Middle-aged Women Research Articles

A novel murine model of stress-induced cardiomyopathy achieved by chemogenetic stimulation of the locus coeruleus-norepinephrine system

Abstract Background Takotsubo syndrome (TTS) is a stress-induced acute cardiomyopathy characterized by transient left ventricular (LV) dysfunction without obstructive coronary artery disease. TTS is often underdiagnosed and undertreated and typically occurs in middle-aged women who recover from initial symptoms within a few weeks. Despite the apparent recovery, TTS patients have a worse cardiovascular prognosis compared to healthy individuals. To date, the pathophysiology underlying TTS remains unclear. So far, preclinical models barely reflect the complete clinical picture of TTS observed in humans. Moreover, these models display several limitations, e.g., high mortality or disregarding the involvement of the central nervous system. Consequently, much of the current obscurity concerning the pathophysiology of TTS is due to the lack of appropriate preclinical models. Purpose The present study aimed to assess whether chemogenetic activation of the locus coeruleus-(LC)-norepinephrine-(NE) system in vivo can induce LV dysfunction similar to that observed in patients with TTS. For this purpose, we used the designer excitatory receptor activated exclusively by designer drug (DREADD) system. Methods 11-13 weeks-old female Cre-dependent DREADD mice were genetically modified to express a codon-improved Cre recombinase under the dopamine-beta-hydroxylase-(DBH) promoter. For this purpose, a designed excitatory receptor exclusively activated by designer drugs or a control vector was stereotactically delivered to the LC using adenoviral transfection. Restricted expression of DBH-positive noradrenergic neurons to the LC was validated using pupillometry. LC-NE was activated by administering low-dose clozapine 0.03 mg/kg/day intraperitoneally. Serial anatomical and functional assessments of the cardiac phenotype in these mice were performed at baseline, the end of stress induction, and after ten days and three months of the recovery phase using echocardiography and cardiac magnetic resonance imaging. Results Targeted stimulation of the LC-NE system resulted in apical LV wall motion abnormality in 70–83% of mice. A complete recovery of LV wall motion abnormality was observed after the recovery phase. Conclusions Chemogenetic stimulation of the LC-NE system in mice mimics LV wall abnormalities similar to those observed in patients with TTS and may, therefore, be a novel preclinical model to investigate the pathophysiology of TTS.

Patterns of overeating in middle-aged Chinese from Hong Kong

Abstract Background Obesity is one of the most important risk factors for non-communicable diseases worldwide. Overweightness may be attributable to a wide spectrum of overeating behaviours. However, the various types of overeating behaviors are under-studied in Asia, particularly in non-adolescent age groups. This study aims to estimate the prevalence and factors associated with various overeating patterns among middle-aged Chinese adults. Methods A random telephone survey was conducted in 2023 on Hong Kong Chinese adults between 35 and 59 years or age (n = 785). An instrument composed of modified Positive-Negative Emotional Eating (EE) Scale, Night Eating Questionnaire-Chinese (NEQ), Binge Eating Disorder Screener (BED-7), Depression Anxiety and Stress Scales (DASS-21), demographic factors, BMI and number of reported gastrointestinal (GI) conditions was used. Multiple regression analyses were conducted to test the association of demographic factors, BMI, GI conditions as well as dysphoric mood with overeating behaviors. Results Hong Kong Chinese middle-aged adults reported the following past-month prevalence of overeating behaviors: positive EE (26.1%), general overeating (12.4%), negative EE (9.2%), binge eating (6.0%) and night eating behavior (1.8%). Nightshift work, mental stress, being single and younger age were common risk factors for the various overeating patterns among middle-aged men. Anxiety, high/low educational levels and younger age were common risk factors among middle-aged women. Obesity was associated with binge eating and positive EE in men (OR: 1.7-4.0) and associated with negative EE and general overeating (OR:2.3-2.7) in women. Conclusions This study noted that binge eating, night eating, positive/negative EE, and GOB were distinct eating patterns requiring different clinical approaches. The significant association between various overeating behaviors with BMI, indicates that these individuals should be prioritized to receive healthy eating interventions. Key messages • Adult overeating is not a singular behavior but represents an array of different eating patterns with different risk factors. • Like their Western counterparts, overeating behaviors in Chinese adults are often linked to dysphoric mood, therefore treatment of obesity may require psychological counseling.

