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• This matched cohort study included 14,620 individuals with audiometry-determined objective hearing loss and 38,479 with subjective hearing loss, together with 29,240 and 38,479 matched unexposed individuals, respectively. • We found both undiagnosed objective and subjective hearing loss were associated with multiple subsequent adverse health consequences, but with discrepancies in comorbidity patterns. • Objective hearing loss had pronounced associations with neurodegenerative disease. • These findings highlight the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention. Hearing impairment is common in the middle-aged population but remains largely undiagnosed and untreated. The knowledge about to what extent and how hearing impairment matters for health is currently lacking. Thus, we aimed to comprehensively examine the adverse health consequences as well as the comorbidity patterns of undiagnosed hearing loss. Based on the prospective cohort of the UK Biobank, we included 14,620 individuals (median age 61 years) with audiometry-determined (i.e., speech-in-noise test) objective hearing loss and 38,479 individuals with subjective hearing loss (i.e., tested negative but with self-reported hearing problems; median age 58 years) at recruitment (2006–2010), together with 29,240 and 38,479 matched unexposed individuals respectively. Cox regression was used to determine the associations of both hearing-loss exposures with the risk of 499 medical conditions and 14 cause-specific deaths, adjusting for ethnicity, annual household income, smoking and alcohol intake, exposure to working noise, and BMI. Comorbidity patterns following both exposures were visualized by comorbidity modules (i.e., sets of connected diseases) identified in the comorbidity network analyses. During a median follow-up of 9 years, 28 medical conditions and mortality related to nervous system disease showed significant associations with prior objective hearing loss. Subsequently, the comorbidity network identified four comorbidity modules (i.e., neurodegenerative, respiratory, psychiatric, and cardiometabolic diseases), with the most pronounced association noted for the module related to neurodegenerative diseases (meta-hazard ratio [HR] = 2.00, 95%confidence interval [CI] 1.67–2.39). For subjective hearing loss, we found 57 associated medical conditions, which were partitioned into four modules (i.e., diseases related to the digestive, psychiatric, inflammatory, and cardiometabolic systems), with meta-HRs varying from 1.17 to 1.25. Undiagnosed hearing loss captured by screening could identify individuals with at greater risk of multiple adverse health consequences, highlighting the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention. [ABSTRACT FROM AUTHOR]

• Cardiovascular disease in aging women is a growing problem. • 89 women initiated the study and 74 of them participated in the 10-year follow-up (from 46 till 56 years of age). • We found early changes in cardiovascular risk factors and sleep-disordered breathing. • Early signs of sleep-disordered breathing, obesity and impaired glucose control in middle age contribute to vascular decline in women even after 10 years. The prevalence of cardiovascular diseases increases in women after menopause. The aim of the study was to determine the impact of conventional cardiovascular risk factors such as age, blood pressure, smoking, cholesterol, obesity, and glucose balance, but also menopausal state and sleep-disordered breathing on vascular impairment during menopausal transition. 89 women initiated the study and 74 of them participated in the 10-year follow-up. Cardiovascular disease risk factor assessments, ultrasound measurements of brachial artery function, including nitroglycerin-mediated vasodilatation and flow-mediated endothelium-dependent vasodilation, and sleep studies were repeated at baseline and at 5-year and 10-year follow-ups. Over the study period, all the cardiovascular disease risk estimates increased. Both flow-mediated endothelium-dependent vasodilatation (decline 55 %) and nitroglycerin-mediated vasodilatation (decline 18 %) worsened over the 10 years (p < 0.001). Vascular function was not associated with menopausal state (determined with follicle stimulating hormone). Systolic blood pressure (p = 0.009) and smoking (p = 0.006) at baseline were negatively associated with nitroglycerin-mediated vasodilatation at 5-year follow-up and the use of hormonal therapy at 5-year follow-up was positively associated with concurrent nitroglycerin-mediated vasodilatation (p = 0.041). Intermittent nocturnal hypoxemia at baseline was associated with flow-mediated endothelium-dependent vasodilatation at 10-year follow-up (p = 0.043). High body mass index and impaired glucose balance at 5-year follow-up were associated with nitroglycerin-mediated vasodilatation decline at 10-year follow-up (p = 0.022 and p = 0.037, respectively). We demonstrate how cardiovascular risk factors and vascular function evolve during menopausal transition. Although menopause was not associated with vascular impairment, short-term improvement in vascular function was observed in those using menopausal hormonal therapy. Intermittent nocturnal hypoxemia, obesity and impaired glucose control are early predictors of vascular decline during postmenopause. [ABSTRACT FROM AUTHOR]

Background: Telehealth has emerged as an alternative to conventional, face-to-face visits, and the COVID pandemic has hastened its introduction. Telephone appointments make use of an easy-to-use and accessible technology.Aim: To investigate the usability of telephone-based telehealth in a women's health outpatient clinic and whether this may be affected by the severity of the COVID pandemic.Method: A telephone survey was prepared to explore two usability domains: interaction quality (4 items) and satisfaction, preference and future use (6 items). Women were selected from two periods during the COVID pandemic when the infection rates were high and low.Results: The survey was completed by 106 women (60 when the prevalence of COVID was high, mean age 53.58 years, and 46 when it was low, mean age 48.59 years) out of the 153 women who had a telephone appointment. The severity of the COVID pandemic showed an effect on responses. Women were less enthusiastic about using the telephone during the period of low COVID prevalence, as shown by lower scores on 3 of the 4 items of the first domain [I had enough time; I would have understood better in person; I would have expressed myself better in person (p < 0.001 for comparison between groups on each of the 3 items)], and on 4 of the 6 items in the second domain [satisfied with quality of care (p < 0.001), or with the information received (p = 0.018); use of telephone in future (p < 0.001); preference to try other technologies in future (p < 0.001)]. Overall, women expressed a preference for in-person visits regardless of COVID prevalence rates.Conclusion: Telephone calls were a feasible alternative to face-to-face visits in a women's health outpatient clinic, but the pandemic pressure modified usability parameters. Respondents preferred in-person visits at any pandemic stage. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity (PA) and total sleep time (TST) are each associated with cognition; however, whether these relationships vary by age and biological sex is unclear. We examined the relationships of PA or TST with cognition, and whether age and sex moderated these relationships, using baseline data from the Canadian Longitudinal Study on Aging (CLSA; 2010-2015).Study Design: A cross-sectional analysis of participants from the Comprehensive cohort of the CLSA with complete PA and sleep data (n = 20,307; age range 45-86 years).Main Outcome Measures: PA and TST were measured using the Physical Activity Scale for the Elderly (PASE) and self-reported TST over the past month. Cognition was indexed using a three-factor structural equation model (i.e., memory, executive function, and verbal fluency).Results: Non-linear restricted cubic spline models indicated that PA and TST explained statistically significant (p < 0.01) but modest variance of each cognitive domain (<1 % of 23-24 % variance). Age and sex did not moderate associations of PA with any cognitive domain. However, age and sex moderated relationships of TST with cognition, whereby: 1) associations of TST with memory decreased with age for males and females; and 2) males and females had different age-associated relationships of TST with executive function and verbal fluency.Conclusions: PA and TST modestly contribute to multiple domains of cognition across middle and older adulthood. Importantly, the association of PA with cognition does not appear to vary across middle or older adulthood, nor does it vary by biological sex; however, TST appears to have a complex relationship with multiple domains of cognition which is both age- and sex-dependent. [ABSTRACT FROM AUTHOR]

