Women's health (London, England)最新文献

Background: Obesity is associated with decreased physical performance, especially in older individuals. Some studies have examined the impact of exercise on obesity outcomes as part of a palliative care program.

Objective: This parallel-group randomized controlled trial investigated the effects of water-based aerobic exercise training and vitamin D3 supplementation on body mass index (BMI) and physical performance in postmenopausal women who were overweight or obese and had insufficient or deficient levels of serum vitamin D.

Design: This was an experimental study.

Methods: Forty women were randomly assigned to one of four groups: Water-based training + vitamin D (WTD), water-based training (WT), vitamin D (D), and control. The training program (aerobic-based exercise) and vitamin D3 supplementation were conducted for 8 weeks, three times a week. Measurements were taken before and after the intervention.

Results: The WTD group showed significant improvement in BMI, handgrip strength, and gait speed compared to all other groups (p > 0.05), and significant enhancements in right and left leg static balance and gait speed compared to the D and control groups (p < 0.05). The WT group demonstrated improvements in handgrip strength compared to the control group and enhancements in right and left leg static balance and gait speed compared to the D and control groups (p < 0.05). Vitamin D3 supplementation improved handgrip strength compared to the control group (p < 0.05).

Conclusion: Water-based training with or without vitamin D3 supplementation significantly improved physical fitness indices, with combination showing the most pronounced effects. Vitamin D3 supplementation alone did not have a significant impact on most physical fitness measures.

Background: Symptomatic hand osteoarthritis frequently affects perimenopausal women and is believed to be associated with estrogen deficiency. However, effective medical therapies for symptomatic relief remain limited.

Objective: To compare the effectiveness of menopausal hormone therapy and complementary and alternative medicine in treating symptomatic hand osteoarthritis in perimenopausal women.

Design: Retrospective observational study.

Data sources and methods: We retrospectively reviewed the medical records of 73 perimenopausal Japanese women treated for symptomatic hand osteoarthritis at Kagoshima University Hospital between 2019 and 2022. Fifty-four patients received menopausal hormone therapy, and 19 received complementary and alternative medicine (Kampo formula and/or S-equol supplementation). No patients received additional orthopedic treatments for hand osteoarthritis, such as analgesics, splinting, rehabilitation, or injections. The outcomes included the disability of the arm, shoulder, and hand score and visual analog scale score for hand pain, which were assessed at baseline and 3 months. Two-factor repeated-measures analysis of variance was used to assess condition-by-time interactions, and effect sizes were calculated. For outcomes with significant interactions, post hoc Mann-Whitney U tests were used to compare between-group changes.

Results: Significant condition-by-time interactions were found for the disability of the arm, shoulder, and hand score (F = 12.85, p = 0.0007, partial η² = 0.17) and visual analog scale score (F = 7.39, p = 0.008, partial η² = 0.02), indicating that treatment effects differed between groups over time. Post hoc analyses revealed that the menopausal hormone therapy group showed significantly greater improvements than the complementary and alternative medicine group in both the disability of the arm, shoulder, and hand (10.85 versus -1.75 points, p = 0.003) and visual analog scale scores (27.9 versus 9.17 mm, p = 0.02). The mean improvement in disability of the arm, shoulder, and hand scores in the menopausal hormone therapy group exceeded the minimal clinically important differences, supporting both statistical and clinical significance.

Conclusions: Compared with complementary and alternative medicine, menopausal hormone therapy showed superior efficacy in improving hand pain and dysfunction associated with symptomatic hand osteoarthritis in perimenopausal Japanese women.

Background: Familial hypercholesterolaemia (FH) is a genetic condition that significantly increases cardiovascular disease (CVD) risk, particularly in women. Lipid-lowering therapies (LLTs), such as statins and PCSK9 inhibitors, play a crucial role in reducing low-density lipoprotein cholesterol (LDL-C) and preventing CVD. However, women with FH often face disparities in diagnosis, treatment and outcomes.

Objectives: To assess the effectiveness of LLT in reducing CVD incidence among women with FH and identify gaps in current treatment practices.

Design: Systematic review.

