International Journal of Women's Health最新文献

Purpose: Gene signatures offer superior power on prognosis and survival of patients over traditional single-gene biomarker. This study aimed to develop a nomogram based on an immunogenic cell death (ICD) and endoplasmic reticulum (ER) stress-related gene signature to predict the overall survival (OS) of patients with ovarian cancer (OC).

Materials and methods: ICD- and ER stress-related genes were identified from public datasets and previous publications. Candidate genes were screened through differential expression and survival analyses. A prognostic risk score was established using Cox and LASSO regression. The model's predictive performance was evaluated by Kaplan-Meier and multivariate analyses, and a nomogram was constructed to estimate individual survival probabilities.

Results: A seven-gene signature related to ICD and ER stress was developed to generate a prognostic risk score. Patients with low risk scores had significantly longer OS compared to high-risk patients. The signature correlated with immune features and remained an independent prognostic factor for OS in multivariate analysis. The prediction performance was good, with AUC values of 0.61, 0.64, and 0.67 for 1-, 2-, and 3-year OS in the training set, and 0.60, 0.61, and 0.60 in the validation set. The calibration curve showed good consistency between predicted and actual results.

Conclusion: We established a clinically applicable nomogram integrating a seven-gene ICD/ER stress signature to provide individualized survival prediction for OC patients. This tool may assist clinicians in risk stratification and personalized treatment planning.

Background: Lipedema is a relatively unknown condition, often leading to misdiagnosis and a lack of proper treatment.

Purpose: To explore the experiences of seeking healthcare support and treatment among women with a physician-verified diagnosis of lipedema.

Methods: Twelve women with lipedema, verified by medical examination, were interviewed using semi-structured interviews. The transcribed data was analyzed using qualitative content analysis with an inductive approach and abstracted to visualize manifest and latent meanings.

Results: The theme "Pushing the barricaded doors to treatment and care while fighting to illuminate the shadows of lipedema" describes the experiences of women being denied subsidized treatment and disregarded by healthcare professionals. The theme is based on three categories "Experiencing societal injustice and gatekeeping in healthcare services", "Combating prejudice and stigmatization with increased awareness", and "Having a solid desire for improved and affordable treatment options". Women with lipedema described feelings of being abandoned by decision-makers and healthcare. When in need of symptom relief, women with lipedema searched and attempted different therapies, and when treatment were available, the women would have to pay for it themselves.

Conclusion: Lipedema remains an unknown disease with few available treatments in subsidized healthcare. Lack of experience regarding lipedema among healthcare professionals and their failure to assess the condition risks damaging the confidence of affected women. Therefore, increased awareness and education of healthcare personnel to increase the clinical recognition of lipedema are necessary first steps to reducing misdiagnosis, improve patient satisfaction, and the availability of care among patients with lipedema.

Objective: Asymptomatic bacteriuria (ASB) is common in pregnant women and can lead to serious complications. During pregnancy, routine screening for bacteriuria is often not standard in many developing countries, leading to underdiagnosis. In Jordan, there is limited data on ASB in pregnant women. This study aimed to determine the prevalence, causative organisms, antibiotic sensitivity, and associations with maternal conditions and diseases.

Methods: This cross-sectional, prospective study conducted at Jordan University Hospital assessed the prevalence of ASB in pregnant women. Pregnant women aged ≥18 years at any trimester, without symptoms of urinary tract infection, and who had not utilized antibiotics for two weeks, were included. Midstream urine samples were collected, analyzed, cultured, and tested for antibiotic susceptibility in the hospital's Microbiology laboratory.

Results: Out of 319 women, 23.5% (n=76) showed positive urine culture. The chi-square and logistic regression analysis revealed that gestational age and grand multipara were associated with ASB. Neither diabetes nor hypertension (true or gestational) was associated with ASB. Fifty-one of the bacteriuria cases (68%) were positive for pure culture of Escherichia coli, and 4% were mixed with Gram-positive organisms. ASB due to Gram-negative organisms was significantly associated with older age group (p = 0.025). Furthermore, the antibiotic sensitivities of the isolated E. coli showed high percentages (≥90%) to nitrofurantoin, aminoglycosides, and some types of cephalosporins, but low (56%) to amoxicillin-clavulanic acid.

