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Diet and Exercise in the Management of Polycystic Ovary Syndrome: Practical Considerations for Person-Centered Care. 饮食和运动在多囊卵巢综合征管理中的作用:以人为本护理的实际考虑。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-01 DOI: 10.1055/s-0043-1777116
Giorgia E Colombo, Stephanie Pirotta, Angelo Sabag

Polycystic ovary syndrome (PCOS) is a complex multisystem condition associated with life-long reproductive, metabolic, and psychological symptoms. Individuals with PCOS are at an increased risk of cardiovascular disease and type 2 diabetes, with approximately 70% of all PCOS cases presenting with insulin resistance. Lifestyle interventions have historically been recommended as first-line therapies for the management of PCOS-related cardiometabolic disorders. The term "lifestyle management" incorporates a multifaceted approach to dietary, exercise, and behavioral strategies, aiming to promote a healthy lifestyle. This approach has been commonly employed in practice, in particular through exercise and dietary modulation, due to its effect on cardiometabolic outcomes as well as its tolerability. Furthermore, there is evidence to suggest that combining dietary change with exercise may yield the greatest improvements in clinical outcomes. However, such practices require careful consideration and coordination, as there are instances where certain exercise and/or dietary prescriptions may compromise the effectiveness of the respective interventions. Thus, this review aims to provide practical guidance on diet and exercise planning in the routine care of PCOS. Such recommendations include emphasizing realistic and achievable goals, as well as minimizing barriers to lifestyle changes in order to increase the long-term sustainability of this treatment strategy.

多囊卵巢综合征(PCOS)是一种复杂的多系统疾病,与终生的生殖、代谢和心理症状有关。多囊卵巢综合征患者患心血管疾病和2型糖尿病的风险增加,大约70%的多囊卵巢综合征患者表现为胰岛素抵抗。生活方式干预历来被推荐为治疗多囊卵巢综合征相关心脏代谢疾病的一线疗法。“生活方式管理”一词包括饮食、运动和行为策略等多方面的方法,旨在促进健康的生活方式。由于其对心脏代谢结果和耐受性的影响,这种方法在实践中被普遍采用,特别是通过运动和饮食调节。此外,有证据表明,将饮食改变与运动结合起来可能会对临床结果产生最大的改善。然而,这种做法需要仔细考虑和协调,因为在某些情况下,某些运动和/或饮食处方可能会损害各自干预措施的有效性。因此,本文旨在为多囊卵巢综合征的日常护理提供饮食和运动计划的实用指导。这些建议包括强调现实和可实现的目标,以及尽量减少改变生活方式的障碍,以增加这种治疗策略的长期可持续性。
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引用次数: 0
Breaking Boundaries: Toward Consistent Gender-Sensitive Language in Sexual and Reproductive Health Guidelines. 打破界限:在性健康和生殖健康指南中使用一致的性别敏感语言。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-05 DOI: 10.1055/s-0043-1777323
Rhonda M Garad, Mahnaz Bahri-Khomami, Maureen Busby, Tania S Burgert, Jacky Boivin, Helena J Teede

This review assesses gender-sensitive language in sexual and reproductive health (SRH) guidelines, including a guideline for polycystic ovary syndrome. We conducted a systematic search across databases like Medline, EMBASE, and Cochrane until July 31, 2023, using terms related to gender-inclusivity, SRH, and guideline protocols. Criteria for inclusion were gender-sensitive language, SRH focus, and guideline relevance, excluding non-English articles or those without policy considerations. Our search yielded 25 studies, with 6 included for qualitative synthesis. Results showed significant gaps in using gender-sensitive language in SRH guidelines. The debate on this language mirrors broader societal discourse. Recognizing gender diversity is essential for research, clinical practices, and societal norms. While promoting inclusion, drawbacks like unintended erasure or miscommunication should also be addressed. A gender-additive approach balances inclusivity and biological accuracy. Precise and inclusive discourse is crucial. Future research should focus on systemic approaches in the SRH sector.

本综述评估了性与生殖健康(SRH)指南中的性别敏感性语言,包括多囊卵巢综合征指南。截至 2023 年 7 月 31 日,我们在 Medline、EMBASE 和 Cochrane 等数据库中使用与性别包容性、SRH 和指南协议相关的术语进行了系统性检索。纳入标准为性别敏感语言、关注性健康和生殖健康以及指南相关性,排除非英语文章或无政策考虑的文章。我们共搜索到 25 项研究,其中 6 项纳入了定性综合研究。结果显示,在性健康和生殖健康指南中使用性别敏感语言方面存在很大差距。关于这种语言的争论反映了更广泛的社会讨论。承认性别多样性对于研究、临床实践和社会规范都至关重要。在促进包容性的同时,也应解决无意抹杀或误传等弊端。性别添加方法兼顾了包容性和生物学准确性。精确和包容性的讨论至关重要。未来的研究应侧重于性健康和生殖健康部门的系统方法。
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引用次数: 0
The Role of the Primary Care Physician in the Assessment and Management of Polycystic Ovary Syndrome. 初级保健医师在多囊卵巢综合征评估和治疗中的作用。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-11-01 DOI: 10.1055/s-0043-1776419
Carolyn Ee