Atrial cardiomyopathy in postmenopausal female healthcare professionals- a single-center study

Abstract Background Atrial cardiomyopathy (ACM) is a new clinical entity with significant importance, because of its potential to be a determinant of heart failure, atrial fibrillation and thromboembolic complications¹. Defining different atrial phenotypes is challenging, because of the lack of consensus for the diagnosis of ACM²'³. Menopausal transition is associated with adverse changes in women’s health such as obesity and hypertension, both known risk factors for ACM⁴. Aim To investigate left atrial (LA) structural and functional echocardiographic parameters in postmenopausal female healthcare professionals and to define atrial phenotype in this population. Methods Consecutive asymptomatic, postmenopausal, middle-age women (n=105), healthcare professionals from our hospital, were separated in 3 groups according to co-morbidities : with obesity (n=50), obesity and hypertension (n=24), healthy control (n=31). All patients underwent 2D echocardiographic examination with volumetric and speckle tracking analysis of LA. Results There were significant differences in LA structural and functional indices between 3 groups- table 1. Higher body mass index was associated with increased LA volume index (p<0.001, r= 0.56), reduced LA total emptying fraction- LATEF (p<0.001, r= -0.62), Peak atrial longitudinal strain-PALS (p<0.001, r= -0.59 ) and Peak atrial contractile strain- PACS (p<0.001, r= 0.56 ). ROC analysis was performed for identifying atrial phenotype of obese women with hypertension: LAVi 16.5ml/m2,(sensitivity 0.833, specificity 0.839, AUC 0.875), PALS 46.55% (sensitivity 0.903, specificity 0.875, AUC 0.951), PACS -20.75% (sensitivity 0.806, specificity 0.708, AUC 0.855), LATEF 69% (sensitivity 0.903, specificity 0.792, AUC 0.920)- figure 1. Conclusion Postmenopausal women with obesity and hypertension are at risk for asymptomatic ACM. Further investigations are needed to confirm this concept.

Contemporary LDL-cholesterol management in male and female patients at high-cardiovascular risk: results from the European observational SANTORINI study

Abstract Background Middle aged women have a faster increase in atherosclerotic cardiovascular disease (ASCVD) events than men over time. Undertreatment with guideline-recommended therapy in women may be one of the drivers for this burden. Purpose To compare high- or very high-risk male and female patients regarding contemporary 1-year low-density lipoprotein cholesterol (LDL-C) goal attainment, lipid-lowering therapy (LLT) intensity, and major adverse cardiovascular event (MACE) rate. Methods SANTORINI is an observational, prospective study that enrolled high- and very high-cardiovascular risk patients between March 2020 and Feb 2021, across 623 sites and 14 countries in Europe from primary & secondary care settings, with a further 1-year prospective follow-up. We included all patients with an LDL-C measurement at baseline and 1-year follow up (1yFU) for the current analysis. LDL-C goal attainment was defined separately for high and very-high risk categories according to 2019 ESC/EAS guidelines. Results Overall, 5197 males with a mean age of 65 years, and 2013 females with a mean age 66 years were included. At baseline, male patients had higher prevalence of pre-existing ASCVD (81.6% vs. 63.5%), and a lower prevalence of familial hypercholesterolaemia (8.7% vs. 17.2%) than female patients (Table 1). The proportion of patients reaching LDL-C goal improved from baseline to 1yFU, but was greater in males (22.9% and 33.3%, respectively) than females (16.9% and 24.6%, respectively). Similarly, the proportion of patients receiving no LLT decreased from baseline to 1yFU for both sexes, however, more females than males received no LLT at 1yFU (male: 20.7% to 2.7%; female: 23.9% to 3.9%). High intensity statin use increased for both sexes but was higher for males (22.2% to 27.3%) than for females (15.5% to 19.5%) at 1yFU. By contrast, PCSK9i use at baseline and 1yFU was lower for males (6.6% to 9.3%) than for females (9.8% to 13.4%). Nevertheless, the use of combination LLT at 1yFU was lower among females than males (male: 27.8% to 42.2%; female: 26.7% to 40.2%). During follow-up, MACE-4 was higher in males (5.31/100 patient years [PY]; 95% confidence interval [CI]: 4.68–5.95) than in females (3.63/100PY; 95% CI: 2.79–4.47). Similar results were observed for MACE-3 (Table 2). Conclusions Despite similar guideline recommendations, use of combination LLT and high intensity statin therapy was lower in female patients at high or very high cardiovascular risk than in male patients over one year of follow-up. Accordingly, female patients had lower LDL-C goal attainment both at baseline and at one-year. Nevertheless, due to intrinsic risk factors, female patients had lower rates of MACE-4 and MACE-3 than male patients.

