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Objective: To determine the pregnancy outcome as a function of the first-trimester serum 25-hydroxyvitamin D(3) [25(OH)D] status and to compare the 25(OH)D levels in the first and third trimesters.Methods: Pregnant women (n=466) tested for serum 25(OH)D levels during the first trimester were followed up until the end of pregnancy, and the obstetric and neonatal outcomes were compared in reference to the baseline 25(OH)D status. The third-trimester 25(OH)D levels were additionally measured in a subset of women (n=148).Results: The obstetric and neonatal outcomes did not vary as a function of the first-trimester 25(OH)D status. Neither did the 25(OH)D levels vary as a function of pregnancy outcomes. Overall, the 25(OH)D levels significantly decreased from the first to the third trimester. The first- and third-trimester 25(OH)D levels of samples initially taken during autumn/winter were significantly lower than those that were initially taken during spring/summer. Interestingly, the decrease in 25(OH)D levels during the third trimester was independent of the season of sampling.Conclusion: The pregnancy outcome was independent of the first-trimester 25(OH)D status. Overall, the 25(OH)D levels significantly decreased in the third trimester. More research in this area is warranted. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine factors involved in urinary incontinence (UI), and psychological resilience in postmenopausal women., Methods: In this cross-sectional study, 137 postmenopausal women (aged 50-75 years) filled out the 4-item International Consultation on Incontinence Questionnaire short form (ICIQ-SF), the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), the 10-item Connor-Davidson Resilience Scale (CD-RISC), and a questionnaire containing personal data. We designed a directed acyclic graph (DAG) to identify covariates related to urinary incontinence and resilience in postmenopausal women., Results: The mean age of all surveyed women was 58.7±5.1 years, the majority were Caucasian (92.7%). There was an inverse correlation between item-1 ICIQ-SF scores and CD-RISC Scores. Women with severe UI had a higher median total ICIQ-SF score and lower total CD-RISC Scores as compared to those with nil or mild (P<0.05 for both). Odds ratios of sociodemographic and clinical characteristics indicate that phytoestrogen use (OR: 10.80; 95% CI 2.42-48.13) and economic problems (OR: 2.46; 95% CI 1.22-4.93) were associated with UI. However, a multivariable logistic model only identified urinary incontinence significantly associated with phytoestrogen use and age (P<0.05). The effect of other variables was attenuated in the model when controlling for population confounders, and significance was not achieved., Conclusions: Urinary incontinence was significantly associated with economic problems, phytoestrogen use, and depressive symptoms compared to women without urinary complaints. The multivariable logistic model confirmed age and phytoestrogen use as causal factors for urinary incontinence.

Aim: The objective of this meta-analysis was to evaluate obstetric outcomes in gestational diabetes mellitus (GDM) patients treated with flexible management based on intrauterine ultrasound fetal growth (FMIUFG) or strict maternal glycemic adjustment (SMGA)., Methods: We performed a comprehensive systematic review of electronic databases for randomized clinical trials (RCTs) comparing obstetrics outcomes of singleton GDM patients managed according to FMIUFG or SMGA. The review protocol was registered in PROSPERO (CRD497888). Searches were conducted in PubMed, Embase, Cochrane, and LILACS. Primary outcomes were gestational age at delivery and birth weight. Random-effect model meta-analyses were used to minimize the effects of uncertainty associated with inter-study variability. Results are reported as standardized mean differences (SMDs) or as odds ratios (ORs) and their 95% confidence interval (CI). Heterogeneity between studies was estimated using the I 2 statistic. The Cochrane Risk of Bias Scale was used to assess the quality of studies. There were five RCTs with low to moderate risk of bias, including 450 patients managed according to the FMIUFSG and 381 according to the SMGA., Results: The macrosomia (birthweight >4000 g) rate was lower in pregnancies managed according to FMIUFG than SMGA adjustments (OR: 0.34; 95%CI: 0.16, 0.71). There were no significant differences in hypertensive disorder, cesarean section, neonatal intensive care unit admission, and large newborn for gestational age rates., Conclusions: The macrosomia rate was lower in women managed with the FMIUFG. There were no significant differences in other obstetric and neonate outcomes., (© 2024 Japan Society of Obstetrics and Gynecology.)

Introduction: hemorrhoidal disease and anal fissure are the two most frequent entities within benign anal pathology, both of which have a negative impact on quality of life. To date, there is no specific questionnaire in Spanish to assess the impact on quality of life in patients suffering from these conditions., Objective: the aim of this study was to validate a questionnaire in Spanish for this purpose, adapting it to our daily clinical practice., Material and Methods: the HEMO-FISS-Quality of Life Questionnaire (HEMO-FISS-CdV) is the Spanish version of the original HEMO-FISS-Quality of Life Questionnaire (HEMO-FISS-QoL) by Abramowitz. The questionnaire consists of 23 items organized in four dimensions (physical, psychological, defecation and sexuality). The reliability of the new tool was assessed by determining internal consistency using Cronbach's alpha and Guttman's coefficient. It was also correlated with the quality of life questionnaire SF12 Health Questionnaire version 2 (SF12v2)., Results: the Cronbach's alpha obtained for our questionnaire (HEMO-FISS-CdV) was 0.951 (CI 95 % ± 0.016), with a range between 0.935 and 0.967. The Guttman two-half coefficient had a value of 0.910. Patients with internal hemorrhoids, anal fissure or both had higher values on the HEMO-FISS-CdV questionnaire than patients without internal hemorrhoids, and these differences were significant (p < 0.05)., Conclusion: both diseases have a negative impact on quality of life. The HEMO-FISS-CdV provides a tool in Spanish that easily and specifically assesses the impact of hemorrhoidal disease and anal fissure on quality of life.

