Frontiers in global women's health最新文献

Sex-based differences in immune function influence susceptibility to infections and predisposition to autoimmunity, with women showing both stronger immune responses and a higher burden of autoimmune and chronic inflammatory diseases. While sex hormones contribute to these differences, accumulating evidence highlights a central role for the X chromosome, which is enriched in immune-related genes and subject to complex regulatory mechanisms such as X-chromosome inactivation, skewing, escape from inactivation, and imprinting. Within this context, X chromosome-encoded microRNAs (miRNAs) have emerged as key post-transcriptional regulators of immune homeostasis. The X chromosome harbors the highest density of miRNAs in the human genome, many of which target pathways involved in immune activation, tolerance, and tumorigenesis. Notably, some X-resident miRNAs escape X-chromosome inactivation, leading to female-biased expression that may enhance immune reactivity but also predispose to loss of tolerance and autoimmunity. In this minireview, we summarize current knowledge on X chromosome-encoded miRNAs in immune regulation, discuss how their sex-biased expression patterns may contribute to female predominance in autoimmune diseases, and explore their potential utility as biomarkers and therapeutic targets for sex-aware precision medicine in inflammatory, autoimmune disorders and vaccine responses.

Menopause remains a largely neglected aspect of women's health in many low- and middle-income countries (LMICs), particularly across Asia, Africa, and the Middle East. Despite the profound physical, cognitive, and emotional changes it entails and the long-term health implications, access to menopause care is limited, and cultural taboos often prevent open discussion and timely support. This article explores the critical role of exercise as a cost-effective, sustainable, and culturally adaptable intervention for managing menopausal symptoms, including vasomotor disturbances, depression, anxiety, cognitive decline, and sleep disruption. Drawing on evidence from neuroscience, public health, and sociocultural research, it highlights the neurochemical benefits of physical activity, such as mood regulation and improved brain function. It also critically examines how religious beliefs, social norms, gender roles, and policy gaps influence women's ability to engage in exercise across different cultural settings. Community-based programmes, corporate initiatives, and digital adaptations underscore pragmatic approaches to integrating exercise into menopause care. We call for healthcare systems, policymakers, and researchers to address systemic neglect, normalise menopause discourse, and embed culturally sensitive, movement-based interventions into broader women's health strategies.

Objective: Mental health issues can be regarded as a severe public health problem that affects low-, middle-, and high-income countries worldwide. However, certain populations in post-conflict countries may have particularly vulnerable mental health, such as women of childbearing age in Somalia. Despite our understanding of this vulnerable group, data on mental health among women living in conflict and post-conflict settings are still scarce. Therefore, this study aims to identify the prevalence of depressive and anxiety symptoms among women living in post-conflict Somalia and their association with sense of coherence (SOC), perceived social support, and individual sociodemographic factors.

Methods: Data were collected from 900 women who attended nine maternal and child health centres (MCHs) in the Banadir region of Somalia, using a self-report validated questionnaire in Somali. This questionnaire was based on the depression component of the Patient Health Questionnaire-9, the Generalised Anxiety Disorder scale, SOC, and sociodemographic factors. The data were analysed using multiple logistic regression with STATA software (v. 16) to determine the factors associated with depression and anxiety.

Results: Depressive symptoms (36%) and anxiety symptoms (38%) were mainly associated with higher income, unstable housing, and comorbid anxiety or depression. Sense of coherence consistently showed a protective effect. No significant associations were found with pregnancy status, MCH visits, social support, or most other sociodemographic factors.

Conclusions: The study identified a high prevalence of depressive and anxiety symptoms among women attending MCH centres, with low socioeconomic status and low sense of coherence emerging as key associated factors. These findings underscore the urgent need to integrate routine mental health screening and support services within primary health care and MCH centres to improve early identification, reduce stigma, and strengthen women's well-being in post-conflict Somalia.