Data sources and methods: A comprehensive literature search was conducted in December 2024 across PubMed, EMBASE, Web of Science and CINAHL, guided by the PICO framework. Thirteen studies met the inclusion criteria; six were rated high quality using the Evidence-Based Librarianship tool. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed.

Results: LLT, particularly statins, consistently reduced LDL-C levels and CVD incidence in women with FH. PCSK9 inhibitors and combination therapies offered additional benefit in high-risk cases. Up to an 80% relative risk reduction was observed in women who initiated early and sustained therapy. However, several studies reported that women were less likely to receive intensive LLT, had a delayed diagnosis and were 32% less likely than men to reach LDL-C targets. Data on premenopausal and menopausal women remain limited.

Conclusion: LLTs are effective in reducing CVD risk in women with FH, yet treatment disparities persist. Addressing barriers such as adherence, hormonal influences and access to advanced therapies is essential. Personalised, gender-specific strategies are needed to close care gaps and improve outcomes for this high-risk population.

Background: Person-centered maternity care (PCMC) is a model that prioritizes respect, dignity, and responsiveness to each woman's needs, values, and preferences during childbirth. It promotes open communication and personalized care, which is crucial for improving maternal satisfaction and increasing hospital-based deliveries. While recognized as a key element of quality maternal care, the implementation of PCMC varies across different countries. This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Objectives: This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Design: Systematic review and meta-analysis.

Data sources and methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed in international databases, and registers including: PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. The quality of included studies was evaluated using the Joanna Briggs Institute tool. Heterogeneity was measured with the I² statistic and its p-value, and publication bias was examined through funnel plots and Egger's test. A random effects model was applied to compute the pooled mean score of PCMC, and adjusted β with results presented as 95% confidence interval (CI).

Results: Seven studies, involving 3383 women, were included in the review. The pooled mean PCMC score was 56.75% (95% CI: 55.08, 58.41). The highest scores were reported in Oromia (60.2) and Addis Ababa (59.2), while the lowest was in South Gondar (52.3). Key factors influencing PCMC included educational status (β: -2.7, 95% CI: -3.98, -1.45), complications during childbirth (β: -5.34, 95% CI: -7.24, -3.44), and time of delivery (β: -3.10, 95% CI: -4.10, -2.11).

Conclusion: The pooled mean score of PCMC in Ethiopia is lower than in many other countries. Key determinants include women's education, complications during childbirth, and the timing of delivery. Addressing these factors is crucial for improving the quality of PCMC in Ethiopia.PROSPERO registration number:CRD42024603854.

Schistosomiasis is a parasitic disease mainly prevalent in tropical and subtropical areas, especially in poor settings without adequate sanitation and access to clean water. It is caused by trematode parasites living within the veins of their human host, where they mate and produce fertilized eggs. The eggs are either shed into the environment through feces or urine, or are retained in host tissues where they induce inflammation and then die. The genital form is caused by Schistosoma haematobium and affects both the urinary and genital tracts in up to 75% of infected individuals, both male and female. Female genital schistosomiasis is a challenging and potentially lethal condition and may affect the whole genital tract leading to a wide range of urinary, sexual, and reproductive health problems. The main reasons leading women to health services are infertility and genital nonspecific symptoms including vaginal discharge, pruritus, pelvic pain, dyspareunia, and haematuria. Other severe complications caused by schistosomiasis include increased risk of HIV and HPV infection, genital ulcers, miscarriage, and ectopic pregnancy. We report in the present case study a 23-year-old female with schistosomiasis and ruptured ectopic tubal pregnancy successfully managed in a low-income setting.

