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Gender differences in factors influencing specialty choice in obstetrics and gynecology: A national survey of graduating senior residents 影响妇产科专业选择因素的性别差异:一项全国应届老年住院医师调查
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-24 DOI: 10.1111/jog.16299
Kyosuke Kamijo, Tokumasa Suemitsu, Masako Hayashi, Yuki Iida, Ayana Ogawa, Yoko Kashima, Yoko Aoyagi, Satoshi Takemori, Takuma Ohsuga, Kazutoshi Nakano, Yu Ito, Hiroaki Komatsu, Kaori Koga, Fuminori Taniguchi

Aim

To analyze gender differences in factors influencing the choice of obstetrics and gynecology as a specialty and to inform gender-specific recruitment strategies for a more diverse and sustainable obstetrics and gynecology workforce.

Methods

This nationwide cross-sectional survey was conducted annually in Japan from 2019 to 2024, targeting post-senior residency obstetricians and gynecologists. The survey collected data on demographics, timing, reasons for choosing obstetrics and gynecology, and changes in concerns from pre- to post-senior residency.

Results

The survey received 2049 responses out of 2458 distributed surveys, resulting in a response rate of 83.9% (60.6% female, 39.4% male). Moreover, 52.4% of respondents initially considered obstetrics and gynecology during medical school, with females more likely to consider it before medical school than males (24.8% vs. 17.3%). Clinical clerkship experience was the most common reason (57.7%), particularly among females compared to males (62.3% vs. 50.5%). However, males were more influenced by family members or relatives (6.9% vs. 13.1%) and lectures (8.6% vs. 12.6%) than females. Pre-residency concerns—physical burden, mental burden, night on-call demands, marriage and family planning, career path planning, litigation risks, and workforce shortages—were higher in females than in males, although these concerns decreased significantly post-residency, excluding those regarding workforce shortages and income. Male-specific concern about the “need for male physicians” decreased significantly from 32.3% to 11.9%.

Conclusions

This nationwide survey provides valuable insights into the role of gender in specialty decision-making, with important implications for developing gender-specific recruitment strategies.

目的分析影响妇产科专业选择的因素的性别差异,为更加多样化和可持续发展的妇产科人才队伍提供针对性别招聘策略。方法本研究于2019年至2024年在日本每年进行一次全国范围的横断面调查,调查对象为高级住院医师后的妇产科医生。该调查收集了人口统计数据、时间、选择妇产科的原因,以及从老年住院医师前到老年住院医师后的关注点变化。结果共发放问卷2458份,收到回复2049份,回复率为83.9%(女性60.6%,男性39.4%)。此外,52.4%的受访者在医学院期间最初考虑过妇产科,女性比男性更有可能在医学院之前考虑过妇产科(24.8%比17.3%)。临床实习经验是最常见的原因(57.7%),尤其是女性(62.3%对50.5%)。然而,男性受家庭成员或亲戚(6.9%比13.1%)和讲座(8.6%比12.6%)的影响大于女性。住院前的担忧——身体负担、精神负担、夜间值班需求、婚姻和计划生育、职业道路规划、诉讼风险和劳动力短缺——在女性中高于男性,尽管这些担忧在住院后显著下降,不包括劳动力短缺和收入方面的担忧。男性对“需要男医生”的关注由32.3%显著下降至11.9%。这项全国性的调查为性别在专业决策中的作用提供了有价值的见解,对制定针对性别的招聘策略具有重要意义。
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引用次数: 0
Microdissection testicular sperm extraction in male partner with non-obstructive azoospermia: Fresh or frozen–thawed sperm for intracytoplasmic sperm injection? 非阻塞性无精子症男性伴侣的显微解剖睾丸精子提取:新鲜精子还是冷冻解冻精子用于胞浆内单精子注射?
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-24 DOI: 10.1111/jog.16298
Sevinc Özmen, Esra Nur Tola

Aim

To compare the outcomes of intracytoplasmic sperm injection (ICSI) of fresh and cryopreserved sperm obtained via microdissection testicular sperm extraction (micro-TESE) in cases of non-obstructive azoospermia (NOA).

