Time-efficient consultation hours in the department of gynecological endocrinology.

BACKGROUND: The aim was to conduct a benchmark pilot study to find the best practice for consultation hours in the field of gynecological endocrinology. Suitable benchmarking participants were found in China, Germany, Greece, and Switzerland. Specifically, the study aimed to find the most time-efficient and beneficial consultation type in gynecological endocrinology focused on menopause and whether a shorter face-to-face consultation correlates with lower patient satisfaction. METHODS: This was an observational study. To analyze the processes of all benchmarking participants three tools were used: a measurement of time needed for the different consultation types, a questionnaire for patients and one for physicians. The primary endpoint was the time measurement of first consultations. Secondary endpoints were the time measurements of follow-up consultations and phone consultations and patient satisfaction. RESULTS: The mean overall duration of a first consultation differed from 20.4 min to 39.7 min (p = 0.003), mainly based on differences of the mean time to acquire the patient history, 5.6 to 21.6 min (p < 0.001). The percentage of patients who felt they had enough time to discuss questions ranged from 70% to 100% (p < 0.001). The percentage of patients who felt fully understood by their physician ranged from 62.5% to 92% (p = 0.006). The duration of a first consultation did not correlate with patients feeling well consulted (r=-0.048, p = 0.557). CONCLUSIONS: A concise patient history that concentrates on the most relevant points can reduce the total consultation time. Reducing consultation time can be made without compromising how well patients feel consulted.

Unmet clinical needs in women with polycystic ovary syndrome in regard to mental health: a cross-sectional study.

PURPOSE: Polycystic ovary syndrome (PCOS) management has hardly been standardized until recent years. Despite the existence of a detailed, evidence-based guideline published by the European Society of Human Reproduction and Embryology (ESHRE), it remains unclear to what extent healthcare providers adhere to this guideline. Our aim is to evaluate the gynaecological medical care provided in women with PCOS, particularly in terms of mental health, from the patients' perspective. METHODS: For this cross-sectional online cohort study in women with PCOS, we designed a standardized, non-validated questionnaire covering aesthetic aspects, metabolism, menstrual cycle, reproduction, mental health, and prevention of chronic non-communicable diseases. RESULTS: Among 1879 participants, various mental health aspects were reported: body image (n = 1879), eating patterns/habits (n = 1878), and emotional well-being (n = 1874). Although nearly all women (99.7%) reported complaints on at least one session of mental health, consultation rates were low (body image 9.7%, eating patterns/habits 16.6%, emotional well-being 4.4%). Mean satisfaction with counselling on the different domains varied from moderate to fairly satisfying, with scores of 56.0 points (SD 31.7), 53.5 points (SD 32.0), and 63.7 points (SD 30.2), respectively. More complaints were associated with lower satisfaction. The overall satisfaction with the management provided by the healthcare practitioner (HCP) was low, averaging 36.5 points (SD 29.7). Consequently, most women wished for more counselling (58.9%). CONCLUSION: Women affected by PCOS are not properly managed according to ESHRE guideline in regard to mental health issues. Overall consultation rates and corresponding satisfaction with management were poor, highlighting the need for significant improvements in healthcare provision.

Awareness of non-communicable diseases in women: a cross-sectional study.

Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.

Impact of chronic stress exposure on cognitive performance incorporating the active and healthy aging (AHA) concept within the cross-sectional Bern Cohort Study 2014 (BeCS-14).

PURPOSE: This study aims to verify that the mental-cognitive domain of the validated generic bio-functional status (BFS)/bio-functional age (BFA) assessment tool, incorporating the concept of Active and Healthy Ageing (AHA), reflects cognitive performance. In addition, the effects of chronic stress exposure on the mental-cognitive BFS/BFA should be investigated. METHODS: The study was carried out as a monocenter, cross-sectional, observational, non-interventional trial (Bern Cohort Study 2014, BeCS-14) with the participation of 147 non-pediatric, non-geriatric subjects. All participants followed a standardized battery of biopsychosocial assessments consisting of BFS/BFA, a validated cognitive performance test battery (Inventar zur Gedächtnisdiagnostik; IGD) and a validated questionnaire for the assessment of chronic stress (Trier Inventory for the assessment of Chronic Stress; TICS), respectively. RESULTS: Mean cognitive performance was average and higher in younger or better educated individuals. The BFA of the participants was 7.8 ± 7.8 year-equivalents below their chronological age. The mental-cognitive BFS/BFA assessment correlated well with the validated questionnaire for cognition assessment, the IGD. Further, three TICS subdomains (work overload (r = - 0.246, p = 0.003), work discontent (r = - 0.299, p = 0.006) and pressure to succeed (r = - 0.274, p < 0.001)), reflecting mainly work-related stress, showed a significant negative correlation with the mental-cognitive BFS/BFA. CONCLUSIONS: Our study shows that the BFS/BFA assessment tool follows European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) requirements. Further, we could demonstrate that higher levels of chronic work-related stress may be associated with poorer mental-cognitive performance and a pro-aging state indicating that cognitive impairments can be reduced by stress management interventions.