Urinary artificial sweeteners and breast cancer risk in women from the Moli-sani Study

Abstract Background Artificial sweeteners (AS) are chemical substances developed by the food industry to reduce sugar and calories while maintaining sweetness. Cohort studies suggested an increased risk of certain cancers, including breast cancer (BC), associated with AS intake, however evidence exclusively relied on self-reported dietary data rather than objectively measured AS. We examined the association of urinary biomarkers denoting AS intake with BC risk in women from the large Moli-sani Study. Methods Using a case-cohort design, a sample of 987 middle-aged women (mean age 55±12 y) was randomly selected as sub-cohort and compared with 273 women with incident BC (26 of them also belong to the sub-cohort). A total of 6 commonly used AS (i.e. aspartame, acesulfame, saccharine, sucralose, cyclamate, and steviol glycosides) were measured through liquid chromatography-mass spectrometry in urinary samples (creatinine-adjusted concentrations; µg/mg) collected at baseline (2005-2010). The multivariable hazard ratios (HRs) were estimated through Cox regression models using the Prentice method, where each AS was dichotomized as absence/presence, independent of concentrations. Results The main urinary AS was saccharine (E954), contributing to 71% of total AS, followed by steviol glycosides (E960;11%). During a median follow-up of 13.2 y we identified 38 premenopausal and 235 postmenopausal incident BC cases. In multivariable-adjusted Cox analyses, none of the individual AS was associated with overall BC risk, nor was the total urinary AS (HR = 0.93; 95%CI 0.63-1.37 for 1-unit increment). Compared to absence, presence of sucralose (E955) in urine was linked to premenopausal BC (HR = 4.23: 95%CI 1.23-14.51; p = 0.022). Conclusions Urinary artificial sweeteners were not associated with BC risk. However, sucralose presence in urine was linked to a higher risk of premenopausal BC. Prospective, dose-related studies with larger sample size are warranted to possibly confirm our findings. Key messages • The presence in the urine of commonly used artificial sweeteners was not associated with breast cancer risk. • Presence of urinary sucralose was linked to higher risk of premenopausal breast cancer.

Demographic, clinical characteristics, managements strategies and in-hospital outcomes of patients enrolled in prospective nationwide SCAD registry

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon yet increasingly recognized cause of acute coronary syndrome (ACS), particularly in young to middle-aged women. This multicentric, prospective nation-wide registry aimed to elucidate the demographic characteristics, clinical presentation, management strategies, and outcomes of patients with SCAD. A total of 95 patients with SCAD were enrolled in 10 centers, with females constituting 81% of the cohort, and with an average age of 49.7±11.9 years. Among the traditional risk factors, prior hypertension was observed in 49%, followed by hyperlipidemia in 43%, diabetes mellitus in 9% and prior or current smoking in 47% of patients. The presentation of SCAD as ST-elevation myocardial infarction (STEMI) was predominant, occurring in 61% of cases, with the left anterior descending artery (LAD) being the most involved vessel (68%). Regarding the classification of SCAD, type 2 SCAD was the most frequent (53%), followed by type 1 (24%) and type 4 (16%). Notably, involvement of the distal segment of the culprit artery was observed in 68% of cases, while baseline TIMI 3 flow was noted in 52% of patients. Percutaneous coronary intervention (PCI) was performed in 52% of cases, with pre-interventional TIMI 0-2 flow (62% Vs. 28%; p<0.05) and proximal artery involvement (41% Vs. 13%; p<0.05) being more prevalent compared to conservatively managed patients. Final stent implantation was performed in 67% of PCI cases, with TIMI 3 flow restoration in 76% of patients undergoing PCI. The average left ventricular ejection fraction prior to discharge was 51±9.9%. In-hospital mortality was reported in three female patients, undergoing attempted PCI with left main and LAD involvement. The use of antiplatelet therapy was widespread, with aspirin administered to 98% and P2Y12 inhibitors to 75% of patients at discharge. Data from this prospective nationwide multicentric SCAD registry show that SCAD occurs predominantly in relatively young female patients, with moderately prevalent traditional cardiovascular risk factors, usually presents as STEMI, with good overall survival rates despite half of the patients managed conservatively. PCI was often attempted in SCAD lesion with compromised arterial flow and located proximally, with lower rates of stent implantation and procedure success compared to traditionally observed rates in primary PCI. This underscores the importance of heightened awareness and tailored management approaches for this unique subset of ACS patients in order to refine risk stratification, optimize treatment strategies, and improve outcomes in this population.