Background: The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population., Objective and Rationale: This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity., Search Methods: A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS., Outcomes: Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) -2.91; 95% CI -4.07 to -1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99-3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD -1.59; 95% CI -3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above., Wider Implications: Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Aim: We performed a systematic review and meta-analysis to assess whether telomerase activity and telomere length are associated with breast cancer., Methods: PubMed, Web of Science, Embase, LILACS, Scielo, Embase, and CNKI databases were searched to obtain relevant articles published through May 10, 2023, following PRISMA guidelines and a registered PROSPERO protocol (CRD42022335402). We included observational studies reporting telomerase activity or telomere length in patients with breast cancer compared with women with benign lesions or normal tissue (control women). The Newcastle-Ottawa Scale was used to evaluate the quality of studies. Data were expressed as odds ratios (OR) and 95 % confidence intervals (CI). Random effects and inverse variance methods were used to meta-analyze associations. The I 2 test was used to assess heterogeneity., Results: The meta-analysis of telomerase shows significantly greater activity in patients with breast cancer than in those without malignancies (OR = 23.46, 95 % CI 14.07-39.11, p < 0.00001, I 2  = 72 %). There were non-significant differences in relative telomere length (OR = 1.16, 95 % CI = 0.90-1.49, p = 0.26, I 2  = 86 %) and leukocyte telomere length (OR = 2.32, 95 % CI = 0.89-6.08, p = 0.09, I 2  = 98 %) between women with and without breast cancer. In subgroup analyses by world regions of studies, both telomerase activity and telomere length displayed the same trends as in their respective meta-analyses. In sensitivity analyses, variables showed their respective same trends., Conclusion: Telomerase activity is higher in patients with breast cancer than in women without malignancies. There were no significant differences in either relative telomere length or leukocyte telomere length in women with and without breast cancer. PROSPERO protocol CRD42022335402., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in perimenopausal and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side-effects or toxicity of ARTs, and opportunistic infections. Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.

The physiological changes during pregnancy may increase the risk of complications in pregnant women with coronavirus disease 2019 (COVID-19). Vitamin D is a fat-soluble secosteroid hormone and its role in immunity is appears to be of particular importance in this recent pandemic. Nevertheless, there is little research about the role of vitamin D levels regarding COVID-19 in pregnant women to date. This study aimed to establish a relationship between serum 25-hydroxyvitamin D (25(OH)D) levels in pregnant women and COVID-19. A comparative case-control study was performed with a study population of 256 pregnant women (82 pregnant women with infection and 174 women in control group). Serum 25(OH)D levels were significantly lower in pregnant women with COVID-19 infection than in those without infection. In addition, 89% of COVID-19-positive pregnant women had 25(OH)D deficiency, while in the control group the percentage was 75.30%, finding statistically significant differences (ORa = 2.68; 95% CI 1.19-6.06; p = 0.01). Our results find a relationship between vitamin D deficiency in pregnant women and COVID-19 infection. This finding could be relevant for actual clinical practice. Thus, more research is needed in this field.

Background: Parents use the Internet to take decisions about their children's health, but few resources have focused on eHealth technology evaluations from their point of view., Objective: The main aim of this research was to evaluate a Spanish eHealth pediatric website for parents., Methods: A previously validated web questionnaire was used to evaluate five domains: usability, utility, trust and confidence, well-child section and accessibility of the website. Univariate, bivariate and multiple linear regression analyses were performed., Results: 516 users participated in the research and rated the website as usable, useful, trustworthy and accessible. Higher scores were given by the participants who relied most on the Internet for taking decisions about health; by the participants who used a smartphone to access the pediatric website; by the participants who knew the website the longest; and by the participants who had accessed it more times. No differences in the evaluations of the website were found regarding age, education level or household income of the participants., Conclusions: eHealth pediatric websites, written by a pediatrician in an easy to understand language, can be perceived as usable, trustworthy, useful and accessible by their users and consequently help them with their decisions making. Some characteristics of the users are associated with a better perception of these websites., Competing Interests: Declaration of Competing Interest The authors (Bruno José Nievas-Soriano, Sonia García-Duarte, Ana María Fernández-Alonso, Antonio Bonillo-Perales and Tesifón Parrón-Carreño) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies., Purpose: The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity., Material and Methods: The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7-14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery., Conclusion: The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery., Trial Registration: EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018., (© 2021. The Author(s).)

