BACKGROUND: Women at middle age are puzzled by a series of menopausal disturbances, can be distressing and considerably affect the personal, social and work lives. We aim to estimate the global prevalence of nineteen menopausal symptoms among middle-aged women by performing a systematic review and meta-analysis.
METHODS: Comprehensive search was performed in multiple databases from January, 2000 to March, 2023 for relevant studies. Random-effect model with double-arcsine transformation was used for data analysis.
RESULTS: A total of 321 studies comprised of 482,067 middle-aged women were included for further analysis. We found varied prevalence of menopausal symptoms, with the highest prevalence of joint and muscular discomfort (65.43%, 95% CI 62.51-68.29) and lowest of formication (20.5%, 95% CI 13.44-28.60). Notably, South America shared dramatically high prevalence in a sort of menopausal symptoms including depression and urogenital symptoms. Besides, countries with high incomes (49.72%) had a significantly lower prevalence of hot flashes than those with low (65.93%), lower-middle (54.17%), and upper-middle (54.72%, p < 0.01), while personal factors, such as menopausal stage, had an influence on most menopausal symptoms, particularly in vaginal dryness. Prevalence of vagina dryness in postmenopausal women (44.81%) was 2-fold higher than in premenopausal women (21.16%, p < 0.01). Furthermore, a remarkable distinction was observed between body mass index (BMI) and prevalence of sleep problems, depression, anxiety and urinary problems.
CONCLUSIONS: The prevalence of menopausal symptoms affected by both social and personal factors which calls for attention from general public.

OBJECTIVE: Urinary incontinence (UI) is relatively common among middle-aged and elderly women and can have significant impacts on patients\' physiological, psychological, and quality-of-life aspects. A higher level of autonomy can encourage better health behaviors in patients, so as to promote rehabilitation of the disease and improve their quality of life. The study is aimed at exploring the level of autonomy and influencing factors among middle-aged and elderly women with UI.
METHODS: A cross-sectional study was conducted at a tertiary hospital in Shenzhen, China. Middle-aged and elderly women were asked to complete the Index of Autonomous Functioning scale (IAF), the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and the Urinary Incontinence Quality of Life (I-QOL) scale. Data were collected in January 2024 to March 2024. Descriptive statistics, univariate analysis, bivariate correlation and multivariate linear regression were used to analyze data.
RESULTS: A total of 646 women completed the questionnaire. The means and standard deviations (SD) of the IAF section were 45.40 ± 8.92, those of the ICIQ-UI SF section were 11.54 ± 3.67, and those of the I-QOL section were 43.95 ± 9.83. Multivariate linear regression models for the IAF revealed that questionnaire scores were independently associated with family\'s monthly income, education level, regular exercise, UI severity, and I-QOL score (p < 0.05).
CONCLUSIONS: The factors influencing the level of autonomy among middle-aged and elderly women with UI include family\'s monthly income, education level, regular exercise, UI severity, and I-QOL score. Higher levels of autonomy were observed among women with high family income, high education level, regular exercise habits, mild to moderate UI, and high quality of life.

BACKGROUND: Intestinal dysbacteriosis has frequently been involved in the context of depression. Nonetheless, only scant information is available about the features and functional changes of gut microbiota in female middle-aged depression (MAD).
OBJECTIVE: This study aims to explore whether there are characteristic changes in the gut microbes of female MAD and whether these changes are associated with depressive-like behaviors. Meanwhile, this study observed alterations in the lipid metabolism function of gut microbes and further examined changes in plasma medium- and long-chain fatty acids (MLCFAs) in mice that underwent fecal microbiota transplantation (FMT).
METHODS: Stool samples obtained from 31 MAD, along with 24 healthy individuals (HC) were analyzed by 16 S rRNA gene sequencing. Meanwhile, 14-month-old female C57BL/6J mice received antibiotic cocktails and then oral gavage of the microbiota suspension of MAD or HC for 3 weeks to reconstruct gut microbiota. The subsequent depressive-like behaviors, the composition of gut microbiota, as well as MLCFAs in the plasma were evaluated.
RESULTS: A noteworthy disruption in gut microbial composition in MAD individuals compared to HC was observed. Several distinct bacterial taxa, including Dorea, Butyricicoccus, and Blautia, demonstrated associations with the demographic variables. A particular microbial panel encompassing 49 genera effectively differentiated MAD patients from HC (AUC = 0.82). Fecal microbiome transplantation from MAD subjects led to depressive-like behaviors and dysfunction of plasma MLCFAs in mice.
CONCLUSIONS: These findings suggest that microbial dysbiosis is linked to the pathogenesis of MAD, and its role may be associated with the regulation of MLCFAs metabolism.

