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Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study 孕前心理压力与生育诊所的分娩结果:EARTH 研究
Pub Date : 2024-02-05 DOI: 10.3389/fgwh.2024.1293255
L. Mínguez-Alarcón, P. Williams, Irene Souter, J. Ford, Russ Hauser, Jorge Chavarro
The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure.To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment.This observational study included women seeking fertility care at the Massachusetts General Hospital (2004–2019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (N = 768 attempting to conceive) and perinatal outcomes (N = 413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (in vitro fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted.Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR = 0.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors.These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.
本观察性研究包括在马萨诸塞州总医院寻求生育治疗的女性(2004-2019 年)。在孕前期间,妇女们使用经过验证的感知压力量表 4 (PSS-4) 的简版提供了有关其心理压力的信息。我们使用回归模型来评估压力与活产(N = 768 例试图怀孕者)和围产期结果(N = 413 例活产)之间的关系,同时对混杂因素进行了调整。我们还按受孕方式(自然受孕、宫腔内人工授精(IUI)和体外受精(IVF))和选定的社会经济因素(种族、教育程度和收入)进行了分层分析。心理压力越大,活产的总体概率越低(调整后RR=0.95,95% CI:0.92,0.98),尤其是在使用体外受精受孕的妇女中。然而,在总体分析和按受孕方式分层的分析中,我们发现妇女的心理压力与胎龄和出生体重之间没有关联。这些结果凸显了在评估妇女孕前压力与活产之间的关系时,考虑孕前窗口期和受孕方式的重要性。
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引用次数: 0
Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study 孕前心理压力与生育诊所的分娩结果:EARTH 研究
Pub Date : 2024-02-05 DOI: 10.3389/fgwh.2024.1293255
L. Mínguez-Alarcón, P. Williams, Irene Souter, J. Ford, Russ Hauser, Jorge Chavarro
The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure.To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment.This observational study included women seeking fertility care at the Massachusetts General Hospital (2004–2019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (N = 768 attempting to conceive) and perinatal outcomes (N = 413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (in vitro fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted.Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR = 0.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors.These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.
本观察性研究包括在马萨诸塞州总医院寻求生育治疗的女性(2004-2019 年)。在孕前期间,妇女们使用经过验证的感知压力量表 4 (PSS-4) 的简版提供了有关其心理压力的信息。我们使用回归模型来评估压力与活产(N = 768 例试图怀孕者)和围产期结果(N = 413 例活产)之间的关系,同时对混杂因素进行了调整。我们还按受孕方式(自然受孕、宫腔内人工授精(IUI)和体外受精(IVF))和选定的社会经济因素(种族、教育程度和收入)进行了分层分析。心理压力越大,活产的总体概率越低(调整后RR=0.95,95% CI:0.92,0.98),尤其是在使用体外受精受孕的妇女中。然而,在总体分析和按受孕方式分层的分析中,我们发现妇女的心理压力与胎龄和出生体重之间没有关联。这些结果凸显了在评估妇女孕前压力与活产之间的关系时,考虑孕前窗口期和受孕方式的重要性。
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引用次数: 0
Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia. 在埃塞俄比亚南部 Wolaita 区农村医疗中心分娩的母亲做出就医决定时的延误及相关因素。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-11 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1236242
Kelemu Abebe Gelaw, Yibeltal Assefa Atalay, Firehiwot Zerefu, Natnael Atnafu Gebeyehu

Background: Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia.

Method and materials: A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant.

Results: The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility.

Conclusion: The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.