Objective: To evaluate the influence of ABO and Rh blood groups on morbidity among SARS-CoV-2 infected pregnancies., Design: Prospective observational study., Setting: 78 centers of the Spanish Obstetric Emergency Group., Population: Pregnant women with SARS-CoV-2 tested with polymerase-chain-reaction between 26-February and 5-November 2020. A cohort of 1278 SARS-CoV-2(+) pregnant women was analyzed and a concurrent comparison group of 1453 SARS-COV-2(-) patients was established., Methods: Data were collected from medical charts. SARS-COV-2(+) was compared with SARS-COV-2(-) for differences in distribution of blood groups. We performed multivariate analysis, controlling for maternal age and ethnicity, to evaluate association of ABO and Rh blood groups with maternal and perinatal outcomes in SARS-CoV-2(+) patients with adjusted odds ratios (aOR) and 95% confidence intervals (CI)., Main Outcomes Measures: Medical morbidity: Symptomatic COVID-19 and medical complications. Obstetric outcomes: caesarean delivery, preterm deliveries, preterm premature rupture of membranes (PPROM), hemorrhagic events, pre-eclampsia, maternal and neonatal mortality, stillbirth., Results: Differences were noted between blood types and Rh for age and ethnicity comparing SARS-CoV-2(+) and SARS-CoV-2(-) groups (p < 0.05). Among the SARS-CoV-2(+) cohort, the odds of symptomatic COVID-19 and obstetric hemorrhagic event were higher in Rh+ vs Rh- mothers (aOR 1.48, 95% CI 1.02-2.14, p = 0.037, and aOR 8.72, 95% CI 1.20-63.57, p = 0.033, respectively), and PPROM were higher among blood type A vs non-A mothers (aOR 2.06, 95% CI 1.01-4.18, p = 0.046)., Conclusions: In SARS-CoV-2(+) pregnant women, Rh- status was associated with a lower risk of symptomatic COVID-19, while Rh+ and blood group A were associated with obstetric hemorrhage and PPROM, respectively., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients' information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Introduction: There are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use., Methods: The technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service., Results: During 5years and 6months of the study, the total cost of the web site was €45,201.56. The cost per visit received was €0.0155€, and €0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of €22,263.89., Conclusions: The costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits., (Copyright © 2020 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background & Aim: Worldwide, measures are being implemented to eradicate hepatitis B (HBV) and C (HCV) viruses, which can be transmitted from the mother during childbirth. This study aims to determine the prevalence of HBV and HCV in pregnant women in Spain, focusing on country of origin, epidemiological factors and risk of vertical transmission (VT)., Methodology: Multicentre open-cohort study performed during 2015. HBV prevalence was determined in 21870 pregnant women and HCV prevalence in 7659 pregnant women. Epidemiological and risk factors for VT were analysed in positive women and differences between HBV and HCV cases were studied., Results: HBV prevalence was 0.42% (91/21870) and HCV prevalence was 0.26% (20/7659). Of the women with HBV, 65.7% (44/67) were migrants. The HBV transmission route to the mother was unknown in 40.3% of cases (27/67) and VT in 31.3% (21/67). Among risk factors for VT, 67.7% (42/62) of the women had viraemia and 14.5% (9/62) tested HBeAg-positive. All of the neonates born to HBV-positive mothers received immunoprophylaxis, and none contracted infection by VT. In 80% (16/20) of the women with HCV, the transmission route was parenteral, and nine were intravenous drug users. Viraemia was present in 40% (8/20) of the women and 10% (2/20) were HIV-coinfected. No children were infected. Women with HCV were less likely than women with HBV to breastfeed their child (65% vs. 86%)., Conclusions: The prevalences obtained in our study of pregnant women are lower than those previously documented for the general population. Among the women with HBV, the majority were migrants and had a maternal family history of infection, while among those with HCV, the most common factor was intravenous drug use. Despite the risk factors observed for VT, none of the children were infected. Proper immunoprophylaxis is essential to prevent VT in children born to HBV-positive women., Competing Interests: The authors have declared that no competing interests exist.

There is a need for health professionals to provide parents with not only evidence-based child health websites but also instruments to evaluate them. The main aim of this research was to develop a questionnaire for measuring users' evaluation of the usability, utility, confidence, the well-child section, and the accessibility of a Spanish pediatric eHealth website for parents. We further sought to evaluate the content validity and psychometric reliability of the instrument. A content validation study by expert review was performed, and the questionnaire was pilot tested. Psychometric analyses were used to establish scales through exploratory and confirmatory factor analyses. Reliability studies were performed using Cronbach's alpha and two split-half methods. The content validation of the questionnaire by experts was considered as excellent. The pilot web survey was completed by 516 participants. The exploratory factor analysis excluded 27 of the 41 qualitative initial items. The confirmatory factor analysis of the resultant 14-item questionnaire confirmed the five initial domains detected in the exploratory confirmatory analysis. The goodness of fit for the competing models was established through fit indices and confirmed the previously established domains. Adequate internal consistency was found for each of the subscales as well as the overall scale.

Background: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life., Methods: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured., Discussion: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery., Trial Registration Number: ISRCTN registry (ISRCTN27697878).