OBJECTIVE: To compare the physical performance, including upper-limb motor and cardiovascular functions, and psychological functions, including anxiety and depression, sleep, and fatigue, between women with and without breast cancer.
METHODS: Thirty-two women with breast cancer and 32 healthy counterparts were recruited for the study. Upper-limb muscle strength, shoulder range of motion, and upper-limb function were assessed using a handheld dynamometer, a goniometer, and the short form of the Disabilities of Arm-Shoulder-Hand Questionnaire, respectively. Exercise endurance and cardiovascular functions were assessed using the 6-min walk test and blood pressure and heart rate variability, respectively. The Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Fatigue Assessment Scale were used to assess the symptoms of anxiety and depression, sleep quality, and fatigue, respectively.
RESULTS: Breast cancer participants\' body-weight-adjusted upper-limb strength of both the affected and unaffected sides (0.11-0.14) was only 61.1-77.8% of those of the healthy participants (0.18). Their shoulder mobility of the affected side (flexion: 161.64°; abduction: 157.01°) were 94.2% (flexion) and 92.5% (abduction) of those of the healthy participants (flexion: 171.56°; abduction: 169.68°), respectively. Breast cancer participants had higher quickDASH mean score (19.53), HADS-A mean score (6.78), HADS-D mean score (4.72), global PSQI mean score (7.22) and FAS mean score (25.97) as well as shorter mean distance covered by 6 MWT (496.66 m) than those of the healthy participants.
CONCLUSIONS: Rehabilitative interventions, such as mind-body interventions and exercise training, target physical fitness and promote the psychological health of women with breast cancer are necessary.

Exposure to perfluoroalkyl and polyfluoroalkyl substances causes oxidative stress, which is strongly associated with adverse health effects. Klotho protein plays an anti-aging role via antioxidation activity.
We investigated the levels of serum α-Klotho and PFAS exposure in adults who participated in the National Health and Nutrition Examination Survey from 2013 to 2016. A nationally representative subsample of 1,499 adults aged 40-79 years was analyzed for the associations of serum α-Klotho levels with serum PFAS exposures by correlation analysis and multiple general linear models. Of note, the potential confounding factors including age and gender were adjusted. Quantile-based g-computation models were used to assess the effects of mixed PFAS exposure on serum α-Klotho levels.
The weighted geometric mean of serum α-Klotho was 791.38 pg/mL for the subjects during 2013-2016. After adjusting for potential confounders, serum Klotho levels showed a statistically significant downward trend with increasing quartiles of PFOA and PFNA. Multivariate adjusted general linear regression analysis showed that increased exposure to PFNA was substantially associated with lower serum levels of α-Klotho, and each 1-unit increase in PFNA concentration was accompanied by a 20.23 pg/mL decrease in α-Klotho level; while no significant association was observed between other PFAS exposures and serum α-Klotho levels. It was negatively correlated between α-Klotho and Q4 for PFNA relative to the lowest quartile (Q1) of exposure (P = 0.025). It was found that the strongest negative correlation between PFNA exposure and serum α-Klotho levels was in the middle-aged (40-59 years) female participants. Furthermore, the mixture of the four PFAS substances showed an overall inverse association with serum α-Klotho concentrations, with PFNA being the major contributor.
Taken together, in a representative sample of the U.S. middle-aged and elderly populations, serum concentrations of PFAS, especially PFNA, have been negatively associated with serum levels of α-Klotho, which is strongly associated with cognition and aging. It was important to note that the majority of associations were limited to middle-aged women. It will be meaningful to clarify the causal relationship and the pathogenic mechanisms of PFAS exposure and α-Klotho levels, which is helpful to aging and aging-related diseases.

Cardiac rehabilitation (CR) is a system that comprehensively manages risk factors to reduce the recurrence rate after cardiovascular disease treatment. This study compared the effects of home-based low-frequency CR (1-2 times/week) and center-based high-frequency CR (3-5 times/week) for 12 weeks. This study was conducted as an observational case-control study. Ninety women, ages 45 to 60, who underwent coronary artery stenting were enrolled. Measurement variables were waist circumference, body mass index (BMI), blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), glucose, VO2 peak, body composition, and quality of life. Significant changes were observed in systolic BP, TC, LDLC, TG, VO2 peak, exercise duration, and quality of life in both groups. However, BMI, waist circumference, body fat percentage, HDLC, and blood glucose only exhibited significant changes with HFT. The interaction effects according to time and group were as follows: systolic BP, waist circumference, body fat, BMI, HDLC, and glucose (p < 0.05). Therefore, in CR participants, HFT improved more than LFT on obesity factors, HDLC, and glucose change. As well as center-based HFT, home-based LFT also improved risk factors for cardiovascular disease, fitness, and quality of life. For female patients who have difficulty visiting the CR center frequently, home-based LFT may be a CR program that can be presented as an alternative.