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous female endocrine disorder with manifestations that span the hormonal, reproductive, metabolic, and psychological. Primary care physicians (PCPs), also known as family physicians or general practitioners, play a key role in the diagnosis, assessment, and management of PCOS. This article outlines the role of the PCP in the timely and accurate diagnosis, provision of information and education, lifestyle and weight management, and management of key features such as hyperandrogenism, irregular cycles, infertility, emotional well-being, and cardiometabolic risk. PCPs play an essential role as the point of first contact for women and adolescents with or at high risk of PCOS, providers of whole-person care and continuity of care, and coordinators of care within a multidisciplinary team. Optimal management of PCOS requires equitable access to primary care. There is a need for systemic approaches to addressing barriers to provision of quality primary care, such as poor remuneration of longer consultations and low awareness of evidence-based guidelines, to women and adolescents with PCOS.

多囊卵巢综合征(PCOS)是一种复杂而异质的女性内分泌紊乱,其表现涵盖激素、生殖、代谢和心理。初级保健医生(PCP),也称为家庭医生或全科医生,在多囊卵巢综合征的诊断、评估和管理中发挥着关键作用。本文概述了PCP在及时准确诊断、提供信息和教育、生活方式和体重管理以及管理高雄激素血症、月经不规律、不孕不育、情绪健康和心脏代谢风险等关键特征方面的作用。PCP作为多囊卵巢综合征患者或高危妇女和青少年的第一接触点、全人护理和连续性护理的提供者以及多学科团队中的护理协调员发挥着重要作用。多囊卵巢综合征的最佳管理需要公平获得初级保健。需要采取系统的方法来解决向患有多囊卵巢综合征的妇女和青少年提供高质量初级保健的障碍,例如长期咨询的报酬低和对循证指南的认识低。
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引用次数: 0
Broadening the Scope of Polycystic Ovary Syndrome (PCOS) Care: Insights from the 2023 International Evidence-Based PCOS Guideline. 拓宽多囊卵巢综合症 (PCOS) 护理范围:2023 年国际循证多囊卵巢综合症指南的启示。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-19 DOI: 10.1055/s-0043-1775835
Chau Thien Tay, Mahnaz Bahri Khomami
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引用次数: 0
Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach. 缩小多囊卵巢综合征的信息差距:采用系统方法的叙述性综述。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-05 DOI: 10.1055/s-0043-1777086
Chau Thien Tay, Fleur Williams, Aya Mousa, Helena Teede, Tania S Burgert

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.

多囊卵巢综合症(PCOS)是一种复杂的内分泌疾病,对患者有着广泛的影响。文献显示,多囊卵巢综合症患者对提供给他们的健康信息不满意,医疗保健专业人员也缺乏足够的知识。在这篇采用系统方法的叙事性综述中,我们探讨了多囊卵巢综合症患者和医护人员在护理方面未得到满足的信息需求。通过对数据库的全面检索,我们发现了 41 项相关研究,这些研究以观察性和定性设计为主。患有多囊卵巢综合症的成人和青少年希望获得广泛的健康信息,并表达了对体重管理指导的强烈渴望。重要的是,在讨论体重问题时,应在了解相关知识的基础上进行,而不应带有体重偏见。因此,医疗保健专业人员应为获取全面的循证资源提供便利。信息的缺乏促使人们在网上搜索与多囊卵巢综合症相关的信息。转介到支持团体,促进个人在多囊卵巢综合症自我管理方面的自主权,可以进一步引导患者获取资源。患者更希望得到专业人士的指导,这些专业人士应了解多囊卵巢综合症的社会心理复杂性,并能根据个人的文化背景,对患者被污名化甚至边缘化的经历感同身受。研究结果为《2023 年国际循证多囊卵巢综合症指南》提供了参考,建议采用以患者为中心的沟通方式、循证信息资源和文化敏感性方法来优化多囊卵巢综合症护理。
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引用次数: 0
Introduction to Seminars in Reproductive Medicine New Editors-in Chief. 生殖医学研讨会简介》新主编。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-19 DOI: 10.1055/s-0043-1774784
Kathleen M Hoeger, Terhi T Piltonen
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引用次数: 0
Introduction to Seminars in Reproductive Medicine New Editors-in Chief. 生殖医学研讨会简介》新主编。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2023-03-01 Epub Date: 2023-12-19 DOI: 10.1055/s-0043-1774784
Kathleen M Hoeger, Terhi T Piltonen
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引用次数: 0
Opportunities for Increasing Access to Effective Contraception in Australia. 在澳大利亚增加获得有效避孕的机会。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2022-11-01 DOI: 10.1055/s-0042-1759554
Danielle Mazza, Jessica R Botfield

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.