Objective: To assess vulvovaginal symptoms and urinary incontinence in postmenopausal women. Secondarily to evaluate factors related to the severity of vulvovaginal symptoms and the internal consistency of the used tools., Methods: In this cross-sectional study, the Spanish language version of the 21-item Vulvovaginal Symptoms Questionnaire (VSQ) and the 3-item International Consultation on Incontinence Questionnaire (ICIQ-SF) were applied to 122 postmenopausal Spanish women aged 45 to 75 years., Results: Mean age of the whole sample was 59.5 ± 4.9 years; 89.3% had natural menopause, 77.9% reported vulvovaginal symptoms, 54.9% had urinary incontinence, 54.1% were sexually active, and 77.0% currently had a partner. Calculated Cronbach's alpha coefficients were 0.87 and 0.88 for the VSQ and the ICIQ-SF, respectively. Multiple linear regression analysis determined that total VSQ scores (more severe vulvovaginal symptoms) were positively correlated with female age, parity, surgical menopause, being sexually active, economic problems, phytoestrogen use, and more severe urinary incontinence. An inverse correlation was found with urban residency and time since menopause onset., Conclusions: Internal consistency of the VSQ and the ICIQ-SF was good in this postmenopausal sample in which age, sexual activity, urinary incontinence, drug use, and other personal aspects were important covariates determining the severity of vulvovaginal symptoms.

Objective: To investigate serum inflammatory markers in singleton gestations complicated with threatened preterm labour (TPL)., Methods: Pregnant women complicated with TPL (n = 61) were recruited to measure maternal serum levels of a panel of cytokines and C-reactive protein and then compared to controls without TPL, matched for gestational age (n = 64) and term pregnancies in the prodromal phase of labour (PPL) (n = 31). In addition, baseline cytokine levels were compared among cases and controls according to the outcome., Results: Women with TPL displayed higher CRP and white blood counts levels together with lower granulocyte macrophage colony-stimulating factor (GMC-SF) compared to both controls without TPL and to term gestations in the PPL. Also, interleukin 10 (IL-10), IL-6, IL-7, IL-8 and tumour necrosis alpha (TNF-α) levels were found significantly higher in TPL cases as compared to controls without TPL and term women in the PLL. Baseline cytokine levels (except IL-10) were higher among TPL cases who later delivered preterm. TPL cases delivering preterm displayed lower GMC-SF levels as compared to those delivering at term. Multivariate analysis found that gestational age at birth positively correlated with cervical length and inversely with CRP, IL-6 and TNF-α levels (p < 0.0001)., Conclusions: TPL and preterm birth were related to inflammatory changes in the maternal side that correlate with cervical shortening and the initiation of uterine contractions.

Objective and Methods: To measure 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) serum levels in singleton gestations complicated with threatened preterm labour (TPL, n = 59) and compare to normal controls matched for gestational age (n = 64). Cases were treated after blood sample according to institutional protocol. Also, analyte levels were compared among cases according to the outcome., Results: Mean serum 25(OH)D levels were similar between cases and controls, with median white blood cell count and CRP levels found significantly higher in TPL cases. Women with TPL delivering preterm displayed shorter mean cervical lengths along with higher CRP and lower 25(OH)D serum levels when compared to those delivering at term. Two multiple linear regression models were constructed to analyse factors related to gestational age at delivery (pooled analysis and only those with TPL). In both models, gestational age positively correlated to cervical length and inversely to CRP levels; whereas, in the TPL model, only 25(OH)D levels correlated positively., Conclusion: Women complicated with TPL showed similar serum 25(OH)D yet higher CRP levels as compared to controls. TPL cases delivering preterm displayed lower 25(OH)D and higher CRP correlated levels.

Objective: To assess the risk of obstructive sleep apnea-hypopnea syndrome (OSAHS) and related factors at the end of pregnancy using the Berlin questionnaire., Methods: A total of 367 women at the end of pregnancy (median gestational age 39 weeks) were interviewed with the Berlin questionnaire and a general survey containing maternal socio-demographic and anthropometric information. Neonatal outcome data were also assessed., Results: Median age for the whole sample was 31 years. According to the Berlin questionnaire, 39.8% were positive for high risk of OSAHS. Upon bivariate analysis, higher risk of OSAHS was significantly related to church attendance, and higher pre-pregnancy body mass index (BMI), current BMI, weight, neck and arm circumference and systolic blood pressure at survey. Logistic regression analysis found that higher maternal pre-pregnancy BMI (OR 2.71 95% CI 1.84-4.00, p < 0.0001) and higher maternal weight at survey (OR 3.02, 95% CI 1.78-5.17, p < 0.0001) were significantly related to a higher risk of OSAHS., Conclusion: The risk of OSAHS is relatively high at the end of pregnancy and related to a higher pre-pregnancy BMI and higher maternal weight at survey. Further studies are needed to confirm our results with a diagnostic tool, such as polysomnography or another similar yet less complicated to carry out procedure.