Dyslipidemia is an established risk factor for cardiovascular disease (CVD), which remains the leading cause of morbidity and mortality in women globally. The incidence of dyslipidemia increases over a woman's lifespan, with adverse changes around the time of menopause. Menopause, and the years leading up to the final menstrual period, is a time of estrogen fluctuation and ultimately estrogen deficiency, which has been associated with proatherogenic changes in the lipid profile. Independent of aging, menopausal status is associated with elevations in serum total cholesterol, LDL cholesterol, apolipoproteins, and triglycerides, and decreases in HDL cholesterol (HDL-C). Emerging research also suggests that after menopause there is a loss of functional HDL cardioprotective properties. Early initiation of menopausal hormone therapy (MHT) confers a favorable effect on lipid profile, though this does not translate into improved CVD outcomes and therefore guidelines do not indicate it for primary or secondary prevention of CVD. At the time of menopause, special consideration should be given to women with conditions more associated with CVD, including polycystic ovarian syndrome, premature menopause, early menopause, premature ovarian insufficiency, and familial hypercholesterolemia. Statins remain the mainstay of dyslipidemia therapy, though novel lipid-lowering agents are emerging. This review provides an overview of lipid alterations observed during the menopausal transition, summarizes the current evidence on the role of estrogen and progestogen on lipids, identifies special populations of women at especially high risk for lipid dysregulation at menopause, and describes approaches to the screening and treatment of midlife women. [ABSTRACT FROM AUTHOR]

• Midlife women are vulnerable to eating and body image issues. • Clinicians should be aware of presentations of body image and eating issues in midlife. • Asking questions can improve awareness of disordered eating and body image concerns at midlife. • Historically marginalized midlife women are uniquely impacted by eating and body image issues. • Treatment programs should consider the unique needs of midlife women. Midlife is a period of transition that is influenced by multiple biopsychosocial and cultural factors. Eating and body image issues are common at this life stage. The purposes of this narrative review are to explore: 1) the aspects of midlife that make individuals vulnerable to eating issues and body image concerns and 2) how these factors may be influenced by weight, cultural background, and socioeconomic status. Within this review, we aim to explore nuances of how eating and body image issues present in some historically marginalized groups at midlife. The aim is to provide clinicians who care for midlife individuals with practical tools to initiate conversations regarding body image and eating issues. Ideally this will facilitate early intervention and assessment for individuals who are struggling with new, chronic, or relapse of symptoms of disordered eating. [ABSTRACT FROM AUTHOR]

Objective: To document the risk of new-onset symptomatic pelvic organ prolapse (POP) among perimenopausal women and examine whether occupational lifting and/or pushing is a risk factor in the development of POP over a 10-year follow-up window.Study Design: Secondary analysis of prospective, longitudinal data from the Study of Women's Health Across the Nation (SWAN) cohort study.Main Outcome Measures: We analyzed women with current employment at the start of SWAN who were followed annually during mid-life. At baseline, women self-reported the frequency of occupational lifting and pushing, which was classified as Never, Infrequent (less than half the time), or Frequent (half the time or more) occupational lifting and/or pushing. Women were asked about new-onset symptomatic POP from the second to tenth annual follow-up. Modified Poisson regression was used to quantify crude and adjusted risk ratios (RRs) and 95 % confidence intervals (CIs) for POP according to load-bearing categories. Parous women were modelled separately, as initial analyses suggested effect modification by parity status.Results: In our sample of 1590 parous women, 8.2 % reported new-onset symptomatic POP over 10 years of follow-up. Multivariable analysis revealed that Infrequent (aRR 1.51, 95 % CI 1.04-2.20) and Frequent (aRR 2.03, 95 % CI 1.29-3.17) occupational lifting and/or pushing were associated with the development of POP.Conclusion: Frequent occupational lifting and/or pushing significantly increased parous women's risk of developing POP symptoms. This strengthens existing evidence that occupational exposures can be risk factors for POP. Gender-based education and prevention strategies in the workplace and in primary health care are necessary to reduce the burden of this condition for mid-life women. [ABSTRACT FROM AUTHOR]

• Weight gain during midlife is not related to menopausal status. • Certain ethnicities exhibit higher rates of midlife weight gain than others. • Physical activity can help decrease the risk of midlife weight gain. • Cultural differences in body image may affect acceptance of weight gain. • Clinicians should consider focusing on overall health rather than weight loss. Fears regarding weight gain and body changes commonly plague midlife women. The aim of this paper is to discuss the impact of weight gain and body changes on midlife women across various cultural backgrounds. Midlife weight gain in women is associated with age as opposed to menopausal status. Weight gain during midlife occurs across all cultural/ethnic groups; however, African Americans and Hispanic women exhibit higher rates of weight gain than their Caucasian counterparts. Although use of menopause hormone replacement therapy does not produce a clinical difference in weight gain, exercise decreases the risk of obesity in midlife women. Cultural differences in perception of body image exist. Recognizing these differences may help clinicians better address the weight concerns of women from diverse backgrounds. A shift in focus from weight goals to cardiometabolic risk reduction may help patients feel more successful and improve health outcomes. [ABSTRACT FROM AUTHOR]