A Case of A Middle-Aged Woman with Cor Triatriatum Dexter and Sick Sinus Syndrome: Comprehensive Cardiovascular Evaluation

This case study discusses a 51-year-old woman with a complex cardiovascular condition, cor triatriatum dexter, complicated by sick sinus syndrome. The patient presented with a history of bradycardia, dizziness, and amaurosis, and was admitted to the emergency department due to numbness in her right limb. Diagnostic examinations, including computed tomography (CT) and cardiac color-ultrasound screening, revealed cor triatriatum dexter along with an enlarged left atrium and ventricle. Additional findings included the absence of the inferior vena cava and polysplenic syndrome. Based on these results, double-chamber pacemaker surgery was recommended, supported by cardiac and thoracic-abdominal CT angiography and three-dimensional vascular reconstruction. This case underscores the importance of comprehensive examinations in identifying associated cardiovascular abnormalities.

Caffeine optimizes Zumba training benefits on functional performances in middle-aged women: a randomized trial study

The current study aimed to explore the effect of daily caffeine supplementation (100 mg/day) and 12-week of Zumba training on functional performances in middle-aged women. Eighty-five middle-aged women were randomized into 4 groups including control, Zumba training (ZT), caffeine supplementation (Ca) or caffeine-Zumba training (Ca + ZT) groups. Functional performances were assessed using 10 m Walk, Timed Up and Go, Functional Reach, and 30-Second Chair Stand tests. As results, ZT, Ca and Ca + ZT intervention programs showed a significant (p < 0.05) functional performances improvement. However, Ca + ZT group showed significant (p < 0.001) better scores in terms of mobility (95%CI [0.71, 1.43]), gait speed (95%CI [0.52, 1.71]) and lower body endurance strength (95%CI [-6.93, -1.92]), except for dynamic balance (95%CI [-9.41, -3.44]). In conclusion, 12-week of Zumba training improves functional performances in middle-aged women, and daily caffeine intake is an effective alternative for improving such performances. Supplementing caffeine (100 mg/day) to Zumba training was effective in boosting Zumba benefits on these functional performances.

Miliary Osteoma Cutis, Report of A Case After Plant Injury

Osteoma cutis (OC) is a rare condition characterized by the presence of bone particles within the skin. One subtype of osteoma cutis is miliary osteoma cutis (MOC), which primarily affects middle-aged women and commonly occurs on the face. Clinical features of MOC include papules and skin-colored hard nodules, similar to milia. In this case, we present a 60-year-old woman with facial skin lesions resulting from a plant injury. The diagnosis was miliary osteoma cutis, and successful surgical treatment was performed

Oral Health Status among Postmenopausal Women Attending Tertiary Hospital of Bharatpur, Nepal

Introduction: Menopause is a biological process occurring in middle aged women causing changes in the level of circulating hormones. Changes in the oral flora, oral mucosa and decrease in bone mineral density leads to many menopauses related oral findings. Objective: This study was conducted with the objective to assess the oral health status of postmenopausal women visiting tertiary health care centre in Bharatpur, Chitwan. Methods: Analytical cross-sectional study was conducted among 224 postmenopausal women attending dental OPD in a tertiary health care centre. Comprehensive oral examination was done where CPITN index was used to record periodontal health and DMFT index was used to record caries experience of the patient. Data entry was done in Microsoft Excel and statistical analysis was done using SPSS version 20. Results: Total 224 patients were examined with age range of 45 to 78 years and the mean age of 56.71 years. 113 study participants comprising 50.4%, showed supra or subgingival calculus followed by gingival bleeding in 54 (24.1%). Mean decayed score among study participants was found to be 2.71±2.85, mean missing score was found to be 4.29±7.83. Conclusion: Mean score for missing teeth suggestive of sequel of dental caries and periodontitis was found higher among the post-menopausal women followed by mean decayed score. Dental caries score was high probably due to dryness of mouth and other predisposing factors.