有效的避孕可以防止意外怀孕,然而,澳大利亚对有效避孕的需求尚未得到满足。尽管有一系列可用的避孕方法,但获得这些方法的机会仍然是公平的,而且最有效方法的使用率很低。澳大利亚有机会通过提高那些希望避孕的人对有效避孕措施的接受程度来降低意外怀孕率。改善获得避孕服务的机会将需要提高消费者对避孕的健康知识,以及将远程保健作为一种服务提供模式的选择,并通过对提供者的适当报销,加强对避孕服务的投资。还需要测试新的护理模式,以增加澳大利亚有效避孕措施的获得和使用,包括护士和助产士主导的避孕护理模式和药房参与避孕咨询。
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引用次数: 0
The Intersection of Abortion and Criminalization: Abortion Access for People in Prisons. 堕胎与刑事定罪的交叉点:监狱中人们的堕胎途径。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2022-11-01 DOI: 10.1055/s-0042-1758481
Martha J Paynter, Wendy V Norman

Most incarcerated women are of reproductive age, and more than a third of women will have an abortion during their reproductive years. Although women are the fastest growing population in Canadian prisons, no one has studied the effect of their incarceration on access to abortion services. Studies outside of Canada indicate rates of abortion are higher among people experiencing incarceration than in the general population, and that abortion access is often problematic. Although international standards for abortion care among incarcerated populations exist, there conversely appear to be no Canadian guidelines or procedures to facilitate unintended pregnancy prevention or management. Barriers to abortion care inequitably restrict people with unintended pregnancy from attaining education and employment opportunities, cause entrenchment in violent relationships, and prevent people from choosing to parent when they are ready and able. Understanding and facilitating equitable access to abortion care for incarcerated people is critical to address structural, gender-, and race-based reproductive health inequities, and to promote reproductive justice. There is an urgent need for research in this area to direct best practices in clinical care and support policies capable to ensure equal access to abortion care for incarcerated people.

大多数被监禁的妇女处于生育年龄,超过三分之一的妇女将在生育年龄堕胎。虽然妇女是加拿大监狱中增长最快的人口,但没有人研究过她们被监禁对获得堕胎服务的影响。加拿大以外的研究表明,被监禁者的堕胎率高于一般人群,而且堕胎往往存在问题。虽然在被监禁人口中存在堕胎护理的国际标准,但反过来,似乎没有加拿大的指导方针或程序来促进意外怀孕的预防或管理。流产护理方面的障碍不公平地限制了意外怀孕者获得教育和就业机会,造成暴力关系的巩固,并阻止人们在准备好和有能力的情况下选择生育。了解和促进被监禁者公平获得堕胎护理,对于解决结构性、性别和种族的生殖健康不平等问题,以及促进生殖正义至关重要。迫切需要在这一领域进行研究,指导临床护理的最佳做法,并支持能够确保被监禁者平等获得堕胎护理的政策。
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引用次数: 0
Best Practice Contraception Care for Women with Obesity: A Review of Current Evidence. 对肥胖妇女的最佳避孕护理:当前证据的回顾。
IF 2.7 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2022-11-01 DOI: 10.1055/s-0042-1760214
Kathleen McNamee, Alison Edelman, Raymond Hang Wun Li, Simranvir Kaur, Deborah Bateson

The prevalence of obesity among females of reproductive age is increasing globally. Access to the complete range of appropriate contraceptive options is essential for upholding the reproductive rights of this population group. People with obesity can experience stigma and discrimination when seeking healthcare, and despite limited evidence for provider bias in the context of contraception, awareness for its potential at an individual provider and health systems level is essential. While use of some hormonal contraceptives may be restricted due to increased health risks in people with obesity, some methods provide noncontraceptive benefits including a reduced risk of endometrial cancer and a reduction in heavy menstrual bleeding which are more prevalent among individuals with obesity. In addition to examining systems-based approaches which facilitate the provision of inclusive contraceptive care, including long-acting reversible contraceptives which require procedural considerations, this article reviews current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy.

全球育龄女性肥胖患病率正在上升。获得各种适当的避孕选择对于维护这一人口群体的生殖权利至关重要。肥胖者在寻求医疗保健时可能会遭受耻辱和歧视,尽管在避孕方面提供者存在偏见的证据有限,但在个体提供者和卫生系统层面认识到其潜力至关重要。由于肥胖人群的健康风险增加,一些激素避孕药的使用可能受到限制,但有些方法提供了非避孕的好处,包括降低子宫内膜癌的风险和减少在肥胖人群中更为普遍的月经大出血。除了审查有助于提供包容性避孕护理的基于系统的方法,包括需要程序性考虑的长效可逆避孕方法外,本文还审查了针对肥胖人群的特定方法优缺点的现有证据,以指导实践和政策。
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引用次数: 0
期刊
Seminars in reproductive medicine
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