• Menopausal symptoms are experienced at different rates among religious groups. • High prevalence of hot flashes among Baptists women is linked to higher rates of smoking and a high body mass index. • Lifestyle factors in certain religious groups should be considered when treating menopausal symptoms. This study's aim is to examine patterns of menopause symptoms and attitudes among United States women from different religious affiliations. We used data from a national sample of midlife and older adults. For this analysis, we included only women who were postmenopausal or had undergone hysterectomy. We constructed univariate and multivariate logistic regression models to examine the relationship between religious affiliation and menopause symptoms and attitudes while adjusting for potential confounders. Menopause symptoms (hot flashes, pain in sexual interactions, pleasure in sexual interactions, trouble falling asleep) and attitudes (relief on periods stopping, regret on periods stopping, worry about becoming less attractive) measured by self-report on Likert scales. Across denominations, 47 % of women experienced hot flashes, 48 % experienced pain in sexual interactions, 95 % experienced pleasure, and 88 % had trouble falling asleep. Regarding attitudes towards menopause and aging, 62 % felt relief in their periods stopping, while 56 % expressed worry about becoming less attractive with aging. Baptist women were more likely to experience hot flashes and trouble falling asleep compared to Catholic women. However, when adjusted for smoking status, this relationship did not persist. Unaffiliated and Spiritual women were less likely to experience trouble falling asleep and more likely to report pleasure in sexual interactions compared to Catholic women. Spiritual women were significantly more likely to feel regret on periods stopping compared to Catholics. There is a relationship between religious affiliation and the menopause experience. These findings demonstrate the importance of considering social influences on women's health. [ABSTRACT FROM AUTHOR]

• The rates of prescription for menopause hormone therapy continue to be low in the U.S. • Estrogen-only therapy was more often prescribed than estrogen-progestin therapy. • Hormone therapy was prescribed more in visits with a diagnosis of depression. • Hormone therapy was prescribed more in visits with women of White race. • Hormone therapy was prescribed less in visits with older and Hispanic/Latina women. The rates of prescription for menopause hormone therapy have been low in the U.S. since the 2002 Women's Health Initiative study, but no recent studies have assessed the prescribing of hormone therapy in the U.S. Using the National Ambulatory Medical Care Survey data from 2018 to 2019, we found that hormone therapy was prescribed in 3.8 % of U.S. visits by midlife and older women, with 60 % of these visits including estradiol-only prescriptions. Older age and Hispanic/Latina ethnicity were associated with decreased odds of prescribing, while White race and depression were associated with increased odds, indicating possible disparities in menopause care. [ABSTRACT FROM AUTHOR]

• Ethnic minorities living in Amsterdam displayed less healthy ageing (across seven biopsychosocial domains) than those of Dutch ethnic origin. • Ethnic disparities in healthy ageing were observed before and after midlife and were more pronounced in women. • Sociodemographic factors may play a role in these disparities and warrant additional research. We investigated ethnic health disparities in the Healthy Life in an Urban Setting multi-ethnic cohort using the multidimensional Healthy Ageing Score. We conducted a cross-sectional analysis of the study baseline data (2011–2015) collected through questionnaires/physical examinations for 17,091 participants (54.8 % women, mean (SD) age = 44.5 (12.8) years) from South-Asian Surinamese (14.8 %), African Surinamese (20.5 %), Dutch (24.3 %), Moroccan (15.5 %), Turkish (14.9 %), and Ghanaian (10.1 %) origins, living in Amsterdam, the Netherlands. We computed the Healthy Ageing Score developed in the Rotterdam Study, which has seven biopsychosocial domains: chronic diseases, mental health, cognitive function, physical function, pain, social support, and quality of life. That score was used to discern between healthy, moderate, and poor ageing. We explored differences in healthy ageing by ethnicity, sex, and age group using multinomial logistic regression. The Healthy Ageing Score [overall: poor (69.0 %), moderate (24.8 %), and healthy (6.2 %)] differed between ethnicities and was poorer in women and after midlife (cut-off 45 years) across ethnicities (all p < 0.001). In the fully adjusted models in men and women, poor ageing (vs. healthy ageing) was highest in the South-Asian Surinamese [adjusted odds ratios (95 % confidence intervals)] [2.96 (2.24–3.90) and 6.88 (3.29–14.40), respectively] and Turkish [2.80 (2.11–3.73) and 7.10 (3.31–15.24), respectively] vs. Dutch, in the oldest [5.89 (3.62–9.60) and 13.17 (1.77–98.01), respectively] vs. youngest, and in the divorced [1.48 (1.10–2.01) and 2.83 (1.39–5.77), respectively] vs. married. Poor ageing was inversely associated with educational and occupational levels, mainly in men. Compared with those of Dutch ethnic origin, ethnic minorities displayed less healthy ageing, which was more pronounced in women, before and after midlife, and was associated with sociodemographic factors. [ABSTRACT FROM AUTHOR]

• Sleep duration in midlife and old age was related to all-cause mortality. • Mortality with short sleep duration in midlife was attributed to unhealthy lifestyle factors. • In old age long but not short sleep duration was associated with mortality. Both short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies. This is a cohort study of 2504 men born between 1919 and 1934. In 1974–1975 (mean age 48), participants underwent baseline clinical examinations and sleep duration assessments. A follow-up examination took place 35 years later, in 2010 (mean age 82). All-cause mortality data from baseline and from old age were collected through to December 31, 2022. At baseline, short sleep duration (≤6 h per night), normal sleep duration (>6 and ≤ 8 h), and long sleep duration (>8 h) was reported by 266, 2019 and 219 men, respectively. Men with short sleep duration had higher levels of smoking, alcohol consumption, body mass index, and poorer self-rated health than those with normal sleep duration. During the 48-year follow-up, 2287 men died. The unadjusted hazard ratio for mortality was 1.20 (95 % confidence interval [CI] 1.05–1.37) for short compared with normal sleep duration, but this association vanished after adjustments (1.01, 95 % CI 0.87–1.17). In old age, the corresponding hazard ratios were 1.41 (1.16–1.72) and 1.19 (0.94–1.51) for short sleep duration and 1.33 (1.09–1.63) and 1.31 (1.02–1.67) for long sleep duration. In a comprehensive lifespan follow-up, the modestly increased mortality among men with short sleep duration in midlife was attributed to unhealthy lifestyle factors. In old age both long and short sleep duration seemed to be associated with modestly increased mortality. ClinicalTrials.gov identifier for the HBS: NCT02526082 [ABSTRACT FROM AUTHOR]