Objective: To assess life satisfaction and related factors in middle-aged Spanish women., Method: This was a cross-sectional study including 235 women aged 40 to 65, living in Granada (Spain), healthy companions of patients visiting the obstetrics and gynecology clinics. They completed the Diener Satisfaction with Life Scale, the Menopause Rating Scale, the Perceived Stress Scale, the Insomnia Severity Index and a sociodemographic questionnaire containing personal and partner data. Internal consistency of each tool was also calculated., Results: Almost two-thirds (61.3%) of the women were postmenopausal, and 43.8% had abdominal obesity, 36.6% had insomnia, 18.7% had poor menopause-related quality of life, 31.9% performed regular exercise, and 5.1% had severe financial problems. Life satisfaction showed significant positive correlations (Spearman's test) with female and male age, and inverse correlations with menopause-related quality of life, perceived stress and insomnia. In the multiple linear regression analysis, high life satisfaction is positively correlated with having a partner who performed exercise, and inversely with having work problems, perceived stress and the suspicion of partner infidelity. These factors explained 40% of the variance of the multiple regression analysis for life satisfaction in middle-aged women., Conclusion: Life satisfaction is a construct related to perceived stress, work problems, and having a partner, while aspects of menopause and general health had no significant influence., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Objective: This study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal women., Methods: In this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data., Results: The median [interquartile range] age of participating women was 54 [10.0] years. Among the women, 55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension, 25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed mood (CESD-10 scores ≥10), and 34.9% had severe menopausal symptoms (total MRS scores ≥17). Less resilience (lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely correlated with WYRS scores (less resilience)., Conclusions: In this postmenopausal sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms (somatic and psychological).

Objective: To assess long-term effects of different hormone replacement therapy (HRT) regimens on mammographic density., Methods: One hundred sixty-five postmenopausal women were treated with the same HRT during 5 years: 38 received transdermal estradiol, 78 cyclic combined therapy and 49 continuous combined therapy. Mammograms were obtained at baseline, at 1-year and 5-year treatment. Breast density changes were categorized as slight focal increased density, considerable focal increased density, slight diffuse increased density and considerable diffuse increased density., Results: Mammographic density increased in 7.9% of women receiving estrogen alone versus 25.2% of women receiving combined therapy (p < 0.022) during 1 year, and in 7.9% of women versus 28.3% of women (p < 0.009) after 5 years of therapy, respectively. There were significant statistical differences in women treated with estrogen alone versus those treated with combined HRT after 1 and 5 years. After 5 years of HRT, breast density increased 21.8% in women receiving cyclic combined therapy versus 38.8% in those under continuous combined therapy (p < 0.039)., Conclusion: An increase in breast density is significantly more frequent in women receiving combined estrogen-progestin therapy than in women receiving estrogen alone. There are differences between cyclic and continuous combined therapy at 5 years of treatment.

Objective: To develop a short 10 item version of the original menopause Cervantes Scale (CS) in order to assess menopausal symptoms in a large cohort of mid-aged Colombian women., Methods: Reliability of the new short tool was assessed through internal consistency determination (Cronbach's alpha values) and intra-class correlation coefficient (ICC) analysis. Ten items out of the 31 composing the original CS were selected according to their clinical relation with menopausal symptoms. Subsequently the short tool was used to assess menopausal symptoms and related factors among 1739 mid-aged women., Results: The CS-10 displayed a mean (±SD) ICC value of 0.45 (±0.06) and a Cronbach's alpha of 0.778 suggesting good internal reliability. For the entire sample median [interquartile range] CS-10 global scores were 10.0 [12.0], and for pre-, peri- and postmenopausal women: 8.0 [9.2], 9.0 [9.0] and 14.0 [14.0], respectively. Median global CS-10 scores significantly increased with menopausal status, marital status and ethnicity. Multiple linear regression analysis determined that higher global CS-10 scores (worse quality of life) correlated with age, parity, years since menopause, body mass index, ethnics (black) and smoking habit., Conclusion: The CS-10 seems to be a simple instrument that may aid everyday clinical consultation and help at performing an accurate diagnosis of menopause-related symptoms. Further studies are needed to confirm our preliminary findings., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aim of this study was to determine the relationship between self-reported sleep quality, menopausal symptom intensity, and correlates (including ethnicity) among middle-aged women., Methods: The present cross-sectional study involved 1,078 Colombian women aged 40 to 59 years who completed the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS), and a general questionnaire exploring sociodemographic data., Results: The median [interquartile range] age of the whole sample was 49.0 [9.0] years. Among the participants, 45.4% were postmenopausal, 57.2% had increased body mass index values, 13.9% were black, 20.7% had hypertension, 74.1% had a stable partner, and 3.8% used hormone therapy. The prevalence of poor sleep quality was 57.1% (PSQI global score ≥5). Significant correlations between PSQI global scores and MRS total and subscale scores were found. Multiple linear regression analysis found that higher PSQI scores (poorer quality of sleep) correlated with higher MRS psychological and somatic subscale scores (more severe symptoms), smoking habit, and hypertension. Menopause status and black ethnicity were excluded from the final regression model., Conclusions: Despite study limitations, poor sleep quality is highly prevalent in this large middle-aged Colombian female sample and is related to menopausal symptom severity, tobacco use, and presence of hypertension.