Only women's age and the duration of infertility are the prognostic factors for the success rate of natural cycle IVF.

PURPOSE: It is controversial who should be recommended to undergo natural cycle IVF (NC-IVF). Therefore, objective prognostic criteria which are already known at the time of counselling were defined. METHODS: A retrospective observational study was performed with 201 couples (age 34.7 ± 4.1) undergoing 311 NC-IVF treatments with 201 transfers, corresponding to a transfer rate of 65.3%. The first cycle resulting in a transfer of one embryo was further analysed. Clinical pregnancy and live birth rates were analysed. RESULTS: Pregnancy rate and live birth rates per first cycle were 21.9% and 13.2%, respectively. Groupwise comparison revealed the following clinical pregnancy/live birth rates per transfer cycle: duration of infertility 1-2 years 34.3/25.7%, 3-4 years 21.8/14.9% and > 4 years 9.1/4.5%. Women's age < 34 years 26.3/22.4%, 34-37 years 25.7/18.9% and 38-42 years 15.7/3.9%. Linear regression analysis showed that pregnancy and live birth rate correlated negatively with the duration of infertility and that live birth rate but not pregnancy rate correlated negatively with increasing female age. In contrast, AMH and infertility factors did not correlate with the success rate. Statistically significant correlations remained if a multivariate logistic regression analysis was performed, supporting further that the duration of infertility (OR 0.61, 95% CI 0.42-0.86) (P = 0.006) and female age (OR 0.87, 95% CI 0.78-0.95) (P = 0.008) are the predictors for live birth rates in NC-IVF transfer cycles. CONCLUSIONS: Based on the success rates, NC-IVF can especially be recommended for women with short duration of infertility and young age, whereas older women and those with long duration of infertility are not the best candidates for this technique.

Effect of a weight-loss stabilization following a weight reduction with or without meal replacement on cardiometabolic risk in overweight women. A randomized controlled trial.

The objective of this study was to examine the effect of a 3-month weight-loss-stabilization phase (phase 2) following a successful 3-month weight-loss phase (phase 1), including a conventional energy-restricted diet with (MR) or without (C) meal replacement, on the cardiometabolic risk profile in 80 overweight women. In phase 2, both groups continued to significantly reduce weight and sustained the significant decreases in waist circumference and LDL-C. During the study, folic acid concentration significantly increased in the MR-group, while homocysteine concentration significantly worsened in the C-group. After 6 months, the number of women with hypertriglyceridemic waist was significantly reduced in both the groups, however with metabolic syndrome and metabolically unhealthy abdominal obesity (MUHAO) only in the MR-group. In conclusion, both strategies were equally effective for weight loss and weight-loss stabilization. The micronutrient supplementation with MR seemed to have an additional beneficial impact on the cardiometabolic risk in the MR-group versus the C-group.

Dietary intervention with a specific micronutrient combination for the treatment of patients with cardiac arrhythmias: the impact on insulin resistance and left ventricular function.

