International Journal of Women's Health最新文献

Purpose: Perinatal mood and anxiety disorders (PMADs) are the leading cause for maternal morbidity and are associated with underlying causes of pregnancy-related death. Healthy Start (HS) programs around the country seek to lower the risk of maternal mortality through services that screen for and address social determinants of health, including mental health. This study used secondary data from the University of Houston Healthy Start (UHHS) to examine postpartum depression screening and referral rates among program participants and feedback from participating mothers about the program's mental health services.

Patient and methods: Secondary quantitative data from the program's administration of services (n = 164) and secondary qualitative data from a sub-set of program participants (n = 23) were analyzed. Using data from the standardized HS tools (required for all sites), aggregate demographic data and screening results of depression and interpersonal violence were assessed. Anonymous qualitative data from focus groups were analyzed for themes related to mental health.

Results: Screening for postpartum depression was 97% with a 78% referral rate. Screening for interpersonal violence (IPV), a known correlate of PMADs, was 98% with a 100% referral rate for the 4 women who screened positive for IPV. Qualitative themes revealed close-knit relationships with case managers and doulas that encouraged disclosure of symptoms, honest discussions, and an increased desire to ask for help when needed. Emergent themes revealed that Persistence and authenticity were critical to gain participant trust; a culture of sisterhood positively participants' mental health; and case managers were proactive with emotional support and resource referral.

Conclusion: High rates of mental health screening and referral at the UHHS site were documented and participant stories revealed that trust with case managers was instrumental to their wellbeing. More robust data is needed to allow statistical comparisons are needed in future research.

Primary vulvar adenocarcinoma of mammary gland type (AMGT) is exceedingly rare and presents significant diagnostic challenges. We report the case of a 70-year-old female with a nodular vulvar lesion, confirmed as vulvar AMGT through comprehensive histological and immunohistochemical analysis. The tumor cells were positive for SOX10, TRPS1, and E-cadherin, and negative for ER, PR, and HER-2/neu, ruling out metastatic breast carcinoma. This case underscores the importance of specific markers like TRPS1 in accurately diagnosing rare vulvar malignancies and guiding effective treatment strategies. Further studies are needed to better understand the pathogenesis and clinical characteristics of vulvar AMGT.

Background: Spontaneous heterotopic pregnancy is an uncommon and possibly serious problem characterized by maternities at unique implantation sites, with only one occurring in the intrauterine cavity. Its incidence is approximately 1 in 30,000 natural pregnancies, posing significant threats to maternal health. The complexity of clinical and laboratory findings complicates its diagnosis, necessitating a high index of suspicion for prompt intervention.

Case presentation: We reported the case of a 36-year-old woman diagnosed with heterotopic pregnancy at 12 weeks of gestation following spontaneous conception, who presented with severe abdominal pain. Initial beta-human chorionic gonadotropin (β-hCG) levels were 57,278.00 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single live fetus in the uterus, estimated at 12 weeks and six days, alongside a thick-walled cystic structure in the right ovary and an irregular hypoechoic mass inferior to the right ovary. An urgent laparoscopic salpingectomy was performed under general anesthesia, revealing a distended right fallopian tube (3.5 cm) with a thickened appearance, bluish-purple discoloration, and a 2 mm rupture with active bleeding surrounded by clots. Histopathological examination confirmed ectopic pregnancy. Postoperative β-HCG levels were 49,213 mIU/mL and 57,577 mIU/mL on the second and third days, respectively.

Conclusion: Clinicians should maintain vigilance for heterotopic pregnancy, especially in the absence of infertility treatments or known risk factors. Lower quadrant abdominal or pelvic pain should prompt consideration of heterotopic pregnancy, as the presence of an intrauterine pregnancy does not exclude a concurrent ectopic pregnancy.

Introduction: Endometriosis is a chronic gynecological disorder that significantly impacts women of reproductive age. Recent evidence suggests a bidirectional link between endometriosis and brain functional networks, though the causal mechanisms remain unclear. This study aims to explore these relationships using Mendelian Randomization (MR) analysis.

Methods: Data from 191 resting-state functional MRI (rsfMRI) phenotypes and endometriosis genetic datasets were analyzed using both forward and reverse MR approaches. Genetic Instrument Selection was performed to identify valid instrumental variables, ensuring their independence from confounders and strong association with the exposure. Sensitivity analyses were conducted to ensure the robustness of the findings.

Results: Forward MR analysis identified three brain networks (Pheno20, Pheno38, Pheno44) significantly associated with endometriosis risk (P _FDR < 0.05). Notably, Pheno38 activity was inversely associated with fallopian tube endometriosis, whereas Pheno20 and Pheno44 were positively linked to adenomyosis. Reverse MR analysis revealed that endometriosis of the ovary was inversely associated with functional connectivity in Pheno932, a network involved in cognitive and attention processes. Sensitivity analyses confirmed the reliability of these results.