Background: Lipedema is a chronic adipose tissue disorder predominantly affecting women and is frequently misclassified as obesity. While its physical manifestations are increasingly recognized, less attention has been paid to eating attitudes and psychological well-being in this population. The objective of this study was to descriptively explore eating attitudes and psychological well-being in women with lipedema.

Methods: This exploratory cross-sectional study used an anonymous online survey to describe eating attitudes and psychological well-being in women with lipedema. A total of 47 participants completed the Eating Attitudes Test (EAT-26) and the World Health Organization-5 Well-Being Index (WHO-5). Descriptive statistics were used to summarize screening indicators of disordered eating risk and reduced psychological well-being.

Results: Approximately two-thirds of participants scored at or above the EAT-26 screening cut-off, reflecting elevated screening indicators of disordered eating risk. When behavioral risk indicators were included, over 70% screened positive according to EAT-26 criteria. Reduced psychological well-being (as indicated by a WHO-5 score of ≤50) was observed in about one-fifth of the sample.

Conclusion: In this exploratory sample of women with lipedema, elevated screening indicators of disordered eating risk and reduced psychological well-being were commonly observed. These findings offer preliminary insights suggesting that eating-related risk and reduced well-being may be prevalent in this population. Further research using larger, clinically verified samples is needed to better understand the psychological aspects of lipedema.

Objective: To disentangle the independent and shared contributions of maternal general psychological distress (GPD) and COVID-19-specific fear (CSF) during pregnancy to gestational age at birth and infant birth weight.

Methods: This study utilized secondary data from the prospective Canadian "Pregnancy during the COVID-19 Pandemic" cohort. The final analytic sample comprised 5,658 pregnant individuals. GPD was a latent variable indicated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scores. CSF was a latent variable indicated by three items assessing pandemic-related fears for self and baby. Structural equation modeling (SEM) examined associations with gestational age and birth weight, controlling for maternal age, income, and education.

Results: The SEM demonstrated good fit. Higher GPD independently predicted shorter gestational age (standardized β = -.048, p = .002) but not lower infant birth weight (p = .632) after accounting for CSF. Higher CSF independently predicted both shorter gestational age (standardized β = -.058, p < .001) and lower infant birth weight (standardized β = -.058, p < .001), controlling for GPD and covariates. GPD and CSF were positively correlated (standardized covariance = .419, p < .001).

Conclusion: COVID-19-specific fear is a unique and significant risk factor for shorter gestational age and lower infant birth weight, distinct from general psychological distress. These findings highlight the need to assess and address pandemic-specific fears in perinatal populations to mitigate adverse birth outcomes during public health crises. Targeted interventions for specific fears may be necessary beyond general mental health support.

Background: Hypertensive disorders in pregnancy (HDP) include gestational hypertension, preeclampsia, and eclampsia. Not all cases of gestational hypertension or mild preeclampsia progress to severe conditions. However, once they develop into severe preeclampsia (SPE), the risks to both the mother and the fetus increase significantly. We aimed to establish a nomogram and train a machine learning (ML) model that could identify SPE, early in the course of HDP.

Methods: In this retrospective study, 593 patients with HDP were enrolled in the training cohort. For predicting SPE early, six supervised ML models were employed, such as XGBoost, K-nearest neighbors (KNN), random forest (RF), LightGBM (LGBM), Support Vector Machines (SVM), and Decision Trees (DT), which were evaluated by accuracy (ACC) and the areas under the receiver operating characteristic curve (AUC). The nomogram was established, and the predictive ability was assessed by AUC, the calibration curve and clinical decision curves (DCA). They were validated by a validation cohort of 255 patients with HDP.

Results: The nomogram model achieved an AUC of 0.934 in the training cohort, with a calibration curve Brier score of 0.083 and a clinical applicability probability threshold of 5%-95%. In the validation cohort, it showed an AUC of 0.882, a calibration curve Brier score of 0.115, and a clinical applicability probability threshold of 10%-95%. In the validation cohort, the AUC of XGBoost, KNN, RF, LGBM, SVM, DT, and multivariate logistic regression analysis models were 0.876, 0.822, 0.866, 0.866, 0.871, 0.784, and 0.847, the XGBoost model showed the highest AUC.