BACKGROUND: Cardiac arrhythmias (CA) are very common and may occur with or without heart disease. Causes of these disturbances can be components of the metabolic syndrome (MetS) or deficits of micronutrients especially magnesium, potassium, B vitamins and coenzyme Q10. Both causes may also influence each other. Insulin resistance (IR) is a risk factor for diastolic dysfunction. One exploratory outcome of the present pilot study was to assess the impact of a dietary intervention with specific micronutrients on the lowering of IR levels in patients with CA with the goal to improve the left ventricular (LV) function. METHODS: This was a post hoc analysis of the randomized double blind, placebo-controlled pilot study in patients with CA (VPBs, SVPBs, SV tachycardia), which were recruited using data from patients who were 18-75 years of age in an Outpatient Practice of Cardiology. These arrhythmias were assessed by Holter ECG and LV function by standard echocardiography. Glucose metabolism was measured by fasting glucose, fasting insulin level and the Homeostasis Model Assessment of IR (HOMA-IR) at baseline and after 6 weeks of dietary supplementation. RESULTS: A total of 54 randomized patients with CA received either a specific micronutrient combination or placebo. Dietary intervention led to a significant decrease in fasting insulin ≥58 pmol/l (p = 0.020), and HOMA-IR (p = 0.053) in the verum group after 6 weeks. At the same time, parameters of LV diastolic function were improved after intervention in the verum group: significant reduction of LV mass index (p = 0.003), and in tendency both a decrease of interventricular septal thickness (p = 0.053) as well as an increase of E/A ratio (p = 0.051). On the other hand, the premature beats (PBs) were unchanged under verum. CONCLUSIONS: In this pilot study, dietary intervention with specific micronutrient combination as add-on to concomitant cardiovascular drug treatment seems to improve cardio metabolic health in patients with CA. Further studies are required. STUDY REGISTRATION: The study was approved by the Freiburg Ethics Commission International and was retrospectively registered with the U.S. National Institutes of Health Clinical Trials gov ID NCT 02652338 on 16 December 2015.

Attitude towards ovarian tissue and oocyte cryopreservation for non-medical reasons: a cross-sectional study.

PURPOSE: To assess the attitude towards ovarian tissue and oocyte cryopreservation for non-medical reasons. METHODS: Cross-sectional electronic survey in 248 Swiss women aged 15-35 years, nationally representative for educational level. RESULTS: Most women did not worry about an age-related fertility decline. Two-thirds of women would consider using hormone therapy (HT) for menopausal symptom relief although concerns about side effects and risks were still high. Acceptance of cryopreservation of oocytes (19%) or ovarian tissue (13%) for postponing fertility or menopause was generally low, but increased (37%) if both goals could be achieved with one surgery. Cryopreservation of ovarian tissue for postponing menopause was acceptable for 22% of women. Not having a suitable partner until age 35 increased the likelihood of considering postponing fertility by cryopreservation (p < 0.001) and had a stronger impact on that decision than the factor "pursuing a career" (p < 0.001). CONCLUSION: More education on age-related fertility decline, menopause and HT (benefit-risk ratio) is needed. Furthermore, the political and socioeconomic discussion should focus on women's needs, especially on compatibility of career and family.

Illness perception in overweight and obesity and impact on bio-functional age.

PURPOSE: Obesity is pandemic. Yet, the success of most weight loss programmes is poor. The aim of the study was to assess illness perception in overweight/obese people and its impact on bio-functional age (BFA) reflecting physical, mental, emotional and social functioning. METHODS: 75 overweight/obese subjects from the cross-sectional Bern Cohort Study 2014 were included. Participants followed a validated "bio-functional status" test battery amended by the validated questionnaires Patiententheoriefragebogen (illness perception) and AD-EVA (eating and movement behaviour). BFA was calculated in subjects aged ≥ 35 years (n = 56). RESULTS: (1) Mental occupation with the cause of overweight/obesity was generally moderate to high, but decreasing with age. (2) The predominant theories for being overweight/obese were health behaviour (58.7%) and psychosocial factors (33.3%). (3) Overweight/obese people with psychosocial theories on illness causes were more likely to have emotional or disinhibited eating patterns. (4) Cognitive control of eating patterns increased with age in both sexes. (5) Overweight/obese people were still bio-functionally younger than their chronological age (8.6 ± 0.8 year equivalents), although (6) quality of life was below average and (7) the risk for functional pro-aging was increased in those being especially mentally occupied with causes for overweight/obesity (r = 0.38, p < 0.001) and those having psychosocial (r = 0.32, p < 0.05) or naturalistic theories (r = 0.47, p > 0.001). CONCLUSIONS: Consciously perceived psychosocial stress was found to be a main factor to disturb health and promote unhealthy cognitive patterns regulating eating and moving habits. Thus, successful weight reduction programmes should integrate subjective illness perceptions to not only improve the therapeutic outcome, but also functioning (BFA).

