Women's health (London, England)最新文献

Background: Obstetric fistula, a preventable consequence of prolonged obstructed labor, inflicts profound physical, psychological, and social suffering, leaving many women described as "living dead." In Ethiopia, where the burden remains high, little is known about women lived experiences and coping strategies beyond clinical outcomes. This review was conducted to synthesize qualitative evidence, illuminate these challenges, and inform holistic interventions.

Objectives: To synthesize available evidence on the lived experiences and coping mechanisms of women with obstetric fistula in Ethiopia.

Design: This study employed a qualitative meta-synthesis approach.

Data sources and methods: This review was conducted in accordance with the Joanna Briggs Institute systematic review and meta-synthesis methodological guidance and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. ATLAS.ti software, Version 25, Lumivero was used for analysis. A comprehensive literature search was performed across multiple databases up to May 25, 2025, including both published and unpublished studies examining the lived experiences of women with obstetric fistula. All eligible studies were critically appraised using the Critical Appraisal Skills Program to ensure methodological rigor. Data were systematically extracted and analyzed using thematic synthesis, and the results are presented through tables, narrative summaries, and illustrative diagrams, providing a coherent and evidence-based synthesis of women's experiences and coping mechanisms.

Results: Eight studies met the inclusion criteria, encompassing the diverse experiences of women with obstetric fistula in Ethiopia. Four major themes were developed: physical challenges such as pain, foot drop, odor, and urinary incontinence; psychological challenges including hopelessness, grief, and suicidal ideation; socioeconomic challenges like stigma, isolation, divorce, loneliness, social disintegration, and economic difficulties; and coping mechanisms such as self-isolation and wearing multiple layers of clothing.

Conclusion: Women with obstetric fistula face intersecting physical, psychological, and socioeconomic burdens that erode dignity and social participation. Coping strategies such as self-isolation and layering clothes, while adaptive, often reinforce stigma and exclusion. These findings highlight the need for comprehensive interventions that go beyond surgical repair to include psychosocial support, stigma reduction, and economic reintegration programs.

Registration: Registered with PROSPERO 2025 CRD420251064015.

Background: Sexual violence (SV) is a profound human rights violation and public health issue worldwide, with significant physical, psychological, and financial impacts. It disproportionately affects women and has both immediate and long-term consequences. In higher learning institutions (HLIs), SV remains prevalent, particularly in low- and middle-income countries, where addressing it is challenging due to the lack of context-specific, evidence-based interventions. Generating such interventions first requires robust evidence on the prevalence and associated factors of SV within local settings.

Objectives: This study assessed the prevalence of SV and its contributing factors in Tanzania's HLIs, with the aim of providing insights that can inform the design of context-specific interventions to reduce SV in these settings.

Design: This study employed a quantitative, cross-sectional, analytical design.

Methods: The study was conducted among female nursing students at Muhimbili University of Health and Allied Sciences, a public institution, and Herbert Kairuki Memorial University, a private institution, in Dar es Salaam. Data were collected through a self-administered questionnaire and analyzed using the IBM SPSS version 25. The chi-square test was used to assess associations between sociodemographic factors and SV, followed by multiple logistic regression to identify factors independently associated with SV.

Results: Of the 296 participants, 21 (7.1%) reported experiencing SV since enrollment at the university, with fellow students primarily identified as perpetrators. Reporting of SV and legal actions was very low, with only 9.5% reporting incidents and 4.8% taking legal action. Studying at a public university (adjusted odds ratio: 4.939; 95% confidence interval: 1.611, 15.141; p = 0.005) was a statistically significant factor associated with the experience of SV.

Conclusion: This study revealed notable SV prevalence among female students in the two HLIs, especially the public institution. Underreporting and lack of legal action persist, with students often perpetrators. Urgent institutional interventions are needed to raise awareness, promote reporting, and target perpetrators.

Background: Dysmenorrhoea, a common gynaecological issue in women, is characterised by lower abdominal cramps during menstruation impacting quality of life (QoL).

Objectives: This study evaluates the effectiveness, utilisation and safety of Buscopan^® Plus (hyoscine butylbromide (HBB) Plus: 10 mg HBB + 500 mg paracetamol) for self-treating menstrual pain.

Design: This non-interventional, prospective cohort real-world study included women with menstrual pain registered with Carenity, an online patient platform by Else Care SAS.

Methods: Eligible German patients with the mean (standard deviation) age of 34.0 (8.0) years were enrolled between 15 September 2020 and 15 June 2022 and grouped into primary analysis or safety cohorts. A maximum of one to two tablets (thrice daily) were allowed, limited to 3 g paracetamol per day. Primary outcomes were pain intensity difference by mean change and percentage variation in numeric rating scale (NRS) score, percentage of NRS responders and time to pain relief; safety was a secondary outcome. All parameters were measured at 15 min, 30 min, 1 h, or 4 h following the first HBB Plus intake.