Conclusions: This study demonstrates that a family history of hypertension, urine protein, umbilical artery S/D ratio, WBC, TBIL, UA, LDL, TG, CRP, and blood Ca are predictors of HDP progression to SPE. A nomogram model for predicting the progression of HDP to SPE was constructed using these predictors. The model exhibited good discrimination, calibration, and clinical utility in both the training and validation cohorts. Additionally, a ML model was developed, with the XGBoost model identified as the optimal one, which can be applied clinically in conjunction with the nomogram prediction model.

Background: The National Institute of Health and Care Excellence in the United Kingdom have recommended the development of a patient-reported outcome measure (PROM) specific to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI), and complications of pelvic mesh surgery (MC).

Aims: To identify all aspects of quality of life (QoL) that may be impacted by surgery for POP, SUI and MC, to inform the development of a new PROM.

Method: Thirty-one patients who had undergone surgery for POP, SUI and MC (ranging from <6 months to >5 years ago) were purposively recruited from various National Health Service (NHS) Trusts, as well as community support groups for the conditions. Semi-structured interviews were undertaken over the phone or via video-conferencing software, and a framework approach was employed to analyse the data. A Patient and Public Involvement group, comprising seven women who had undergone surgery for POP, SUI and/or MC, were consulted on various aspects of the study.

Findings: We identified nine themes for potential inclusion in the PROM. The themes are short-term impacts of surgery; long-term impacts on pre-surgery symptoms; pain and/or discomfort; impact on daily activities; social and leisure activities; emotional wellbeing; sexual activity; personal relationships; and work/education. While some participants showed improvements in these areas following surgery, it was also evident that for some, issues persisted, worsened, or developed post-surgery. Those in the sample who had previous surgery involving mesh reported worse QoL outcomes overall.

Conclusion: The impact of surgery for POP, SUI and MC on QoL is multidimensional and complex. It is recommended that a future PROM encompasses the potential for improvement of symptoms, the failure of surgery to improve symptoms, the development of new symptoms after surgery, and the consequential positive and negative impacts of surgery on activity, roles, psychological well-being and ultimately QoL, in both the short and long term.

Women's health concerns play a role in several of the UAE's major public health challenges, including cardiovascular disease, injuries, cancer, and respiratory conditions. The UAE's 2024 National Policy for improving Women's health aims to lower cancer mortality rates to 23.24 per 100,000 females, with translational research projects utilizing bio-registries and biobanks supporting this goal. This article describes the protocol for the Dubai Women's Health Study, a prospective cohort study aimed at investigating the feasibility of establishing a dedicated Women's health biobank in Dubai to support translational research on improving Women's health. Initial focus will be on polycystic ovarian syndrome (PCOS), endometriosis, pre-eclampsia, and endometrial cancer, which are prevalent health conditions in the UAE. Recruitment will start at the largest public Women's hospital in Dubai (Latifa Women's Hospital), with possible future inclusion of other private hospitals. The study will approach women diagnosed with PCOS, endometriosis, pre-eclampsia, and endometrial cancer over a 12-month period from April 2025 to April 2026, obtaining clinical details and biological samples for establishing a bio-registry and biobank. The feasibility will be evaluated based on recruitment rates, the willingness to contribute samples and logistical challenges. The biobank will support ongoing studies on endometrial cancer risk in PCOS and endometriosis, Co-enzyme A's role in pre-eclampsia, and genetic profiling of inherited endometrial cancer cases in Dubai. The study recruitment only commenced in July 2025 and there are no results yet. Aligned with the National Policy for Improving Women's Health, the biobank provides a foundation for local and global Women's health research, addressing historical gender neglect in medical research, and promoting health equity globally.