Serum and follicular fluid testosterone concentrations do not correlate, questioning the impact of androgen supplementation on the follicular endocrine milieu.

Basic research into a possible link between serum and follicular fluid androgen concentrations to detemine whether androgen supplementation in low responders affects follicular endocrine milieu is still lacking. Ninety-seven women (aged 28-43 years) undergoing one natural IVF cycle without any hormone stimulation were analysed. Serum and follicular fluid were collected at the time of follicle aspiration, and the concentrations of LH, total testosterone, oestradiol, dehydroepiandrosterone and anti-Mullerian hormone (AMH) were determined. Serum LH (P = 0.003) and AMH (P = 0.026) concentrations, and follicular fluid AMH (P = 0.015) decreased with increasing age. Within follicular fluid, total testosterone was correlated with oestradiol (P < 0.001) and AMH (P = 0.010); LH correlated with AMH (P = 0.005). Correlation analysis of serum and follicular fluid hormone concentrations revealed that LH, oestradiol and AMH correlated (P < 0.001), whereas testosterone did not. Testosterone serum concentrations did not correlate with other follicular fluid hormones, such as dehydroepiandrosterone, oestradiol and AMH, whereas serum LH correlated with follicular flulid AMH (P < 0.008). Follicular fluid hormone concentrations seem to be independent from serum testosterone. Therefore, it is questionable whether an increase in serum testosterone concentration by androgen supplementation could improve the follicular endocrine milieu.

Higher prevalence of vitamin D deficiency in German pregnant women compared to non-pregnant women.

PURPOSE: Adequate vitamin D status is crucial for normal development of the fetus and for maternal health. As data on vitamin D status (25-hydroxyvitamin D, 25(OH)D) in German women of different states of pregnancy were not available, this study compared the vitamin D status of German women in all trimesters of pregnancy with that of non-pregnant women. METHODS: The study sample of 858 women (18-45 years) was recruited from April 2013 to March 2015 as a part of the cross-sectional Germany-wide VitaMinFemin study. Serum 25(OH)D levels were determined using chemiluminescence immunoassay. RESULTS: A total of 78.1% of the pregnant women and 53.9% of the non-pregnant women had a vitamin D status <50.0 nmol/L (p < 0.001). In pregnant women, the multivariate binary analysis showed that winter [odds ratio (OR) 13.5], longitude of residence between 6.3°E and 8.9°E (OR 2.0) or 9.0°E and 10.9°E (OR 2.3) and third trimester (OR 2.3) were associated with a higher risk of vitamin D status <25.0 nmol/L, whereas increasing age per one year (OR 0.9) with a lower risk. Compared with non-pregnant women, pregnant women were 3.7 times more likely to have a vitamin D status <25.0 nmol/L. CONCLUSION: A low vitamin D status is prevalent among German pregnant women and should be improved to supply mother and fetus adequately.

Has a mixture of amino acids and micronutrients influence on glucose metabolism and dietary fatty acid pattern in chronic psychosocially stressed persons? A pilot study.

Brain food, e.g. L-tryptophan, antioxidative substances, B vitamins and magnesium are thought to be beneficial for obesity, inflammation and insulin resistance. In the present pilot study we hypothesised that a specific amino acid mixture with micronutrients improves the cardiometabolic situation of chronically stressed persons. Cardiovascular and metabolic parameters were analysed as per protocol in 32 patients. Chronic stress disorders in the same patients were assessed by a psychological neurological questionnaire (PNF). After dietary intervention a reduction of the fasting serum insulin concentrations occurred in the treatment group. An association was found between PNF values, insulin concentrations at baseline and an insulin reduction after 12 weeks. The results support the use of our specific dietary supplement for improved stress management and a decrease in metabolic dysfunction.

Placebo-controlled dietary intervention of stress-induced neurovegetative disorders with a specific amino acid composition: a pilot-study.