Phthalates are endocrine-disrupting chemicals that influence endogenous hormones. Few studies have examined the link between phthalates and menopause. A recent secondary analysis revealed that phthalates were associated with self-reported sleep measures in perimenopausal women. However, the associations between phthalate exposure and additional measures of sleep remain unknown. We recruited a population of 27 midlife women (aged 45-54) to study the relationship between phthalate exposure and both subjective and objective measures of sleep. Preliminary results indicate that women with higher phthalate exposure have reduced sleep quality, more frequent sleep disruptions, and more restless sleep compared to women with lower exposure. [ABSTRACT FROM AUTHOR]

Background: Frailty is a clinically discernible state in which decreased physiological reserve and function result in a reduced ability to cope with stressors. Information and communication technology (ICT) has been proposed as an aid to help with frailty, yet the use of ICT by older people, particularly women, is an understudied area.Aim: To analyze the association between use of ICT (specifically internet functions and social media) and frailty status in postmenopausal midlife and elderly women.Methods: A cross-sectional study was designed to investigate whether frailty status is related to ICT use in postmenopausal midlife and older women. Community-dwelling women attending primary health care centers for health checks were invited to participate in the study. Postmenopausal status was the only inclusion criterion, whereas limitations that could interfere with use of ICT were exclusion criteria. The Fried phenotype was used to assess frailty. Four types of ICT use were examined: the internet for e-mail, the internet for other functions, and social media (WhatsApp or Facebook). Chi-square test and multivariate multinomial regression analysis were used to examine the association between frailty status and ICT use.Results: We included 409 women (age = 67.45 ± 7.81 years, mean ± SD), who were frail (n = 135, 33.01%), pre-frail (n = 159, 38.87%), or robust (n  =  115, 28.11%). Frailty status was significantly and inversely associated with any ICT use, showing a strong association with use of WhatsApp (P < 0.001) and internet searches (P < 0.001). ICT non-use was a predictor of frailty, while ICT users were more likely to be robust (OR 10.62; 95% [CI], 5.34-21.10) or pre-frail (OR 9.03; [CI], 95% 5.18-15.74).Conclusion: Postmenopausal midlife and older women not using ICT were more likely to be frail. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence has shown that charged metabolites, such as amino acids, may play an important role in the pathogenesis of various metabolic disorders, many of which women in the postmenopausal period are at high risk of developing. This study examined the metabolic profile of middle-aged Japanese women to investigate alterations in charged metabolites induced by menopausal transition.Methods: The participants were 1193 female residents aged 40-60 at the baseline survey of the Tsuruoka Metabolomics Cohort Study. We investigated the cross-sectional association of menopausal status with 94 metabolomic biomarkers assayed in fasting plasma samples via capillary electrophoresis time-of-flight mass spectrometry using linear regression analysis.Results: Among the participants, 529 were premenopausal, 132 were in menopausal transition (MT), and 532 were postmenopausal. Significant differences were found in age, blood pressure, glucose and lipid levels, and smoking and drinking habits among the three groups. The concentrations of 5 metabolites in the MT group and 15 metabolites in the postmenopausal group were significantly higher than those in the premenopausal group after adjusting for confounding factors. When classified into pathways, these metabolites were related to the tricarboxylic cycle, urea cycle, and homocysteine metabolism, some of which are linked to arteriosclerosis.Conclusion: Multiple charged metabolites were associated with women's menopausal status, showing a gradual increase as women shifted from pre-, to peri-, to postmenopause. These findings might reflect the early changes behind the increased risk of dyslipidemia, diabetes, cardiovascular disease, and osteoporosis in later life. [ABSTRACT FROM AUTHOR]

Objectives: To examine factors relating to both sexual inactivity and sexual dysfunction in midlife Singaporean women.Study Design: Sociodemographic, medical/lifestyle factors, physical activity, BMI, handgrip strength (HGS) and physical performance data collected from healthy Chinese, Indian, and Malay women, aged 45-69 years, attending gynaecology clinics.Main Outcome Measures: Sexual inactivity and sexual dysfunction (defined as total score ≤ 26.55) assessed using the Female Sexual Function Index (FSFI).Results: 1048 women completed the FSFI. Mean (±SD) age was 56.2 (±6.2). Sexual inactivity was reported by 43.2% and was positively associated with older age [55-64 years (aOR 2.0, 95% CI 1.3-3.0) and ≥65 years (aOR 2.5, 95% CI 1.2-5.1)], younger menarche (aOR 1.8, 95% CI 1.3-2.5), lowest education (aOR 2.1, 95% CI 1.2-3.6), lowest income (aOR 1.8, 95% CI 1.1-2.8), unmarried (aOR 4.0, 95% CI 2.6-6.4), nulliparity (aOR 1.9, 95% CI 1.1-3.4), and BMI <18.5 kg/m2 (aOR 2.7, 95% CI 1.3-5.6). Among the sexually active, sexual dysfunction was identified in 70.3%. Sexual dysfunction was positively associated with menopause ≥10 years (aOR 2.4, 95% CI 1.1-5.0), nulliparity (aOR 3.0, 95% CI 1.1-9.8), moderate/severe vaginal dryness (aOR 13.8, 95% CI 4.8-38.7) and HGS <18 kg (aOR 1.9, 95% CI 1.1-3.2) and negatively associated with use of menopausal hormone therapy (aOR 0.3, 95% CI 0.1-0.6).Conclusion: This, the largest Singaporean sexual function study, is the first to include physical performance in a healthy population. Most were sexually active but reported dysfunction. Novel associations included underweight BMI with sexual inactivity and weaker HGS and Malay ethnicity with greater and less sexual dysfunction, respectively. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) has the potential to attenuate cardiovascular disease risk in midlife women through multiple pathways, including improving lipid profiles. Longitudinal patterns of PA and blood lipid levels have not been studied in midlife women. Our study identified trajectories of PA and blood lipids across midlife and characterized the associations between these trajectories.Methods: We evaluated 2,789 participants from the Study of Women's Health Across the Nation (SWAN), a longitudinal cohort study with follow-up over the menopause transition. Women reported PA using the Kaiser Physical Activity Survey at seven study visits across 17 years of follow-up. Serum high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were measured at eight study visits across the same 17-year follow-up period. We used group-based trajectory models to characterize trajectories of PA and blood lipids over midlife and dual trajectory models to determine the association between PA and blood lipid trajectories adjusted for race/ethnicity, body mass index category, smoking, and lipid-lowering medication use.Results: Women were 46 years old, on average, at study entry. Forty-nine percent were non-Hispanic white; 32 % were Black; 10 % were Japanese; and 9 % were Chinese. We identified four PA trajectories, three HDL cholesterol trajectories, four LDL cholesterol trajectories, and two triglyceride trajectories. The most frequently occurring trajectories were the consistently low PA trajectory (69 % of women), the low HDL cholesterol trajectory (43 % of women), the consistently moderate LDL cholesterol trajectory (45 % of women), and the consistently low triglycerides trajectory (90 % of women). In dual trajectory analyses, no clear associations were observed between PA trajectories and HDL cholesterol, LDL cholesterol, or triglycerides trajectories.Conclusions: The most frequently observed trajectories across midlife were characterized by low physical activity, low HDL cholesterol, moderate LDL cholesterol, and low triglycerides. Despite the absence of an association between long-term trajectories of PA and blood lipids in this study, a large body of evidence has established the importance of clinical and public health messaging and interventions targeted at midlife women to promote regular and sustained PA during midlife to achieve other cardiovascular and metabolic benefits. [ABSTRACT FROM AUTHOR]