Objective: To assess the prevalence of insomnia and related factors in a large cohort of mid-aged Colombian women of different ethnical background., Methods: This cross-sectional study involved 1325 women aged 40-59 of 3 ethnical groups: Mestizo (70.0%), Black (11.5%) and Zenú indigenous (18.5%), who completed the items of the Athens Insomnia Scale (AIS), the Menopause Rating Scale (MRS) and a general questionnaire containing personal socio-demographic data., Results: Median [interquartile range] age of the whole sample was 48.0 [10.0] years. A 43.4% were postmenopausal, 51.7% had increased body mass index values, 18.2% had hypertension and 5.1% used hormone therapy. A 27.5% displayed insomnia (AIS total score ≥6). Significant Spearman rho correlations were found between total AIS and MRS scores (total and subscales). Multiple linear regression analysis found that higher total AIS scores (more insomnia) correlated with tobacco consumption and higher MRS psychological and somatic subscale scores (more severe symptoms). Age, ethnicity and partner and menopausal status were excluded from the final regression model., Conclusions: In this large mid-aged Colombian cohort insomnia was present in nearly one third of cases, related to smoking habit and the severity of somatic and psychological menopausal symptoms and independent of ethnics and menopausal status., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine urinary incontinence (UI) prevalence, related factors and menopause-related quality of life (QoL) in mid-aged Colombian women., Methods: A total of 1739 women aged 40-59 were surveyed with the 31 item Cervantes Scale (CS) and a socio-demographic questionnaire. Item 18 of the scale was used to categorize the degree of UI. Remaining 30 items (Adjusted global score) were used to assess global menopause-related QoL., Results: Median age of the sample was 46 years. A 26.0% of women presented some degree of UI, rated as moderate to severe in 16.4% of cases. Adjusted global CS scores (excluding item 18) significantly increased with the severity of UI. Mean scores for item 18 were found to be significantly higher in relation to age, menopausal status, body mass index values, lower education and unemployment status. Multiple linear regression analysis determined that age, postmenopausal status and ethnicity (Mestizo) were significantly related to higher item 18 scores, and thus more severe UI., Conclusion: This is the first study to report UI prevalence in a large mid-aged Latin American female population in which age, menopausal status and ethnicity were related factors., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Studies assessing perceived stress and insomnia in mid-aged women are scarce., Objective: To assess perceived stress, insomnia and related factors in mid-aged Spanish women., Method: This was a cross sectional study in which 235 women aged 40-65 completed the Menopause Rating Scale (MRS), the Perceived Stress Scale (PSS), the Insomnia Severity Index (ISI), and a general socio-demographic questionnaire containing personal and partner data. Internal consistency of each tool was also computed., Results: Median [interquartile range] age of the sample was 52 [9.0] years. A 61.3% were postmenopausal, 49.4% had increased body mass index values, 43.8% were abdominally obese, 11.9% had hypertension, and 74.0% had a partner. In addition, 9.8% used hormone therapy and 12.3% psychotropic drugs. Multiple linear regression analysis found that higher PSS scores (more stress) inversely correlated with female age and positively with MRS psychological and urogenital scores (impaired quality of life in these domains), total higher ISI scores (more insomnia) and partner premature ejaculation. Higher ISI scores positively correlated with PSS and MRS somatic scores and partner unfaithfulness, and inversely with female hip circumference., Conclusion: In this mid-aged Spanish sample perceived stress and insomnia were significantly correlated and related to various female and partner issues., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy., Methods: A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey., Results: Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness)., Conclusion: Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.

Background: Vitamin D regulates the human genome and it is thought to influence the fetal growth and development, but its relation to early ultrasound fetal measures is still unknown., Objective: To assess first trimester 25-hydroxyvitamin D [25(OH)D] maternal serum status and correlate with ultrasound crown-rump length (CRL) and nuchal translucency (NT) measurements., Method: In this cross-sectional study, women with singleton pregnancies undergoing the first trimester standard two-dimensional ultrasound scan for fetal anomalies were included: CRL (n = 498) and NT (n = 487). Concomitantly, maternal serum 25(OH)D levels were also measured., Results: Median serum 25(OH)D levels for the entire sample (n = 498) was 27.4 ng/mL (interquartile range 20.9-32.7). Serum 25(OH)D was adequate (≥ 30 ng/mL) in only 36.1% of gravids, whereas levels were found to be insufficient (20-29.99 ng/mL) in 41.2% and deficient (< 20 ng/mL) in 22.7%. No significant correlation was found between the serum 25(OH)D levels and the measured ultrasound parameters., Conclusion: First trimester 25(OH)D levels did not correlate to fetal ultrasound measurements.

Background: Vitamin D has been implicated in embryo/placental development and growth; however information in this regard is limited or unavailable., Objective: To assess 25-hydroxyvitamin D (25(OH)D), free β-human chorionic gonadotropin (β-hCG) and pregnancy associated plasma protein A (PAPP-A) status during pregnancy., Methods: Serum 25(OH)D, β-hCG, and PAPP-A levels were measured in the first trimester of otherwise healthy Spanish pregnant women (n=488). Rho Spearman coefficients were calculated to determine correlations between analytes., Results: Median serum 25(OH)D levels for the entire sample was 27.4 ng/ml (interquartile range=12.1). 25(OH)D levels were insufficient (20-29.99 ng/ml) and deficient (<20 ng/ml) in 40.6% and 23.2%, respectively, in relation to ethnics, body mass index values, tobacco use, and season/gestational age at blood sampling. β-hCG and PAPP-A levels significantly correlated (r²=0.47) yet neither of them with 25(OH)D levels. Despite this, the three analytes significantly correlated with gestational age at sampling., Conclusion: First trimester 25(OH)D, β-hCG, and PAPP-A levels increase with gestational age; however, placental peptides do not correlate with vitamin D levels, suggesting a non-placental 25(OH)D production. More research is required in this regard.