Methods

A total of 147 patients with NOA who underwent micro-TESE and obtained viable sperm via micro-TESE at Istanbul Medipol In Vitro Fertilization unit were recruited retrospectively. The cases were divided into two groups depending on the sperm used (fresh or frozen–thawed) for ICSI: The micro-TESE group (n = 93) underwent ICSI cycles with fresh spermatozoa and the micro-TESE-Thaw group (n = 54) underwent ICSI cycles with cryopreserved spermatozoa. Patient demographics, embryo development, and pregnancy outcomes were compared between the two groups.

Results

No statistical difference was observed between the two groups in terms of demographic features (age, body mass index, etc.) and cycle characteristics (induction protocol, gonadotropin dose, etc.). Fertilization rates and embryo quality were also similar between the groups. Higher clinical pregnancy and live birth rates were observed in the micro-TESE group than in the micro-TESE-Thaw group (p <0.04 and p <0.003, respectively). The miscarriage rate was higher in the micro-TESE-Thaw group, although the difference did not reach statistical significance.

Conclusion(s)

In cases where frozen sperm obtained by micro-TESE are used, even if viable and motile sperm are found after thawing, there may be a negative impact on the ICSI result. Fresh testicular spermatozoa appear to result in better clinical pregnancy and live birth rates than cryopreserved testicular spermatozoa in males with NOA.

目的比较非阻塞性无精子症(NOA)患者通过显微解剖睾丸精子提取(micro-TESE)获得的新鲜精子和冷冻精子卵胞浆内单精子注射(ICSI)的效果。方法回顾性分析伊斯坦布尔Medipol体外受精中心147例NOA患者,经微创tese手术获得活精子。根据使用的精子(新鲜或冷冻解冻)将病例分为两组:使用新鲜精子进行ICSI的micro-TESE组(n = 93)和使用冷冻保存的精子进行ICSI的micro- tse - thaw组(n = 54)。比较两组患者的人口统计、胚胎发育和妊娠结局。结果两组在人口统计学特征(年龄、体质指数等)和周期特征(诱导方案、促性腺激素剂量等)方面无统计学差异。各组受精率和胚胎质量相似。微tese组临床妊娠率和活产率高于微tse - thaw组(p <;0.04和p <;0.003)。微tse - thaw组流产率较高,但差异无统计学意义。结论(5)使用微低温冷冻获得的冷冻精子,即使在解冻后发现有活力和活动的精子,也可能对ICSI结果产生负面影响。在男性NOA患者中,新鲜睾丸精子比冷冻保存的睾丸精子有更好的临床妊娠和活产率。
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引用次数: 0
The persistence of HPV type-specific infections in patients following colposcopic examination: An observational study 阴道镜检查后患者持续存在HPV型特异性感染:一项观察性研究
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-23 DOI: 10.1111/jog.16301
Serkan Akis, Canan Kabaca, Yunus Emre Purut, Esra Keles, Ugur Kemal Ozturk, Mine Guray Uzun, Murat Api

Aim

High-risk HPV infection is a necessary but not sufficient factor for the development of precancerous lesions and cervical cancer. Beyond mere HPV positivity, the persistence of infection over time plays a crucial role. This study aims to evaluate the clearance and persistence rates of HPV 16 and 18 genotypes.

Methods

The cervical cytology results were reported using the 2014 Bethesda System classification. The cervical cytology samples were analyzed using the Roche Cobas® 4800 HPV tests. Patients with any HPV genotype other than 16 or 18, those with missing data, those who were lost to follow-up, those who underwent excisional procedures or hysterectomy, and those with high-grade cervical dysplasia were excluded from this study.

Results

Among 191 patients (mean age: 41.2 ± 0.6 years, 16.8% postmenopausal), the mean follow-up was 21.6 ± 0.7 months. No significant differences were found between the clearance and persistence groups in age, follow-up duration, cervical biopsy, or endocervical curettage results. However, HPV 16 had a higher persistence rate (28.2%), and abnormal cytology was more frequent in the persistence group (p = 0.038).

Conclusions

Around 25% of patients had persistent HPV infection. Close monitoring is essential for those with CIN 1 on initial colposcopy, as they may have a higher risk of progressing to high-grade dysplasia compared to those without dysplasia.

