Maturitas最新文献

Purpose: To perform clinical and histomorphometric evaluations of the vagina before and after treatment for genitourinary syndrome of menopause with CO₂ laser, fractional radiofrequency, and promestriene in breast cancer survivors using adjuvant endocrine therapy.

Methods: The study included women experiencing moderate to severe genitourinary syndrome of menopause. Following pre- and post-treatment protocols, participants graded their symptoms on a visual analog scale and underwent a gynecological examination to evaluate the Vaginal Health Index and obtain a vaginal biopsy. Subsequently, they were randomized to laser, radiofrequency, and promestriene groups. The energy groups underwent three consecutive monthly outpatient vulvovaginal treatments, while the control group received promestriene treatment for four months, followed by a post-treatment evaluation.

Results: Sixty-two women completed the study protocol (21 laser, 20 radiofrequency, and 21 promestriene). While histological differences (vaginal thickness [p = 0.002] and number of stromal papillae [p = 0.004]) were observed between the pretreatment samples of tamoxifen and anastrozole users, the symptoms did not differ between them. A decrease in symptom intensity (p < 0.05) and an improvement in the Vaginal Health Index (p < 0.001) were observed post-treatment, regardless of the type of adjuvant endocrine therapy used. Most pretreatment vaginal samples did not indicate histological atrophy, and no significant histological differences were observed after treatment. No clinical or histological damage was observed.

Conclusion: CO₂ laser and radiofrequency therapies could be considered alternative treatments for genitourinary syndrome of menopause in breast cancer survivors receiving adjuvant therapy. These treatments promoted significant improvements comparable to those delivered by promestriene, without histological or clinical tissue damage.

Trial registration number: NCT04081805.

Background: The association between menopause, changes in body composition, and nonalcoholic fatty liver disease is not clear, and there is a lack of weight management strategies for perimenopausal women from the perspective of preventing nonalcoholic fatty liver disease.

Methods: A total of 1316 postmenopausal and 3049 premenopausal women in the Kailuan cohort in China between 2006 and 2017 were enrolled and followed up till 2021. Cox regression models, including the causal mediation analyses, were used to estimate the association between menopause and nonalcoholic fatty liver disease and the potential mediation effect of changes in body composition. We also explored the impact of weight changes on the correlation between menopause and nonalcoholic fatty liver disease.

Results: Women who experienced menopause had a higher risk of nonalcoholic fatty liver disease than premenopausal women (9-year cumulative incidence: 56.87 % vs. 48.80 %, adjusted hazard ratio = 1.219, 95 % confidence interval: 1.088-1.365). The nine-year cumulative incidence of nonalcoholic fatty liver disease was higher among overweight/obese postmenopausal women (67.24 % vs. 45.74 %, P < 0.001) and those with abdominal obesity (63.36 % vs. 49.69 %, P < 0.001); however, the hazard ratio of menopause for nonalcoholic fatty liver disease was more evident in women with a body mass index under 23.0 kg/m² (hazard ratio = 1.434, 95 % confidence interval: 1.168-1.759) and those with normal waist circumference (hazard ratio = 1.362, 95 % confidence interval: 1.129-1.643), which could partially be explained by the visceral fat index (7.09 % and 7.35 % mediation, respectively). Weight loss of 3 % or more or reduction in waist circumference by 5 % or more was associated with a 31.1 % reduction (95 % confidence interval, 20.8 %-40.0 %) or a 14.2 % reduction (95 % confidence interval, 1.1 %-25.6 %) in the risk of nonalcoholic fatty liver disease among the premenopausal women. For postmenopausal women, weight gain of 3 % or more was associated with an increased risk of nonalcoholic fatty liver disease, especially in individuals with a body mass index under 23.0 kg/m².

Conclusion: Menopause was associated with a higher risk of nonalcoholic fatty liver disease, partially by increasing visceral fat. Controlling weight in perimenopausal women may reduce the risk.

Background: We investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations.

Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011-2015) and four in ELSA (2001-2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength.

Findings: Lower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline.

Interpretation: Lower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.

Objectives: Cognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment and is associated with increased risk of falls. Exercise is an evidence-based strategy to prevent falls, but whether exercise reduces falls in people with cognitive frailty is unknown. We examined the effects of home-based exercise on subsequent falls among community-dwelling older adults with cognitive frailty who have previously fallen.

Study design: A sub-group analysis of a 12-month, single-blind, randomized controlled trial among 344 adults aged 70 years or more who had fallen within the past 12 months. Participants were randomized to either 12 months of home-based exercise (n=172) or usual care (n=172). In this sub-analysis, we included 192 participants with cognitive frailty (home-based exercise=93; usual care=99) with Short Physical Performance Battery scores ≤9/12 and Montreal Cognitive Assessment scores <26/30.

Main outcome measures: Our primary analysis examined the effect of exercise on self-reported falls rate over 12 months. Secondary analyses investigated the intervention's effects on scores on the Short Physical Performance Battery and the Montreal Cognitive Assessment. We also explored whether greater than or equal to mean average monthly adherence (i.e., ≥45.5%) moderated treatment effects.

Results: At 12 months, falls rates were 35% lower in the home-based exercise group compared with the usual care group (IRR=0.65; p=0.042). Score on the Short Physical Performance Battery significantly improved among home-based exercise participants with greater than or equal to mean adherence vs. those with less than mean adherence (estimated mean difference: 0.94; p=0.022).

Conclusions: Exercise is a promising strategy for reducing subsequent falls in people with cognitive frailty. Greater exercise adherence improved physical function in this population.

Clinicaltrials: gov identifier: NCT01029171.