Humans acquire vitamin D through skin photosynthesis and digestive intake. Two hydroxylations are needed to obtain the bioactive compound, the first produces 25-hydroxyvitamin D [25(OH)D], and the second 1,25-dihydroxyvitamin D [1,25(OH)2D]. There is no consensus regarding the appropriate cut-off level to define the normal serum 25(OH)D range. Experimental, epidemiological and clinical studies have related low vitamin D status with longevity. Although some results are controversial, low serum 25(OH)D levels have been linked to all-cause, cardiovascular, cancer and infectious related mortality. Throughout life span a significant proportion of human beings display insufficient (20-30 ng/mL) or deficient (<20 ng/mL) serum 25(OH)D levels. Appropriate lifestyle changes, such as regular short exposures to sunlight (15 min a day), and an adequate diet that includes vitamin D rich components, are not always easily accomplished. Studies relating to vitamin D supplementation have methodological limitations or are based on relatively low doses. Therefore, dosages used for vitamin D supplementation should be higher than those traditionally suggested. In this sense, there is an urgent need for prospective controlled studies using high daily vitamin D doses (2,000 IU or higher) including cardiovascular, cancer, infectious and other endpoints. Relationship between vitamin D and health outcomes is not linear, and there are probably various optimal vitamin D levels influencing different endpoints.

Objective: To assess body weight composition in postmenopausal women and determine correlations with metabolic and hormonal parameters., Methods: Medical records of 574 postmenopausal Caucasian Spanish women first time attending a menopause clinic were retrospectively reviewed. Retrieved information included general demographic data, type of menopause, time since menopause onset and baseline hormonal and metabolic parameters. A body mass index (BMI) value of >28.8 kg/m(2) was used to define obesity. The metabolic syndrome (METS) was diagnosed with three or more criteria: fasting glycemia ≥ 100 mg/dL, high density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides (TG) ≥ 150 mg/dL, blood pressure ≥ 130/85 mmHg and obesity (as defined above)., Results: Mean age of the whole cohort was 49.9 ± 6.1 years, with 66% having a natural menopause. A 38.9% and 23.1% of all women were obese or had the METS, respectively. Obese women were older, had a higher parity, smoked less, had more time since menopause onset and a higher rate of surgical menopause as compared to non-obese ones (p = 0.001). BMI values positively correlated with age, time since menopause, parity, and glucose, TG and systolic blood pressure levels; displaying an inverse correlation with HDL-C and SHBG levels. SHBG levels inversely correlated with glucose, TG, HDL-C and systolic blood pressure levels., Conclusion: In this Spanish postmenopausal population BMI significantly increased with age, time since menopause and parity displaying significant correlations with hormonal and metabolic parameters.

Objective: To assess first trimester serum 25-hydroxyvitamin D [25(OH)D] status and factors related to deficient levels in pregnant Spanish women., Methods: This cross-sectional study was carried out among 502 gravids (11 to 14 weeks) living in the Spanish Mediterranean sea coast (near Almería at latitude 36° N, longitude 2° W) to whom serum 25(OH)D levels were measured by electrochemiluminescence immunoassay. Logistic and multiple linear regression analysis were performed to assess the influence of ethnicity, immigration status, season of the year at blood sampling, body mass index (BMI), parity and smoking habit over 25(OH)D levels., Results: The median (interquartile range, IQR) serum 25(OH)D levels for the entire sample was 27.4 ng/mL (IQR = 20.9-32.8). Only 35.9% of participants had adequate serum 25(OH)D levels (≥30 ng/mL) whereas in 41.4% and 22.7% these levels were found to be insufficient (20-29.9 ng/mL) and deficient (<20 ng/mL), respectively. Vitamin D status was found to be significantly lower in Arab women as compared to Caucasian women. 25(OH)D levels were positively correlated with gestational age at sampling and inversely with BMI values (univariate analysis). Logistic regression analysis determined that non-Caucasian ethnicity, season at sampling (autumn/winter), and nulliparity were factors related to deficient 25(OH)D levels. Multiple linear regression found a similar model yet also including maternal weight inversely correlating with 25(OH)D levels., Conclusion: Despite living in one of the sunniest, warmest, and driest climates of Europe, gravids displayed a high prevalence of first trimester insufficient/deficient serum 25(OH)D levels related to season at sampling, nulliparity, maternal weight, and non-Caucasian ethnicity.