Results: Of 1733 eligible women, 94% provided written consent and completed the baseline questionnaire, 56% met all inclusion criteria, 10% completed all intake assessments (primary analysis cohort) and 33% had ⩾1 dose of HBB Plus (safety cohort). Percent decrease in NRS score from baseline was 11.1%, 29.5%, 42.4%, 53.4% and 65.8% at 15 min, 30 min, 45 min, 1 h and 4 h (p < 0.001 at all-time points), respectively. Overall, 90.8% patients were categorised as responders up to 4 h post HBB Plus intake. Median time to first perceptible pain relief and meaningful pain relief was 30.0 and 37.5 min, respectively. In the safety analysis cohort, five non-serious treatment-emergent adverse events were reported.

Conclusion: HBB Plus effectively reduced menstrual pain within 4 h of treatment and was well-tolerated, providing a viable option for self-management of pain and improving QoL.

Background: Healthcare professionals' and students' willingness to provide abortion influences access to care and workforce readiness.

Objective: We conducted a literature synthesis to identify patterns in willingness across various clinical scenarios.

Design: Systematic review and meta-analysis.

Data sources: We searched five databases (PubMed, Scopus, Web of Science, Medline, and CINAHL) and gray literature for studies (January 2014 to February 2025) without language restrictions. Eligible studies reported cross-sectional data on providers' willingness, while we excluded conditionally framed scenarios. Willingness was defined as the intent, readiness, or affirmative response to provide abortion.

Methods: Summary-level data on theme-specific willingness were extracted and re-coded into binary or proportional format (yes/no or n/N). Estimates were pooled using random-effects models. Meta-regression and publication bias assessments were performed. Study quality was assessed using a novel in-house tool tailored for survey-based research.

Results: We included 36 studies (n = 18,779), reporting 137 estimates across 24 themes. Willingness to provide was highest for lethal fetal anomalies (88.7%, 95% CI: 76.1%-95.1%) and maternal physical health risks (88.6%, 95% CI: 55.7%-98.0%) but substantially lower for on-request scenarios (33.1%, 95% CI: 14.9%-58.4%), surgical abortion (32.1%, 95% CI: 11.6%-63.0%), and social reasons (range 20.1%-32.0%). Multilevel modeling captured both converging and diverging response patterns across categories. Meta-regression indicated that students had consistently higher willingness than professionals. Dominant religion was also observed to be more strongly associated than legal status and other country-level indices. Evidence of small-study effects was limited apart from in a few themes. Risk of bias was high in 31% of studies, with our tool showing strong structural overlap with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) frameworks.

Conclusions: Providers often prioritized abortion in life-threatening contexts but hesitated in non-urgent scenarios. Values-based training and systemic reforms are needed for equitable access to and expansion of abortion care.

Registration: PROSPERO: CRD42025634868.

Background: Adequate gestational weight gain affects birth outcomes and increases the risk of non-communicable diseases later in life. Weight gain in pregnant Ethiopian women with hyperemesis gravidarum has not been investigated comprehensively.

Objective: To assess the determinants of weight gain in pregnant women with hyperemesis gravida in Dire Dawa Administration, Eastern Ethiopia.

Design: Unmatched case-control studyMethods:Pregnant women who visited health facilities for ante-natal care were recruited into this study using random sampling techniques. The World Health Organization Global Physical Activity Questionnaire, FANTA Version III Women's Dietary Diversity Score Questionnaire, and anthropometric measurements were used for the assessment of physical activities, dietary diversity, and gestational weight gain, respectively. Bivariate and multivariate logistic regression analyses with a 95% confidence interval (CI) and a Hosmer-Lemeshow goodness model were used to identify the determinants of gestational weight gain in the study population. A P value of <0.05 was considered significant.

Results: A total of 657 pregnant women (219 patients and 438 controls) were included in this study. Among them, 44.3% and 47% of those in the patient and control groups, respectively, gained adequate weight during pregnancy (Std. 0.499: 95% CI: 42-49.8). Gravidity (adjusted odds ratio (aOR): 0.43, 95%CI: 0.22-0.81), planned pregnancy (aOR: 0.28, 95%CI: 0.11-0.69), and pre-pregnancy weight (aOR: 0.16, 95%CI: 0.72-0.74) were determinants of weight gain in the patient group, whereas the secondary level of education (aOR: 0.59, 95%CI: 0.36-0.97) and pre-pregnancy weight (aOR: 0.20, 95%CI: 0.08, 0.50) were determinants of gestational weight gain in the control group.