Objectives: The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender) was originally validated to screen for obstructive sleep apnea (OSA) in the surgical population. It has been validated in mixed populations of men and women. We aimed to evaluate its reliability for OSA screening of midlife women.Study Design: We retrospectively evaluated midlife women seen at the Women's Health Clinic at Mayo Clinic in Rochester, Minnesota, who completed the STOP-BANG questionnaire and subsequently underwent diagnostic polysomnography (PSG) or home sleep apnea testing (HSAT).Main Outcome Measures: The questionnaire's predictive ability was assessed with the apnea hypopnea index (AHI) measured at PSG and HSAT.Results: Because participants were female, the gender question response was consistently 0, making the mean (SD) STOP-BANG score low at 3 (1.2). The most sensitive item to detect any OSA and moderate to severe OSA through STOP-BANG was observed apneas; the most specific item to detect OSA and moderate to severe OSA was neck circumference exceeding 40 cm. A score of 3 or more had a sensitivity of 77 % and a specificity of 45 % to detect moderate to severe OSA. The area under the curve with the STOP-BANG score to predict moderate to severe OSA was 0.67 (95 % CI, 0.51-0.84).Conclusions: Interpretation of the STOP-BANG questionnaire is nuanced for midlife women. Given the nature of its questions, a lower score may be predictive of more severe OSA in women, necessitating use of a lower threshold to trigger further testing. [ABSTRACT FROM AUTHOR]

Objectives: To advance knowledge of the influence of educational level on trajectories and determinants of healthy ageing in midlife and older Americans.Study Design: Data are from the Health and Retirement Study, a nationally representative, longitudinal survey of Americans age 51 and over. We used generalized estimating equations to examine trajectories and determinants of healthy ageing by level of education among 17,591 adults followed over a 14-year period. Educational level was categorized as less than a high school diploma, high school diploma, some college education, and a college or higher degree. Potential determinants included demographic factors, early-life characteristics (childhood health and childhood poverty), health-related factors (health behaviours, physical and mental health conditions), and psychosocial characteristics (perceived neighbourhood safety, volunteerism, and work status).Main Outcome Measures: Informed by earlier work, we defined healthy ageing as freedom from cognitive impairment, freedom from disability, and high physical functioning.Results: The log odds of healthy ageing declined over time in all educational groups. Importantly, the decline was smaller in adults with a college or higher degree than in those without a high school diploma. Age, gender, wealth, health behaviours, productive engagement, depressive symptoms, and the presence of chronic conditions predicted healthy ageing across the educational spectrum; however, the impact of several factors (age, gender, race/ethnicity, childhood poverty, and volunteerism) varied by educational level.Conclusions: Education shapes trajectories of healthy ageing in the United States. Similarities and differences in determinants of healthy ageing are evident across levels of education. Findings highlight broad-based and education-specific targets for intervention. [ABSTRACT FROM AUTHOR]

Progressive age-related reductions in muscle mass and strength (sarcopenia) can cause substantial morbidity. This narrative review summarizes evidence of nutritional interventions for maintaining muscle mass and strength from midlife through old age. PubMed and Cochrane databases were searched to identify studies of dietary intake and nutritional interventions for sustaining muscle mass and strength. The benefits of progressive resistance training with and without dietary interventions are well documented. Protein and amino acid (particularly leucine) intake should be considered, and supplementation may be warranted for those not meeting recommended intakes. Vitamin D receptors are expressed in muscle tissue; meta-analyses have shown that vitamin D benefits muscle strength. Data suggest that milk and other dairy products containing different bioactive compounds (i.e. protein, leucine) can enhance muscle protein synthesis, particularly when combined with resistance exercise. Omega-3 s can improve muscle mass and strength by mediating cell signaling and inflammation-related oxidative damage; no studies were specifically conducted in sarcopenia. Low-dose antioxidants (e.g. vitamins C and E) can protect muscle tissue from oxidative damage, but relevant studies are limited. Magnesium is involved with muscle contraction processes, and data have shown benefits to muscle strength. Acidogenic diets increase muscle protein breakdown, which is exacerbated by aging. Alkalizing compounds (e.g. bicarbonates) can promote muscle strength. Small studies of probiotics and plant extracts have generated interest, but few large studies have been conducted. Based on available data, dietary and supplemental interventions may add to the benefits of exercise on muscle mass and strength; effects independent of exercise have not been consistently shown. [ABSTRACT FROM AUTHOR]

• Most midlife Singaporean women experience moderate to severe menopausal symptoms. • Ethnic differences in the prevalence and type of menopausal symptoms were observed. • A score of over 6 on the Menopause Rating Scale (MRS) was associated with menstrual irregularity at 25 years and poor performance on the repeated chair stand (RCS) test. • Moderate disability and poor self-rated health were associated with high MRS scores. • Lower education levels and age ≥65 were inversely associated with high MRS scores. Menopausal symptoms can substantially impact quality of life. We studied somatic, psychological, and urogenital symptoms and their associated factors. Cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups. In 2014–16, women aged 45 to 69 attending well-woman clinics at the National University Hospital Singapore completed the Menopause Rating Scale (MRS). Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols. We analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression. Of the 1054 eligible women, 62.6 % reported at least one moderate to extremely severe symptom. The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes. Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95 % confidence interval: 2.88–33.34), poorer self-rated health status (2.18, 1.60–2.97), menstrual irregularity at 25 years (1.63, 1.07–2.49), and slower chair stands (1.49, 1.09–2.03). Age ≥65 (0.54, 0.30–0.94) and a lower level of education (0.45, 0.26–0.76) had significant inverse associations with total MRS score. Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength. These data add to the limited Asian evidence and raise the profile of this important area of health. [ABSTRACT FROM AUTHOR]