目的高危HPV感染是癌前病变和宫颈癌发生的必要因素,但不是充分因素。除了单纯的HPV阳性外,感染的持续时间也起着至关重要的作用。本研究旨在评估HPV 16和18基因型的清除率和持久性。方法采用2014年Bethesda系统分类方法对宫颈细胞学结果进行报告。宫颈细胞学样本使用罗氏Cobas®4800 HPV检测进行分析。除16或18以外的任何HPV基因型的患者,数据缺失的患者,失去随访的患者,接受切除手术或子宫切除术的患者,以及高度宫颈发育不良的患者均被排除在本研究之外。结果191例患者平均年龄41.2±0.6岁,绝经后16.8%,平均随访21.6±0.7个月。清除组和持续组在年龄、随访时间、宫颈活检或宫颈内膜刮除结果方面无显著差异。然而,HPV 16的持续率更高(28.2%),并且细胞学异常在持续组中更频繁(p = 0.038)。结论:约25%的患者存在持续性HPV感染。密切监测对于初次阴道镜检查CIN 1的患者至关重要,因为与没有发育不良的患者相比,他们可能有更高的发展为高度发育不良的风险。
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引用次数: 0
Retrospective analysis of treatment and prognosis for clear cell carcinoma of the uterine cervix: 15-year experience at a single institution 回顾性分析宫颈癌透明细胞癌的治疗和预后:在一个机构15年的经验
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-23 DOI: 10.1111/jog.16300
Yusuke Inomata, Keisuke Kodama, Shoji Maenohara, Hiroshi Yagi, Masafumi Yasunaga, Ichiro Onoyama, Kazuo Asanoma, Hideaki Yahata, Yoshinao Oda, Kiyoko Kato

Aim

Clear cell carcinoma of the uterine cervix (CCCUC) is a rare disease, accounting for 4% to 9% of cervical adenocarcinomas. Because it is so rare, its pathogenesis is largely unknown, and the standard treatment is unclear due to a lack of prospective studies. Our aim is to investigate the clinical features, treatment, and prognosis of CCCUC.

Methods

We retrospectively evaluated the clinical characteristics, treatment choices, and outcomes of 12 patients with CCCUC treated at our institution between January 2009 and July 2024.

Results

The median patient age was 62.5 years (range, 14–90 years). The most common stage was IB (IA, n = 3; IB, n = 4; IIB, n = 1; IIIC, n = 2; IVB, n = 2). Ten patients underwent surgery as initial treatment: 6 underwent radical hysterectomy plus pelvic lymphadenectomy (PLD) or sentinel lymph node biopsy (SLNB), with or without para-aortic lymphadenectomy (PALD); 3 underwent modified radical hysterectomy plus PLD with or without PALD; and 1 underwent radical trachelectomy with SLNB as fertility-preserving surgery. All patients underwent bilateral salpingo-oophorectomy except for the patient who opted for radical trachelectomy. Five patients received adjuvant treatment: 3 received platinum-based systemic chemotherapy (2 of whom had combination therapy with bevacizumab), and 2 received concurrent chemoradiotherapy. The median follow-up was 43.5 months (range, 1–123 months). The 5-year progression-free survival rate was 64.5%.

Conclusion

Systemic platinum-based chemotherapy with bevacizumab may be more effective than concurrent chemoradiotherapy as adjuvant therapy for CCCUC.