Conclusion: The main determinants of gestational weight gain in women with hyperemesis gravidarum are gravidity, planned pregnancy, and pre-pregnancy weight. However, educational status and pre-pregnancy weight are the main determinants of gestational weight gain in women without hyperemesis gravidarum. Strengthening the nutritional life-cycle approach during pregnancy is important for ensuring that mothers maintain a healthy gestational weight.

Background: In light of ongoing HIV diagnoses among cis women, despite decreases in other populations, such as men who have sex with men, various testing approaches, including HIV self-tests are being targeted at cis women as a means of identifying undiagnosed HIV infections and of linking those with positive test results to care. Little, however, is known about risk characteristics of cis women who access HIV self-tests in Canada.

Objectives: Our objectives were to examine demographic characteristics, risk factors, and test results of cis women who obtained HIV self-tests through the HIV self-testing platform, GetaKit.ca.

Design: GetaKit.ca was an observational cohort study that provided free HIV self-tests to Canadians with reported risk factors for HIV acquisition.

Methods: We completed an analysis of cis women who ordered HIV self-tests from GetaKit.ca between April 1, 2021 and May 31, 2023. Data analysis involved tabulating frequencies and means, plus chi-square calculations to determine significant differences between cis women and cis men who obtained HIV self-tests.

Results: During the study period, 7420 orders for HIV self-tests were made through GetaKit.ca; 22% of these orders were made by cis women. Compared to cis men, cis women had significantly higher reported rates of injection drug use and significantly lower reported rates of prior sexually transmitted infection testing, HIV testing (with more cis women indicating their last HIV test was more than 12 months ago), and reporting HIV self-test results. Despite this, we found no differences in the number of cis women with a positive HIV self-test compared to cis men (positivity rate of 0.2% versus 0.3%, respectively).

Conclusion: Our findings showed less overall uptake of HIV testing in cis women, despite matched risks and positive test results. Future interventions to engage cis women in HIV testing should include increased access points for HIV self-tests and enhanced linkage to care pathways to HIV pre-exposure prophylaxis or HIV treatment.

Background: Antenatal care (ANC) is vital for the health and well-being of mothers and their babies during pregnancy. It provides care, education, counseling, screening, and treatment to manage pregnancy-related complications. However, many pregnant women, especially in low-income regions like sub-Saharan Africa, do not complete recommended visits, leading to high dropout rates. Ethiopia, following WHO 2016 recommendations, has adopted an eight-contact ANC model, but still faces a 30% dropout rate. Effective ANC is crucial for reducing maternal mortality rates and ensuring positive pregnancy outcomes.

Objectives: The aim of the study is to identify the determinants of ANC dropout among mothers who delivered in South Mecha Woreda, North West Ethiopia, 2024.

Design: A community-based unmatched case-control study design was employed.

Methods: Study conducted from May 25 to June 25, 2024, using a structured and pre-tested interviewer-administered questionnaire. The final sample included 111 cases and 215 controls, totaling 326 participants. Participants were selected based on the outcome variable of ANC visit dropout (mothers who did not complete the recommended four visits during pregnancy) and ANC visit completion, identified through simple random sampling. Bivariable and multivariable analyses were performed, with a 95% confidence interval (CI) and p-value used to determine significance.

Results: Women who could not read and write had higher likelihood of ANC drop out (adjusted odds ratio (AOR) = 6.475; 95% CI: 2.662, 13.747; p < 0.001), women from families with a monthly income of less than 3000 (AOR = 2.036; 95% CI: 1.666, 6.221; p = 0.012), women who waited more than 30 min (AOR = 5.132; 95% CI: 3.352, 12.877; p < 0.001), and dissatisfaction with the service received (AOR = 5.397; 95% CI: 1.406, 10.719; p = 0.014).

Conclusion: The research indicates that variables like educational level, family income, service waiting times, and satisfaction with services are significant determinants of ANC dropout rates among women in South Mecha Woreda. Women with lower levels of education and income are at a higher risk of dropping out, highlighting the necessity for focused interventions. The research underscores the need for holistic strategies to enhance maternal health and decrease ANC dropout rates.

Background: Vulvodynia is a significant genital pain condition, affecting an estimated 10% to 28% of individuals worldwide. Its multifactorial etiology, diagnostic challenges, and limited treatment options contribute to its substantial personal and socioeconomic burden. Despite its prevalence, vulvodynia remains under-recognized and under-researched, necessitating a comprehensive review of existing evidence to inform future research strategies.

Objective: This scoping review examines the extent and nature of clinical and psychosocial research on vulvodynia, with a focus on diagnosis, treatment, healthcare access, and its impact on quality of life, psychological well-being, and intimate relationships.