Climate change poses profound and multifaceted threats to global health, with women disproportionately affected due to intersecting social, economic, and environmental vulnerabilities. This editorial synthesizes current evidence on the relationship between climate change and women's health, emphasizing the critical lens of environmental racism and its exacerbation of health disparities. Women in marginalized communities often face heightened exposure to climate-related hazards such as extreme heat, air pollution, and water scarcity, compounded by systemic inequities that limit access to health care and resources. The focus of this article is to highlight how climate change and environmental racism interact to impact women's health and the need for gender-just health policy. Thus, the article examines the direct and indirect impacts of climate change on women's physical and mental health, including increased risks of reproductive health issues, malnutrition, and psychological stress. This editorial highlights the crucial role of policy and advocacy in addressing these challenges, advocating for gender-responsive climate policies that incorporate health equity and social justice. Finally, it offers actionable recommendations for policymakers, healthcare providers, and advocates to mitigate health risks and promote sustainable, inclusive solutions. This article echoes the importance of inclusive policymaking, the enhancement of healthcare infrastructure, and targeted investments in education and capacity building that address the specific needs of women. By centering women's experiences and leadership in climate action, this editorial contributes to a more equitable and effective response to the intertwined crises of climate change and public health.

Introduction: Unsafe abortion is a significant cause of maternal morbidity and mortality in low- and middle-income countries. Female sex workers in Ethiopia are exposed to unwanted and unplanned pregnancy and subsequent abortion. In the absence of access to quality abortion care services, the chances of experiencing unsafe abortion are high. However, limited evidence is available on female sex workers' experience with abortion services and their exposure to unsafe abortion.

Objective: To explore the lived experiences of female sex workers who underwent unsafe abortion in Gedeo Zone, Southern Ethiopia.

Methods: The study was conducted among female sex workers in Gedeo Zone, Southern Ethiopia, from April to June 2024. The study was employed among female sex workers who had a history of unsafe abortion in the past 2 years. Both establishment-based and street-based female sex workers were selected using the snowball sampling method. Face-to-face in-depth interviews were conducted with participants in locations of their preference to ensure privacy. Data saturation was achieved after interviewing 18 participants. The collected data were transcribed verbatim, translated into English, and analyzed thematically using the Open Code 4.03 software. Trustworthiness was ensured throughout the data analysis process.

Design: A qualitative study with a phenomenological design was employed.

Results: The findings of this study revealed that poor knowledge of safe abortion services and poor socioeconomic status are the main causes for seeking unsafe abortion services by commercial sex workers. Unsafe pregnancy terminations were mainly experienced using commercial medications from private pharmacies and using traditional practices through herbal and mechanical techniques. Sex workers resorted to traditional methods and self-induced medication abortions, leading to adverse health, psychosocial, and economic consequences.

Conclusion: The study highlights the poor information literacy and limited access to abortion services for sex workers, leading to unsafe practices and subsequent physical and psychological suffering. Therefore, stakeholders should collaborate to increase female sex workers' knowledge and access to safe abortion services.

Background: HIV pre-exposure prophylaxis (PrEP) use is low among Southern, Black cis-gender women (CGW). Gynecology clinics are well-positioned to integrate PrEP services as a component of sexual and reproductive healthcare for CGW.

Objectives: Identify key determinants to PrEP implementation into routine gynecologic care.

Design: Qualitative, in-depth interviews (IDIs).

Methods: We conducted IDIs with key informants (i.e., physicians, nurses, medical assistants) and focus group discussions (FGDs) with patients accessing care in a gynecology clinic serving under- and uninsured women in Alabama. IDIs explored individual-, setting-, and process-level factors that may impact PrEP care implementation in a clinic serving approximately 3000 women yearly, 64% of whom are Black women.

Results: Ten key informants participated in individual IDIs (median age 33.5, range 24-58 years, 80% female); 20 women participated in either 1 of 4 FGDs (n = 8) or an individual IDI (n = 12); median age 32, range 19-44. The following themes emerged: (1) patient- and provider-level stigmas related to sexuality, sexually transmitted infections (STIs), and HIV limit discussions about sexual health and HIV prevention. (2) Providers report limited knowledge about prescribing and monitoring PrEP, which is reflected in patient's observations that providers do not routinely initiate discussions about HIV prevention or PrEP. (3) Providers utilize a more risk-based approach to PrEP counseling; patients expect non-targeted, comprehensive sexual health information. (4) Structural and social barriers will be challenges to implementing PrEP in routine gynecological care. (5) Patients and providers support a clinic-wide approach to integration of PrEP into gynecology clinics.