BACKGROUND: Psychosocial stress leads to altered neuroendocrine functions, such as serotonergic dysfunction, as well as alterations of the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA)-axis activity resulting in an imbalance between inhibitory and excitatory neurotransmitters. Poor dietary intake of L-tryptophan as a precursor of serotonin increases sensitivity to stress. METHODS: This randomized, double-blind, placebo-controlled study investigated the effect of a specific amino acid composition with micronutrients on neurovegetative disorders and the cardiometabolic risk profile in psychosocially stressed patients. 32 patients (18-65 years) were eligible for protocol analysis. Points in the Psychological Neurological Questionnaire (PNF), clinical and blood parameter, in particular the serotonin level, salivary cortisol levels, and dietary intake were evaluated at baseline and 12 weeks after supplementation. RESULTS: The intervention in the form of either verum or placebo resulted in both groups in a significant decrease of neurovegetative symptoms. However, patients of the placebo group achieved significantly less points in the PNF compared to the verum group. But the rate of responders (≥10 points loss in PNF) was not significantly different between the groups. The macronutrient intake did not differ between verum and placebo group. On average, the HPA-axis was not disturbed in both groups. Blood serotonin indicated in both groups no significant correlation with dietary tryptophan intake or PNF. CONCLUSIONS: Daily supplementation of a specific amino acid composition with micronutrients in psychologically stressed patients resulted in no improvement of neurovegetative disorders as measured by the PNF when compared to the placebo group. TRIAL REGISTRATION: Clinical Trials.gov ( NCT01425983 ).

Vitamin Intake from Food Supplements in a German Cohort - Is there a Risk of Excessive Intake?

Food supplements, if not properly used, may lead to potentially harmful nutrient intake. The purpose of this survey was to examine vitamin intake from food supplements. Taking into account the intake from food, as obtained from the National Nutrition Survey, it was determined whether the tolerable upper intake levels (ULs) were exceeded via supplements alone, or in combination with food. Data from 1070 supplement users (18-93 years) was available. The dietary and supplemental vitamin intakes of three groups were analyzed: average intake (50th percentile food+50th percentile supplements), middle-high intake (50th+95th) and high intake (95th+95th). Vitamin C (53%), vitamin E (45%) and B vitamins (37-45%) were consumed most frequently. Few subjects (n=7) reached or exceeded the ULs through supplements alone. The UL for vitamin A and folate was reached by a few men in the middle-high group, and by a few men and women in the high intake group. Otherwise, even in the high intake group, the recommended vitamin D intake of 20 µg/day (in case of insufficient endogenous synthesis) could not be achieved. The use of food supplements was not associated with excessive vitamin intake in this survey, except in a small number of cases. Vitamin A intake above the UL was the result of high dietary intake which also included the intake of ß-carotene, rather than the result of overconsumption of food supplements. Diets mainly included folate from natural sources, which has no associated risk.

Measuring Quality of Life: Incorporating Objectively Measurable Parameters within the Cross-Sectional Bern Cohort Study 2014 (BeCS-14).

Up until now, the measurement of Quality of Life (QoL) was based on validated subjective rating tools rather than objective measurement. To become more independent of the self-assessment of probands, a way to objectively measure QoL should be found. A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the bio-functional status (BFS), a complex, generic, non-invasive, sex- and age-validated assessment tool, in a wide range of areas. A standardized battery of assessments was performed on 464 females and 166 males, ages 18 to 65 (n = 630). In addition to the survey of the BFS, participants replied-among others-to the validated questionnaire SF-36 for health-related QoL (n = 447, subgroup 1). Since the accepted cut-off value for BFA calculation is age ≥ 35 years, subgroup 2 included 227 subjects (all participants aged ≥ 35 years out of subgroup 1). In order to be able to compare the eight SF-36 subscales to BFS parameters, a comparable score set of single BFS items had to be constructed. Subsequently, we aimed to statistically identify BFS item combinations that best represented each SF-36 subscale. All eight SF-36 subscales were significantly represented by various different combinations of BFS items. A total of 24 single BFS items significantly correlated with SF-36 subscales, of which 15 were objective and nine were subjective. All eight SF-36 subscales were significantly represented by various different combinations of BFS items leading to stronger correlations (range five to nine BFS items), and overall, sex and age did not affect these associations, but in the SF-36 subscales 'bodily pain' (sex) and 'role limitations due to physical health problems' (age in men). To our knowledge, we are the first to correlate a validated set of 34 objective and 9 subjective parameters with subjectively evaluated SF-36 subscales. This first study on the objectifiability of the SF-36 questionnaire demonstrated that questions on quality of life can be answered independently of a subjective assessment by subjects in future scientific studies.

Immune Response to Molecular Radiotherapy with 177Lu-DOTATOC: Predictive Value of Blood Cell Counts for Therapy Outcome.