Knowledge, attitude, and practice regarding the prevention of osteoporosis among middle and old-aged women of Kirtipur Municipality, Nepal.

Osteoporosis is a major public health problem that can lead to physical disability, working performance limitations, decreased self-sufficiency, and increased hospitalization and mortality rates. People are unaware of osteoporosis, and it is often undiagnosed until fractures occur. Limited studies have been conducted to determine the knowledge, attitude, and practice regarding osteoporosis among middle-aged women in Nepal. This study aimed to determine existing knowledge, attitude, and practice towards osteoporosis among middle and old-aged women in Nepal. A cross-sectional study was conducted among the selected wards of Kirtipur Municipality to recruit 405 participants. Participants were selected using a stratified random sampling technique. Face-to-face interviews using a structured questionnaire were performed to collect the data. Frequencies, percentages, mean, and standard deviation were used to describe the characteristics of participants. Multivariate logistic regression was used to determine the factors associated with knowledge, attitude, and practice regarding osteoporosis. Pearson's correlation coefficient was used to determine the correlation between knowledge, attitude, and practice regarding osteoporosis. The mean ± SD age of the participants was 46.2 ±9.1 years. Nearly half of the participants (48.8%) had good knowledge, while 57.7% and 51.8% had positive attitudes and good practices regarding osteoporosis, respectively. The occupation and income of the participants were statistically significant and associated with the knowledge level. Meanwhile, age, ethnicity, education, occupation, and monthly household income were associated with attitude level. With a good practice level, ethnicity, family type, and education were statistically significant. The knowledge-attitude (rka = 0.093, p < 0.05), attitude-practice (rap = 0.171, p < 0.001), and knowledge-practice (rkp = 0.274, p < 0.001) for osteoporosis were positively correlated. The study found that still around half of the middle and old-aged women had poor knowledge, negative attitudes, and poor practices regarding osteoporosis. Moreover, it highlighted inadequate dietary practices, such as low consumption of milk, vegetables, fruits, and calcium supplements among women, indicates are at greater risk of osteoporosis. The study emphasized the need for community-based awareness programs for the target population such as housemakers, and lower-income groups, to prevent osteoporosis among women.

Perceived Susceptibility to and Severity of Cardiovascular Disease Is Associated With Intent to Change Behavior Among Women 25-55 Years Old.

Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased, whereas CVD knowledge and awareness remain low. The objective of this study was to describe the relationship between the stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify predictors of the stage of behavior change. A cross-sectional online survey of women ages 25-55 years living in the United States was conducted. Awareness was measured with the question "What is the leading cause of death for women in the United States?" Knowledge, perceptions, and the stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and Precaution Adoption Process Model instruments, respectively. Chi-square and t tests were used to determine differences between awareness, knowledge, and perceptions based on the stage of behavior change. Multiple logistic regression was used to evaluate the relationship between the stage of behavior change and awareness, knowledge, and perceptions. A total of 149 primarily minority women (n = 105) were included (mean age = 37.15 ± 7.86 years). The perception of CVD susceptibility was associated with increased intention to change behavior (odds ratio, 1.247; 95% confidence interval, 1.101-1.414; P < .001). The perception of CVD severity was associated with reduced intention to change behavior (odds ratio, 0.809; P = .004). Women who believed they were susceptible to CVD and did not perceive CVD as severe were more likely to report intent to change behavior, suggesting perception of CVD risk is more important than awareness or knowledge. Addressing misperceptions may be a strategy for primary risk reduction.

Factors influencing sleep duration among middle-aged women in Korea: insights from the community health survey.

