Frontiers in global women's health最新文献

Background: The decisions of women with high-risk pregnancies to continue or terminate a pregnancy are complex and influenced by various factors. This scoping review synthesises the qualitative literature on the underlying motivations influencing these decisions.

Aim: This analysis explores the underlying motivations that influence women's decisions regarding the continuation or termination of pregnancy, considering the challenges and dilemmas this population faces.

Methods: This review was conducted following the Joanna Briggs Institute's methodology. No date restrictions were applied to the search. Titles and abstracts were screened to select original studies, and cross-checking was performed to avoid case overlap. We included studies that focused on the factors influencing women's decisions to either continue or terminate pregnancies when complications arose.

Results: Eighteen studies involving women from different countries and cultural contexts were included. The review identifies four main themes driving these decisions: health considerations, religious convictions, social and political factors and ethical and moral dilemmas. Each theme interlinks to form a complex web of influences that significantly shape women's choices, illustrating how deeply personal, societal, and ethical contexts converge in these critical decisions. Significant emotional and cognitive factors, particularly hope, also play a crucial role. The findings highlight the complexity of the decision-making process and provide a deeper understanding of the personal, social, and spiritual dimensions involved.

Conclusions: Multiple factors shape the complex decisions of women with high-risk pregnancies. Understanding these motivations is crucial to providing appropriate support and counselling. This review underscores the need for healthcare professionals to be aware of the diversity of factors involved and to adopt an individualized and context-sensitive approach in their practice, guiding their future actions.

Objective: Lower genital tract microbiome dysbiosis has been associated with several gynecological diseases. However, the differences in microbiome composition among patients with several gynecological diseases, such as endometrial polyps and uterine myoma, are poorly understood. Studying the lower genital tract microbiome composition in patients with benign gynecological diseases could provide new insights for interpreting the complex interplay between the microbiome and pathogenesis and finding new targets for preventive measures.

Methods: A total of 16 patients with endometrial polyps (EPs), 11 patients with uterine myoma (UM), 6 patients with ovarian cysts (OC) and 36 healthy women (HWs) were recruited for this study. Samples were obtained from vaginal secretions. The DNA was isolated from the samples, and the V3-V4 regions were amplified. The sequencing libraries were generated and sequenced on an Illumina NovaSeq 6000 platform.

Results: Firmicutes, Actinobacteria and Bacteroidota were the most common phyla in all four groups, whereas OC presented the highest abundance of Firmicutes and the lowest abundance of Bacteroidota. At the genus level, Lactobacillus in the OC group was significantly greater than that in the HW group, and Atopobium in the UM group was significantly lower than that in the HW group. The abundance of Gardnerella was greater in the UM group than in the EP group, and the abundance of Streptococcus was greater in the EP group. The richness and evenness of the microbiome were generally consistent among the HW, EP, UM, and OC groups. Principal component analysis (PCA), principal coordinate analysis (PCoA) and nonmetric multidimensional scaling (NMDS) revealed no distinct separation trends among the four groups. According to ANOSIM, there was no significant difference in community structure among the four groups.

Conclusions: A nonsignificant result was obtained from the microbiome diversity comparison among the different groups. However, we demonstrated that the OC group had a greater abundance of Lactobacillus and that the UM group had a lower abundance of Atopobium, which might contribute to the occurrence of diseases, providing new clues for preventive measures.

Introduction: Maternal nutrition promotes maternal and child health. However, most interventions to address undernutrition are only implemented once pregnancy is known, and cannot address broader risk factors preceding conception. Poverty and socio-economic status are considered systemic risk factors, but both economic growth and cash transfers have had limited success improving undernutrition. Another generic risk factor is low human capital, referring to inadequate skills, knowledge and autonomy, and represented by traits such as low educational attainment and women's early marriage. Few studies have evaluated whether maternal human and socio-economic capital at conception are independently associated with maternal and offspring outcomes.

Methods: Using data on 651 mother-child dyads from the prospective Pune Maternal Nutrition Study in rural India, composite markers were generated of "maternal human capital" using maternal marriage age and maternal and husband's education, and 'socio-economic capital' using household wealth and caste. Linear and logistic regression models investigated associations of maternal low/mid human capital, relative to high capital, with her own nutrition and offspring size at birth, postnatal growth, education, age at marriage and reproduction, and cardiometabolic risk at 18 years. Models controlled for socio-economic capital, maternal age and parity.