Conclusion: The prevalence of ASB among Jordanian women was higher than in developed countries and some low-to-middle-income countries, and ASB was significantly associated with gestational age and parity. These findings emphasized the importance of routine screening for ASB during pregnancy, particularly in the third trimester and in grand multiparous women. Although no significant association was found with maternal age or common comorbidities such as diabetes and hypertension, further extensive studies are needed.

Background: Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection, significantly contributing to cervical lesions and cancer. It not only damages physical health but also causes substantial mental problems, including depression and anxiety. However, research remains fragmented in China.

Methods: A hospital-based cross-sectional study was conducted in Shenzhen, China, from December 2024 to February 2025. Five hundred and one female participants with HPV infection, cervical lesions, or cancers were recruited via convenience sampling. Data on demographic characteristics, HPV-related information, and psychosocial indicators were collected using a self-reported questionnaire. Key measures included the 9-item Patient Health Questionnaire (PHQ-9, cutoff ≥10 for PHQ-defined depression), 7-item Generalized Anxiety Disorder Scale (GAD-7, cutoff ≥10 for GAD-defined anxiety), 14-item Fatigue Scale (FS-14, higher scores = more severe fatigue), 10-item Connor-Davidson Resilience Scale (CD-RISC-10, higher scores = stronger resilience), and 5-item Mindful Attention Awareness Scale (MAAS-5, higher scores = lower mindfulness levels). Univariate analysis and multivariable binary logistic regression were performed to identify factors associated with depression and anxiety.

Results: The prevalence of PHQ-defined depression and GAD-defined anxiety was 22.36% (n=112/501, 95% CI: 0.187-0.260) and 21.36% (n=107/501, 95% CI: 0.178-0.250), respectively. Multivariable binary logistic regression indicated that high-grade cervical lesions or cervical cancer (vs HPV infection or low-grade cervical lesions; Depression: OR = 8.879, P < 0.00; Anxiety: OR = 14.154, P < 0.001) and poor sleep condition (Depression: OR = 1.155, P = 0.004; Anxiety: OR = 1.175, P < 0.001) emerged as significant predictors of depression and anxiety, whereas higher levels of resilience (Depression: OR = 0.896, P = 0.001; Anxiety: OR = 0.934, P = 0.018) demonstrated a protective effect among females infected with HPV. Meanwhile, the results also found that fatigue (OR = 1.284, P = 0.008) and lower mindfulness level (OR = 1.163, P = 0.011) were also associated with depression among females infected with HPV.

Conclusion: This study reveals a high prevalence of depression and anxiety among HPV-infected women, along with the associations between PHQ-defined depression, GAD-defined anxiety, and advanced disease staging, fatigue, lower mindfulness, and higher resilience in women infected with HPV. Routine mental health assessment is warranted for this population, especially for those with high-grade cervical lesions or cervical cancer.

Purpose: To assess the incidence of complete tooth loss and dental visits in menopausal women and to identify relevant influencing factors in China.

Methods: This study analyzed data of 5,602 women sourced from the China Health and Retirement Longitudinal Study (CHARLS) during 2015. The incidence of complete tooth loss and dental visits in menopausal and non-menopausal women was explored. Univariate and multivariate logistic regression models evaluated the relationships between demographic background, health status and function, health care and insurance, blood data and complete tooth loss and dental visits in menopausal women. The results were expressed as odds ratios (OR) of 95% confidence intervals (CI).

Results: Risk factors for complete tooth loss in menopausal women included age (OR=1.09, 95% CI: 1.08-1.11), living in villages (OR=1.58, 95% CI: 1.29-1.93), smoke (OR=1.29, 95% CI: 1.01-1.65). Factors for dental visits in menopausal women included age (OR=0.99, 95% CI: 0.98-1.00), living in villages (OR=0.75, 95% CI: 0.64-0.88).