背景:妇女在怀孕和分娩期间延迟到医疗机构就诊可能会导致产科并发症的不良后果。在埃塞俄比亚等发展中国家,这些并发症会导致孕产妇死亡和发病。关于埃塞俄比亚(尤其是该国农村地区)孕产妇首次延误的严重程度和根本原因,目前还没有很好的记录。本研究旨在评估在埃塞俄比亚南部 Wolaita 区农村医疗中心分娩的产妇在决定就医时的延迟程度及相关因素:在 2020 年 6 月 30 日至 2022 年 7 月 30 日期间,对埃塞俄比亚南部沃莱塔区农村医疗中心的产妇进行了一项基于设施的横断面研究。采用系统随机抽样法从每个公共医疗中心抽取了 410 名样本参与者。数据是通过使用开放数据工具包进行预先测试的结构化问卷收集的;分析是使用 SPSS 25 版进行的。采用二元逻辑回归法确定了首次延迟的决定性因素。选择二元分析中 p 值小于 0.25 的变量进行多变量分析。P 值小于 0.05 的变量被认为具有统计学意义:在埃塞俄比亚南部沃莱塔地区的农村医疗中心分娩的母亲中,42.1%的人迟迟未决定到医疗机构就医。失业母亲(调整后奇数比为 2,529; 95% CI, 1.546, 4.136)、未受过正规教育的丈夫(调整后奇数比为 1.290; 95% CI, 1.029, 1.616)、对到医疗机构就医持消极态度的母亲以及(调整后奇数比为 1.695; 95% CI, 1.061, 2.709)与延迟做出到医疗机构就医的决定显著相关:在研究地区,孕产妇首次决定到医疗机构就医的比例很高。应努力提高母亲丈夫的文化水平,并通过各种创收方法增加家庭收入。此外,传播健康信息可有效提高社区对住院分娩重要性的认识。
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引用次数: 0
Embodied sociotechnical imaginaries: how donor-conceived people imagine identity, family and reprodigital futures beyond regulation. 具身的社会技术想象:捐献者如何想象身份、家庭和超越监管的数字化未来。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-11 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1221913
Giselle Newton, Kerryn Drysdale, Christy E Newman

Sociological scholarship has begun to explore imaginaries of family and reproduction, yet less work has focused on the emerging social form of the donor family. In this article, we consider the embodied sociotechnical imaginaries of donor-conceived people, exploring their reflections, judgements, hopes, and predictions regarding donor conception. Combining reflexive thematic analysis of free-text survey responses from sperm donor-conceived (n = 90) and egg donor-conceived (n = 1) and data from semi-structured interviews with sperm donor-conceived people (n = 28), conceived in both clinical and non-clinical contexts in Australia, we analyse donor-conceived people's imaginings of family, identity, and the practice of donor conception in the digital age. Our analysis centres the donor-conceived body that imagines, and in doing so, highlights the entanglements of reproductive and digital technologies, and the humans and institutions that drive their uptake. We argue that leveraging the imaginative and political capacities of donor-conceived people is a productive approach that illuminates possible (re)directions of the assisted reproduction industry as well as illustrating potential policy futures.

社会学学术界已开始探索家庭和生育的想象,但关注捐赠家庭这一新兴社会形态的研究较少。在本文中,我们将探讨捐精受孕者的体现性社会技术想象,探索他们对捐精受孕的反思、判断、希望和预测。通过对精子捐献受孕者(n = 90)和卵子捐献受孕者(n = 1)的自由文本调查回复进行反思性主题分析,以及对澳大利亚临床和非临床背景下的精子捐献受孕者(n = 28)进行半结构式访谈,我们分析了数字时代捐献受孕者对家庭、身份和捐献受孕实践的想象。我们的分析以想象中的捐献受孕者身体为中心,并以此强调生殖技术和数字技术之间的纠葛,以及推动其应用的人类和机构。我们认为,利用受孕捐献者的想象力和政治能力是一种富有成效的方法,它揭示了辅助生殖行业可能的(再)发展方向,并说明了潜在的政策前景。
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引用次数: 0
Cancer incidence, mortality, and survivorship in African women: a comparative analysis (2016-2020). 非洲妇女的癌症发病率、死亡率和存活率:比较分析(2016-2020 年)。
IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-11 eCollection Date: 2023-01-01 DOI: 10.3389/fgwh.2023.1173244
Chibuikem Chrysogonus Nwagwu, Uchenna Petronilla Ogoke

Objectives: This research aims to provide concrete insight into cancer incidence, mortality, and survivorship dynamics among African women between 2016 and 2020.

Methods: The study computes the Mortality-to-Incidence Ratio (MIR) for 53 countries in Africa with available mortality and incidence data. It uses relevant Life Tables to obtain the 5-year Relative Survival rate for women in different age cohorts based on General Survival Rate and 5-year Cancer Prevalence data from the World Health Organization (WHO). The study performs an analysis of variance tests.

Results: The results of the initial data analysis show that women in the top economies in Africa have the highest cancer incidence and mortality. The study also finds that women in Northern and Southern African countries have higher relative survival rates and lower MIR than other African regions. ANOVA results confirm statistically significant differences in 5-year relative survival across the African regions. The relative survival at 5 years was an average of 45% across all age groups within the continent although relative survival is highest among females aged 5-19 and 80-84. The lowest relative survival rates are seen for infants (0-4), adolescents and young adults (25-29), and the very elderly (85+).