Results: Independent of socio-economic capital, and relative to high maternal human capital, low human capital was associated with shorter maternal stature, lower adiposity and folate deficiency but higher vitamin B₁₂ status. In offspring, low maternal human capital was reflected in shorter gestation, smaller birth head girth, being breastfed for longer, poor postnatal growth, less schooling, lower fat mass and insulin secretion at 18 years. Daughters married and had children at an early age.

Discussion: Separating maternal human and socio-economic capital is important for identifying the aspects which are most relevant for future interventions. Low maternal human capital, independent of socio-economic capital, was a systemic risk factor contributing to an intergenerational cycle of disadvantage, perpetuated through undernutrition, low education and daughters' early marriage and reproduction. Future interventions should target maternal and child human capital. Increasing education and delaying girls' marriage may lead to sustained intergenerational improvements across Sustainable Development Goals 1 to 5, relating to poverty, hunger, health, education and gender equality.

Background: Gestational diabetes mellitus (GDM) is currently the most common complication of pregnancy, and the prevalence of undiagnosed hyperglycemia and overt diabetes in young women is increasing. In this regard, the present study aimed to investigate the effect of training intervention based on the health belief model of self-care behaviors in women with gestational diabetes.

Methods: The present study was an interventional study, which was conducted on 160 women with gestational diabetes (80 in the interventional group and 80 in the control group), who were under treatment in healthcare centers in the city of Fasa in Fars Province, Iran, in 2022-2023. The method was simple random sampling. The collecting data tools were demographic characteristics questionnaire (age, education, occupation, monthly income of the family, gestational age (in the week), and rank of pregnancy, a knowledge assessment questionnaire, a questionnaire based on the health belief model (perceived sensitivity, perceived severity, perceived advantages, and disadvantages, self-efficiency), and the self-care behaviors questionnaire. The questionnaires were completed before the intervention and 6 weeks after the intervention. The women in the intervention group received six sessions of 50-55 min. Fasting blood sugar level and blood sugar level 2 h after the meal, A1C hemoglobin, and the need for taking insulin and the required dosage were recorded. The data were analyzed using SPSS 24, Kolmogorov-Smirnov tests (for normal distribution of data), independent t-test, paired t-test, chi-2 test, and descriptive statistics (P < 0.05).

Results: The mean age of the participants in the intervention group and control group was 32.45 ± 4.82 and 33.16 ± 4.69, respectively. The results showed that the mean scores of all structures of the health belief model in the intervention group were significantly different from those obtained after the intervention in this group (p < 0.001). Also, the comparison of averages of blood sugar levels after the intervention in the two groups indicated that fasting blood sugar level, A1C hemoglobin, and blood sugar levels measured 2 h after the meal significantly decreased in the intervention group (p < 0.001). The need to increase the dosage of insulin in the intervention group was lower than in the control group.

Conclusions: according to the results, the health belief model was effective in improving clinical results of self-care behaviors in women with gestational diabetes. HBM played an important role in understanding what care and support the women need. Therefore, the incidence of various diseases can be prevented and mothers with GDM can experience such vulnerability less than before. It can also be used as a model to design, implement, and monitor health programs for women with gestational diabetes.

Recent ageing research has projected the lifespan and proportion of postmenopausal women living in low- and middle-income countries to substantially increase over the years, especially on the African continent. An important subgroup within the African postmenopausal population is those with female genital circumcision/mutilation/cutting (FGC). Practised across 31 African nations, FGC holds cultural significance as it is deemed essential to marriage and successful womanhood. Perhaps because of this, most FGC studies have primarily focused on women's reproductive functioning and their mood experiences. These studies also usually exclude postmenopausal women from their cohorts. Consequently, cognition and age-related cognitive decline and preservation remain understudied. Therefore, we investigated what is known about mood and cognition in local and immigrant postmenopausal African women with FGC. To do this, we carried out a narrative review searching PubMed, PsycInfo, and Google Scholar databases. Boolean combinations of keywords related to FGC, cognition, ageing, and mood were used, with a focus on cognition and ageing-related terms. Only studies published in English, those that recruited African women with FGC aged 50 years and older, and those that investigated cognitive and/or mood-related experiences were included. Ten studies were found; these included quantitative, qualitative, and case reports. The age range of cohorts across included studies was 13-90 years; women who were likely postmenopausal formed a minority within the cohorts (4.5%-25%). There were no studies assessing memory or cognition beyond those looking at FGC-related memories, which were vivid, especially if women had type III FGC (Pharaonic) or were older at the time of FGC. Although most of these women reported experiencing negative emotions concerning FGC, quantitative reports showed that only a minority of women experienced post-traumatic stress disorder, anxiety, or depression. Thus, there remains an urgent need to bring this understudied group into ageing and dementia research. Future research should adopt mixed-methods with culturally sensitive methodologies to investigate the lived experience of ageing as well as cognitive changes. A holistic understanding of ageing women from the Horn of Africa's experiences and needs will support an improvement in the quality of care delivered to this cohort in both local and immigrant contexts.