Eligibility criteria: Eligible studies included primary research using quantitative, qualitative, or mixed methods designs, as well as systematic, scoping, and topical reviews. Studies were included if they examined clinical or psychosocial aspects of vulvodynia. Research on other types of vulvar pain, animal studies, neurobiological research, and studies from non-high-income countries were excluded.Sources of Evidence and Methods:A systematic search of Medline, PubMed, CINAHL, PsycINFO, and Cochrane was conducted in March 2024 using predefined search terms related to vulvodynia, diagnosis, treatment, and patient experiences. Review findings, limitations, and recommendations were extracted to provide an overview of existing research, mapping methodologies, measures, and key findings of primary studies on vulvodynia.

Results: A total of 144 articles were included, comprising 21 reviews and 123 primary studies. Clinical research primarily addressed diagnosis, risk factors, and comorbidities, while treatment studies evaluated pharmacological therapies, psychological therapies, laser therapy, physiotherapy, acupuncture, and multidisciplinary approaches. Psychosocial research focused on patient experiences, psychosocial factors, and barriers to care. However, methodological limitations, inconsistent measurement tools, limited patient involvement, and study heterogeneity challenge the generalizability of findings.

Conclusions: This review highlights critical gaps in vulvodynia research. Despite considerable research efforts, vulvodynia remains poorly understood. Addressing methodological weaknesses and involving patients more robustly in research design are essential to advance knowledge and improve care outcomes in vulvodynia.

Background: Menopause, characterised by significant hormonal changes, can greatly impact mental health. While physical symptoms are well-known, the psychological effects, particularly suicidality, are underexplored. Suicide rates among women aged 45-55, the typical menopausal transition age, are notably higher, potentially linked to hormonal fluctuations that affect mood regulation. Despite this, little qualitative research exists on the relationship between perimenopause and mental health challenges, including suicidality.

Objectives: This study explores the mental health challenges, especially suicidality, experienced by women during perimenopause and menopause. It seeks to understand the factors contributing to these experiences and the role of healthcare in addressing them.

Design: Qualitative semi-structured interviews explored women's experiences of perimenopause and menopause, with a particular focus on mental health challenges including suicidality. The interviews were conducted and spanned from March 2023 to February 2024.

Method: Semi-structured interviews were conducted with 42 women, recruited from a private menopause clinic and the general population. Interviews, lasting 30-45 min, explored participants' mental health experiences during perimenopause and menopause. Data were analysed using reflexive thematic analysis, with NVivo 14 used for data management.

Results: Participants reported varying degrees of suicidality from abstract thoughts to suicide attempts. Feelings of hopelessness and entrapment were common triggers. Delays in receiving appropriate hormone replacement therapy (HRT) and misdiagnoses, such as being prescribed antidepressants instead of HRT, worsened symptoms. Women reported significant improvements in mental well-being after receiving timely HRT. Peer support and lifestyle changes were also identified as beneficial.

Conclusions: Improved training for healthcare providers, timely HRT access and holistic care are crucial for addressing perimenopausal mental health challenges. Women's Health Hubs, as outlined by the Women's Health Strategy for England, offer a potential solution for integrated care.

Background: Choriocarcinoma (CC), a rare and aggressive form of cancer, is composed of cytotrophoblasts and syncytiotrophoblasts. It is present in two subtypes: gestational choriocarcinoma (GCC) and non-gestational choriocarcinoma (NGCC). Recognizing the disparities between GCC and NGCC is essential for the precise staging, prognosis, and determination of the primary treatment strategy.

Objective: This study aimed to differentiate clinical outcomes, treatment responses, and prognostic factors between GCC and NGCC and to introduce innovative tools for personalized treatment strategies.

Design: A retrospective cohort study with Survival Analysis and Nomogram Development.

Methods: We analyzed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database and identified female patients diagnosed with GCC and NGCC between 2000 and 2020. The clinicopathological features of each group were compared using the chi-square test. Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression were used to assess overall survival and cancer-specific survival and to determine risk factors. The 5-year survival predicting nomogram was constructed, evaluated, and validated.

Results: The study included 919 patients with 719 CC and 200 patients with NGCC. The NGCC group was characterized by older age, a higher proportion of married individuals, more advanced disease stages, larger tumor sizes, and a higher frequency of surgical interventions than the GCC group. NGCC was associated with worse survival rates than GCC patients.

Conclusions: This study highlights the critical role of chemotherapy in improving the survival of patients with NGCC, in contrast to its limited effect on GCC. The negative prognosis associated with radiotherapy underscores the urgent need for further investigation to optimize its use. In addition, the introduction of the first web-based survival prediction tool and predictive nomogram marked a significant advancement in personalized treatment strategies, enabling improved clinical outcomes by tailoring therapy to individual patients.