The role of PCOS in mental health and sexual function in women with obesity and a history of infertility

STUDY QUESTION: Do mental health and sexual function differ between women with or without polycystic ovary syndrome (PCOS) with comparable BMI and fertility characteristics? SUMMARY ANSWER: Women with PCOS have a poorer mental quality of life than women without PCOS, but there were no differences in symptoms of depression, anxiety, physical quality of life or sexual function. WHAT IS KNOWN ALREADY: Various studies suggest that women with PCOS have poorer mental health, such as higher symptoms of anxiety and depression with a lower quality of life, and have an impaired sexual function compared to women without PCOS. However, in most studies, BMI and infertility status differ between women with and without PCOS, which may hamper comparability. STUDY DESIGN, SIZE, DURATION: This study is a cross-sectional analysis of a 5-year follow-up of a randomized controlled trial (RCT) among women with obesity and a history of infertility. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants in this follow-up study of an RCT were women with obesity and infertility randomized to a lifestyle intervention followed by infertility treatment or prompt infertility treatment (control), stratified by ovulatory status and trial centre. In total, 173 (30.0%) women of the 577 women randomized in the initial trial participated in this follow-up study, with a mean follow-up of 5.5 years (range 3.7–7.0 years); of these women 73 had been diagnosed with PCOS and 100 did not have PCOS. Participants completed questionnaires on symptoms of anxiety and depression (Hospital Anxiety and Depression scale (HADS)), quality of life (36-item Short Form Health Survey (SF-36)) and sexual function (McCoy Female Sexuality Questionnaire (MFSQ)). We also compared quality of life subscale scores in women with and without PCOS and compared them to an age-matched Dutch reference population with average BMI. Effect sizes were calculated to assess the differences. MAIN RESULTS AND THE ROLE OF CHANCE: Symptoms of anxiety and depression, physical quality of life and sexual function did not differ significantly between obese women with and without PCOS. However, women with PCOS had a worse mental quality of life summary component score (−3.60 [95% CI −6.72 to −0.56]), mainly due to a lower score on the subscale ‘role limitations due to emotional problems’ (−12.41 [95% CI −22.78 to −2.28]), compared to women without PCOS. However, compared to an age-matched Dutch reference population, the obese infertile women with and without PCOS both scored lower on almost all physical and mental quality of life subscales. LIMITATIONS, REASONS FOR CAUTION: These are secondary analyses of the follow-up study of the RCT. No power analysis was performed for the outcomes included in this analysis and, as our study had a relatively small sample size, the null findings could be based on insufficient power to detect small differences between the groups. Our study population had a high mean BMI (average total group 34.5 [SD ± 5.1]); therefore, our results may only be generalizable to women with obesity. WIDER IMPLICATIONS OF THE FINDINGS: Our results indicate that PCOS status is associated with impaired mental quality of life. Anxiety and depression, physical quality of life and sexual function in obese infertile women with PCOS seem more related to the obesity than the PCOS status. STUDY FUNDING/COMPETING INTEREST(S): The initial study and follow-up were supported by grants from: ZonMw (50-50110-96-518), the Dutch Heart Foundation (2013T085) and the European Commission (633595). The Department of Obstetrics and Gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands, outside the submitted work. A.H. reports consultancy for Ferring pharmaceuticals. B.W.J.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.J.M. reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet. All other authors declare no competing interests. TRIAL REGISTRATION NUMBER: The initial trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530

Seasonal pattern of regional carbon balance in the central Rocky Mountains from surface and airborne measurements

[1] High-elevation forests represent a large fraction of potential carbon uptake in North America, but this uptake is not well constrained by observations. Additionally, forests in the Rocky Mountains have recently been severely damaged by drought, fire, and insect outbreaks, which have been quantified at local scales but not assessed in terms of carbon uptake at regional scales. The Airborne Carbon in the Mountains Experiment was carried out in 2007 partly to assess carbon uptake in western U.S. mountain ecosystems. The magnitude and seasonal change of carbon uptake were quantified by (1) paired upwind-downwind airborne CO2 observations applied in a boundary layer budget, (2) a spatially explicit ecosystem model constrained using remote sensing and flux tower observations, and (3) a downscaled global tracer transport inversion. Top-down approaches had mean carbon uptake equivalent to flux tower observations at a subalpine forest, while the ecosystem model showed less. The techniques disagreed on temporal evolution. Regional carbon uptake was greatest in the early summer immediately following snowmelt and tended to lessen as the region experienced dry summer conditions. This reduction was more pronounced in the airborne budget and inversion than in flux tower or upscaling, possibly related to lower snow water availability in forests sampled by the aircraft, which were lower in elevation than the tower site. Changes in vegetative greenness associated with insect outbreaks were detected using satellite reflectance observations, but impacts on regional carbon cycling were unclear, highlighting the need to better quantify this emerging disturbance effect on montane forest carbon cycling

Obesity and associated reproductive conditions in women

Obesity is a worldwide public health problem and has extensive adverse effects on mental and physical health. In women of reproductive age, obesity additionally lowers pregnancy chances and increases the rate of pregnancy complications. Pregnancy complications can have negative effects on their offspring and children of obese mothers have a high risk of becoming obese themselves. Preconception lifestyle interventions could lower the negative effects of obesity on women’s health and their pregnancy, because women with a wish to conceive might be more motivated to change their lifestyle. Part one of this dissertation describes studies evaluating the effects of a preconception lifestyle intervention on cardiometabolic health, mental well-being, sexual function and quality of life, with a short and long-term perspective. Part two of this dissertation comprises three systematic reviews that incorporate all available evidence on the effect of obesity, obesity-associated reproductive diseases (polycystic ovary syndrome and gestational diabetes) and their treatment on future health of women and their children

Dyscholesterolemia Protects Against Ischemia-Induced Ventricular Arrhythmias

FWN – Publicaties zonder aanstelling Universiteit Leide

Observations and Numerical Simulations of Subrotor Vortices during T-REX

High-resolution observations from scanning Doppler and aerosol lidars, wind profiler radars, as well as surface and aircraft measurements during the Terrain-induced Rotor Experiment (T-REX) provide the first comprehensive documentation of small-scale intense vortices associated with atmospheric rotors that form in the lee of mountainous terrain. Although rotors are already recognized as potential hazards for aircraft, it is proposed that these small-scale vortices, or subrotors, are the most dangerous features because of strong wind shear and the transient nature of the vortices. A life cycle of a subrotor event is captured by scanning Doppler and aerosol lidars over a 5-min period. The lidars depict an amplifying vortex, with a characteristic length scale of 500–1000 m, that overturns and intensifies to a maximum spanwise vorticity greater than 0.2 s−1. Radar wind profiler observations document a series of vortices, characterized by updraft/downdraft couplets and regions of enhanced reversed flow, that are generated in a layer of strong vertical wind shear and subcritical Richardson number. The observations and numerical simulations reveal that turbulent subrotors occur most frequently along the leading edge of an elevated sheet of horizontal vorticity that is a manifestation of boundary layer shear and separation along the lee slopes. As the subrotors break from the vortex sheet, intensification occurs through vortex stretching and in some cases tilting processes related to three-dimensional turbulent mixing. The subrotors and ambient vortex sheet are shown to intensify through a modest increase in the upstream inversion strength, which illustrates the predictability challenges for the turbulent characterization of rotors