Women's health (London, England)最新文献

Background: Science recognizes the anxieties, depression, stress, and "turbulences" that women face in doctoral studies, but women's mental health in this context is still little addressed, even though it is a critical aspect for the well-being, persistence, and success of women doctoral candidates, who continue to be underrepresented in many professional fields.

Objectives: The study aims to evaluate the relationship between academic motivation, psychological capital, and university academic performance (UAP) and to identify factors of female mental health success.

Design: A cross-sectional, mixed-methods study was conducted with a sample of 108 female doctoral students from a university in Lima, during the first quarter of 2024.

Methods: In the quantitative phase, three standardized scales were administered to assess academic motivation, psychological capital, and university academic performance (UAP). In the qualitative phase, interviews were conducted to gather relevant information on mental health.

Results: The findings emphasize five important points: (1) levels and the relationship between psychological capital, academic motivation, and performance, (2) motivational behavior according to study cycles, (3) risk and protection profiles, (4) protective functions, and (5) mental health success factors. The results indicate that 36% of the women have a low level of psychological capital, 34% have a medium level of academic motivation, and 37% have a high level of UAP, likewise "Intrinsic Motivation toward Accomplishment" is the positive core where most of these women converge. Significant differences were found between the study cycles with academic motivation and "University Academic Performance," and a significant gap between these variables. The risk profile (which limits performance) and the protective profile which allows high performance are determined; this positive profile is identified by women who present a high level of "Self-efficacy." The study demonstrates that "Psychological Capital" and "Academic Motivation" along with the dimensions of "Self-efficacy" and "Intrinsic Motivation to Experience Stimulation" serve protective functions. Fourteen success factors for women's mental health were identified and organized into four main approaches: Optimism, Hope, Resilience, and Self-efficacy.

Conclusion: Limitations and future projections are discussed. The practical implications include implementing psychological support programs, fostering intrinsic motivation, integrating psychological assessments, establishing support networks, and making tailored curricular adjustments.

Influential guidelines have supported the role of metformin in the management of polycystic ovary syndrome (PCOS) for a number of years. However, regulatory approvals for this therapeutic indication are still exceptional and exist only in a few countries, including for the originator, Glucophage®. PCOS is an insulin-resistant state, which drives hyperandrogenism and anovulatory infertility. The metabolic action of metformin involves amelioration of insulin resistance, which helps to resolve hormonal and metabolic disturbances and increases ovulation, pregnancy, and live birth rates relative to placebo. A combination of metformin with clomifene citrate (another widely used treatment for PCOS) is more effective than either alone and is a useful option in women with clomifene-resistant PCOS. Combining metformin with letrozole (1st-line agent for ovulation induction in women with PCOS and no other infertility risk factors) is not more effective than letrozole alone. Continuing metformin to the end of the 1st trimester at an effective dose (e.g. 1000-2000 mg/day) may help to reduce the rate of miscarriages. Metformin also has an adjunctive role in women with PCOS receiving assisted reproduction technology (ART) using the long gonadotrophin-releasing hormone agonist protocol, where it appears to increase the pregnancy rate and to reduce the risk of ovarian hyperstimulation syndrome. There is no role for metformin in women receiving short ART protocols. Where a successful pregnancy is achieved, metformin is generally safe for the mother and neonate. Further research is needed to define with greater precision the optimal dosage and times to initiate and discontinue metformin in women with PCOS who achieve pregnancy.

Background: Breast cancer (BC) is a significant burden on healthcare systems, especially in low- and middle-income countries where access to diagnosis and treatment is challenging.

Objectives: The purpose of this study was to assess the diagnostic accuracy and cost using tissue microarray (TMA) instead of traditional immunohistochemical (IHC) evaluation for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and the proliferation marker Ki-67 and BC subtyping within the Brazilian public health system.

Design: This is a retrospective cohort study comparing TMA slides with traditional whole-slide evaluation for IHC markers in 242 BC cases.

Methods: We used formalin-fixed tissue blocks for TMA assembly. Clinical data and IHC scores for ER, PR, HER2, and Ki-67 were obtained from pathology reports. Cohen's kappa (k) was used to assess TMA performance.