目的宫颈透明细胞癌(CCCUC)是一种罕见的疾病,占宫颈腺癌的4% ~ 9%。由于它非常罕见,其发病机制在很大程度上是未知的,由于缺乏前瞻性研究,标准治疗尚不清楚。我们的目的是探讨CCCUC的临床特点、治疗和预后。方法回顾性评价2009年1月至2024年7月在我院治疗的12例CCCUC患者的临床特征、治疗选择和结局。结果患者年龄中位数为62.5岁(14 ~ 90岁)。最常见的分期为IB (IA, n = 3;IB, n = 4;IIB, n = 1;IIIC, n = 2;IVB, n = 2)。10例患者接受手术作为初始治疗:6例患者行根治性子宫切除术加盆腔淋巴结切除术(PLD)或前哨淋巴结活检(SLNB),伴或不伴腹主动脉旁淋巴结切除术(PALD);3例行改良根治性子宫切除术加PLD,伴或不伴PALD;1例行根治性气管切除术,SLNB作为保留生育能力的手术。除选择根治性气管切除术的患者外,所有患者均行双侧输卵管-卵巢切除术。5例患者接受辅助治疗:3例患者接受以铂类药物为基础的全身化疗(其中2例患者联合贝伐单抗治疗),2例患者同时接受放化疗。中位随访时间为43.5个月(范围1-123个月)。5年无进展生存率为64.5%。结论全身铂基化疗联合贝伐单抗作为CCCUC的辅助治疗可能比同期放化疗更有效。
{"title":"Retrospective analysis of treatment and prognosis for clear cell carcinoma of the uterine cervix: 15-year experience at a single institution","authors":"Yusuke Inomata,&nbsp;Keisuke Kodama,&nbsp;Shoji Maenohara,&nbsp;Hiroshi Yagi,&nbsp;Masafumi Yasunaga,&nbsp;Ichiro Onoyama,&nbsp;Kazuo Asanoma,&nbsp;Hideaki Yahata,&nbsp;Yoshinao Oda,&nbsp;Kiyoko Kato","doi":"10.1111/jog.16300","DOIUrl":"https://doi.org/10.1111/jog.16300","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Clear cell carcinoma of the uterine cervix (CCCUC) is a rare disease, accounting for 4% to 9% of cervical adenocarcinomas. Because it is so rare, its pathogenesis is largely unknown, and the standard treatment is unclear due to a lack of prospective studies. Our aim is to investigate the clinical features, treatment, and prognosis of CCCUC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated the clinical characteristics, treatment choices, and outcomes of 12 patients with CCCUC treated at our institution between January 2009 and July 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median patient age was 62.5 years (range, 14–90 years). The most common stage was IB (IA, <i>n</i> = 3; IB, <i>n</i> = 4; IIB, <i>n</i> = 1; IIIC, <i>n</i> = 2; IVB, <i>n</i> = 2). Ten patients underwent surgery as initial treatment: 6 underwent radical hysterectomy plus pelvic lymphadenectomy (PLD) or sentinel lymph node biopsy (SLNB), with or without para-aortic lymphadenectomy (PALD); 3 underwent modified radical hysterectomy plus PLD with or without PALD; and 1 underwent radical trachelectomy with SLNB as fertility-preserving surgery. All patients underwent bilateral salpingo-oophorectomy except for the patient who opted for radical trachelectomy. Five patients received adjuvant treatment: 3 received platinum-based systemic chemotherapy (2 of whom had combination therapy with bevacizumab), and 2 received concurrent chemoradiotherapy. The median follow-up was 43.5 months (range, 1–123 months). The 5-year progression-free survival rate was 64.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Systemic platinum-based chemotherapy with bevacizumab may be more effective than concurrent chemoradiotherapy as adjuvant therapy for CCCUC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16593,"journal":{"name":"Journal of Obstetrics and Gynaecology Research","volume":"51 4","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jog.16300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The 76th Annual Congress of the Japan Society of Obstetrics and Gynecology 第 76 届日本妇产科学会年会
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-22 DOI: 10.1111/jog.16282
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引用次数: 0
The 77th Annual Congress of the Japan Society of Obstetrics and Gynecology 第77届日本妇产科学会年会
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-22 DOI: 10.1111/jog.16285
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引用次数: 0
Histological classification of uterine cervical adenocarcinomas: Its alteration and current status 子宫颈腺癌的组织学分型:改变及现状
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-21 DOI: 10.1111/jog.16287
Masanori Yasuda, Tomomi Katoh, Yu Miyama, Taku Honma, Mitsutake Yano, Akira Yabuno