Conclusion: Discussions around sexual health and STIs are limited in routine gynecologic care, but patients expect comprehensive counseling from knowledgeable providers. Additional provider training may increase comfort discussing and providing PrEP. These findings will inform development of implementation strategies to integrate PrEP care into gynecologic services.

Background: Female sex workers (FSWs) face significant stigma, which hinders their access to healthcare, social support, and fundamental human rights. Stigma is often compounded by criminalization, violence, and discriminatory attitudes, particularly in low-income regions like Northern Uganda.

Objectives: This study aims to analyze the underlying dimensions of stigma among FSWs in Gulu City, Northern Uganda, to provide insights for targeted interventions.

Design: A community-based cross-sectional study was conducted from February to March 2023 in Gulu City, Northern Uganda.

Methods: A total of 314 FSWs aged 18-49 years participated in the study, yielding a response rate of 83.9%. Participants were recruited using consecutive sampling from hotspots such as bars, brothels, streets, and community health centers. Data were collected through face-to-face interviews using a pre-tested semi-structured questionnaire. Descriptive statistics summarized sociodemographic and economic characteristics. Principal component analysis (PCA) with varimax rotation was applied to identify the primary components of stigma. Factor retention was guided by eigenvalues >1.0, scree plot analysis, and factor loadings ⩾0.35. Reliability was assessed using Cronbach's alpha. Multivariate analysis examined the association between stigma and demographic variables.

Results: The mean age of participants was 28.8 years (standard deviation = 6.4), with most having completed primary education (46.2%). A majority resided in urban areas (93.3%), and 70.7% reported experiencing violence from clients. PCA identified three key dimensions of stigma: social stigma, healthcare-related stigma, and self-stigma. Social stigma encompassed community rejection and discrimination, while healthcare-related stigma involved negative attitudes and experiences within health settings. Self-stigma reflected internalized shame and reduced self-worth among participants. The cumulative variance explained by the three components was 67.2%, with strong internal reliability (Cronbach's alpha = 0.88). Factors significantly associated with stigma included age, education level, and experience of violence (p < 0.05).

Conclusion: The multidimensional nature of stigma among FSWs in Gulu City highlights the urgent need for holistic interventions. Addressing community stigma, improving healthcare provider attitudes, and offering psychosocial support to reduce self-stigma are critical for improving health outcomes and quality of life. The use of PCA provided a robust framework to uncover key stigma dimensions and guiding tailored interventions.

Background: Brain-derived neurotrophic factor (BDNF) is associated with the development of different psychiatric conditions, including eating disorders (EDs).

Objectives: To investigate the salivary BDNF's ability to act as a potential biomarker for detecting the risk of developing EDs among young females.

Design and methods: A cross-sectional study was carried out in Amman, Jordan, with a total of 216 nutrition students completing the Eating Attitudes Test-26 (EAT-26) to assess the risk of developing EDs, the Cohens' Perceived Stress Scale-10 (PSS-10) to measure stress levels, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) to assess physical activity levels. Dietary intake was analyzed using a semiquantitative food frequency questionnaire. A nested sample of 34 females from both extreme EDs was selected and tested for salivary BDNF levels.

Results: The nested sample of 34 female nutrition students 22.00 (2.75) years old with body mass index (BMI) of 23.60 (3.35) kg/m² were divided into two groups; 18 students were at lower risk, while 16 were at higher risk of developing EDs. The salivary BDNF levels did not differ significantly between the low-risk and high-risk groups (391.03 (128.17), 339.15 (102.52), and p = 0.347, respectively). BMI, PSS-10 score, and total metabolic equivalent (MET) were significantly different between the two groups. No associations were found between salivary BDNF levels and BMI, PSS-10 score, MET, or different food groups. The odds ratio for the risk of BDNF-related EDs was 1.07 (95% CI, 1.03-1.10) in the higher-risk group versus the lower-risk group.

Conclusion: BDNF is not a robust biomarker of risk for EDs. The changes in salivary BDNF levels could reflect individual ED eating patterns rather than indicating a direct causative role in the disorder's development. According to our results, psychiatric consultation for ED detection remains the gold standard for diagnosis and treatment.