Conclusion: The study concludes that while cancer incidence in Africa is linked to affluence, survival is very challenging, especially for the least developed economies in Western, Eastern, and Central Africa. The results indicate the need for crucial intervention in the continent concerning awareness, research, and data collection methodology.

研究目的本研究旨在具体了解 2016 年至 2020 年非洲妇女的癌症发病率、死亡率和存活率动态:本研究计算了非洲 53 个国家的死亡率与发病率之比(MIR),这些国家均提供了死亡率和发病率数据。研究根据世界卫生组织(WHO)提供的一般存活率和 5 年癌症发病率数据,利用相关生命表获得不同年龄组妇女的 5 年相对存活率。研究进行了方差分析测试:初步数据分析结果表明,非洲顶级经济体的妇女癌症发病率和死亡率最高。研究还发现,与非洲其他地区相比,非洲北部和南部国家妇女的相对存活率较高,死亡率较低。方差分析结果证实,非洲各地区的 5 年相对存活率在统计上存在显著差异。非洲大陆所有年龄组的 5 年相对存活率平均为 45%,但 5-19 岁和 80-84 岁女性的相对存活率最高。婴儿(0-4 岁)、青少年和年轻成人(25-29 岁)以及高龄老人(85 岁以上)的相对存活率最低:研究得出结论,虽然非洲的癌症发病率与富裕程度有关,但存活率却非常具有挑战性,尤其是对于非洲西部、东部和中部的最不发达经济体而言。研究结果表明,有必要在非洲大陆就认识、研究和数据收集方法采取重要干预措施。
{"title":"Cancer incidence, mortality, and survivorship in African women: a comparative analysis (2016-2020).","authors":"Chibuikem Chrysogonus Nwagwu, Uchenna Petronilla Ogoke","doi":"10.3389/fgwh.2023.1173244","DOIUrl":"10.3389/fgwh.2023.1173244","url":null,"abstract":"<p><strong>Objectives: </strong>This research aims to provide concrete insight into cancer incidence, mortality, and survivorship dynamics among African women between 2016 and 2020.</p><p><strong>Methods: </strong>The study computes the Mortality-to-Incidence Ratio (MIR) for 53 countries in Africa with available mortality and incidence data. It uses relevant Life Tables to obtain the 5-year Relative Survival rate for women in different age cohorts based on General Survival Rate and 5-year Cancer Prevalence data from the World Health Organization (WHO). The study performs an analysis of variance tests.</p><p><strong>Results: </strong>The results of the initial data analysis show that women in the top economies in Africa have the highest cancer incidence and mortality. The study also finds that women in Northern and Southern African countries have higher relative survival rates and lower MIR than other African regions. ANOVA results confirm statistically significant differences in 5-year relative survival across the African regions. The relative survival at 5 years was an average of 45% across all age groups within the continent although relative survival is highest among females aged 5-19 and 80-84. The lowest relative survival rates are seen for infants (0-4), adolescents and young adults (25-29), and the very elderly (85+).</p><p><strong>Conclusion: </strong>The study concludes that while cancer incidence in Africa is linked to affluence, survival is very challenging, especially for the least developed economies in Western, Eastern, and Central Africa. The results indicate the need for crucial intervention in the continent concerning awareness, research, and data collection methodology.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10808777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pre-lacteal feeding practice and its associated factors among mothers with children under the age of two years in Dubti town, Afar region, North East Ethiopia: a community based mixed study design 埃塞俄比亚东北部阿法尔地区杜布蒂镇有两岁以下儿童的母亲的母乳喂养前做法及其相关因素:基于社区的混合研究设计
Pub Date : 2024-01-09 DOI: 10.3389/fgwh.2023.1315711
Temesgen Gebeyehu Wondmeneh
Pre-lacteal feeding prevents the early initiation of breastfeeding and exclusive breastfeeding. It is understudied in Afar, a pastoral region in northeast Ethiopia. The study assessed the prevalence of pre-lacteal feeding practice and its associated factors among mothers with children under the age of two years in Dubti, North East Ethiopia.A community-based mixed-study design was employed. A systematic sampling technique was used to recruit 370 study participants for the quantitative study, while purposive sampling was used to select 17 study participants for the qualitative study. Logistic regression analysis was used to determine the association between independent variables and dependent variable. The results of logistic regression analysis were presented as an odd ratio with a 95% CI. A P-value <0.05 was used as a cutoff point to determine statistical significance. The qualitative data were analyzed using a thematic approach.Pre-lacteal feeding was practiced by 36% of mothers. Afar ethnicity (AOR = 2.5, 95% CI: 1.2–5.1), an extended family size (≥5) (AOR = 1.73, 95% CI: 1.02–2.9), a birth interval of less than 2 years (AOR = 2.77, 95% CI: 1.59–4.82), the first birth order of an indexed child (AOR = 3.87, 95% CI: 2.14–7.0), male-indexed children (AOR = 2.95, 95% CI: 1.67–5.2), and no antenatal care visits (AOR = 2.67, 95% CI: 1.67), or once or twice antenatal visits were significantly associated with pre-lacteal feeding practice. Breastfeeding counseling (AOR = 0.38, 95% CI: 0.2–0.7) and delivery at a health institution (AOR = 0.3, 95% CI: 0.17–0.55) were protective factors of pre-lacteal feeding practice. The most common pre-lacteal foods were dairy products, water, and certain plant species. Cultural beliefs are the main reason for practicing these pre-lacteal feedings.A significant number of study participants practiced prelacteal feeding. A public health campaign emphasizing the importance of antenatal care follow-ups should be initiated. Breastfeeding counseling and delivery in a health facility should also be strengthened. Community health education about the disadvantages of pre-lacteal feeding practices should be provided to reduce traditional beliefs.
乳前喂养阻碍了母乳喂养的早期开始和纯母乳喂养。埃塞俄比亚东北部的阿法尔牧区对这一问题的研究不足。这项研究评估了埃塞俄比亚东北部 Dubti 地区有两岁以下婴儿的母亲中母乳前喂养做法的普遍性及其相关因素。在定量研究中,采用系统抽样技术招募了 370 名研究参与者;在定性研究中,采用目的性抽样选取了 17 名研究参与者。逻辑回归分析用于确定自变量与因变量之间的关联。逻辑回归分析的结果以奇数比和 95% CI 表示。以 P 值小于 0.05 作为判定统计显著性的临界点。36%的母亲采用母乳喂养。阿法尔民族(AOR = 2.5,95% CI:1.2-5.1)、大家庭规模(≥5)(AOR = 1.73,95% CI:1.02-2.9)、出生间隔少于 2 年(AOR = 2.77,95% CI:1.59-4.82)、索引婴儿的第一个出生顺序(AOR = 3.87,95% CI:2.14-7.0)、男婴(AOR = 2.95,95% CI:1.67-5.2)、无产前检查(AOR = 2.67,95% CI:1.67)或产前检查 1 次或 2 次与母乳喂养实践显著相关。母乳喂养咨询(AOR = 0.38,95% CI:0.2-0.7)和在医疗机构分娩(AOR = 0.3,95% CI:0.17-0.55)是母乳喂养的保护因素。最常见的母乳喂养前食物是乳制品、水和某些植物物种。文化信仰是进行母乳喂养的主要原因。应开展公共卫生运动,强调产前护理随访的重要性。还应加强母乳喂养咨询和在医疗机构接生。应在社区开展健康教育,使人们认识到母乳喂养的弊端,从而减少传统观念的影响。
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引用次数: 0
Determinants of short birth interval among married multiparous women in Chinaksen district, eastern Ethiopia: a case-control study 埃塞俄比亚东部 Chinaksen 地区已婚多产妇生育间隔短的决定因素:病例对照研究
Pub Date : 2024-01-08 DOI: 10.3389/fgwh.2023.1278777
Bekry Aleye, Ahmedin Aliyi Usso, B. Mengistie, Yadeta Dessie, Hassen Abdi Adem, A. Alemu, M. Yuya, Aminu Mohammed
The short birth interval is a common public health issue that affects women's and children's health in sub-Saharan Africa. Despite a higher burden of short birth intervals reported in Ethiopia, there is limited evidence to indicate the primary risk factors, particularly in rural eastern Ethiopia. Therefore, this study assessed the determinants of the short birth interval among married multiparous women in Chinaksen district, Eastern Ethiopia.A community-based case-control study was conducted among randomly selected 210 cases and 210 controls from April 01 to June 30, 2019. The total sample size (219 cases and 219 controls) were calculated using Epi-Info software version 7.2. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27, and multivariable logistic regression analyses conducted to identify the determinants of short birth intervals. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the strength of association and statistical significance declared at p-value < 0.05.The women in the young age group (AOR = 2.33, 95% CI: 1.03, 5.26), missed their antenatal care visits (AOR = 2.23, 95% CI: 1.18, 4.21), failed to utilize postpartum contraceptives (AOR = 5.98, 95% CI: 3.62, 9.89), did not attend postnatal care visit (AOR = 1.86, 95% CI: 1.13, 3.05), nonexclusive breastfed (AOR = 4.05, 95% CI: 2.18, 7.52), short and medium period of breastfeeding (AOR = 4.00, 95% CI: 1.34, 12.10) and (AOR = 3.56, 95% CI: 1.62, 7.82), respectively and female sex of preceding child (AOR = 1.92, 95% CI: 1.18, 3.12) were the important risk factors of short birth interval.Women's age, antenatal care visits, postnatal care attendance, utilization of postpartum contraceptives, exclusive breastfeeding practice, duration of breastfeeding, and sex of the preceding child were the primary predictors of short birth intervals. Improving the utilization of maternal healthcare services in health facilities would be imperative to prevent and reduce short birth intervals, and its negative consequences.