Adenocarcinomas (ADCs) of the uterine cervix are relatively minor compared to squamous cell carcinomas. However, ADCs are histologically and histogenetically unique, especially because they can be with or without human papillomavirus (HPV) infection. At present, ADCs are divided into tumors as HPV-associated ADCs (HA-ADCs) and HPV-independent ADCs (HI-ADCs), including adenocarcinomas in situ (AIS) as their precursor, both of which consist of variable histological types. The usual-type accounts for the majority of HA-ADCs, and the gastric-type is a representative of HI-ADCs. Notably, it is clinicopathologically significant to differentiate between HA-ADCs and HI-ADCs because of the discrepancy in prognosis between them. Although relatively rare in comparison with HPV-associated AIS (HA-AIS), HPV-independent AIS (HI-AIS) has gradually attracted attention since gastric-type ADC (g-ADC) was introduced in the World Health Organization Classification 4th ed. (2014). Occasional HA-ADCs and HI-ADCs, including HA-AIS and HI-AIS, require p16 immunostaining, in situ hybridization, or HPV testing to differentiate between them because morphological features alone cannot often be conclusive for the diagnosis. A system focusing on the infiltrative pattern has been introduced due to its clinicopathological value. Staging criteria of HA-ADCs with polypoid/exophytic growth, recommended by the International Collaboration on Cancer Reporting, may supplement the International Federation of Gynecology and Obstetrics staging system for clinical management and treatment.

与鳞状细胞癌相比,子宫颈腺癌(ADC)的发病率相对较低。然而,ADC 在组织学和组织遗传学上有其独特性,尤其是因为它们可能感染或未感染人类乳头瘤病毒(HPV)。目前,ADC分为与HPV相关的ADC(HA-ADC)和与HPV无关的ADC(HI-ADC),其中原位腺癌(AIS)是ADC的前身,两者的组织学类型各不相同。普通型占 HA-ADC 的大多数,而胃型则是 HI-ADC 的代表。值得注意的是,区分 HA-ADC 和 HI-ADC 具有重要的临床病理学意义,因为两者的预后不同。与 HPV 相关性 AIS(HA-AIS)相比,HPV 非相关性 AIS(HI-AIS)虽然相对罕见,但自从胃型 ADC(g-ADC)被引入世界卫生组织分类第 4 版(2014 年)后,HPV 非相关性 AIS(HI-AIS)逐渐引起了人们的关注。偶发的 HA-ADC 和 HI-ADC,包括 HA-AIS 和 HI-AIS,需要通过 p16 免疫染色、原位杂交或 HPV 检测来鉴别,因为单凭形态学特征往往不能确诊。由于浸润模式具有临床病理学价值,因此引入了以浸润模式为重点的系统。国际癌症报告合作组织推荐的多形性/外生性 HA-ADC 的分期标准可作为国际妇产科联盟分期系统的补充,用于临床管理和治疗。
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引用次数: 0
Association between low-grade cervical cytology and histological cervical intraepithelial neoplasia concurrent vaginal intraepithelial neoplasia among outpatient colposcopy: A retrospective study 门诊阴道镜检查中低度宫颈细胞学检查与组织学宫颈上皮内瘤变并发阴道上皮内瘤变之间的关联:回顾性研究
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-20 DOI: 10.1111/jog.16289
Min Lu, Xiping Luo, Qiaowen Bu, Peijuan Li, Wanting Luo, Shuling Ji, Huanxin Yue, Xiaoshan Hong

Background

There is evidence that cytological low-grade squamous intraepithelial lesion (LSIL) is associated with cervical intraepithelial neoplasia (CIN) in colposcopy, but its link to cervical intraepithelial neoplasia concurrent vaginal intraepithelial neoplasia (VaIN) remains unclear.

Methods

A retrospective chart review was performed that encompassed patients who were pathologically diagnosed with CIN at a single center from 2017 to 2021. Demographics, referring cytology, HPV genotype, and histologic information were recorded. The primary outcome was CIN coexisted with VaIN.

Results

Among 5488 patients included in this study (mean age, 37.0 years [SD 10]; 1376 [25.4]) had low-grade cervical cytology positive. A total of 458 participants were classified as having histologically CIN concurrent VaIN. Compared with participants without LSIL cytology, those with LSIL cytology had a higher prevalence of histological CIN concurrent VaIN (38.1% [172] vs. 24.2% [1204]). After adjusting for potential confounders, we found an association between LSIL cytology and histological CIN concurrent VaIN (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.84–5.82). In subgroup analyses, LSIL cytology was associated with histological CIN concurrent VaIN among participants sexual life year 10 to 19 years (OR, 5.35; 95% CI, 1.58–18.04), gravidity 1–2 fetus (OR, 5.49; 95% CI, 1.62–18.61), HPV33 positive (OR, 90.06; 95% CI, 2.27–3579.46), HPV52 positive (OR, 9.09; 95% CI, 1.96–42.12).