Results: BC samples were distributed in 10 TMAs and 968 cores were scored (242 BC cases × 4 markers). In 97% of these, TMA reached high quality to adequate IHC scoring with minimal technical issues. Inter-examiner agreement was almost perfect for all markers (ranging from 0.85 for HER2 to 0.91 for ER, p < 0.001). The intratumoral heterogeneity ranged from almost perfect agreement for ER and HER2 to moderate to substantial for PR and Ki-67. TMA offers substantial time and cost savings, with an approximately 11-fold reduction compared to traditional methods. The concordance between TMA and original reports was almost perfect, with 93% overall agreement (k = 0.81, p < 0.001). However, TMA performance varied between markers, with intratumoral heterogeneity significantly impacting discordant results, particularly for Ki-67 and HER2. This ultimately affected the accuracy of BC subtyping. TMA performed well in identifying luminal A and triple-negative cases, but misclassification was common for luminal B and HER2-positive cases.

Conclusion: TMA offers accurate and lower-cost results in the individualized IHC assessment of BC markers. However, we do not recommend the use of TMA in the subtyping of BC, where analysis of the whole section remains necessary for more accurate results. We advocate more studies using the TMA approach in the Brazilian public health system to advance women's health care.

Background: Considering how gendered experiences play a role in the lives of patients with heart failure (HF) is critical in order to understand their experiences, optimise clinical care and reduce health inequalities.

Objectives: The aim of our study was to review how gender is being studied in qualitative research in HF, specifically to (1) analyse how gender is conceptualised and applied in qualitative HF research; and (2) identify methodological opportunities to better understand the gendered experiences of patients with HF.

Eligibility criteria: We conducted a systematic search of literature, including qualitive or mixed-methods articles focussing on patients' perspectives in HF and using gender as a primary analytical factor, excluding articles published before 2000.

Sources of evidence: Our search returned 3121 records, which were independently screened by two authors, resolving disagreements through a consensus procedure.

Charting methods: Two reviewers extracted the characteristics of the included studies and methodological quality. We applied the Integrating Sex and Gender Checklist and gender theory as an analytical tool to synthesise results relating to the conceptualisation and application of gender in the included studies.

Results: We included 11 qualitative articles that used interviews (n = 10) or focus groups (n = 1) to investigate the role of gender in experiences of patients with HF. None of the included studies defined their conceptual approach to gender, or used gender-related theoretical frameworks. This led to results and conclusions which were drawn along binary lines - representing gender as two separate, oppositional and mutually exclusive categories, and paying little attention to the dynamic, relational and context-dependent aspects of gender.

Conclusions: Although researchers have investigated the role of gender in the experiences of patient with HF, methodological improvements are needed to prevent the current retelling of gender as a binary variable with two opposed and mutually exclusive categories. To better understand gendered experiences in HF, researchers need to avoid a reductionist and essentialist approach to gender. To this end, researchers should clearly state their conceptual approach to gender and analyse their findings using state-of-the-art gender theoretical frameworks and intersectional approaches. Ultimately, this will allow the development of tailored and effective clinical care.

Background: Contraceptive use is vital in reducing the risk of unintended pregnancies and early motherhood. Despite the well-established benefits, the uptake of modern contraceptive methods among adolescent girls and young women (AGYW) is sub-optimal in sub-Saharan Africa. Furthermore, the discontinuation rate of modern contraceptive use poses a significant challenge to its effectiveness.

Objective: We aimed to determine a 12-month modern contraceptive discontinuation rate, reasons for discontinuation, and associated factors among AGYW in Tanzania.

Design: Retrospective nested within the cross-sectional utilizing quantitative approach.

Methods: We retrospectively analysed calendar data on contraceptive use collected in the 2022 Tanzania Demographic and Health Survey (2022 TDHS). The 2022 TDHS data collection was implemented between February and July 2022. The study population comprised AGYW aged 15-24 years. The unit of analysis was the contraceptive episode of use, defined as the period between the start of use and the termination of the method. Our analysis was mainly based on the discontinuation due to dissatisfaction with the method. We used a life-table method to estimate the contraceptive discontinuation rates. A frailty model was employed to assess the factors associated with the discontinuation rate.

Results: A total of 668 AGYW with a mean (±standard deviation) age of 21.5 ± 2.1 years were included in the analysis. The overall prevalence of 12-month discontinuation rate due to dissatisfaction with the method was 32.3%. Higher discontinuation rates were observed among injectable and pills. The main reasons for discontinuation were side effects (13.7%) and change in menstrual cycle (8%). Factors associated with higher discontinuation rates included higher age (adjusted hazard ratio (aHR) 1.64, 95% confidence interval (CI) 1.06-2.51 for the 20-24 age group), residing in households headed by a female (aHR 1.40, 95% CI 1.05-1.85), and residing in the western zone (aHR 1.87, 95% CI 1.21-2.90).