This study aimed to investigate the influence of demographic and health-related characteristics on sleep duration among middle-aged women aged 44-64. Utilizing raw data from the 2022 Community Health Survey, a cross-sectional analysis was conducted. The study included middle-aged women who participated in the survey, with data collected through structured interviews. χ2 tests and logistic regression analysis were employed to assess associations between sleep duration and demographic as well as health-related factors. The findings revealed that sleep duration in middle-aged women was significantly associated with multiple factors. Age (p < .001), spouse status (p = .001), occupation (p < .001), self-rated health (p = .004), perceived stress (p < .001), depression (p < .001), cognitive impairment (p = .009), unmet medical needs (p = .034), current cigarette smoking (p = .001), and binge drinking (p = .006) were all identified as important determinants of sleep duration. The results highlight the need for targeted interventions that address both health and psychological risk factors contributing to sleep disturbances among middle-aged women. An integrated approach, considering these factors, is essential to improve sleep health in this vulnerable population.

Nutraceutical Synergy in the Treatment of Polymorbid Pathology: Black Seed Supplementation in Hypertension, Diabetes, Knee Osteoarthritis and Anxiety - A Case Study

Introduction: Investigate combining black seed (Nigella sativa) and honey to manage hypertension, type-2 diabetes, knee osteoarthritis, and anxiety in a middle-aged woman. Case Presentation: A 55-year-old woman, poorly controlled on allopathic meds for 4 months, had her BP and blood sugar monitored for 2 weeks. She then started a black seed-honey mix, and BP and blood sugar were monitored for another 2 weeks. Significant reductions in BP and blood sugar levels were observed. The knee osteoarthritis score was halved, and anxiety was reduced from moderate to none. The patient continued the supplement with adjusted meds and experienced no adverse effects. Conclusion: The black seed-honey mix shows promise as an adjunctive therapy for multiple conditions and warrants further investigation.

In or out of reach? Long-term trends in the reach of health assessments in the Swedish occupational setting.

This study aimed to investigate the reach of a large-scale health assessment delivered by the occupational health service in Sweden for almost 30 years. A total of 418 286 individuals who participated in a health assessment (Health Profile Assessment, HPA) between 1995-2021 were included. A comparative sample was obtained from Statistics Sweden, comprising the entire working population for each year (4 962 127-6 011 829 unique individuals per time period). Sociodemographic and work organization characteristics were compared between the HPA and comparative population for six different periods. Under- and overrepresented groups in the private and public sectors were identified using the most recent data (2015-2021). With negative per cent indicating underrepresentation, the most notable changes over time in representation in the HPA population compared to the comparative were observed for women (-1.2% to -12.8%), private sector employees (-9.4% to 14.9%), individuals with ≥3 years of employment (14.5% to 0.9%), in personal care (0.8% to -8.8%) and manufacturing (0.7% to 6.4%) occupations. Consistently overrepresented groups (median representation across periods) included individuals who had a single income source (6.3%) and were middle-aged (10.8%), born in Sweden (5.9%), associate professionals (8.7%), and employed in companies with high operating profit (17.9%) and low staff turnover (14.3%). Conversely, individuals with low income (-34.0%) and employed in small companies/organizations (-10.9%) were consistently underrepresented. Middle-aged women in education occupations were most underrepresented in the public sector, while in the private sector, it was young women in service and shop sales occupations. This health assessment has reached many professionals, including hard-to-reach groups, but did not fully represents the Swedish workforce throughout the years.

Народжуваність та сімейна політика у країнах Європи у період пандемії COVID-19

The study of shifts in the fertility dynamics during crisis periods along with changes in the system of family policy in European countries is a relevant direction of research for the further development of Ukraine’s demographic policy, increasing its effectiveness, especially in the period of post-war reconstruction. In this regard, the purpose of our paper is to find out the changes in trends and structural characteristics of fertility in the first years of the COVID-19 pandemic in European countries in combination with the analysis of change in family policy, effectiveness of current and implemented during this period policy measures. The main methods used in the paper were systematization and generalization of statistical information from various sources, structural-logical and comparative analysis and critical assessment of measures implemented to counter crisis situations in developed European countries. The scientific novelty consists in generalizing fertility characteristics and family policy measures to counteract the negative impact of COVID-19 pandemic on family wellbeing in European countries. The grouping of European countries was based on the changes that occurred in the fertility dynamics on the eve of the COVID-19 pandemic and in 2020—2021. In most countries, there was a decrease in the total fertility rate in 2020 followed by a rather sharp rise in 2021. This became possible due to the increase in childbirth among women of middle and older reproductive age. The countries in which there was a long period of decline in the total fertility rate before the epidemic but in 2021 fertility increased despite the complexity of the epidemiological situation (Ireland, the Netherlands, Iceland, Norway) have drawn the most attention. Consistency, comprehensiveness, adherence to principles, variety are key characteristics of family policy that strengthen reproductive resilience. Along with providing financial assistance to families with children, in many countries, parents were given additional paid leave, measures were introduced to counter the dismissal of employees who have children, support was provided to institutions that continued to provide childcare services, and remote employment opportunities were expanded. The issues of the influence of population’s trust in the government (especially in periods of crisis) on formation of reproductive intentions and their realization need further study.