Conclusions

In this cross-sectional study, LSIL cytology was associated with histological CIN concurrent VaIN in the outpatient colposcopy in adjusted models. This association may be important to consider in the colposcopy for the early detection of CIN concurrent VaIN.

有证据表明,阴道镜检查中发现的低级别鳞状上皮内病变(LSIL)与宫颈上皮内瘤变(CIN)有关,但其与宫颈上皮内瘤变并发阴道上皮内瘤变(VaIN)的关系尚不清楚。方法回顾性分析2017年至2021年在单一中心病理诊断为CIN的患者。记录人口统计学、参考细胞学、HPV基因型和组织学信息。主要结局为CIN合并VaIN。结果本研究纳入5488例患者(平均年龄37.0岁[SD 10];1376例[25.4])宫颈细胞学低度阳性。共有458名参与者被分类为组织学CIN并发VaIN。与没有LSIL细胞学检查的参与者相比,有LSIL细胞学检查的参与者有更高的组织学CIN并发VaIN患病率(38.1%[172]对24.2%[1204])。在调整了潜在的混杂因素后,我们发现LSIL细胞学和组织学CIN并发VaIN之间存在关联(优势比[OR], 3.28;95%可信区间[CI], 1.84-5.82)。在亚组分析中,LSIL细胞学与性生活10 - 19年的参与者的组织学CIN并发VaIN相关(OR, 5.35;95% CI, 1.58-18.04),妊娠1-2胎(OR, 5.49;95% CI, 1.62-18.61), HPV33阳性(OR, 90.06;95% CI, 2.27-3579.46), HPV52阳性(OR, 9.09;95% ci, 1.96-42.12)。结论:在本横断面研究中,在调整模型的门诊阴道镜检查中,LSIL细胞学与组织学CIN并发VaIN相关。这种关联在阴道镜检查早期发现CIN并发VaIN时可能是重要的考虑因素。
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引用次数: 0
Factors influencing healthy dietary behavior changes among patients with gestational diabetes mellitus during pregnancy: A meta-synthesis using the theoretical domains framework 影响妊娠期糖尿病患者健康饮食行为改变的因素:运用理论域框架的综合研究
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-20 DOI: 10.1111/jog.16294
Qianqian Li, Yueshuai Pan, Yi Li, Ruting Gu, Jingyuan Wang, Yan Zhang, Xinwei Zhang, Yuan Zhu, Lili Wei

Aims

To examine factors that facilitate and impede healthy dietary behavior modification in patients with gestational diabetes mellitus (GDM). Additionally, it sought to assess the strength of the evidence for these factors and offer insights into promoting positive behaviors.

Methods

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. We searched seven databases in February 2023 to include qualitative studies related to patients with GDM that explored their perceptions of and changes in healthy eating behaviors. Two researchers independently screened the articles, assessed their quality, extracted data, and coded the factors using the theoretical domain framework. For the factors involved, we performed a meta-synthesis based on their frequency and assigned a confidence level to determine their level of evidence.

Results

We included 32 of the 536 extracted articles. Barriers identified by high levels of evidence include: “Environmental context and resources,” “Social influences,” “Knowledge,” “Emotion,” and “Social/professional roles and Identity.” The facilitators identified by high levels of evidence include the following: “Beliefs about consequences,” “Social influences,” “Environmental context and resources,” “Skill,” and “Memory, attention, and decision processes.”

Conclusion

This meta-synthesis highlights that healthy eating behavior change is influenced by the interaction of factors at different levels of individuals, organizations, and sociocultural environments. Furthermore, we established a framework that displayed the associations between these factors, giving prominence to those with higher levels of evidence. This framework will aid researchers in identifying priority areas for intervention and facilitating the implementation of high-quality strategies.