出生间隔短是撒哈拉以南非洲地区影响妇女和儿童健康的一个常见公共卫生问题。尽管有报道称埃塞俄比亚的生育间隔短负担较重,但能说明主要风险因素的证据却很有限,尤其是在埃塞俄比亚东部农村地区。因此,本研究评估了埃塞俄比亚东部 Chinaksen 区已婚多产妇生育间隔短的决定因素。2019 年 4 月 1 日至 6 月 30 日,研究人员在随机抽取的 210 例病例和 210 例对照中开展了一项基于社区的病例对照研究。总样本量(219 例病例和 219 例对照)使用 Epi-Info 软件 7.2 版计算。数据用 EpiData 3.1 版输入,用 SPSS 27 版分析,并进行多变量逻辑回归分析,以确定出生间隔短的决定因素。使用调整后的几率比(AOR)和 95% 的置信区间(CI)来报告相关性的强度,并以 p 值小于 0.05 为统计显著性。年轻组妇女(AOR = 2.33,95% CI:1.03, 5.26)、错过产前检查(AOR = 2.23,95% CI:1.18, 4.21)、未使用产后避孕药具(AOR = 5.98,95% CI:3.62, 9.89)、未参加产后检查(AOR = 1.86,95% CI:1.13, 3.05)、非纯母乳喂养(AOR = 4.05,95% CI:2.18,7.52)、短期和中期母乳喂养(AOR = 4.00,95% CI:1.34,12.10)和(AOR = 3.56,95% CI:1.62,7.82)以及前一胎性别为女性(AOR = 1.92,95% CI:1.18,3.12)是出生间隔短的重要危险因素。妇女的年龄、产前护理就诊次数、产后护理就诊次数、产后避孕药具使用情况、纯母乳喂养实践、母乳喂养持续时间和前一胎的性别是预测出生间隔短的主要因素。要预防和减少出生间隔过短及其负面影响,必须提高医疗机构对孕产妇保健服务的利用率。
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引用次数: 0
Feasibility and acceptability of an HPV self-testing strategy: lessons from a research context to assess for ability to implement into primary care at a national level in Botswana 人乳头瘤病毒自我检测战略的可行性和可接受性:从研究背景中汲取的经验教训,以评估在博茨瓦纳国家一级实施初级保健的能力
Pub Date : 2024-01-08 DOI: 10.3389/fgwh.2023.1300788
R. Luckett, D. Ramogola-Masire, Devon A. Harris, Annika Gompers, Kelebogile Gaborone, Lorato Mochoba, Lapelo Ntshese, A. Mathoma, Maduke Kula, Roger Shapiro, Elysia Larson
The WHO strategy for cervical cancer elimination strives to achieve 70% coverage with high-performance cervical screening. While few low- and middle-income countries have achieved this, high-risk human papillomavirus (hrHPV) self-testing creates the possibility to rapidly upscale access to high-performance cervical screening across resource settings. However, effective hrHPV screening requires linkage to follow-up, which has been variable in prior studies. This study developed and tested an implementation strategy aimed at improving screening and linkage to follow-up care in South East District in Botswana.This study performed primary hrHPV self-testing; those with positive results were referred for a triage visit. Withdrawals for any reason, loss-to follow-up between hrHPV test and triage visit, and number of call attempts to give hrHPV results were also documented. Acceptability of the program to patients was measured as the proportion of patients who completed a triage visit when indicated, meeting the a priori threshold of 80%. Feasibility was defined as the proportion of participants receiving the results and attending follow-up. To assess the associations between participant characteristics and loss-to-follow-up we used log-binomial regressions to estimate risk ratios and 95% confidence intervals (CI).Enrollment of 3,000 women occurred from February 2021 to August 2022. In total, 10 participants withdrew and an additional 33 were determined ineligible after consent, leaving a final cohort of 2,957 participants who underwent self-swab hrHPV testing. Half (50%) of participants tested positive for hrHPV and nearly all (98%) of participants received their hrHPV results, primarily via telephone.  