Objectives: More knowledge about health related quality of life (HRQoL) among mothers with inflammatory joint disease (IJD) is needed to understand the complex challenges for this group of patients. The overall aim of this study was to investigate changes in HRQoL among mothers with IJD from year 2000 to year 2020.

Methods: This study had a comparative cross-sectional design with two study groups 20 years apart, year 2000 (n = 77) and year 2020 (n = 197). Patients were identified from RevNatus, a Norwegian nationwide medical quality register (2020 cohort) and from a national centre for pregnancy and rheumatic disease (2000 cohort). Mothers with the diagnoses of rheumatoid arthritis, juvenile idiopathic arthritis, axial spondyloarthritis and psoriatic arthritis with children aged 0-6 were included. Data on HRQoL were self-reported and assessed by the RAND-36 (SF-36) questionnaire, along with data on educational status, number of children, months since last childbirth and eight questions on experienced motherhood limitations and experienced anxiety and distress for the children. Descriptive statistics were performed using the Mann-Whitney U-test, the Pearson chi-squared test and independent samples t-test. Multivariable linear regression were used to investigate changes and association between the RAND36 (SF-36) scores and the two study groups and possible confouders.

Results: The 2020 cohort had significantly higher scores on bodily pain (p < 0.001), physical function (p < 0.001), and role physical (p = 0.01) scales compared to the 2000 cohort, indicating better health. There were no significant differences between the two cohorts in the mental health (MH) (p = 0.81), vitality (p = 0.09), general health (p = 0.06), social function (p = 0.83), and role emotional (p = 0.93) scales. Compared to the calculated norm scores, the 2020 cohort had significantly lower scores on all scales (p < 0.01) except on the MH scale (p = 0.37).

Conclusion: Mothers with IJD were affected in most dimensions of RAND-36 (SF-36) both in year 2000 and year 2020. The findings emphasize the importance of understanding the intrusiveness of being a mother with IJD despite the improved medical treatment options over the last 20 years.

Background: The use of modern contraceptives by married Ethiopian women has increased over the past 15 years. Despite a few studies reporting different predictors of satisfaction with family planning services, there is a lack of nationwide data showing the determinants of client satisfaction with family planning services. Thus, this meta-analysis aimed to determine the predictors of client satisfaction with family planning services in Ethiopia.

Methods: From January 20 to March 10, 2024, a thorough search of the literature was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Google Scholar. The quality of the included studies was assessed using the critical assessment checklist developed by the Joanna Briggs Institute (JBI). The statistical program Stata 11 was used to carry out the analysis. Using Cochran's Q-statistic, heterogeneity was statistically assessed and measured by the I ² value. If significant heterogeneity was found across the included studies, a random effects model was used to assess the factors influencing client satisfaction with family planning services. Otherwise, a fixed-effects model was employed.

Results: Independent factors influencing clients' satisfaction with family planning services included waiting times of less than one hour (POR = 4.37; 95% CI: 2.05, 9.32), ensuring privacy (POR = 6.31; 95% CI: 2.78, 14.28), convenient opening hours (POR = 5.91; 95% CI: 1.61, 21.63), education level above primary school (AOR = 2.61; 95% CI: 1.02, 6.68), being informed about side effects (AOR = 3.08; 95% CI: 1.22, 7.74), and receiving adequate information (POR = 4.2; 95% CI: 1.87, 9.44).

Conclusion: The findings indicate that key factors significantly influencing client satisfaction with family planning services include reduced waiting times, privacy protection, convenient service hours, higher education levels, being informed about potential side effects, and receiving comprehensive information. These elements are critical for improving satisfaction and should be prioritized in family planning services. As a result, Ethiopian policymakers and decision-makers must devise plans to maximize client satisfaction with healthcare services through client-centered care.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=563937, PROSPERO (CRD42024563937).