue (OR 0.85; 95% CI 0.73-0.98). In stratified analyses, high live-microbe intake corresponded to 38-65% lower odds of moderate/severe fatigue only among adults with higher levels of 5-methyltetrahydrofolate, with no significant associations among those with lower levels.

Conclusions: Intake of microbe-rich foods and higher levels of circulating 5-methyltetrahydrofolate are both associated with lower levels of fatigue in midlife and older adults, and folate sufficiency appears to potentiate the fatigue-reducing benefits of live-microbe foods, supporting a nutrient-microbe pathway relevant to healthy aging.

Objectives: Serum 25-hydroxyvitamin D concentrations have been associated with the risk of dementia, but the results are inconsistent. Previous studies have reported that vitamin D metabolism is related to sleep characteristics. We investigated the association between serum 25-hydroxyvitamin D concentrations and the risk of dementia, as well as whether sleep characteristics and sleep patterns modified this association.

Study design: In this prospective population-based cohort study, serum 25-hydroxyvitamin D concentrations were measured. Sleep characteristics, including sleep duration, chronotype, sleeplessness, snoring, and daytime sleepiness, were integrated to generate an overall sleep pattern. We used a multivariable adjusted Cox proportional hazards regression model to evaluate the association of serum 25-hydroxyvitamin D concentrations with the risk of incident dementia.

Results: Over a median follow-up of 13.7 years, there were 7030 cases of all-cause dementia, including 3089 of Alzheimer's disease and 1539 of vascular dementia in the cohort of 366,160 participants. Higher concentrations of serum 25-hydroxyvitamin D were associated with a lower risk of all-cause dementia, Alzheimer's disease and vascular dementia. We found a statistically significant interaction of modest magnitude between serum 25-hydroxyvitamin D concentrations and sleep patterns with the risk of vascular dementia (P interaction = 0.04). Among the sleep characteristics, an interaction was found between serum 25-hydroxyvitamin D concentrations and daytime sleepiness in their effect on the risk of vascular dementia (P interaction = 0.03). The protective hazard ratios for vascular dementia were more pronounced in individuals with low daytime sleepiness than in those with high daytime sleepiness.

Conclusions: Serum 25-hydroxyvitamin D concentrations were inversely associated with the risks of all-cause dementia, Alzheimer's disease and vascular dementia. Sleep characteristics, particularly daytime sleepiness, may modify the association between serum 25-hydroxyvitamin D concentrations and the risk of vascular dementia.

Background: Cataract remains the leading cause of visual impairment globally, with women at higher risk than men. Understanding factors associated with cataract surgery in women is crucial for informing targeted interventions and addressing disparities in vision health.

Methods: We conducted a cross-sectional analysis of 1404 women aged 39 years and older using data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES). History of cataract surgery was determined by self-report, as collected in the NHANES interview. A purposeful selection algorithm identified candidate factors and multivariate logistic regression, accounting for complex survey design, determined independent associations. Sociodemographic, behavioral, medical, and occupational variables were evaluated.

Results: Of the sample, 9% reported a history of cataract surgery. In adjusted models, older age (odds ratio per year 1.13, 95% CI 1.11-1.16), being divorced (odds ratio 1.52, 95% CI 1.10-2.12), and presence of heart disease (odds ratio 4.79, 95% CI 1.56-14.7) were associated with higher odds of cataract surgery, while employment was associated with lower odds (odds ratio 0.59, 95% CI 0.40-0.86). Race/ethnicity, education, income, health insurance, behavioral factors, and occupational exposures were not significantly associated after adjustment.

Conclusion: Advancing age, marital status, heart disease, and employment were independently associated with cataract surgery among U.S. women aged 39 years and older, reflecting the impact of aging, social support, comorbidity, and socioeconomic factors. These findings underscore the need to integrate preventive care and address social determinants to reduce disparities in cataract outcomes.

Background: As global aging accelerates, cognitive decline is a major public health concern. Natural menopause, characterized by a sharp decline in endogenous estrogen, is a hypothesized modulator of long-term cognitive health, yet epidemiological evidence remains inconsistent. This study aimed to clarify the cross-sectional and longitudinal associations between age at natural menopause and cognitive function using data from the English Longitudinal Study of Aging (ELSA).

Methods: This study included 3712 postmenopausal women aged ≥50 years from the English Longitudinal Study of Aging Wave 4 (2008-2009), with follow-up until Wave 9. The primary exposure was self-reported age at natural menopause. Cognitive function (memory, executive function, orientation) was synthesized into a global z-score. Multiple linear regression (cross-sectional) and linear mixed-effects models (longitudinal) were employed, with sequential adjustment for sociodemographic, lifestyle, and health-related covariates.

Results: In these 3712 postmenopausal women, later age at menopause was consistently associated with better global cognitive function. Cross-sectionally, each additional year was linked to higher cognitive scores (β = 0.058, P < 0.001). Longitudinally, each year was associated with improved cognitive performance (β = 0.008, 95% CI 0.002-0.015, P = 0.014), with the latest menopause quartile (Q4) significantly outperforming the earliest (Q1) (β = 0.100, 95% CI 0.010-0.189, P = 0.030). Subgroup and sensitivity analyses corroborated the robustness of the primary findings.

Conclusion: This study found that a later age at menopause correlates with improved cognitive abilities.

Objective: To examine the association between body mass index and the severity of menopausal symptoms among Danish nurses.

Study design: Cross-sectional analysis of the 2024 wave of the Danish Nurse Cohort.

Main outcome measures: Total score on the Menopause Rating Scale dichotomized as no-to-mild (<9) versus moderate-to-severe (≥9), with domain cut-offs applied for somatic, psychological, and urogenital symptoms. Multiple logistic regression models were applied, adjusted for age, smoking, alcohol, physical activity, diet, cohabitation, and age at last menstrual period.

Results: Of 6078 women (mean age 63.5 (standard deviation 9.3) years), 55.8% reported moderate-to-severe symptoms. Each 5-unit increase in body mass index was associated with higher odds of moderate-to-severe symptoms (odds ratio 1.13, 95% confidence interval 1.06-1.20). Domain analyses showed associations for psychological (odds ratio 1.15, 95% confidence interval 1.08-1.23) and somato-vegetative (odds ratio 1.15, 95% confidence interval 1.08-1.22) domains, but not urogenital (odds ratio 0.96, 95% confidence interval 0.91-1.03). Participants with a body mass index of less than 18.5 kg/m² had lower associated odds (odds ratio 0.53, 95% confidence interval 0.34-0.83) and participants with a body mass index of 30 kg/m² or more had higher odds (odds ratio 1.24, 95% confidence interval 1.05-1.46) than women with an eutrophic body mass index.

Conclusions: In a large national representative cohort of Danish nurses, higher body mass index was significantly associated with greater severity of menopausal symptoms, particularly psychological and somato-vegetative. These findings highlight the importance of considering weight-related factors when addressing midlife women's health and menopause care.