Conclusion: This study found that menopausal women have higher rates of complete tooth loss and dental visits. Age, place of residence, and smoking are major risk factors for complete tooth loss, while age and place of residence influence dental visits, indicating that menopausal women should pay more attention to their dental health, improve compliance with dental visits, and actively intervene to prevent tooth loss.

Background: Oxidative stress is a critical mediator in ovarian aging, a key process leading to premature menopause (PM), which is defined as menopause before age 40. While the Oxidative Balance Score (OBS), a composite measure of dietary and lifestyle pro- and anti-oxidant exposures, provides valuable insight, its association with PM remains unclear. This study aimed to investigate the association between OBS and PM in a nationally representative US population.

Methods: This cross-sectional study utilized data from 4,128 participants in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The OBS was calculated from 16 dietary and 4 lifestyle components. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with all analyses accounting for the complex survey design using appropriate NHANES sample weights. The potential nonlinear relationship was explored using restricted cubic splines (RCS).

Results: A higher total OBS was significantly associated with a lower risk of PM (Adjusted OR for the highest compared to the lowest quartile, 0.51; 95% CI, 0.31 to 0.83). The dietary OBS component showed a consistent inverse association. Subgroup analysis suggested potential ethnic variations, although the interaction did not reach statistical significance (P for interaction = 0.054). RCS analysis confirmed a nonlinear inverse association. Further threshold effect analysis identified a turning point at an OBS of 28; the association was significant below this threshold (OR per unit increase, 0.95; 95% CI, 0.93 to 0.97), but this was not observed above it (OR, 1.09; 95% CI, 1.00 to 1.18).

Conclusion: In this nationally representative sample of US women, a higher OBS was associated with a lower risk of PM, particularly below a score of 28. These findings suggest that dietary and lifestyle factors contributing to antioxidant balance may play a role in preserving ovarian function, although prospective studies are required to confirm causality.

Purpose: This study analyzed physical activity (PA) trajectories, identified subgroups, and explored their associations in women with gestational diabetes mellitus (GDM).

Methods: From January to November 2024, a longitudinal study was conducted using convenience sampling to recruit women with GDM from a maternal and child health hospital in Guangzhou (China). General information and baseline PA data were collected at diagnosis (24--26 weeks of gestation), and follow-up PA assessments were carried out at 28, 32, and 36 weeks. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess PA levels. The latent class growth model (LCGM) identified distinct PA trajectories.

Results: Of the 236 women enrolled, 223 completed follow-up. PA scores increased from T0 to a peak at T1 (median 156.45 MET·h/w, IQR: 113.08-221.10), then declined to a low at T3 (114.63 ± 47.30 MET·h/w). LCGM identified three trajectory subgroups: high-level reduction (4.04%), moderate-level fluctuation (43.50%), and low-level stable (52.47%). Ordinal logistic regression showed that unemployment (odds ratio (OR): 4.754; 95% confidence interval (CI): 1.878-12.037) and exercising alone (OR: 2.268; 95% CI: 1.219-4.225) were significantly associated with subgroup membership (P<0.05).

Conclusion: PA levels in women with GDM initially rose and then declined, with most sustaining stable low activity. Unemployment and solitary exercise were significant predictors of lower PA trajectories.

Background: Cancer is a significant cause of morbidity and mortality among women worldwide, particularly breast and cervical cancers. Continuity of care (CoC) is essential for effective cancer management but is often hindered by systemic, social, and economic barriers. Patient navigation has emerged as a promising intervention to improve access and coordination across the cancer care trajectory.

Purpose: This review aimed to explore how patient navigation has been applied to support continuity of cancer care for women.

Methods: This scoping review was conducted based on the framework developed by Arksey and O'Malley (2005). Comprehensive literature search across five electronic databases, including CINAHL, PubMed, ScienceDirect, Scopus, Taylor & Francis, and search engine: Google Scholar. Eligible studies included English-language, original articles that involved women aged 18 years or older, focusing on the impact of patient navigation on continuity of care for cancer. Data were extracted independently by three reviewers using a standardized form. A thematic analysis approach was used to synthesize the findings across key domains.