Discussion: This study highlights a complex bidirectional relationship between brain functional networks and endometriosis. Increased activity in specific networks may protect against or predispose individuals to certain subtypes of endometriosis. Conversely, endometriosis also can influence brain connectivity, potentially contributing to cognitive and emotional symptoms.

Background: The progression of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer is accompanied by a reduction in the immune response. The objectives of the study were to determine whether colposcopic lesion area is associated with serum levels of cytokines IL (interleukin) -1, IL-6, IL-8, IL-10, IL-12 and TNF-α in precursor lesions of cervical cancer.

Methods: The study population comprised patients with high-grade squamous intraepithelial lesion who had undergone colposcopy, cervical biopsy, and measurements of serum cytokines by ELISA (Enzyme-Linked Immunosorbent Assay). Genotyping for HPV (human papillomavirus) 16, 18, 45 and 52 was performed by PCR (Polymerase Chain Reaction). ROC (Receiver Operating Characteristic) curves were calculated to determine whether there existed a cut-off value for serum cytokines in patients with colposcopic lesion area smaller vs larger than 1 cm². For cytokines with significant results, these cut-off values were used to perform the multivariable analysis.

Results: There were 71 patients with CIN 2/3. ROC curves were calculated to verify a cut-off value for serum cytokine levels that could be used to distinguish between lesion areas <1 cm2 vs ≥1 cm2. Values with statistical significance were IL-1 >13.3 pg/mL and IL-12 ≤349.6 pg/mL. In the multivariable analysis, the independent variables associated with colposcopic lesion area greater than 1cm² were IL-1>13.3 pg/mL and IL-12 ≤349.6 pg/mL [OR (95% CI) = 10.10 (1.50-67.96); OR (95% CI)=10.70 (1.17-97.45), respectively].

Conclusion: Although CIN 2/3 is a local uterine cervix lesion, there is a systemic immunological response. Our results are unprecedented and could be the target of new important studies in public health and cervical cancer prevention.

Background & aims: There is a growing focus on the role of dietary factors and metabolic conditions in the evolution and progression of iron deficiency (ID), yet few studies have examined the underlying mechanisms. Dietary Inflammatory Index (DII) is a metric that gauges the inflammatory potential of an overall diet. This study explores the association between DII and triglyceride glucose-body mass index (TyG-BMI) with ID in reproductive-age women.

Methods: This analysis utilized data from 2311 reproductive-age women in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. ID was identified using serum ferritin and transferrin receptor (TfR). The association between DII, TyG-BMI and ID was assessed using weighted logistic regression, linear regression and restricted cubic spline (RCS) models, with receiver operating characteristic (ROC) curve analysis for diagnostic power. Mediation effects of TyG-BMI were further explored by causal mediation analysis.

Results: Among reproductive-age women, both DII and TyG-BMI were significantly positively associated with ID (DII: OR = 1.32, 95% CI 1.19, 1.48; TyG-BMI: OR = 1.13, 95% CI 1.02, 1.35). There is a close relationship between the DII index and TfR (β= 1.17, 95% CI 1.03, 1.13). RCS analysis indicated that the relationships were mostly linear (P-overall < 0.05, P-nonlinear > 0.05). Furthermore, TyG-BMI mediated 5.19%, 12.83%, and 5.63% of the associations between DII and ID, Ferritin, and transferrin receptor (TfR), respectively.

Conclusion: The findings suggest that targeted interventions to enhance dietary practices, nutritional intake, and overall metabolic well-being may result in substantial amelioration of ID among reproductive women.

Objective: To evaluate the association between background parenchymal enhancement (BPE) level and extent on contrast-enhanced mammography (CEM) with age, menopausal status, breast density, and menstrual cycle phase in women. Additionally, to characterize the dynamic changes in BPE during CEM.

Methods: This retrospective study included 103 women who underwent CEM at a single institution between September 2019 and November 2021 for screening or diagnostic purposes. Menopausal status and menstrual cycle phase were recorded for all patients. BPE on subtracted CEM images was assessed quantitatively (region of interest [ROI] analysis of pixel values) and qualitatively (subjective classification). Statistical analysis was performed to determine the relationship between BPE (level and extent) and age, menopausal status, breast density, and menstrual cycle phase. Dynamic changes in BPE level over time were also analyzed.