Background: Low serum 25-hydroxyvitamin D (25[OH]D) levels are common and may be associated with morbidity and mortality (and indeed with frailty more generally). This association is not restricted to the links between vitamin D and calcium and bone metabolism., Objective: To review the influences of vitamin D on the aging process other than those related to bone and calcium. Its effect on mortality is also assessed., Methods: The PubMed database was searched for English-language articles relating to vitamin D, using the following MeSH terms: vitamin D, mortality, cardiovascular diseases, and frailty. In addition, searches were carried out with Google., Results: Although some of the reported results have proved controversial, overall the evidence seems to support an association between low serum 25[OH]D levels and mortality rates (all-cause and cardiovascular). Frailty is a condition frequently associated with low serum 25[OH]D levels., Conclusion: The aging process and mortality are associated with low vitamin D levels. Prospective controlled trials are warranted to determine whether vitamin D supplements can increase longevity and reduce the incidence of certain conditions., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: In the post-Women's Health Initiative Study era few post-menopausal women complete long term hormonal treatment (HT)., Objective: To analyse metabolic/hormonal parameters and frequency of the metabolic syndrome (METS) in post-menopausal women after 10 years of HT., Methods: Retrospective data from parallel cohorts of post-menopausal women receiving HT for 10 years was analysed. Regimens included: transdermal oestradiol (50 microg) (n=22), sequential cyclic HT with transdermal oestradiol (50 microg) plus 200 mg/day micronized oral progesterone (cycle days 12-25) (n=83), or continuous combined HT with transdermal oestradiol (50 microg) plus 100 mg/day micronized oral progesterone (n=46). A group of women who elected not to use HT served as a control group (n=35)., Results: Frequency of the METS did not significantly increase after 10 years of HT. Oestradiol and sex hormone binding globulin (SHBG) levels displayed a significant increase compared to baseline after 10 years of HT (all regimens). These values were significant higher when compared to the control group. Glucose levels were significantly higher after 10 years in women receiving the sequential cyclic regimen. Although not reaching statistical significance, there was a trend for transdermal oestradiol alone to increase HDL-C and decrease triglyceride levels., Conclusion: Serum oestradiol and SHBG levels were significantly higher after 10 years of transdermal oestradiol, alone or combined with micronized oral progesterone, without differences observed in serum metabolic parameters. More research through randomised clinical trials is required.

Objectives. To compare the effectiveness of postcesarean thromboprophylaxis with two different regimens of bemiparin. Material and Methods. The study included 646 women with cesarean delivery in our hospital within a 1-year period, randomly assigned to one of two groups for prophylaxis with 3500 IU bemiparin once daily for 5 days or 3500 IU bemiparin once daily for 10 days. Results. There was one case of pulmonary embolism (first day following cesarean). An additional risk factor was present in 98.52% of the women, most frequently emergency cesarean, anemia, or obesity. The only risk factors for thromboembolic disease significantly related to pulmonary thromboembolism were placental abruption and prematurity. There were no differences in thromboembolic events among the two thromboprophylaxis regimens. Conclusions. Cesarean-related thromboembolic events were reduced in our study population due to the thromboprophylactic measures taken. Thromboprophylaxis with 3500 IU bemiparin once daily for 5 days following cesarean was sufficient to avoid thromboembolic events.

Objective: To assess the metabolic syndrome (METS) and its components in postmenopausal women using updated diagnostic criteria and explore their relation to menopausal symptom severity., Method: Medical records of the first visit of 574 postmenopausal Caucasian Spanish women attending a menopause clinic were retrospectively reviewed. Recorded information included general demographic data, type of menopause, menopausal symptom intensity (Kupperman index) and baseline hormonal and metabolic parameters. METS was established if three or more of the following criteria were met: body mass index (BMI) >28.8 kg/m(2), fasting glycaemia ≥100 mg/dL, high-density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides ≥150 mg/dL and blood pressure ≥130/85 mmHg., Results: Mean ± SD age of the whole cohort was 49.9 ± 6.1 years, 66% had natural menopause and 38.9% were obese. In all, 23.1% met diagnostic criteria for METS who were significantly older and displayed higher rates of being married, obesity and abnormal glucose, triglyceride, HDL-C, low-density lipoprotein cholesterol and blood pressure values, when compared with those without the syndrome. The mean Kupperman index score for the whole sample was 26.4±10.6, with 73.8% displaying moderate to severe scores (20 or more). Logistic regression analysis determined that obesity and marriage status were independent risk factors related to more severe menopausal symptoms (Kupperman index scores of 20 or more)., Conclusion: Although METS was observed in a lower frequency than previous reports, obesity was associated with more severe menopausal symptoms among postmenopausal Spanish women.

Objective: To assess fatal cardiovascular disease (FCD) risk among women in early post-menopausal years, as evaluated with the Systematic Coronary Risk Evaluation (SCORE) scale., Design: This was a retrospective study of parallel cohorts. Two hundred seventy-three healthy post-menopausal women. Participants received one of the following hormone treatment (HT) regimens: transdermal estradiol (50 microg) (n = 99), sequential cyclic HT with transdermal estradiol (50 microg/day) plus 200 mg/day natural micronised oral progesterone (cycle days 12-25) (n = 63) and combined HT using transdermal estradiol (50 microg) plus 100 mg/day of micronised oral progesterone (n = 61). A group of women who elected not to use HT served as control group (n = 50). SCORE values were assessed before HT or follow up., Results: Only one woman displayed a high-risk SCORE value both before and after 10 years of HT, the remaining had low risk values (<5%) for FCD. After 10 years, SCORE values increased significantly as compared to baseline among HT users (all three regimens) and controls. Although post-treatment SCORE values significantly differed among groups, values were all below the high risk cut-off (5%). There were no FCD events during the 10 year observation period., Conclusion: As assessed with the SCORE scale, FCD risk in young post-menopausal women (HT users and controls) had a slight significant increase after 10 years, being values in the low risk range.