Few calls to participants were required to communicate results: 2,397 (82%) required one call, 386 (13%) required 2 calls, and only 151 (5%) required 3–5 calls. The median time from specimen collection to participant receiving results was 44 days (IQR, 27–65). Of all hrHPV positive participants, 1,328 (90%) attended a triage visit.In a large cohort we had low loss-to-follow-up of 10%, indicating that the strategy is acceptable. Telephonic results reporting was associated with high screening completion, required few calls to participants, and supports the feasibility of hrHPV self-testing in primary care followed by interval triage.
世卫组织的消除宫颈癌战略力争使高效宫颈筛查的覆盖率达到 70%。虽然只有少数中低收入国家实现了这一目标,但高危人乳头瘤病毒(hrHPV)自我检测为在各种资源环境下迅速扩大高效宫颈筛查的覆盖面提供了可能。然而,有效的 hrHPV 筛查需要与随访联系起来,而之前的研究在这一点上存在差异。本研究制定并测试了一项实施策略,旨在改善博茨瓦纳东南区的筛查和后续治疗的衔接。本研究进行了初级 hrHPV 自我检测;检测结果呈阳性者将被转诊至分诊中心。此外,还记录了因任何原因退出测试、在 hrHPV 测试和分诊之间失去随访机会以及试图提供 hrHPV 结果的呼叫次数。患者对该计划的接受度是指在有指示的情况下完成分诊的患者比例,达到 80% 的先验阈值。可行性的定义是收到结果并参加随访的参与者比例。为了评估参与者特征与失去随访机会之间的关系,我们使用对数二叉回归来估计风险比和 95% 置信区间 (CI)。共有 10 名参与者退出,另有 33 名参与者在同意后被认定不符合条件,最终有 2957 名参与者接受了自我抽血 hrHPV 检测。半数参与者(50%)的 hrHPV 检测结果呈阳性,几乎所有参与者(98%)都收到了 hrHPV 检测结果,主要是通过电话收到的。很少有参与者需要通过电话来告知结果:2,397 人(82%)只需要打一次电话,386 人(13%)需要打两次电话,只有 151 人(5%)需要打 3-5 次电话。从标本采集到参与者收到结果的中位时间为 44 天(IQR,27-65)。在所有 hrHPV 阳性参与者中,有 1328 人(90%)接受了分诊。电话报告结果与筛查的高完成率有关,只需给参与者打几个电话,支持在初级保健中进行 hrHPV 自我检测后再进行间隔分诊的可行性。
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引用次数: 0
Women and the risk of Alzheimer's disease 女性与阿尔茨海默病的风险
Pub Date : 2024-01-05 DOI: 10.3389/fgwh.2023.1324522
Mary A. O’Neal
This review will elucidate reasons to explain why women may be at greater risk for Alzheimer's disease.Potential mechanisms to explain sex and gender differences in Alzheimer dementia include: differences in risk associated with the apolipoprotein E 4 allele; telomere shortening- which is linked with neurodegeneration, higher incidence of depression and insomnia in women as psychiatric co-morbidities which are linked with an increased Alzheimer disease risk, disorders of pregnancy including gestational hypertension and preeclampsia and psychosocial factors such as educational level which may contribute to differences in cognitive reserve.The sex and gender differences in Alzheimer's disease can be explained by biological and psychosocial factors.