Objective: To clarify the effect of programmed exercise (PE), performed for at least six weeks, on perceived stress (PS) in middle aged and old women.Methods: A structured search was carried out in PubMed, Embase, Cochrane Library, Scielo, Web of Science and Scopus, from database inception through January 10, 2018, without language restriction. The US, UK, and Australian clinical trials databases were also searched. The search included a combination of the terms "programmed exercise", "perceived stress", "menopausal women" and "randomized controlled trial" (RCTs). PE was classified according to duration as "mid-term exercise intervention" (MTEI; mean duration 6 months), and "long-term exercise intervention" (LTEI; mean duration 12 months). Mean ± standard deviations of changes in PS scores, as assessed with different questionnaires, were calculated as standardized mean differences (SMDs) and used as effect size for meta-analysis. SMDs of PS after intervention were pooled using a random-effects model. Study quality and bias risk were assessed with the Cochrane tool.Results: Five RCTs that studied midlife and older women (mean age 47.0 ± 1.7 years minimum to 71.8 ± 5.6 maximum) were included in the meta-analysis. There was no significant effect of PE on PS score (SMD: -0.16; 95% CI: -0.43 to 0.11). In subgroup analyses, there was no significant effect of PE on PS with mid-term interventions (SMD: - 0.17; 95% CI: -0.59 to 0.25) nor with long-term interventions (SMD: -0.02; 95% CI: -0.42 to 0.38) as compared with controls.Conclusion: PE of low to moderate intensity does not improve PS in midlife and older women. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to identify clusters of midlife women by their cognitive symptoms and to examine racial/ethnic differences in the clusters.Study Design: This secondary analysis was conducted on the data from 1054 midlife women of multi-ethnic groups in two Internet studies (conducted from 2005 to 2013).Main Outcome Measures: Only the data from the questions on background characteristics, health status, and menopausal status and the Cognitive Symptom Index for Midlife Women were used for this secondary analysis. The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic analyses, and analyses of covariance.Results: Four clusters were extracted: the low total symptom group (Cluster 1; 49.9%), the low-moderate total symptom group with high tertiary symptoms (Cluster 2; 17.3%), the high-moderate total symptom group with low tertiary symptoms (Cluster 3; 21.2%); and the high total symptom group (Cluster 4; 11.7%). There were significant differences in the level of education, employment status, family income, marital status, social support, the country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease(s), access to health care, and menopausal status among the clusters (p < .01). There were significant racial/ethnic differences in the total numbers and total severity scores of tertiary symptoms in Cluster 1. Also, there were significant racial/ethnic differences in individual symptoms in each cluster.Conclusions: Racial/ethnic differences in midlife women's cognitive symptoms and multiple factors that might differently influence their cognitive symptoms need to be considered in health care for midlife women in menopausal transition. [ABSTRACT FROM AUTHOR]

There is substantial multimorbidity at mid-life but little is known about the strength of evidence on multimorbidity and health-related quality of life (HrQoL) at mid-life. This review addresses this gap, focusing on studies of the general population. PubMed, Web of Science, Embase and APA PsycNET databases were screened on 6 March 2017 for original research on multimorbidity and HrQoL in adults aged 40-65 years from the general population. Studies focused on index conditions, using single-item HrQoL measures, unlikely to represent the general population (e.g. primary care), and papers that were not in the English language were excluded. A narrative synthesis was presented due to heterogeneity in the measurement of multimorbidity. Of the 2557 articles, 83 underwent full text screening and 8 were included in the review. Included studies were of moderate to high quality and no exclusions were made on the basis of quality or bias. Multimorbidity was associated with poorer HrQoL at mid-life. Two cross-sectional studies found that adults with multimorbidity at early mid-life reported poorer HrQoL than adults with multimorbidity at late mid-life, while another found the reverse. Two distinct disease clusters were identified: mental health conditions and cardiovascular disease (CVD). Those in the mental health cluster reported poorer HrQoL than those in the CVD cluster, women more so than men. Limitations of the selected studies include lack of longitudinal evidence, use of self-reported conditions and no assessment of disease severity. Multimorbidity is associated with poor HrQoL at mid-life at the population level, with some evidence of differences in association with age and disease cluster and sparse evidence on sex differences. Longitudinal research using a weighted disease severity index and multimorbidity trajectories is needed to strengthen the evidence base. [ABSTRACT FROM AUTHOR]

DSD (Disorders or Differences in Sex Development) and Intersex are terms used to describe a diverse group of congenital conditions where the development of the reproductive system is different from what is usually expected. These conditions usually present at birth or adolescence and the health implications are wide ranging and often life-long. Given the complexity of many of the conditions, health care input when required should be provided by a multidisciplinary team who have appropriate expertise. Holistic care should include the consideration of the risk of cancer, prevention of osteoporosis, advice on hormones, sexual health and fertility options, and ongoing support in order to optimise quality of life and wellbeing. There is little evidence on the health of this group of individuals beyond middle age. Research in this field is essential to guide clinicians in providing high-quality care but also to allow affected individuals to make informed decisions about their own health care. This review will focus on the gynaecological aspects of multidisciplinary management. [ABSTRACT FROM AUTHOR]

Sleep disturbances are common among women from middle age onwards, into advanced age, and they are connected to menopause. The loss of ovarian hormones can alter cognition directly but probably also through sleep disturbances, which play an important role as a risk factor and a pathogenetic factor in dementia. Alzheimer's disease is common in older women. Knowledge of the fascinating relationship between sleep disturbances and cognitive decline, and in particular the sex/gender differences, is growing but needs to be further investigated. [ABSTRACT FROM AUTHOR]