Results: A total 26 studies were included, most of which were conducted in the United States. Patient navigation demonstrated positive impacts across the cancer care continuum: (1) improved screening, especially in minority populations; (2) reduced time to diagnostic resolution; (3) improved patient treatment and rehabilitation. Five thematic domains were identified: care coordination, education/information, empowerment, emotional and social support, and logistical or financial assistance.

Conclusion: This scoping review provides an overview of how patient navigation contributes to strengthening the continuity of cancer care for women and identifies gaps in its current implementation across settings. Future research should investigate scalable and culturally adapted navigation models in low-resource settings, evaluating their cost-effectiveness and long-term outcomes.

Introduction: Effective ovarian stimulation and luteal phase support (LPS) are key factors for the success of in vitro fertilization and embryo transfer (IVF-ET) The present multicenter randomized trial evaluates whether adding Gushen Antai Pill (GSATP) to standard LPS improves the ongoing pregnancy rate (OPR) in women with normal ovarian reserve (NOR) undergoing fresh embryo transfer.

Methods: This study is a multicenter, randomized, double-blind, placebo-controlled trial, taking place at 20 reproductive centers within public tertiary hospitals. We plan to enroll around 800 women who are expected to have a NOR. Participants are randomized 1:1 using a stratified block randomization method with block sizes of 4 and 6, stratified by age (<35 vs ≥35 years). The primary endpoint is the OPR, with comprehensive safety evaluations also being performed. Data analysis will adhere to both intention-to-treat (ITT) and per-protocol (PP) principles to ensure robust statistical validity.

Discussion: This randomized controlled trial (RCT) aims to evaluate the effectiveness and safety of combining LPS with GSATP to improve pregnancy outcomes in women with NOR who are undergoing fresh embryo transfer. By rigorously evaluating endpoints such as OPR and early pregnancy complications, this study seeks to establish evidence for GSATP as a potential adjuvant therapy in IVF-ET protocols. The findings may offer innovative therapeutic perspectives for integrating traditional Chinese medicine (TCM) into contemporary assisted reproductive technology, particularly in enhancing implantation conditions and reducing miscarriage risks during fresh cycles.

Trial registration: ClinicalTrials.gov, ID: NCT04872660, 05/04/2021.

Purpose: This study aimed to investigate the causal relationship between sleep and Premature ovarian insufficiency (POI) using genetic methods and to evaluate the efficacy and safety of the Chinese herbal medicine Ningxin-Tongyu-Zishen Formula (NTZF) combined with hormone replacement therapy (HRT) on reproductive hormone levels and sleep quality in patients with POI through a clinical controlled trial.

Patients and methods: A multi-stage research design was implemented. Initially, a cross-sectional analysis was conducted on 200 POI patients. Two -sample Mendelian randomization analysis (MR) was then performed using publicly available data from the UK Biobank and FinnGen to infer causal relationships. Finally, a clinical observational study involving 119 patients compared three regimens over a 6-month treatment period: NTZF combined with HRT, NTZF alone, and HRT alone. The primary outcomes were reproductive hormone levels and the Pittsburgh Sleep Quality Index (PSQI).

Results: Cross-sectional analysis showed that decreased sleep quality was an independent risk factor for altered reproductive hormone levels in POI patients. MR analysis further provided genetic evidence that insomnia may be a causal risk factor for POI. The clinical study indicated that NTZF combined with HRT was significantly more effective than either monotherapy in improving reproductive hormone levels, enhancing sleep quality, and overall clinical efficacy, with a favorable safety profile.

Conclusion: This study confirmed a strong association between sleep quality and POI from both epidemiological and genetic perspectives. NTZF combined with HRT, as an integrated traditional Chinese and Western medicine therapy, can synergistically improve reproductive endocrine and sleep disturbances in POI patients, providing a new and effective strategy for clinical management.