本综述将阐明女性罹患阿尔茨海默病风险更大的原因。解释阿尔茨海默氏痴呆症的性别差异的潜在机制包括:与载脂蛋白 E 4 等位基因相关的风险差异;端粒缩短--这与神经变性有关;女性抑郁症和失眠症的发病率较高,这是精神疾病的并发症,与阿尔茨海默氏病的风险增加有关;妊娠期疾病,包括妊娠高血压和先兆子痫;以及社会心理因素,如教育水平,这可能会导致认知储备的差异。阿尔茨海默氏症的性别差异可以用生物和社会心理因素来解释。
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引用次数: 0
Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges 法属圭亚那 30 年来的艾滋病毒妊娠:预防工作的成功和产科方面仍然存在的挑战
Pub Date : 2024-01-03 DOI: 10.3389/fgwh.2023.1264837
Mathieu Nacher, Julie Blanc, Sébastien Rabier, A. Lucarelli, A. Adenis, C. Basurko, Alphonse Louis, Dominique Dotou, Malika Leneuve, Lindsay Osei, N. Elenga, N. Hcini
In a context of high HIV prevalence, poor pregnancy follow-up, frequent poverty, preeclampsia, and preterm delivery, we aimed to describe the characteristics and outcomes of pregnancies among women living with HIV in French Guiana.A retrospective cohort study was conducted on HIV-infected pregnancies enrolled between January 1st 1992 to 31st July 2022. Overall, there were 1,774 pregnancies in 881 women living with HIV.For 75.1% of pregnancies, the HIV diagnosis was already known before pregnancy and in 67.6% of women, HIV follow-up predated pregnancy. Nearly half of women, 49.6%, only had one pregnancy since having been diagnosed with HIV. Although most women received antiretroviral therapy during pregnancy, for those with the available information we found only 48.5% had an undetectable viral load at delivery. Overall, 15.3% of pregnancies ended with an abortion. There were a total of 110 newborns infected with HIV representing an overall transmission rate of 6.2% (110/1,771). Between 1993 and 2002, the transmission rate was 34%, between 2003 and 2012 it was 1.3%, and between 2013 and 2022 it was 0.7%. Overall, in Cayenne, since 2008, 106 of 581 HIV–infected pregnancies (18.2%) with available information were premature before 37 weeks of pregnancy; of these, 33 (5.7%) were very preterm deliveries and 73 (13.3%) were late preterm deliveries. Over time, in Cayenne, preterm delivery declined significantly.The present study emphasizes that, despite spectacular progress in reducing mother to child transmission, pregnancy outcomes among women living with HIV are still preoccupying with high incidence of preterm delivery and low birth weight. Teasing out what fraction is linked to HIV and what fraction is linked to social precariousness and poor follow-up was not possible in this study. Despite the high incidence of very preterm delivery recent progress suggests that coordination efforts to improve follow-up may also have improved obstetrical outcomes.
在法属圭亚那,艾滋病病毒感染率高、妊娠随访率低、贫困、先兆子痫和早产现象频发,在这种情况下,我们旨在描述感染艾滋病病毒的妇女的妊娠特征和妊娠结局。在 75.1%的孕妇中,艾滋病毒诊断结果在怀孕前就已知晓;在 67.6%的孕妇中,艾滋病毒随访在怀孕前就已开始。近一半的妇女(49.6%)在确诊感染艾滋病毒后只怀孕过一次。虽然大多数妇女在怀孕期间都接受了抗逆转录病毒治疗,但我们发现,在那些有相关信息的妇女中,只有 48.5% 在分娩时检测不到病毒载量。总体而言,15.3% 的孕妇以流产告终。共有 110 名新生儿感染了艾滋病毒,总传播率为 6.2%(110/1,771)。1993 至 2002 年间,传播率为 34%,2003 至 2012 年间为 1.3%,2013 至 2022 年间为 0.7%。总体而言,自2008年以来,在卡宴,581例感染艾滋病毒的孕妇中有106例(18.2%)在怀孕37周前早产;其中33例(5.7%)为极早产,73例(13.3%)为晚期早产。本研究强调,尽管在减少母婴传播方面取得了令人瞩目的进展,但感染艾滋病病毒的妇女的妊娠结局仍以早产和出生体重不足的高发生率而令人担忧。在这项研究中,不可能找出哪一部分与艾滋病毒有关,哪一部分与社会不稳定和随访不力有关。尽管极早产的发生率很高,但最近的进展表明,为改善后续工作而进行的协调努力也可能会改善产科结果。
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引用次数: 0
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Frontiers in global women's health
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