Purpose: In a prior, retrospective study, 76% of patients with advanced neuroendocrine tumors undergoing 177Lu-DOTATOC molecular radiotherapy (MRT) showed their best response within 8 months from the first MRT cycle. In 24% of patients, latency was much greater up to >22 months after the first cycle, and long after near-complete decay of 177Lu from the last cycle. An immune response induced by MRT seems a likely explanation. As a crude measure of immunocompetence, the authors investigated whether blood cell counts (BCCs) may have predictive value for MRT outcome with 177Lu-DOTATOC. Methods: 56 Patients with neuroendocrine tumors (NET) were administered 177Lu-DOTATOC (mean 2.1 cycles; range 1-4) with median radioactivity of 7.0 GBq/cycle at 3-month intervals. Patients' BCCs were evaluated for four responder categories: CR, PR, SD, and PD (RECIST 1.1). Furthermore, baseline BCCs were correlated with progression-free survival (PFS). Finally, BCCs of patients with (PMT+) and without prior medical therapy (PMT-) were compared. Results: Significant differences between responder categories were found for baseline hemoglobin (Hb), erythrocytes, neutrophils, lymphocytes, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and LEHN-score, integrating lymphocyte, erythrocyte, and neutrophil counts, and Hb level, but not for leukocytes and platelets. LEHN-score yielded an almost complete separation between CR and PD groups. In analogy, PFS times showed significant correlations with baseline Hb, erythrocytes, neutrophils, lymphocytes, NLR, PLR, and LEHN-score, the LEHN-score showing the strongest correlation, but not with leukocytes and platelets. For PMT- patients, median PFS was 34.5 months, compared with 20.8 months in PMT+ patients, with corresponding baseline lymphocyte (32.1 ± 9.6% vs. 24.5 ± 11.6%, p = 0.028) and neutrophil (54.9 ± 11.6% vs. 63.5 ± 13.7%, p = 0.039) counts. Conclusion: These findings emphasize the significance of an immune response to MRT for obtaining optimal therapy efficacy and support concepts to enhance the immune response of less immunocompetent patients before MRT. It seems advisable to avoid prior or concomitant immunosuppressant medical therapy.

Unmet Clinical Needs in Women with Aesthetic Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Study.

Background: Polycystic ovary syndrome (PCOS) management has hardly been standardized until recent years. There is an accurate, evidence-based guideline published by the European Society of Human Reproduction and Embryology (ESHRE). However, it remains unclear to which extent, if at all, the guideline is followed by health care providers. The aim was to explore the subjectively perceived quality of gynecological medical care in women with PCOS suffering from aesthetic complaints. Materials and Methods: A nonvalidated questionnaire was constructed in a standardized manner covering the domains: aesthetic aspects, metabolism, menstrual cycle, reproduction, mental health, and prevention of chronic noncommunicable diseases. Results: A total of 1960 participants with aesthetic complaints, such as acne (66.2%), alopecia (43.9%), hirsutism (77.9%), or overweight/obesity (72.3%) were included. The percentage of women being counseled was low (acne 20.3%, alopecia 12.9%, hirsutism 17.5%, overweight/obesity 36.2%). Satisfaction with counseling was moderate (40.4-44.1 points). Many women tried at least one therapeutic method (75.9%), whereas only a few were counseled for therapy (acne 27.0%, alopecia 24.6%, hirsutism 24.0%, overweight/obesity 18.8%) with moderate satisfaction for hyperandrogenism (mean 55.1-59.5 points) and good satisfaction for overweight/obesity (mean 60.8 points). Overall satisfaction was rated with a mean of 30.5 points (standard deviation 27.1) on a scale from 0 to 100 and thus considered "not satisfied." Fewer complaints were significantly correlated with higher satisfaction. Most women wished for more counseling (80.8%), as well as more diagnostic (63.2%) and therapeutic options (70.2%). Conclusions: Women affected by PCOS are not properly managed according to the ESHRE guideline. Indeed, this guideline recommends comprehensive history and physical examination for clinical hyperandrogenism as well as holistic approaches in therapy, including education and counseling of patients. Still, overall consultation rates and satisfaction were poor.

Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study.