Aims: There are few population-based studies evaluating the epidemiology of overactive bladder syndrome (OAB) in women, especially in the climacteric stage where there is a decrease in estrogen production. This study aimed to assess the prevalence of OAB and associated factors in climacteric Brazilian women.Methods: A descriptive, exploratory, cross-sectional study was conducted between September 2012 and June 2013 with 749 women (a population-based household survey). The dependent variable was OAB, defined as the presence of urinary urgency, with or without urinary incontinence, and when there was no concomitant stress urinary incontinence. The independent variables were sociodemographic data, health related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by Chi-square test and Poisson regression using the backward selection criteria.Results: Mean age was 52.5 (± 4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The prevalence of OAB was 7.8%. The vast majority of women had only urinary urgency. Only two women who responded to the interview reported urge incontinence. In the final statistical model, vaginal dryness (PR 1.75; 95% CI 1.13-2.69; p=0.012) and bilateral oophorectomy (PR 2.21; 95% CI 1.11-4.40; p=0.025) were associated with a greater prevalence of OAB.Conclusions: Health professionals should adopt a proactive behavior in surgically menopausal women and those with a history of genital atrophy to identify and treat OAB, thus contributing to an improved quality of life and healthier aging. [ABSTRACT FROM AUTHOR]

Women at middle age have decreased fertility and their pregnancies are higher risk. Combined oral contraceptives (COC) are effective but confer increased risk of age-related diseases, especially cardiovascular diseases. These risks are lower, however, with progestogen-only pills (POP). Therefore, other than the levonorgestrel intrauterine device (LNG-IUD), POP are usually the first choice, even though they do often lead to bleeding problems, which are already frequent in the perimenopause. However, the main risk of COC, venous thromboembolism, seems not to be relevant in (non-hospitalized) Chinese women and perhaps also other Asian women. COC may therefore be in fact a better choice than POP for these groups. In contrast to POP and IUDs, they have a variety of benefits especially important for middle-aged women, including a large decrease of the risk of ovarian, endometrial and colorectal cancer, an improvement in bleeding irregularities, a reduction of climacteric symptoms and some protection against bone loss. Further research is needed into individualized and safe contraception that takes into account ethnicity, as well as other factors. [ABSTRACT FROM AUTHOR]

Abstract: Whether there is any association between urinary incontinence and menopause is the subject of debate, partly due to the fact it is difficult to tell the difference between the effects of menopause and those of ageing. For some time it was hoped that hormonal treatment for menopause would be beneficial for urinary incontinence because there are hormonal receptors in the urinary tract. The goal of this survey of current knowledge on the subject is to explore thoroughly the relationship between menopause and urinary incontinence. Our study is based on a review of the literature dealing with the epidemiology of urinary incontinence in women aged between 45 and 60, and the effects of hormonal treatment with respect to the symptoms of involuntary loss of urine. Analysis of the epidemiological data drawn from large cohorts shows that on the one hand, the menopause has little if any impact on the risk of urinary incontinence, and on the other hand that the effects of oestrogen medication on urinary incontinence vary according to how it is administered and the type of incontinence. The effect of oral hormone treatments for menopause is rather negative with respect to stress incontinence. Vaginal treatment appears to be beneficial for overactive bladder symptoms. [Copyright &y& Elsevier]

Abstract: Background: Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors. Objective: To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed. Methods: A total of 6079 women aged 40–59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire. Results: Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40–44 to 45.2% in those aged 55–59, p <0.0001) and menopausal stage (from 39.5% in premenopausal aged 40–44 to 46.3% in late postmenopausal ones, p <0.0001). “Awakening during the night” (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6–8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality. Conclusion: Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause. [Copyright &y& Elsevier]

Abstract: Progesterone treatment for menopausal symptoms is still controversial. Progesterone levels fall during menopause transition, therefore some menopausal women may benefit from progesterone therapy. A systematic review was conducted of studies published from 2001 reporting on progesterone use to treat symptoms associated with menopause or postmenopausal women. Fourteen data bases were searched using the search terms progesterone, menopause, aged, female and human; exclusions were breast cancer, animal and contraception. Thirteen studies were selected for inclusion (11 clinical trials, 1 cohort study and 1 qualitative study), evaluating progesterone effects on menopausal symptoms, bone, sleep, skin, cognition, plasma lipids and plaque progression. Most studies were of low methodological quality (GRADE low or very low). Progesterone improved vasomotor symptoms and sleep quality, with minimal risk. Large studies designed to identify confounders, such as hormone levels, menopausal status and metabolism are required to understand the place of progesterone in clinical practice. [Copyright &y& Elsevier]

Abstract: Background: Studies reporting on resilience (capacity to overcome life adversity) and the menopausal transition are scarce. Objective: To assess resilience and related factors in mid-aged Ecuadorian women. Method: This was a cross sectional study in which 904 women aged 40–59 completed the 14-item Wagnild and Young Resilience Scale (WYRS) and a general socio-demographic questionnaire containing personal and partner data. Lower total WYRS scores indicate less resilience. Internal consistency of the tool was also assessed. Results: Median age of all surveyed women was 49 years. A 51.1% were postmenopausal, 43.8% lived high altitude, 43.5% were abdominally obese, 12.6% used hormone therapy and 80.8% had a partner. Internal consistency was high for the WYRS tool (Cronbach''s alpha: 0.94). Multiple linear regression analysis determined that lower total WYRS scores (less resilience) correlated with high altitude residency, more severe hot flushes, sedentarism, higher abdominal circumferences and having a partner with erectile dysfunction. Contrary to this, higher WYRS scores correlated with higher parity and sexual activity. Conclusion: As assessed with the WYRS tool, lower resilience of this mid-aged Ecuadorian female sample was related to various female and partner lifestyle and health issues, not necessarily related per se to the ageing process. More research using the tool is warranted. [Copyright &y& Elsevier]