Results: Both BPE level and extent were negatively correlated with age (P=0.004, r=-0.280; P=0.001, r=-0.318). Postmenopausal women exhibited lower BPE level and extent compared to premenopausal women (P=0.003, Z=-2.958; P=0.042, 2=4.123). No significant association was observed between BPE and breast density or menstrual cycle phase (P>0.05). BPE level increased significantly from 3 to 9 minutes post-contrast injection (P<0.001, t=-10.7).

Conclusion: BPE in CEM is significantly associated with age and menopausal status. Further research is needed to clarify the relationship between BPE and breast density and menstrual cycle phase. BPE demonstrates a dynamic increase in level over time, this relates to post-contrast injection, rather than to the age of the woman.

Background: Fear of childbirth (FOC) is a psychological state of fear and distress that pregnant women experience when they approach labor. This fear can have significant negative effects on both the mother and the newborn, making it crucial to study the influencing factors of FOC to implement early interventions.

Objective: First, identify the risk factors for FOC occurrence, then construct a predictive model for FOC and evaluate its predictive efficiency.

Methods: A total of 901 pregnant women who underwent regular prenatal check-ups at Anhui Women and Children's Medical Center were selected. Participants completed questionnaires. General information and relevant medical data of the patients were collected for data aggregation. The data was randomly divided into a training set (n = 632) and a testing set (n = 269) in a 7:3 ratio. Univariate analysis of risk factors for FOC was performed on the training set data. Using univariate logistic regression and multivariate logistic regression to analyze the risk factors associated with the occurrence of FOC, we constructed a FOC risk predictive model via ten different machine learning methods and evaluated the predictive performance of the model.

Results: Our study indicated that educational level, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, assisted reproduction, income, payment, SAS scores, and age are independent risk factors for FOC. The risk predictive model included six factors, such as gravidity, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, payment, and SSRS scores. The model was built using ten types of machine learning and was evaluated to perform well.

Conclusion: Gravidity, history of adverse pregnancy outcomes, history of cesarean section, planned pregnancy, payment method, and SSRS score are risk factors for FOC in late-pregnancy women. The risk predictive model established in this study has a high clinical reference value.

Purpose: Therapeutic options for patients with platinum-resistant ovarian cancer (PROC) remain a major unmet need. PROC patients with multiple recurrences are unable to continue highly toxic treatment after prior multiple lines of systemic therapy. Chemotherapy-free option lenvatinib plus anti-programmed cell death protein-1 (PD-1) combination therapy has shown promising results in several malignancies including ovarian cancer, but the toxicity of a high starting dose of lenvatinib is also notable and needs to be improved. Our previous pilot study indicated that a reduced starting dose of lenvatinib may maintain comparable anti-tumor activity with favorable safety in heavily pre-treated ovarian cancer. This study is designed to further validate the efficacy and safety of the combination therapy of low-dose lenvatinib and PD-1 inhibitor toripalimab in patients with recurrent PROC.

Study design and methods: The study is designed as a multicenter, open-label, single-arm, prospective phase II study. Patients with recurrent epithelial ovarian cancer who have disease progression either during or within 6 months after completion of platinum-based therapy will be included. A total of 69 participants will receive low-dose lenvatinib (8 mg or 12 mg, daily, orally, based on patient's body weight) and toripalimab (240 mg, every 21 days, intravenously). Treatment will continue until the development of unacceptable toxicity or disease progression. The primary endpoint is the progression-free survival. The secondary endpoints include objective response rate, duration of response, disease control rate, overall survival, toxicity and patients' quality of life. Exploratory objectives aim to identify biomarkers and molecular signatures for predicting response or prognosis.

Introduction: Postpartum depression (PPD) is a mood disorder characterized by symptoms such as changes in sleep and eating patterns, fatigue, sadness, crying, anxiety, and guilt. The Edinburgh Postnatal Depression Scale (EPDS) was developed to be used as a self-report questionnaire for English-speaking populations to screen for postnatal depression. This study aims to translate, validate, and adapt the EPDS into Eritrean settings.

Methods: This study employed a cross-sectional study design to evaluate the performance of the EPDS as a screening tool by using a sample of 380 mothers from four primary healthcare facilities. The standard Diagnostic and Statistical Manual of Mental Disorders was used as a criterion to assess depression in postpartum women.

Results: Postpartum depression was identified in 28 (7.4%) of the mothers based on the standard Diagnostic and Statistical Manual of Mental Disorders. The translated Tigrinya version EPDS has good internal consistency with Cronbach's alpha of 0.712. The exploratory factor analysis identified three factors, confirming the EPDS's multidimensionality. The area under the receiver operating characteristic curve was 0.87, and optimal sensitivity and specificity combination was found at 10/11 score cut-off points, 85.7% and 88%, respectively.

Conclusion: The Eritrean version of EPDS has proven to be a valid and reliable instrument for the identification of postpartum depression in clinical settings.