Aim: The national Olympic committee of Switzerland has conducted an online survey among female elite athletes with a focus on cycle disorders, contraception, and injuries in 2021. Methods: A total of 1,092 female elite athletes from 107 different sports were asked to answer the questionnaire. A descriptive analysis was carried out to determine location parameters and create frequency tables. Results: The questionnaire was completed by 408 athletes (37.4%) from 92 different sports. 43.4% participated in a lean sport. 57.1% reported no injuries, 32.6% one injury, and 10.2% two or more injuries per year. A considerable proportion reported being affected by primary amenorrhoea (10.8%). Primary amenorrhoea occurred significantly more often in female athletes with a BMI lower than 21.7 kg/m2 (15.2%) than in athletes with a BMI above 21.7 kg/m2 (7.4%, p = 0.021). Considering contraception, 25.8% of female athletes were currently using an oral contraceptive pill. The proportion of female athletes not using contraception at all or using non-hormonal contraceptive methods was high at 54.4%. In lean sports, significantly more athletes used no or non-hormonal contraceptives (p < 0.05). Conclusion: Among top Swiss female athletes, a considerable proportion used non-hormonal or no contraceptives. This trend was more evident in lean sports. Delayed menarche and cycle irregularities were common among female athletes, especially among athletes with high training volumes as well as a BMI below 21.7 kg/m2. This orienting survey underlines the importance of specialized gynecological care for elite female athletes.

Exploratory analysis of the effect of a controlled lifestyle intervention on inflammatory markers - the Healthy Lifestyle Community Programme (cohort 2).

BACKGROUND: Chronic low-grade inflammation is associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a healthy lifestyle intervention on biomarkers of inflammation (among other risk markers). METHODS: We conducted a non-randomized controlled trial with mostly middle-aged and elderly participants from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme focusing on diet (largely plant-based; strongest emphasis), physical activity, stress management, and social support. High-sensitivity C-reactive protein (hs-CRP) was assessed at baseline, 10 weeks, 6 months, and 1 year. Homocysteine (Hcy) was assessed at baseline, 10 weeks, and 1 year. Adiponectin (Apn) was assessed at baseline and 10 weeks. An exploratory analysis of these inflammatory markers assessing the between-group differences with ANCOVA was conducted. RESULTS: The 1-year trajectory of hs-CRP was significantly lower in the intervention group compared to control (between-group difference: -0.8 (95% CI -1.2, -0.3) mg/l; p = 0.001; adjusted for baseline). The 1-year trajectory of Hcy was non-significantly higher in the intervention compared to control (between-group difference: 0.2 (95% CI -0.3, 0.7) µmol/l; p = 0.439; adjusted for baseline). From baseline to 10 weeks, Apn decreased significantly more in the intervention group compared to control (between-group difference: -1.6 (95% CI -2.7, -0.5) µg/ml; p = 0.004; adjusted for baseline). CONCLUSIONS: Our study shows that healthy lifestyle changes can lower hs-CRP and Apn levels and are unlikely to significantly affect Hcy levels within 1 year. TRIAL REGISTRATION: German Clinical Trials Register (DRKS; reference: DRKS00018775 , registered 12 Sept 2019; retrospectively registered; www.drks.de ).

Effect of Two Different Dietary Weight Loss Strategies on Risk Factors for Urinary Stone Formation and Cardiometabolic Risk Profile in Overweight Women.

Overweight has been suggested to increase the risk of kidney stone formation. Although weight reduction might affect risk factors for urolithiasis, findings on the impact of different dietary weight loss strategies are limited. This randomized, controlled study evaluated the effect of a conventional energy-restricted modified diet with (MR group) or without meal replacement (C group) on risk factors for stone formation in overweight women without a history of urolithiasis. Of 105 participants, 78 were included into the per-protocol analysis. Anthropometric, clinical, biochemical, and 24 h urinary parameters were collected at baseline and after 12 weeks. Although both dietary interventions resulted in a significant weight reduction, relative weight loss and rate of responders were higher in the MR group. Weight loss improved cardiometabolic risk profile in both groups. Unfortunately, the benefit of decreased GPT activity in the C group was offset by a significant increase in homocysteine and a decline in GFR. While the relative supersaturation of calcium oxalate decreased significantly in both groups, a significant decline in serum uric acid concentration and relative supersaturation of uric acid was observed only in the MR group. Finally, the energy-restricted modified diet with meal replacement showed significant advantages over the energy-restricted modified diet alone.