Conclusion: This study revealed a high prevalence rate of modern contraceptive discontinuation among AGYW in Tanzania. The management of side effects needs to be incorporated into programs aimed at promoting the sustained use of modern contraceptive methods.

Background: Population-level mammography screening for early detection of breast cancer is a secondary prevention measure well-embedded in developed countries, and the implications for women's health are widely researched. From a public health perspective, efforts have focused on why mammography screening rates remain below the 70% screening rate required for effective population-level screening. From a sociological perspective, debates centre on whether 'informed choice' regarding screening exists for all women and the overemphasis on screening benefits, at the cost of not highlighting the potential harms. We dovetail these disciplinary agendas to contextualise the factors that impact mammography screening choices, interpreting screening status through a social class lens.

Objective: To understand how social class impacts informed choice-making among midlife women (45-64 years), regarding (non) participation in mammography screening.

Design: A qualitative study using semi-structured interviews.

Methods: We interviewed 36 Australian midlife women from differing social class groups who were 'screeners' or 'non-screeners'. We conducted a theory-informed thematic analysis and used Bourdieu's relational social class theory to consider how women's access to social, cultural and economic capital influenced their screening identities. We conducted matrix and crosstab queries across themes to identify patterns by social class. We extend the findings from Friedman's study of women's screening perspectives as 'attentional' types utilising the 'sociology of attention'.

Results: Our results map to Friedman's four 'attentional' types (default or conscious interventionists, conflicted or conscious sceptics), and we show how social class impacts women's attention to screening and participation. We show for middle-class women screening is a 'given', they align closely with normative screening expectations. Working-class women who screen, do so out of a sense of compliance. Affluent non-screeners make informed choices, while working-class women are more passive in their non-screening choices, being a group that sits outside of Friedman's four attentional types.

Conclusion: Current approaches to screening communication and programme delivery can be improved by tailoring approaches to reflect the impacts of social class in shaping women's 'choices'. Subsequently, equitable breast cancer prevention may be afforded, which impacts positively on population-level screening rates.

Background: Early pregnancy loss (EPL) occurs in 10%-15% of all pregnancies but remains an underrecognized and undertreated condition. In Canada, resources to support individuals and their partners facing EPL remain scarce despite a high burden of psychosocial sequelae. Digital health tools hold the potential to fill important gaps in reproductive healthcare.

Objectives: We sought to better understand the perspectives of individuals who experienced pregnancy loss and explore how digital health tools could offer support.

Design: We conducted a qualitative study with grounded theory methodology to address our objectives.

Methods: The study was conducted between September 2021 and April 2022 in Ottawa, Canada. Participants between 18 and 45 years of age who resided in Canada and experienced EPL up to 12 + 6 week gestation within the last 2 years were included. Enrolled participants who provided informed consent completed a single in-depth interview. Data were analyzed iteratively by two trained research team members with thematic techniques supported by NVivo software.

Results: Interviews were conducted with 14 participants who had experienced EPL. All participants identified as female and resided in Canada, with 28.6% (n = 4) between 26 and 30 years of age, and the remaining 71.4% (n = 10) between 31 and 40. Qualitative analysis identified three primary themes centered around participants' experiences of miscarriage, access to information and support for EPL in Canada, and desires and preferences for a digital miscarriage tool.

Conclusion: Miscarriage is an emotionally difficult experience for women and their loved ones, who often do not receive timely and compassionate care within the healthcare system. Participants were highly motivated to co-develop a digital intervention for EPL that is designed to fill gaps in care. The digital companion would assist individuals through their miscarriage journey by providing evidence-based and locally relevant medical information as well as avenues to access both professional and informal forms of psychosocial support.

Background: After breast cancer (BC), women may face other severe symptoms such as sleep problems. The use of simple, fast, and reliable scales is necessary in the clinic to improve patient benefits, and sleep is an important aspect to be addressed.

Objective: This study was conducted to adapt and validate the Spanish version of the satisfaction, alertness, timing, efficiency, and duration (SATED) scale for measuring sleep health in women who have completed treatment for BC in Spain (SATED-BC).

Design: Cross-sectional study.