Eating disorders of the perimenopause.

Except for psychosis, women's mental health problems across the reproductive lifespan are common. There are periods in a woman's life, associated with significant sex hormone fluctuations, that render her particularly susceptible to mood disturbance and mental health illnesses, including eating disorders. Whilst eating disorders are usually conceptualized as diseases afflicting adolescence and young adults, there is increasing evidence to suggest the landscape for eating disorders has considerably changed and includes a peak in midlife, correlating with the perimenopause. Inpatient admissions and outpatient clinic attendances have increased amongst older women. It is likely this increasing trend is the result of numerous biopsychosocial factors. A diagnosis of an eating disorder in midlife may be more common in those women simultaneously navigating the perimenopause than in midlife women who remain pre-menopausal owing to the significant ovarian hormonal fluctuations encountered in the perimenopause. Eating disorders are serious illnesses associated with significant morbidity and mortality, which are exacerbated when present at older ages. Research is beginning to recognize the importance of including this typically under-represented cohort of middle-aged women in empirical studies, which is critical to a complete etiological understanding. Recognizing and treating these varied presentations and establishing effective treatments for chronic, recurrent and new-onset eating disorders in midlife women is crucial.

Statistical analysis of predictors of effectiveness of complex physiotherapeutic treatment in patients with involutional skin changes

BACKGROUND: Analysis of predictors of the effectiveness of various treatment regimens for diseases, as well as the correction of involutionary processes in the human body, is increasingly becoming a standard in scientific medical research. The technology for identifying them traditionally includes the use of correlation and regression analysis, as well as the principles of correlation adaptometry, which makes it possible to approach the solution of this problem from the position of system analysis. AIM: Analysis of predictors of the effectiveness of correction of involutive skin changes in middle-aged and older women with metabolic syndrome using various therapeutic regimens, including hyaluronic acid laser phoresis and the use of transcranial magnetic therapy in combination with oxygen barotherapy. MATERIALS AND METHODS: The study was carried out with the participation of 60 patients from middle and older age with involutional changes in the skin against the background of metabolic syndrome. All patients were divided into 2 groups using simple fixed randomization. The first group (comparison, 30 patients) received laser phoresis of hyaluronic acid in the form of a 1.5% sodium hyaluronate gel using a laser and laser-vacuum therapy device LAZMIK. Patients of the second group (main group, 30 patients) were prescribed combined physiotherapy. For transcranial magnetic therapy, the Amo-Atos device with the Headband attachment was used, and oxygen barotherapy was carried out in single pressure chambers of the Oka-MT or Irtysh-Shch1 type under a pressure of 2 atm for 1 hour. RESULTS: It was found that in the initial state, the quality of life of patients with involutional changes in the skin against the background of metabolic skin syndrome was largely determined by the presence of pathological correlation galaxies that integrate changes in the condition of the skin, metabolic disorders, indicators of oxidative stress and microhemodynamics, and the activity of proinflammatory cytokines. At the same time, the leading role in the deterioration of the quality of life belonged to the age of the patients, the insulin resistance index, transepidermal water loss and microcirculation indicator. However, predictors of effectiveness varied across different treatment regimens. With laser phoresis of hyaluronic acid, its effectiveness increases in younger women with minimal involutional manifestations of skin aging, tested for the condition of the skin, while combined physiotherapy is also most effective in women with a low average age limit, with minimal manifestations of metabolic syndrome and inflammatory processes, as well as against the background of high activity values of one of the enzymes of antioxidant protection ― superoxide dismutase. CONCLUSION: The results obtained convincingly prove the effectiveness of combination therapy in correcting involutive skin changes in middle-aged and older women due to metabolic syndrome, which is comparable in a number of parameters to the effectiveness of hyaluronic acid laser phoresis. At the same time, predictors of effectiveness depend on the characteristics of the mechanisms of therapeutic action of the treatment regimens used, which allows for a more correct approach to the choice of personalized treatment methods.