Abstract: Background: Assessing sexuality is a difficult task, hence used tools should be straight forward and easy to use. Objective: To assess sexual function in mid-aged Ecuadorian women. Method: In this cross sectional study, 904 otherwise healthy women 40–59 years completed the short 6-item Female Sexual Function Index (FSFI-6) and a general socio-demographic questionnaire containing personal/partner data. Internal consistency of the tool was also assessed. Results: Median age of the whole sample was 49 years, 51.1% were postmenopausal, 43.8% lived at high altitude, 12.6% used hormone therapy (HT), 58.5% presented hot flushes, 43.5% were abdominally obese and 80.8% had a partner. Overall, 72.4% of surveyed women reported sexual activity (n =655/904) with 65% of these presenting total FSFI-6 scores equal or below 20 the calculated median (lower sexual function). A 10.2% of those having a partner were sexually inactive. Internal consistency of tool was high (Cronbach''s alpha=0.91). Total FSFI-6 scores positively correlated with coital frequency and female and partner educational level and inversely with female age, waist circumference, hot flush intensity and partner age (bivariate analysis). Multiple linear regression analysis determined that lower scores (lower sexual function) were related to high altitude, history of sexual abuse, sedentarism, hot flush intensity, partner age and sexual dysfunction whereas partner educational level, coital frequency and female parity were significantly related to higher scores (better sexual function). Conclusion: As assessed with a consistent, short, and easy to use tool lower sexual function of this mid-aged series was related to several female and partner factors. More research with this tool is warranted. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women. Study design: This population survey included 1140 middle-aged women aged 45–65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area. Main outcome measures: Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms. Results: In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value<0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta=−3.17, p-value=0.008), by physical exercise (beta=4.84 and beta=4.57 for 1–3h and >3h per week respectively, p-value<0.001) and by a good financial status (beta=7.05, p-value<0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta=−0.77, p-value<0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources. Conclusions: Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL. [Copyright &y& Elsevier]

Abstract: Objective: Sleep disturbance and hot flashes are common during menopause, but their association is not well understood. We sought to understand the associations among sleep disturbance and the frequency, bothersomeness, and interference of hot flashes in mid-life women. Study design: STRIDE is a study of women ages 40–65 years at varied menopausal stages. We examined the cross-sectional associations of sleep disturbance with the frequency and bothersomeness of hot flashes, and interference of hot flashes with work, social, and leisure activities during the 2nd year of STRIDE. Main outcome measure: Self-reported sleep disturbance. Results: Of the 623 women with complete data, 370 (59%) reported having hot flashes. Bivariate analyses showed that reporting hot flashes with bother, but not hot flashes alone, was associated with sleep disturbance (odds ratio [OR] [95% confidence interval (CI)]: 2.8 [2.0–4.0] and 1.3 [0.7–2.5], respectively). In multivariable models, women reporting bothersome hot flashes were more likely to report sleep disturbance (OR [95% CI]: 2.1 [1.4–3.2]) compared to women who reported no hot flashes. When the perceived interference of hot flashes with work, social activities, and leisure activities were included in the model, the relationships between bothersome hot flashes and sleep disturbance disappeared. Conclusions: Hot flashes are not associated with sleep disturbance, unless they are bothersome. Mid-life patients should routinely be queried about the bothersomeness of their hot flashes. [Copyright &y& Elsevier]

Abstract: Objective: To assess predictors of sexual function in mid-aged women. Methods: We analyzed data of 262 healthy sexually active women (40–59 years) who filled out the Female Sexual Functioning Index (FSFI), the Menopause Rating Scale (MRS) and a general questionnaire containing female/partner data. Correlations between these two measures were also analyzed. Results: Significant inverse correlations were found between all FSFI and MRS scores. This was most evident for the MRS urogenital score in relation to FSFI total, pain and lubrication scores. Multiple linear regression analysis determined best model predicting total FSFI index scores that explained a 66% of the variance. In this model, MRS urogenital score was an important predictor of female sexual function (total FSFI scores) with a significant inverse relation. Additionally total FSFI scores displayed a significant positive correlation with female educational level and HT use and an inverse relation with partner age and female parity. Conclusion: Several female/partner factors predicted female sexual function in this mid-aged series. MRS urogenital scores significantly correlated with total FSFI scores. [Copyright &y& Elsevier]

Abstract: Factors contributing to increased risk for Alzheimer''s disease (AD) include age, sex, genes, and family history of AD. Several risk factors for AD are endogenous; however, accumulating evidence implicates modifiable risk factors in the pathogenesis of AD. Although the continued task of identifying new genes will be critical to learning more about the disease, several research findings suggest that potentially alterable environmental factors influence genetic contributions, providing targets for disease prevention and treatment. Here, we review midlife risk factors for AD, and address the potential for therapeutic intervention in midlife. [Copyright &y& Elsevier]

Abstract: Objective: To determine whether depressed mood and fatigue mediate the relationships between physical activity, body mass index, menopausal hot flashes, and perceived stress. Method: This study is a secondary analysis of data obtained from a sub-sample of peri- and postmenopausal women (N =212) from the TREMIN Research Program on Women''s Health. Results: The hypothesized mediational model was tested using path analysis within a structural equation modeling framework in Mplus Version 5.1. In unadjusted analysis, the relationships between physical activity, menopausal hot flashes, and perceived stress were mediated by depressed mood; fatigue mediated the relationships between hot flashes, body mass index, and perceived stress. When adjusting for age, insomnia, menopausal and hormone use status, the mediational effects of depressed mood on stress remained significant only for physical activity, and fatigue mediated the relationship between hot flashes and stress. The adjusted model explained 70% of variance in perceived stress, 82% of variance in depressed mood, and 81% of variance in fatigue. Conclusion: Depressed mood may partially explain the relationship between physical activity and perceived stress in middle-aged women, however further studies are needed to corroborate causality. [Copyright &y& Elsevier]

Abstract: Objectives: The objectives of this study were to specifically investigate the differences in culture, attitudes and social networks between Australian and Taiwanese men and women and identify the factors that predict midlife men and women''s quality of life in both countries. Methods: A stratified random sample strategy based on probability proportional sampling (PPS) was conducted to investigate 278 Australian and 398 Taiwanese midlife men and women''s quality of life. Multiple regression modelling and classification and regression trees (CARTs) were performed to examine the potential differences on culture, attitude, social networks, social demographic factors and religion/spirituality in midlife men and women''s quality of life in both Australia and Taiwan. Results: The results of this study suggest that culture involves multiple functions and interacts with attitudes, social networks and individual factors to influence a person''s quality of life. Significant relationships were found between the interaction between cultural circumstances and a person''s internal and external factors. The research found that good social support networks and a healthy optimistic disposition may significantly enhance midlife men and women''s quality of life. Conclusion: The study indicated that there is a significant relationship between culture, attitude, social networks and quality of life in midlife Australian and Taiwanese men and women. People who had higher levels of horizontal individualism and collectivism, positive attitudes and better social support had better psychological, social, physical and environmental health, while it emerged that vertical individualists with competitive characteristics would experience a lower quality of life. This study has highlighted areas where opportunities exist to further reflect upon contemporary social health policies for Australian and Taiwanese societies and also within the global perspective, in order to provide enhanced quality care for growing midlife populations. [Copyright &y& Elsevier]