Introduction: Menstrual disorders-including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and dysmenorrhea-are highly prevalent among women of reproductive age and are associated with impaired academic performance, psychological distress, and reduced social functioning. Nursing students are particularly vulnerable due to the combined demands of intensive academic schedules and clinical training, yet prevalence estimates and institutional responses remain inconsistent.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251109363). PubMed, Scopus, Web of Science, CINAHL Ultimate, and APA PsycINFO were searched for studies published between 2016 and 2025. Eligible studies reported prevalence or impact of PMS, PMDD, or dysmenorrhea exclusively in nursing students. The Joanna Briggs Institute checklist for prevalence studies was used for quality appraisal. Random-effects meta-analysis was applied to calculate pooled prevalence estimates, and thematic synthesis was used to evaluate academic, social, and psychosocial impacts, coping strategies, and interventions.

Results: Twenty studies involving 5,131 nursing students were included. The pooled prevalence was 62% for PMS, 21% for PMDD (including severe PMS), and 72% for dysmenorrhea, with substantial heterogeneity (I ² > 80%). Reported impacts included absenteeism, reduced concentration, diminished clinical performance, and impaired quality of life. Coping strategies were largely self-directed, including analgesics, rest, and dietary modifications, while few students accessed formal healthcare or institutional support. Only a limited number of studies evaluated structured interventions such as exercise, yoga, or nutritional supplementation.

Conclusion: Menstrual disorders are highly prevalent among nursing students and carry significant academic, social, and psychological consequences. Nursing education programs should integrate routine screening, structured wellness initiatives, and evidence-based interventions to improve student wellbeing, reduce academic disruption, and strengthen workforce preparedness.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251109363, PROSPERO CRD420251109363.

Introduction: Severe perineal trauma (SPT), defined as third- or fourth-degree lacerations during childbirth, is a known risk factor for adverse postpartum health-related quality of life (HRQoL). Although HRQoL may improve within six months postpartum, up to 30% of affected women in Sweden report long-term health problems beyond one year. While qualitative studies highlight the broad negative impact, quantitative findings remain inconclusive, particularly regarding the role of pelvic floor symptoms and the degree of SPT, underscoring the need for further research. The aim is to assess and compare HRQoL in a sample of women with SPT, and to identify predictors of physical and mental health at least 18 months postpartum.

Methods: A nationwide cross-sectional study was conducted in Sweden using an online questionnaire to assess HRQoL via the validated RAND-36 instrument. Linear regression analysis was employed to explore associations.

Results: Two hundred and twenty-one women with SPT and varying symptom bother from SPT, at least 18 months after the childbirth, responded. The study population exhibited worse-than-average RAND-36 scores across most dimensions (apart from physical functioning and pain) compared to normative data for women in Sweden. Further, the mean physical health score was significantly lower in our study sample (M = 70.7, SD = 22.1) compared to the reference population of women in Sweden (M = 73.63, SD = 29.45), t [df (degrees of freedom) 220] = -1.99, p = 0.047, Cohen's d = 0.13. The mean mental health score was significantly lower in our study sample (M = 63.2, SD = 21.4) compared to normative Swedish women (M = 71.7, SD = 27.15), t (df 220) = -5.90, p < 0.001, Cohen's d = 0.40. Health change over the past year remained relatively static with a slight trend towards improvement (mean 54.5; SD 21.6; CI 95% 51.6-57.4). Physical health was predicted by the extent of symptom bother, perceived work ability, educational attainment, and level of physical activity. Mental health was predicted by age, extent of symptom bother, and perceived work ability.

Conclusions: These findings underscore the need for individualized, multidisciplinary care strategies that address both physical and psychological dimensions of recovery after sustaining SPT at childbirth. Future research should investigate the barriers and facilitators influencing HRQoL, to enhance HRQoL and support the reintegration of women with SPT into their social and professional spheres. A deeper understanding of the socioeconomic and occupational contexts of affected women is essential to promote more equitable health outcomes.