Yoga fitness with middle-aged women: benefits for physical and mental health

Physical education of adults is important for maintaining their health. The choice of directions for the use of means of physical education should be based on the prevailing needs for motor activity of persons of mature age. The goal is to develop and experimentally substantiate the methodology of yoga classes for women aged 21-35. Participants Women 21-35 years old. Methods. Psychodiagnostics, movement testing, pedagogical experiment. Intervention. The method of yoga classes with middle-aged women has been developed and tested. The peculiarity of the proposed method is connected with the systematic use of original sets of yoga gymnastics exercises. The developed complexes were applied taking into account the successive increase in exposure and were used in accordance with the solution of specific training tasks. The results. The effectiveness of the proposed format of using yogic gymnastics exercises to improve indicators of the physical and psychological state of middle-aged women has been established. The improvement of performance characteristics, the cardiorespiratory system and the normalization of the psychological state of the participants under the influence of the applied sets of exercises were recorded. Discussion. Systematic yoga classes in the format of using developed sets of exercises were to determine their effectiveness in improving physical conditions and improving the psychological state of middle- aged women. The selected physical exercises belonged to the field of mental fitness and were stato-dynamic in nature. Accordingly, the mild effect of the classes on women who do not regularly engage in fitness should be related to the improvement of physical conditions, and meditative practices were associated with expectations regarding the normalization of the psychological state of the participants. The obtained results confirmed the stated expectations and do not contradict the results of similar studies. Conclusions. The established features of building effective yoga classes with middle-aged women allow us to recommend this type of fitness as an affordable means of improving the health of this contingent of people. The obtained results contribute to the further search for possibilities of detailing the program of yoga classes with middle-aged women in order to expand the range of tasks of physical education of this continent of people.

Chronotypes in middle-aged women with polycystic ovary syndrome: A population-based study.

Circadian rhythm disruption has been associated with the risk of polycystic ovary syndrome (PCOS), as the evening chronotype (EC) shares several traits with PCOS, including metabolic disorders, cardiovascular diseases, and psychiatric disorders. It has been suggested that the biological clock could be targeted with new, preventive, and therapeutic strategies for PCOS in women with biorhythm disorders. We evaluated inner circadian rhythmicity in middle-aged women with PCOS in a population-based setting, focusing on whether women with PCOS and an EC have a specific subtype in relation to their clinical characteristics. The data derived from the Northern Finland Birth Cohort, a population-based longitudinal birth cohort of 12 058 individuals born in 1966. We compared the circadian phenotype between 314 women with PCOS (according to the Rotterdam criteria) and 1248 women without PCOS at age 46 years using the validated Finnish shortened 6-item Morningness-Eveningness Questionnaire (sMEQ) and the single-item self-assessed morningness-eveningness question. PCOS was not associated with the EC by the sMEQ (p = 0.495) or self-assessment (p = 0.303). The self-assessed morningness-eveningness values differed from the sMEQ chronotype distribution (p < 0.001), nevertheless, the most frequent chronotype was the intermediate chronotype (IC) determined by both chronotyping methods (sMEQ PCOS 47.7% vs. 45.2% non-PCOS; self-assessment PCOS 66.5% vs. 68.4% non-PCOS). The hyperandrogenic PCOS phenotypes A-C did not differ from the non-hyperandrogenic phenotype D as for the chronotype (p = 0.271). The EC was associated in both groups with depressive and anxiety symptoms (PCOS p = 0.012, non-PCOS p < 0.001) and the use of sleep medication (PCOS p = 0.017, non-PCOS p < 0.001). The EC was not over-represented in middle-aged women with PCOS or in the hyperandrogenic PCOS phenotypes A-C in our study. This does not support the need for chronotyping in the comprehensive assessment of women with PCOS. However, as chronotypes tend to change with aging, cross-sectional studies in different age groups are warranted to draw conclusions on the role of chronotypes in PCOS and the associated metabolic risks.