UNASSIGNED: Impaired left ventricular (LV) relaxation is indicative of grade I diastolic dysfunction, which is mainly assessed by late diastolic transmitral flow velocity (E/A ratio). Although the E/A ratio has important diagnostic and prognostic implications with cardiac outcomes, the causal link between abnormal E/A ratio and left ventricle remodeling (LV remodeling) remains unclear.
UNASSIGNED: A longitudinal analysis of 869 eligible women aged ≥45 years, who had received echocardiography scans as well as 5-year follow-up assessments between 2015 and 2020. Women with pre-existing cardiac abnormalities including grade II/III diastolic dysfunction as diagnosed by echocardiography, or structural heart disease were excluded. E/A abnormality was defined as baseline E/A ratio <0.8. The classification of LV remodeling was based on the measurements of left ventricular mass index (LVMI) and relative wall thickness (RWT). Logistic and linear regression models were used.
UNASSIGNED: Among the 869 women (60.71±10.01 years), 164 (18.9%) had developed LV remodeling after the 5-year follow-up. The proportion of women with E/A abnormality versus non-abnormality was also significantly different (27.13% vs 16.59%, P=0.007). Multivariable-adjusted regression models showed that E/A abnormality (OR: 4.14, 95%Cl:1.80-9.20, P=0.009) was significantly associated with higher risk of concentric hypertrophy (CH) after follow-up. No such association was found in either concentric remodeling (CR) or eccentric hypertrophy (EH). Higher baseline E/A ratio was correlated with lower ΔRWT during the 5-year follow-up (β=-0.006 m/s, 95% CI: -0.012 to -0.002, P=0.025), which was independent of demographics and biological factors.
UNASSIGNED: E/A abnormality is associated with a higher risk of CH. Higher baseline E/A ratio may be associated with decreased relative changes in RWT.

OBJECTIVE: To explore the network structure underlying the symptoms of menopausal syndrome and to identify the central and bridge symptoms of menopause among middle-aged women.
METHODS: This is a cross-sectional survey study conducted in the Chinese community with a total of 1829 women aged 40-65 years. The Menopause Rating Scale (MRS) was used to assess the menopausal syndrome, including somato-vegetative, psychological, and urogenital subdomains. The network analysis was performed to determine the central and bridge symptoms of menopause.
RESULTS: In the network of menopausal symptoms, anxiety, vaginal dryness, depressive mood, and irritability were the most central symptoms. Depressive mood, anxiety, and vaginal dryness were also detected as the bridge symptoms. The estimated network between the symptoms had good stability (CS-strength = 0.75 and CS-edge = 0.75).
CONCLUSIONS: The present network analysis provided unique insights into the inner structure of menopausal symptoms. Psychological symptoms should be considered as the core symptoms in developing relevant interventions to improve the health and well-being of middle-aged women.

Background: Although the relevant underlying biological mechanisms are still lacking, mental disorders have been closely associated with several metabolic abnormalities including high rates of obesity and metabolic syndrome especially in vulnerable populations. Therefore, the current study aims to examine how metabolic parameters increase the risk for developing mood disorders in individuals stratified by gender and age. Methods: In a routine physical examination, 319 healthy participants were recruited and assigned to six different groups according to age (young adults: 25-34 Y, middle age: 35-49 Y, and older age: 50-65 Y) in both males and females. A linear regression and bivariate correlation analysis were used to analyze the relationship between mood health outcomes measured by the Kessler 10 Psychological Distress Scale (K10) and the metabolic function. Results: The results demonstrated that there was a significant association between K10 scores and metabolic parameters, including Body Mass Index (BMI), total-, LDL-cholesterol, and triglyceride. Furthermore, poor mental health (higher K10 scores) was observed in individuals with increased BMI, total-, LDL-cholesterol, and triglyceride levels particularly in middle-aged women relative to other groups. Limitations: This is a cross-sectional study with a small sample size and lacks longitudinal follow-up evidence and preventive interventions and therefore could not provide the causal inference of metabolic pathophysiology on the increased sensitivity to mental disorders. Conclusions: The potential association suggests that targeting of the metabolic parameters might give us a better understanding of the underlying mechanisms of psychiatric diseases and provide preventive strategies and potential treatment for those with metabolic disturbances especially in middle-aged females.

Background: Chinese square dance has become well known worldwide in recent years, and most participants are women who dance with a group in their communities. In particular, middle-aged women may have physical and mental health problems, and participating in square dance may increase women\'s positive subjective well-being and decrease their negative emotions, which may improve their health over the long term. In addition, participating in square dance can promote group cohesion. Our study aimed to examine the relationship between the subjective exercise experience of participating in square dance and group cohesion and whether some variables (e.g., age, education, duration, income level, and work) play a role as mediators in the association with subjective exercise experience and group cohesion. Methods: In total, 1,468 Chinese women from 31 provinces and 82 cities participated in this study by completing an online questionnaire. The questionnaire consisted of a subjective exercise experience questionnaire and a group environment questionnaire. We analyzed the collected data and built a statistical model. Results: (a) Square dance satisfied women\'s physical and psychological needs partly; (b) positive well-being (PWB) was positively correlated with group cohesion, and fatigue was negatively correlated with group cohesion; and (c) the income level was a partial mediator of the relationship between group cohesion and subjective exercise experience. Conclusion: Chinese women have different motivations for participating in square dance. Because this activity can help meet women\'s physical and psychological needs, an increasing number of individuals worldwide participate in square dance. As women\'s subjective well-being increases, group cohesion increases, and vice versa. Moreover, the subjective exercise experience remains a significant predictor of group cohesion after including income level as a mediator, suggesting that the model indicates partial mediation.