Methods: The adaptation process involved adding a sixth item to the SATED-BC scale: "the impact of symptoms experienced after completing breast cancer treatment on sleep" item was not considered for scoring. The SATED-BC score ranged from 0 (poorest sleep health) to 10 (best sleep health). A validation analysis was performed using the Pittsburgh Sleep Quality Index, the Consensus Sleep Diary, and actigraphy, and the results were compared with those obtained using the SATED-BC scale.

Results: The SATED-BC scale was reliable in terms of its internal consistency (Cronbach's α = 0.70; McDonald's ω = 0.72), showed high intrasubject reliability (r = 0.90), and was shown to be valid for use in women who have completed treatment for breast cancer.

Conclusion: The SATED-BC scale is a reliable and valid tool for comprehensively evaluating sleep health in women who have completed treatment for breast cancer.

Background: Postpartum is a critical period to interrupt weight gain across the lifespan, decrease weight-related risk in future pregnancies, promote healthy behaviors that are often adopted during pregnancy, and improve long-term health. Because the postpartum period is marked by unique challenges to a person's ability to prioritize healthy behaviors, a multi-level/domain approach to intervention beyond the individual-level factors of diet and activity is needed.

Objectives: The purpose of this study was to understand postpartum people's perceptions about the relationship between their social networks and support, and their health behaviors and weight.

Design: We used a qualitative descriptive approach and in-depth interviews.

Methods: Participants (aged 18+, 12-15 months postpartum, who had a pre-pregnancy body mass index ⩾25) engaged in one-on-one, in-depth interviews conducted via Zoom (n = 28). Additional qualitative data came from open-ended responses to an online survey (n = 84) and a personal social-network survey (n = 84). Qualitative analysis used content and thematic analysis in stages of deductive coding applying codes derived from social-network and support theories, followed by inductive coding.

Results: Thirty-eight participants (38.4%) returned to or weighed less than pre-pregnancy weight. We identified two overarching themes grounded in social-network and support theories. They were: (1) normative influence impacts health behaviors, body image, and experiences of weight stigma, and (2) network social support is related to health goals and overall postpartum health. Postpartum networks/support hindered and supported participants' goals. Partners provided an important source of accountability but were often associated with barriers to healthier behaviors.

Conclusion: Our findings reinforce the importance of the social context when considering how to support healthy behaviors and weight during the postpartum period. Healthcare providers should focus on health indicators other than maternal weight, and those wishing to support healthy postpartum behaviors could focus on child and family health, rather than solely on maternal weight and health behaviors.

Background: Empowerment is vital for individuals' control over their lives but is often constrained for women in India due to deep-rooted patriarchal norms. This affects health, and resource distribution, and increases domestic violence. Domestic violence including physical, sexual, emotional, economic, and psychological abuse is a significant human rights and public health issue. Understanding the link between women's empowerment and attitudes toward physical violence is essential for addressing this problem.

Objectives: To explore the relationship between various aspects of women's empowerment and their attitudes toward the justification of physical violence in specific circumstances. The study aimed to provide insights into how empowerment can serve as a protective factor against domestic violence.

Design: A cross-sectional study was conducted using the data from the National Family Health Survey-5 (NFHS-5), collected from 2019 to 2021. The study was carried out between July 2023 and March 2024.

Methods: Data from NFHS-5, focusing on women aged 15-49 who completed the domestic violence module, were analyzed. Women's empowerment was measured through employment, asset ownership, and decision-making autonomy. The study assessed 8 indicators of employment, 12 of asset ownership, 9 of decision-making, 5 justifying physical violence, and 11 indicators of physical abuse. Frequencies, percentages, Fischer's exact test, and logistic regression were used, with significance set at p < 0.05.

Results: Of 4562 women, 23 (0.7%) were employed, 3397 (74.5%) owned mobile phones, and 744 (21.9%) used them for transactions. Joint financial decisions were made by 2692 (75.2%) couples. Restrictions on meeting friends were reported by 376 (10.1%), and 431 (11.6%) had trust issues with partners. Physical violence was justified by 934 (20.5%) for neglecting children, and 3365 (90.4%) experienced partner violence. Land ownership was reported by 383 (8.4%) women. Empowered women were less likely to justify or experience violence, with mobile phone use and decision-making autonomy linked to reduced violence.

Conclusion: Women's empowerment through employment, asset ownership, and decision-making is associated with reduced justification and prevalence of physical violence. Despite progress, entrenched societal norms persist. Interventions should focus on economic and social empowerment, addressing cultural attitudes and promoting gender equality.