目的探讨促进和阻碍妊娠期糖尿病(GDM)患者健康饮食行为改变的因素。此外,它还试图评估这些因素的证据力度,并为促进积极行为提供见解。方法本系统评价遵循系统评价和meta分析报告标准的首选报告项目。我们于2023年2月检索了7个数据库,纳入了与GDM患者相关的定性研究,探讨了他们对健康饮食行为的看法和变化。两位研究人员独立筛选文章,评估其质量,提取数据,并使用理论领域框架对因素进行编码。对于所涉及的因素,我们根据它们的频率进行了综合分析,并分配了一个置信度来确定它们的证据水平。结果536篇提取的文献中有32篇被纳入。高水平证据确定的障碍包括:“环境背景和资源”、“社会影响”、“知识”、“情感”和“社会/职业角色和身份”。高水平证据确定的促进因素包括:“对后果的信念”、“社会影响”、“环境背景和资源”、“技能”和“记忆、注意力和决策过程”。结论健康饮食行为的改变受到个体、组织和社会文化环境等不同层面因素相互作用的影响。此外,我们建立了一个框架来显示这些因素之间的关联,突出那些证据水平较高的因素。这一框架将有助于研究人员确定干预的优先领域,并促进高质量战略的实施。
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引用次数: 0
Impact of insurance coverage on access to assisted reproductive technology: A nationwide survey in Japan (the IZANAMI project) 保险对辅助生殖技术使用的影响:日本全国调查(IZANAMI 项目)
IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-04-14 DOI: 10.1111/jog.16292
Aika Wada, Mitsutoshi Yamada, Hiromitsu Shirasawa, Seung Chik Jwa, Keiji Kuroda, Miyuki Harada, Yutaka Osuga

Aim

Assisted reproductive technology (ART) is a well-established infertility treatment. However, financial and geographical barriers can hinder patient access. The Japanese government implemented insurance coverage in April 2022 for specific ART treatments. This study assessed the effects of insurance coverage on ART utilization and accessibility.

Methods

An online survey was administered to 427 ART facilities that participated in a pre-policy assessment from December 1, 2023, to January 30, 2024.

Results

A total of 283 facilities responded (response rate: 66.3%). The number of ART patients increased by 4.0% (217 699–226 401) following the implementation of insurance coverage. The number of insured patients aged 25–43 years increased by 6.6%, with a notable increase of 22.9% (range: 44 144–54 253) in the 25- to 34-year age group. However, the number of uninsured patients aged ≥44 decreased by 16.3%; 172 facilities experienced an increased number of patients, whereas 111 facilities experienced no increase or decline. Patient growth rates were significantly higher in rural areas than in metropolitan regions (mean difference: 0.07; 95% confidence interval: 0.0–0.1; p = 0.03). Although there was a significant negative association between the proportion of out-of-pocket treatment and the rate of patient increase (p = 0.02), no such association was observed in rural areas (p = 0.68).

Conclusions

Insurance coverage improved patient access to ART services, especially for those in their 20s and early 30s. However, the number of patients in the uninsured group decreased significantly. Accessibility in rural areas also notably improved. These findings highlight the importance of economic support for enhancing ART accessibility.

目的辅助生殖技术(ART)是一种成熟的不孕症治疗方法。然而,财政和地理障碍可能阻碍患者获得。日本政府于2022年4月实施了针对特定ART治疗的保险。本研究评估了保险覆盖率对抗逆转录病毒治疗的利用和可及性的影响。方法对2023年12月1日至2024年1月30日参与政策前评估的427家ART设施进行在线调查。结果共有283家机构回复,回复率为66.3%。实施保险后,ART患者人数增加4.0%(217 699-226 401)。25- 43岁参保人数增加6.6%,其中25- 34岁参保人数增加22.9%(范围:44 144-54 253)。≥44岁未参保患者数量下降16.3%;172家医院的病人数量有所增加,而111家医院的病人数量没有增加或减少。农村地区的患者增长率明显高于大城市地区(平均差异:0.07;95%置信区间:0.0-0.1;p = 0.03)。自费治疗比例与患者增加率之间存在显著负相关(p = 0.02),但在农村地区没有观察到这种关联(p = 0.68)。结论:保险覆盖改善了患者获得抗逆转录病毒治疗服务的机会,特别是对20多岁和30岁出头的患者。然而,未参保组的患者数量明显减少。农村地区无障碍条件明显改善。这些发现突出了经济支持对提高抗逆转录病毒治疗可及性的重要性。
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Journal of Obstetrics and Gynaecology Research
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